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
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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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