Digital Pathology Blog

Anatomic Pathology has been experiencing a major paradigm shift over the past several years as digital technology provides new ways of performing the daily work. Changes in workflow are affecting all aspects of pathology, whether clinical, research or education.

The early years of whole-slide-scanning offered academic institutions a way to provide teaching sets, resident collections and publication images without requiring technical staff to perform additional recuts, staining procedures and handling of blocks and slides. While there was indeed clinical utilization of telepathology techniques as far back as 1968¹, widespread use was limited. Over time, however, the use of telepathology became a way to perform intra-operative consultations, share cases, collaborate and seek clinical opinions from colleagues and outside experts.

The strains of the last two plus years have forced us to make many changes to our daily routines, both on a personal and a professional level. Remote interactions have become the norm, with families “zooming” for the holidays and family events, elbow bumps instead of hand-shakes, and remote work conferences and meetings in all walks of life. We are all looking forward to the return to many of our previous lifestyles, but the old adage remains true, out of adversity comes opportunity.

Don’t get me wrong based on the title; I am not advocating for proficiency testing (PT). After Medical Boards, Resident In-Service and Board exams, I never thought I would be thinking about any more testing at all. There are better ways to test for ongoing real proficiency. Exercises that test “real-world” skills, such as focused review of signed out cases or concurrent reviews - with feedback – not only lead to better outcomes (patient safety) but also improve practice (constructive feedback). But testing is an unfortunate part of modern life. It’s a metric, and regulators like metrics. For years we dealt with the specter of impending gynecologic cytology PT. Based on the complexity of the federally mandated glass slide testing format, the organizations capable of producing such a monumental effort appeared to reach a détente with CMS, and no testing took place for many years after the federal regulation went into effect. However, when one organization came up with a program, the seeming détente was at an end, and CAP and ASCP were essentially forced to enter the fray.

Whole slide scanning of pathology slides is becoming more affordable and convenient for building the foundation of a laboratory’s digital pathology service.  

Once you’ve obtained a whole slide scanner and your laboratory has developed an effective workflow for scanning images of pathology slides from your cases, you can store your whole slide images (WSI) on a server making them easily accessible from your laptop or tablet. As your image repository grows, however, finding the images you need becomes a challenge.

Most WSI directories are based on laboratory accession numbers.  When needing to access images to demonstrate certain features, whether for research, teaching, publication, creating digital study sets or other applications, you must first determine which cases will potentially have the images that best demonstrate what you want to show.