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Liron Pantanowitz, MDAssociate Professor of Pathology & Biomedical Informatics
University of Pittsburgh Medical Center, USAEmail: [email protected]
Pros & Cons of Digital Pathology
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
• Images glass slides from 3" x 1" to 8" x 6"
• Whole mount specimens
TISSUEscopeTM Digital Slide Scanner (Huron Technologies)
Whole Mount Human Brain Imaging
CellaVision Analyzer & Remote Review System
Cell Phone Adapters
Magnifi SkyLight (Arcturus) (SkyLightScope)
15
gsmnation.com
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 UsesPantanowitz. J Pathol Inform. 2010;1: 15
• Primary diagnosis• 2nd 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, PhDDirector, 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 Key Problem
Pre-imaging Lack of standardization
Image acquisition Scan fail rate
Image management No DICOM adoption
Image viewing Unlike microscopy
Image analysis 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 ViewJared N. Schwartz, MD, PhD, FCAP
CAP 2008 Futurescape of Pathology Conference Series
WSI is a few % behind glass in accuracy
Glass/Microscope
Glass/Microscope
Whole slide imaging1. Study design
2. Technology
3. Training
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 PathologySustainable 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 PathologySustainable 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
