Analytical Cellular Pathology - Volume 35, issue 1

Authors: Yagi, Yukako | Rojo, Marcial Garcia | Kayser, Klaus | Kayser, Gian | Laurinavicius, Arvydas | Mea, Vincenzo Della | Levy, Bruce | Klossa, Jacques | Tearney, Gary | Szymas, Janus | Tsuchihashi, Yasunari | Têtu, Bernard

Article Type: Research Article

DOI: 10.3233/ACP-2011-0049

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 1-2, 2012

Authors: Kayser, Klaus | Borkenfeld, Stephan | Kayser, Gian

Article Type: Research Article

Abstract: Context: Virtual microscopy which is the diagnostic work with digitized microscopic images in tissue – based diagnosis is in its childhood in being implemented in routine diagnosis. Until today, only a few pathology institutions take use of this new technology, although it is available since several years. Why? Design: Virtual microscopy requires a new workflow organisation in the pathologist's diagnostic procedure. At a first view, the laboratory workflow seems to remain untouched to a high degree. However, the used laboratory information system (LIS), which is commonly built in a hierarchic order, has to be adjusted at its highest levels, i.e., …diagnosis statement, quality evaluation, submission to the clinician (hospital information system), and feedback to the laboratory. Therefore, the laboratory's workflow is involved at all levels too, and the LIS has to be changed or adjusted to the requirements of VM. VM systems are usually equipped with a viewer that mimics the viewing of a conventional microscope, and do not offer access to sensitive nodes of the LIS. Similar, LIS are usually closed and fixed systems because of data security and certification demands. Thus, VM systems have to possess communication access at different LIS levels together with steering commands for the LIS in close association with the diagnostic quality and efficiency (for example demands for additional stains, immunohistochemical or quantitative image methods, etc.), as well as expert consultation, or panel discussion. Outcome: An implementation of an open and active LIS – VM management system could significantly promote the introduction of VM into routine diagnostic surgical pathology. The management system has to coordinate and translate the demands of VM to LIS (and vice versa), and to assure the communication with HIS. Mandatory features include streaming of the laboratory workflow, feedback commands to LIS, as well as regulation of temporary priority levels. Conclusion: A successful implementation of VM systems in routine tissue-based diagnosis requires communicative management systems as long as VM is considered to be a “stand alone system” that just mimics a conventional microscope. Show more

Keywords: Virtual microscopy, pathology laboratory workflow, laboratory information system, EAMUS

DOI: 10.3233/ACP-2011-0044

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 3-10, 2012

Authors: Têtu, Bernard | Fortin, Jean-Paul | Gagnon, Marie-Pierre | Louahlia, Said

Article Type: Research Article

Abstract: Background: The aim of the Eastern Québec telepathology project is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region in order to avoid unnecessary patient transfer. Methods: The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, two videoconferencing devices and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory. Of the …remaining 15 sites, two have no pathologists, 6 have one and 7 have two or more. Results: The project has been successful and most appreciated by pathologists and surgeons. We report a number of challenges related to change management that we had to take into account in the course of implementation of this network. The challenges underscore the need for regular visits and active support to participating centers by the project team. Conclusion: The Eastern Québec telepathology network is successful and improves medical care in this region. In the course of implementation, we encountered a number of challenges which required innovative solutions. Show more

Keywords: Telepathology, digital pathology, Eastern Quebec telepathology network, whole-slide imaging

DOI: 10.3233/ACP-2011-0023

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 11-18, 2012

Authors: Rojo, Marcial García | Daniel, Christel | Schrader, Thomas

Article Type: Research Article

Abstract: Background: EURO-TELEPATH is a European COST Action IC0604. It started in 2007 and will end in November 2011. Its main objectives are evaluating and validating the common technological framework and communication standards required to access, transmit, and manage digital medical records by pathologists and other medical specialties in a networked environment. Business modelling: Working Group 1, “Business Modelling in Pathology,” has designed main pathology processes – Frozen Study, Formalin Fixed Specimen Study, Telepathology, Cytology, and Autopsy – using Business Process Modelling Notation (BPMN). Informatics standards in pathology: Working Group 2 has been dedicated to promoting the application of informatics standards …in pathology, collaborating with Integrating Healthcare Enterprise (IHE), Digital Imaging and Communications in Medicine (DICOM), Health Level Seven (HL7), and other standardization bodies. Conclusions: Health terminology standardization research has become a topic of great interest. Future research work should focus on standardizing automatic image analysis and tissue microarrays imaging. Show more

Keywords: Digital pathology, digital slide, business modelling, DICOM, HL7, IHE, SNOMED CT

DOI: 10.3233/ACP-2011-0036

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 19-23, 2012

Authors: Sohani, Aliyah R. | Sohani, Moez A.

