Pros & Cons of Digital Pathology

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1 Pros & Cons of Digital Pathology Liron Pantanowitz, MD Associate Professor of Pathology & Biomedical Informatics University of Pittsburgh Medical Center, USA

2 No conflicts of interest

3

4 Objectives Review benefits of digital imaging in Pathology Discuss the challenges of Digital Pathology Recommendations & future trends in the field

5

6

7 Why did KODAK go BANKRUPT? They did not go digital Thought it was just a fad Failed to consider the benefits (e.g. applications) Stuck with what they always did

8 Why did KODAK go BANKRUPT? They did not go digital Thought it was just a fad Failed to consider the benefits (e.g. applications) Stuck with what they always did

9 Imaging Modalities

10

11 Desktop WSI scanners

12 Versatile WSI Scanners TISSUEscope TM Digital Slide Scanner (Huron Technologies) Images glass slides from 3" x 1" to 8" x 6" Whole mount specimens Whole Mount Human Brain Imaging

13 CellaVision Analyzer & Remote Review System

14 Cell Phone Adapters Magnifi (Arcturus) SkyLight (SkyLightScope)

15 gsmnation.com 15

16 Pros of Digital Pathology

17 WSI is Enabling Technology vs

18 WSI is Enabling Technology

19 WSI is Enabling Technology

20 WSI is Enabling Technology

21 WSI is Enabling Technology

22 WSI is Enabling Technology

23 WSI is Enabling Technology

24 Digital Pathology Uses Pantanowitz. J Pathol Inform. 2010;1: 15 Primary diagnosis 2 nd opinion (consultation) Telepathology Quality Assurance (PT) Archiving & Sharing Education/Conferencing Image analysis Research & Publications Marketing & Business Track (audit) & Training

25 J Pathol Inform 2014; 5:33

26 Scientific American May 2010:74-77.

27 Telepathology Benefits Clinical advantages Access to pathology experts Improved patient care Operational gains Easier to move images Encourages consultation Business rewards Increased potential revenue

28 Education Paradigm Shift

29

30

31

32 Image analysis

33 Identification of Rare Events

34 Accurate & Reproducible Quantification Quantitative Measurements Spatial Patterns of Features

35 Digitization of images ushers in a new world of computational analysis. Computational analysis opens up a whole new world of digital imaging. Stanley Cohen, MD, PhD Director, Center for Biophysical Pathology Rutgers-New Jersey Medical School, USA

36 Cons of Digital Pathology

37 Imaging Process CAPTURE SAVE EDIT/ANALYZE VIEW/SHARE

38 Barriers to Adoption Imaging Step Pre-imaging Image acquisition Image management Image viewing Image analysis Key Problem Lack of standardization Scan fail rate No DICOM adoption Unlike microscopy Heterogeneity & artifacts

39 Relationship between slide quality & image quality in WSI Yagi & Gilbertson Diagn Pathol Jul 15;3 Suppl 1:S12

40

41

42 Imaging Phase (Acquisition Failures) Thick Glass Slides Broken Slide Material too Pale

43 WSI Scan Variability

44

45 45

46 Pathologist s Mindset Transforming Pathology: The Ingredients for Change a Chef s Husband s View Jared N. Schwartz, MD, PhD, FCAP CAP 2008 Futurescape of Pathology Conference Series

47

48 WSI is a few % behind glass in accuracy

49 1. Study design 2. Technology 3. Training Whole slide imaging Glass/Microscope Glass/Microscope 1. Observer variability 2. Case difficulty 3. User experience

50

51

52

53 Pre-Imaging Phase (Slide Preparation) Coverslips Air Bubble

54 The Z-Axis 3D cell groups Thick smears Z-AXIS

55 Multiplane Images Take a long time to scan Produce large files

56

57 LIS transformation to PACS Interoperability

58 Supplement 145 promotes standardization in digital pathology Singh RH et al. J Pathol Inform 2011; 2:13

59 Trends & Recommendations Think Outside the Box

60 1. Tipping point - Standard of Care (asset vs. liability?)

61 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities)

62 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications

63 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit)

64 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory

65 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth)

66 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth) 7. Growing source of international trade (underserved areas)

67 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth) 7. Growing source of international trade (underserved areas) 8. More virtual education (digital pathology schools)

68 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth) 7. Growing source of international trade (underserved areas) 8. More virtual education (digital pathology schools) 9. Computer assisted diagnoses & image analysis (more data)

69 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth) 7. Growing source of international trade (underserved areas) 8. More virtual education (digital pathology schools) 9. Computer assisted diagnoses & image analysis (more data) 10.Refined image registration (multiplexing, Radiology & 3D)

70 1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications 4. Imaging optimization (color, workstations/cockpit) 5. Digital workflow for the slideless laboratory 6. Increased leveraging of mobile devices (mhealth) 7. Growing source of international trade (underserved areas) 8. More virtual education (digital pathology schools) 9. Computer assisted diagnoses & image analysis (more data) 10.Refined image registration (multiplexing, Radiology & 3D) 11.Helpful standards, regulatory & legal issues

71 Digital Pathology Sustainable or Disruptive Innovation? In general, most new products marketed fail. Companies innovate faster than customers can change. Products too good, expensive & inconvenient for users.

72 Digital Pathology Sustainable or Disruptive Innovation? In general, most new products marketed fail. Companies innovate faster than customers can change. Products too good, expensive & inconvenient for users. Disruptors Create new markets by targeting non-consumers Innovators Offer simpler, cheaper & more convenient products

73

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