Transforming Clinical Workflow: Digital Pathology in Research and Education
David C. Wilbur, M.D.
Digital pathology offers significant advantages to pathology laboratories within academic institutions. In addition to clinical activities, for which digital pathology has already shown significant improvements in workflow efficiency and accuracy, such laboratories have missions of research and education, both of which can also be enhanced in the digital environment.
Case-based research projects and educational activities require the use of whole slide images (WSIs) derived from the clinical workflow. But cases flowing into these activities have specific requirements and workflows of their own.
Optimizing the Clinical Data to Research Project Workflow
For research, digital systems can seamlessly move cases from the clinical archive into research projects. The Corista DP3® system adds the further advantage of anonymizing the WSIs during this transfer, maintaining a HIPAA-compliant project environment necessary to comply with human subjects review boards. Not only is this a great benefit, but the manner in which the DP3 architecture was built, intended for the pass-through of data from one module to the other. A major cost efficiency is the ability with Corista’s streaming technology, to seamlessly move WSI’s, analysis and metadata from one module to the other, without the requirement of duplicating data—freeing up valuable storage and its associated costs. Secure access to projects can be controlled so that only investigators involved in the whole, or parts of projects will be allowed access to their respective WSIs.
Digital projects facilitate important research activities such as clinical trial adjudication, where expert pathologists review cases to determine “ground truth.” In the digital environment cases can easily be reviewed remotely and simultaneously, making for faster and more efficient project workflows, and obviating the need for expensive and slow “snail mail” slide deliveries.
Taking this one step further, DP3’s Collaboration feature allows for multi-individual review of cases for consensus and for providing instruction to investigators on how to perform tasks. In a machine learning research project, annotation of features is an important step in defining truth for the algorithm development process. As multiple investigators can annotate features on the same slides at the same time, the concept of “crowd annotation” is possible with digital systems, with the added benefit that all the annotations can be easily stored, analyzed and archived for further use in other projects, allowing for an ever-growing database of research information. Lastly, the voice-enabled collaboration feature allows investigators to speak to each other during collaboration, without the additional use of third-party meeting platforms that often freeze, or lag during these data-dense meetings.
The Digital Classroom
Many of the above features used in the research environment are also applicable to the educational mission of the academic laboratory. Postgraduate training programs must now develop systems to ensure that trainees receive documented educational materials and that proficiency is demonstrated. As anatomic pathology training is largely based on making diagnoses on slides, WSIs transferred (again, in an anonymized fashion to maintain HIPAA compliance) to the educational module to form the basis of teaching exercises and challenges. Using these images within exercise templates more easily allows mentors across multiple specialties to develop specific relevant content. Exercises can be viewed by multiple trainees simultaneously, obviating the need for voluminous, hard to maintain glass slide collections. In addition, if appropriate, developed content can be shared with other programs or commercialized. Proficiency challenges can be given “anytime, anywhere” and statistical records can be easily kept to show progress or highlight areas of difficulty. Digital systems can track trainees’ performance and improvement of WSI review by generating “heatmaps” of slide reviews which can be very useful in honing screening skills.
As with the research consensus exercises above, a huge advantage to education in the digital environment is the capability to have multiple individuals viewing a WSI at the same time, essentially making a “digital classroom.” In Collaboration mode, DP3 allows many viewers to review the same WSI, with the ability to pass control of the slide back and forth, and to have voice communication between participants directly through the platform.
In Conclusion
Corista’s DP3 offers a complete digital pathology package for laboratories which supports clinical, research and education activities requiring the use of WSIs. Using anonymized images streamed from the clinical database. and with the ability to share these images for teaching and research collaborations, DP3 provides the tools needed to implement the total academic mission.