Pros & Cons of Digital Pathology Liron Pantanowitz, MD Associate Professor of Pathology & Biomedical Informatics University of Pittsburgh Medical Center, USA Email: pantanowitzl@upmc.edu
No conflicts of interest
Objectives Review benefits of digital imaging in Pathology Discuss the challenges of Digital Pathology Recommendations & future trends in the field
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
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
Imaging Modalities
Desktop WSI scanners
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
CellaVision Analyzer & Remote Review System
Cell Phone Adapters Magnifi (Arcturus) SkyLight (SkyLightScope)
gsmnation.com 15
Pros of Digital Pathology
WSI is Enabling Technology vs
WSI is Enabling Technology
WSI is Enabling Technology
WSI is Enabling Technology
WSI is Enabling Technology
WSI is Enabling Technology
WSI is Enabling Technology
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
J Pathol Inform 2014; 5:33
Scientific American May 2010:74-77.
Telepathology Benefits Clinical advantages Access to pathology experts Improved patient care Operational gains Easier to move images Encourages consultation Business rewards Increased potential revenue
Education Paradigm Shift
Image analysis
Identification of Rare Events
Accurate & Reproducible Quantification Quantitative Measurements Spatial Patterns of Features
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
Cons of Digital Pathology
Imaging Process CAPTURE SAVE EDIT/ANALYZE VIEW/SHARE
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
Relationship between slide quality & image quality in WSI Yagi & Gilbertson Diagn Pathol. 2008 Jul 15;3 Suppl 1:S12
Imaging Phase (Acquisition Failures) Thick Glass Slides Broken Slide Material too Pale
WSI Scan Variability
45
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
WSI is a few % behind glass in accuracy
1. Study design 2. Technology 3. Training Whole slide imaging Glass/Microscope Glass/Microscope 1. Observer variability 2. Case difficulty 3. User experience
Pre-Imaging Phase (Slide Preparation) Coverslips Air Bubble
The Z-Axis 3D cell groups Thick smears Z-AXIS
Multiplane Images Take a long time to scan Produce large files
LIS transformation to PACS Interoperability
Supplement 145 promotes standardization in digital pathology Singh RH et al. J Pathol Inform 2011; 2:13
Trends & Recommendations Think Outside the Box
1. Tipping point - Standard of Care (asset vs. liability?)
1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities)
1. Tipping point - Standard of Care (asset vs. liability?) 2. Digital pathology market poised to explode (opportunities) 3. Continued technological advances & niche applications
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)
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
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)
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)
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)
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)
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)
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
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.
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