Adekunle M Adesina, M.D., Ph.D

Adekunle M Adesina, M.D., Ph.D

Update of knowledge base is a prerequisite for excellence and maintenance of standards in the practice of medicine Recertification every 7 10years is standard requirement in the USA License renewals in most in the USA are based on the declaration of candidates that they have met some specific hours of CME credit Random audit is the way of ensuring compliance How does a busy practicing pathologist achieve this?

Options for knowledge update Self directed journal subscription Internet with access to pubmed, medscape, `and wickipedia etc USCAP knowledge hub Options hampered by limited funds for journal subscription, erratic power supply with limited internet access Buyer beware just because it is on the internet does not mean that the information is correct

1800 Educational Modules: Short Courses, Specialty Conferences, Companion Societies, Scientific Abstracts: Text, Images, Tables, Cartoons, References, etc. Searchable by Table of Contents, Index/Key Word Search, Year, Type of Presentation Approximately 50,000 pages of text, 10K s of images and tables, hundreds of thousands of up-to-date references Over 250 Virtual Slides (IAP Congress; Annual Meeting 07) FREE

1000 Free Educational Modules: 3-9 Million Hits /Month Up to 22,000 different Pathologists 85 Different Countries 600,000 page views/month

Short Courses (Over 65) Specialty Conferences (17/year) Companion Societies (26/year) Scientific Abstracts (3 years: about 5000) Entire IAP Centennial Congress Offerings Over 250 Virtual Slides (06 and 07)

GI (X6) Gyn: Cervix; Uterus (X4) Heme: Lymphomas, etc (X8) Pulmonary/Mediastinal (X6) Breast (X3) Dermatopathology (x3) GU: Renal Tumors (x2) Cytopathology (x2) Liver/Bile Duct/Pancreas (X4) Cardiovascular Thyroid/Endocrine (x3) Transplantation: Kidney/Liver (x2) Soft Tissue Tumors (X2) Gene/Tissue Arrays; In situ hybridization; IHC; (X4) Head & Neck Tumors (x2) CNS: Gliomas Bone (x2) Artery/Venous Diseases (x2) Infectious Disease, Pediatric/Placenta, Renal, Forensic Pathology, Odontogenic neoplasms/cysts, Statistics

Easy access at no cost Invaluable material for self education and the education of residents Material compiled by experts and leaders in the field of pathology Provides an opportunity for continuing medical education

Annual and consistent international, regional and national short courses May be easily rolled into the annual general meeting There is a need to encourage local experts to do presentations and provide updates but must avoid 100% in breeding External and well known experts should be invited to provide new or possibly different insite and cutting edge information. This is the way to keep abreast of the knowledge explosion in pathology

Great tool for teaching and consultation: Cheap technology Skype Neurooncology tumor board participation from Prague Baylor s Cancer Center gives regular lectures with participation by all Baylor project sites in Africa. There is a desire to extend this to other institutions

Expensive technology such as the Aperio digital pathology system for consultation Allows virtual microscope sessions with a consultant who may be anywhere in the world An effective way to get a second opinion ipath demo provides a cheaper alternative for consultation without a virtual microscopy component

Why digital pathology? If it ain t broke, don t fix it?

Today s practice of anatomic pathology Gross images are captured and stored in one area Glass slides are prepared in another location Surgical pathology reports, flow cytometry or cytogenetics etc are stored in separate information systems Case history is filed in the patient s medical record or separate EMR. Images needed for slide reviews and tumor board Slides are packaged and mailed when consultation or second opinion are needed Teaching Residents conferences and medical student teaching

Digital pathology is based on a computerized, digitized glass slide It is an image-based environment Virtual microscopy is the tool entire glass microscope slides are converted to high-resolution wholeslide digital images that can be viewed, managed and analyzed image quality comparable to those of a microscope

Characteristic features or hurdles for an effective digitized pathology slide system Easy to archive and store information Easy replication Easy access over networks Easy integration with laboratory information systems

What is the state of the art? Is it ready for prime time? Creating the image ultra-fast linear-array-based scanners Digitized slides created at giga-pixel resolution and in 24-bit true color in less than two minutes per slide superior image quality. high-capacity slide scanners (up to 120 slides with automatic load and scan several hundred slides at a time Submicron resolutions corresponding to conventional 20x and 40x microscope objective lenses. Newer scanners capable of using high numerical aperture oil-immersion 100x objective lenses have recently become available provide the ability to digitize blood smears, gram stains etc

Internet or network based system provides access to digital slide images using specialized server software Direct display on a computer monitor Specialized viewing software Needed to view and navigate around a digital slide image Able to display multiple digital slides Digital slide conferencing software Simultaneous remote access by multiple viewers for consultation, consensus conference or multi-head viewing for teaching

Image analysis software for ER, PR, CISH, her2/neu Correlate and localize specific patterns of marker expression in different slides of the same tissue Information management software Archival and intelligent retrieval of volumes of histopathologic data Integrate digital pathology systems with laboratory information systems (LIS) to capture, share and display related information such as patient reports, case histories, gross (macro) images, and other associated documents or images.

Other applications Remote access for long distance multicenter intraoperative consultation Teaching Continuing medical education Resident teaching conferences

DICOM standards for digital pathology are now available (PathPACS) Will set the stage for storing digital slides in conventional radiology PACS. Allow a combination of pathology to existing radiology and cardiology image management systems for a more complete electronic health record. Whole-slide imaging for cytology with z stacking capabilities for three-dimensional - a prerequisite for replicating real live cytology slides Multi-spectral whole-slide imaging Ability to capture images in multiple discrete spectral bands needed for fluorescence and multi-spectral imaging

Components of digital pathology services Image capture Image storage Setup and management of network for image viewing For diagnosis local and multisite diagnostic services For remote access and conferencing / multihead viewing Telepathology remote frozen section support / consultation Resident teaching Digital slide access for tumor board

Options for execution Contract out entire process to a commercial company Contract out components of the process e.g. storage Setup and manage entirely with an internal team of professionals Procure equipment and appropriate software/s Setup and train technical team for slide scanning Obtain IT resources for data management Personnel and software management (installation and maintenance) End user viewing monitors Timing design and develop in stages with build up according to need

From scanning to final report Digital pathology software can deliver all the information a pathologist needs, anywhere, anytime including: Microscope-quality digital slides; Macro (gross) images and data; Case history Associated image analyses; Pathology reports; Worklist

Visiting pathologists and exchange programs; Technical staff training and education