Article Type: Research Article

Abstract: Background: The practice of pathology in the developing world presents challenges in terms of limited resources, shortages of trained personnel, and lack of continuing education programs. Telepathology holds promise as a means of diagnostic and educational support. Methods: We donated multiheaded teaching microscopes equipped with digital cameras to four hospitals in Eastern Africa and trained local pathologists on their use. Static images of challenging cases were posted on a web-based telepathology platform. A U.S.-based pathologist reviewed images in consultation with subspecialist colleagues. Results: Over a period of 40 months, 109 cases were submitted for second opinion consultation, including 29 dermatopathology …cases (26.6%), 14 hematopathology cases (12.8%), and 13 cases each (11.9%) in cytopathology and bone and soft tissue pathology. Static images enabled a complete or partial diagnosis in 100/109 cases (91.7%). Factors precluding a definitive diagnosis included absence of confirmatory immunophenotyping, technical issues, or lack of clinical history. Case responses included a diagnosis and discussion, including differential diagnosis, references, and treatment recommendations. Conclusion: Static digital telepathology is a simple, cost-effective, reliable and efficient means to provide diagnostic and educational support to pathologists in the developing world. Additional training may help overcome technical factors precluding a definitive diagnosis in certain cases. Show more

Keywords: Telepathology, static imaging, developing world, teledermatopathology, telecytology

DOI: 10.3233/ACP-2011-0032

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 25-30, 2012

Authors: Fontelo, Paul | Faustorilla, John | Gavino, Alex | Marcelo, Alvin

Article Type: Research Article

Abstract: Background: Medical education in pathology and histology in low-resource countries face many obstacles because of equipment cost and telecommunication deficiencies. Digital Pathology may provide solutions. We report student experience to virtual slides on a local network and a remote image server. Methods: Using an iPad tablet device, fifty 3rd and 4th year medical students viewed digital pathology slides from a Web server at the National Library of Medicine and a mirror server on the local network. Results: The quality of images from both servers was found to be satisfactory, but the local server was deemed faster and preferred by the …participants in this study (p < 0.005). Conclusions: Virtual slides on a local network server may provide solutions to equipment and technical obstacles and could enhance student learning in developing countries. Show more

Keywords: Digital pathology, virtual slide, virtual microscope, whole slide imaging, medical education, low-resource countries

DOI: 10.3233/ACP-2011-0024

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 31-36, 2012

Authors: Fung, Kar-Ming | Hassell, Lewis A. | Talbert, Michael L. | Wiechmann, Allan F. | Chaser, Brad E. | Ramey, Joel

Article Type: Research Article

Abstract: Examination of glass slides is of paramount importance in pathology training. Until the introduction of digitized whole slide images that could be accessed through computer networks, the sharing of pathology slides was a major logistic issue in pathology education and practice. With the help of whole slide images, our department has developed several online pathology education websites. Based on a modular architecture, this program provides online access to whole slide images, still images, case studies, quizzes and didactic text at different levels. Together with traditional lectures and hands-on experiences, it forms the back bone of our histology and pathology education …system for residents and medical students. The use of digitized whole slide images has a.lso greatly improved the communication between clinicians and pathologist in our institute. Show more

Keywords: Whole slide image, pathology education, online slides, digital imaging, residency training

DOI: 10.3233/ACP-2011-0028

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 37-40, 2012

Authors: Hipp, Jason | Smith, Steven Christopher | Cheng, Jerome | Tomlins, Scott Arthur | Monaco, James | Madabhushi, Anant | Kunju, Lakshmi Priya | Balis, Ulysses J.

