The Evolution of Digital Pathology

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The Evolution ofDigital Pathology

• Dirk G. Soenksen, CEO

October 2007
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Agenda

• Aperio overview
• Digital Pathology (DP) defined
• How DP creates opportunity for pathology
• Evolution of digital pathology capabilities
• State of the digital pathology industry
• Summary

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Aperio Overview
US News and World Report, Top Rated Hospitals
(2006)
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Digital Pathology Defined
Digital Pathology is an environment for the
management and interpretation of pathology
information that is enabled by the digitization
of a glass slide
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A Digital Pathology System (PACS) Manages
Information Enabled by Digital Slides other
Images
Slide Scanner
Digital Camera
Robotic Microscope
digital slide
digital image
live images (incl. video)
Data Management
Viewing
Security
Image Information Management Software (PACS)
Workflow Management
Reporting
Image Analysis / CAD
DICOM
HL-7
Image Storage
Other Lab Equipment
LIS
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Core Capabilities of Digital Pathology

• A Consolidated View of Relevant Case Information
  Anywhere, Anytime
• Digital slides
• Gross and other images
• Case history
• Work list
• Reports
• Data from other modalities

• Clinical and Workflow Tools
• Remote viewing
• Conferencing to review slides from multiple
  locations
• Simultaneous view of multiple digital slides
• Image analysis
• Archiving and intelligent retrieval capabilities

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Digital Pathology Improves the Quality
Efficiency of Pathology Services
Slide Scanner
Slide scanned and immediately available anywhere
in the world
Glass slide
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Trends Create Pressures for Change in Pathology
Pathology
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Pressures on Pathology create Needs and
Opportunities
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How Can Pathology Satisfy Needs and/or Create and
Capitalize Upon Opportunities?
Innovate Create New Models
Redesign the Current Model
Tweak the Current Model
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How Can Digital Pathology Help?
Innovate Create New Models
Redesign the Current Model
Tweak the Current Model
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Evolution of Capabilities
Capability
Create
View
Analyze
Manage
Time
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Evolution of Digital Pathology Capabilities

• Image Quality
• Scan Speed ? /Slide
• Supported Applications (Niches)
• Image Analysis
• Compliance/Regulatory

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Evolution of Image Quality
No Bayer Mask
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Evolution of Scan Speed benefiting from Moores
Law
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Total Scan Time Scan Time Post-Processing Time
20
15
Minutes/slide
10
5
lt 2 min
2001
2002
2003
2004
2005
2006
2007
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Scan Speed Improvements haveReduced Scanning
Cost per Slide
Annual throughput per scanner operating 24/7/365
over 4-yr life
5
500K
Scanning cost per slide (fully loaded over 4-yr
life, excl. storage)
400K
4
3
300K
2
200K
1
100K
0.5/slide
2001
2002
2003
2004
2005
2006
2007
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Supported ApplicationsNot all Applications
require Fast Scanning
Manual Read of Digital HE Slides
High
ToxPath Decision Support (Normal vs Abnormal)
Q/A automatic slide quality assessment
WBC Diff Count
Peer Review (BioPharma)
Frequency of Scanning
Virtual IHC
Immuno-Fluorescence
Q/A - digital over-reads
IHC Image Analysis
Archival Retrieval
TMAs
Tumor Boards
Secondary Consultations
FNA Sample Assessment
Classroom Teaching
Clinical Decision Support
Frozen Section Telepathology
DS Confer.
Low
CME Proficiency Testing
Slow ( 10 min)
Fast ( 1 min)
Scan Speed
Diagnostic
Non-Diagnostic
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Peer-Reviewed DP PublicationsAddress Growing
Number of Applications
This chart reflects publications citing the use
of digital pathology products from Aperio.
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Evolution of Image Analysis
Evolution of Digital Pathology Image Analysis
Architecture
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Morphometric AnalysisIHC HER2/neu
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Morphometric AnalysisIHC HER2/neu
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Morphometric AnalysisIHC ER/PR
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Digital Slide Image Quality ImprovementUsing
Image IQ
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IQ Stain Decomposition Colon Cancer
HE
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IQ Stain Decomposition Colloid Cyst
HE
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Image Quality and Symphony

• Ventanas Symphony High Definition HE
• Better color separation more nuclear detail
• At a cost of 3-5 / slide

Symphony HE
HE
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Pattern Recognition / CADFinding tumor cell
regions
Entire-slide analysis
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Pattern Recognition / CADFinding crypts in
appendix
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Evolution of Compliance/RegulatorySerious
efforts are underway
File Format
Proprietary ? Open ? DICOM-compliant
Open APIs ? LIS (HL-7) ? PACS (DICOM)
Interfaces
ICC-compliant Color Management
Color
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State of theDigital Pathology (DP) Industry
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Summary