Article Type: Research Article

Abstract: For personalization of medicine, increasingly clinical and demographic data are integrated into nomograms for prognostic use, while molecular biomarkers are being developed to add independent diagnostic, prognostic, or management information. In a number of cases in surgical pathology, morphometric quantitation is already performed manually or semi-quantitatively, with this effort contributing to diagnostic workup. Digital whole slide imaging, coupled with emerging image analysis algorithms, offers great promise as an adjunctive tool for the surgical pathologist in areas of screening, quality assurance, consistency, and quantitation. We have recently reported such an algorithm, SIVQ (Spatially Invariant Vector Quantization), which avails itself of the …geometric advantages of ring vectors for pattern matching, and have proposed a number of potential applications. One key test, however, remains the need for demonstration and optimization of SIVQ for discrimination between foreground (neoplasm- malignant epithelium) and background (normal parenchyma, stroma, vessels, inflammatory cells). Especially important is the determination of relative contributions of each key SIVQ matching parameter with respect to the algorithm's overall detection performance. Herein, by combinatorial testing of SIVQ ring size, sub-ring number, and inter-ring wobble parameters, in the setting of a morphologically complex bladder cancer use case, we ascertain the relative contributions of each of these parameters towards overall detection optimization using urothelial carcinoma as a use case, providing an exemplar by which this algorithm and future histology-oriented pattern matching tools may be validated and subsequently, implemented broadly in other appropriate microscopic classification settings. Show more

DOI: 10.3233/ACP-2011-0040

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 41-50, 2012

Authors: Bautista, Pinky A. | Yagi, Yukako

Article Type: Research Article

Abstract: Background: Digital staining can be considered as a special form of image enhancement wherein the concern is not only to increase the contrast between the background objects and objects of interest, but to also impart the colors that mark the objects' unique reactions to a specific stain. In this paper, we extended the previously proposed multispectral enhancement methods such that the colors of the background pixels can also be changed. Methods: In the previous multispectral enhancement methods a shifting factor is provided to the original spectrum. To implement digital staining, a spectral transformation process is introduced prior to spectral shifting. …Results: The enhancement method is applied to multispectral images of H&E stained liver tissue. The resulting digitally stained images show good correlation with the serial-section images of the tissue which are physically stained with Masson's trichrome. Conclusions: We have presented a multispectral enhancement method that can be adjusted to produce digitally stained-images. The current experimental results show the viability of the method. However, to achieve robust enhancement performance issues that arise from variations in staining conditions has to be addressed as well. This would be part of our future work. Show more

Keywords: Multispectral imaging, multispectral enhancement, spectral enhancement, digital staining, digital pathology

DOI: 10.3233/ACP-2011-0038

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 51-55, 2012

Authors: McClintock, David S. | Lee, Roy E. | Gilbertson, John R.

Article Type: Research Article

Abstract: Background: Whole slide Imaging (WSI) has been touted by many as the future of pathology, with estimates of full adoption occurring sometime in the next 5 to 15 years. While WSI devices have become increasingly capable since their inception, there has been little consideration of how WSI will be implemented and subsequently affect the workflow of high volume histology laboratories. Methods: Histology workflow process data was collected from a high-volume histology laboratory (Massachusetts General Hospital) and a process model developed using business process management software. Computerized workflow simulations were performed and total histology process time evaluated under a number of …different WSI conditions. Results: Total histology process time increased approximately 10-fold to 20-fold over baseline with the presence of one WSI robot in the histology workflow. Depending on the specifications of the WSI robot, anywhere from 9 to 14 WSI robots were required within the histology workflow to minimize the effects of WSI. Conclusions: Placing a WSI robot into the current workflow of a high-volume histology laboratory with the intent of full adoption is not feasible. Implementing WSI without making significant changes to the current workflow of the histology laboratory would prove to be both disruptive and costly to surgical pathology. Show more

Keywords: Whole slide imaging, virtual microscopy, workflow, histology, business analysis software, computer simulations, process modeling, BPMN

DOI: 10.3233/ACP-2011-0034

Citation: Analytical Cellular Pathology, vol. 35, no. 1, pp. 57-64, 2012