Slide Digitization: Taking Things to the Next Level

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Slide DigitizationTaking Things to the Next
Level  

• Michael B. Cohen, MD
• (thanks to Fred R. Dee, MD)
• Department of Pathology
• The University of Iowa
• Virtual slide education at Iowa has been
  supported by
• UI Carver College of Medicine educational
  developmental funds
• UI Student Computing Fees Award
• Universities Associated for Research and
  Education in Pathology
• National Library of Medicine
• I have no financial or consultative relationship
  with any commercial entity, nor have I had any in
  the past

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Course Implementation atIowa (2000-2006)

• First year Histology (110 annotated virtual
  slides on-line syllabus)
• Virtual Histology Laboratory 
• Heidger P, Dee FR, Consoer D, Leaven T,
  Kreiter C. An Integrated Approach to Teaching and
  Testing in Histology with Real and Virtual
  Imaging. The Anatomical Record (The New
  Anatomist) 269107-112, 2002.
• Second year Pathology (stand alone course for two
  semesters)
• Case Analysis
• Virtual Slidebox of Histopathology
• Dee (Dick) FR. Web-based Virtual Microscope
  Laboratories. Pathol Education 2558-62, 2001.
  (a GRIPE publication)
• Kumar RK, Velan GM, Korell SO, Kandara M,
  Dee FR, Wakefield D. Virtual microscopy for
  learning and assessment in Pathology. Journal of
  Pathology 204613-618, 2004. (in collaboration
  with Univ. of New South Wales)

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Case Analysis

• In lieu of of Path Lab we teach morphology in
  pathology case based learning exercises
• 22 two-hour sessions
• 3-4 cases/week
• Eight students one facilitator
• Students prepare cases before class (2-4 hr) and
  then students present in small group
• Students examine 70 slides in the 2 semester
  course
• Case Analysis content is integrated with about 76
  lectures

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Traditional Case Analysis materials 1970-1999
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Preparation for small group before and after
2000
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Virtual Slidebox of Histopathology
www.path.uiowa.edu/virtualslidebox

• An atlas of 570 core virtual histopathology
  slides for medical students
• General Path slides are annotated
• Students use this resource to
• prepare for Case Analysis
• Independently study morphologic objectives that
  are not covered in Case Analysis

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Outcomes (Histology and Pathology)

• A significant increase in efficiency and
  accessibility expressed by both students and
  faculty.
• Increase in student skill in presenting
  morphologic findings on slides in Case Analysis
  (subjective evaluation by their facilitator)
• Students continue to learn traditional microscopy
  in Microbiology and Histology and are tested in
  Histology
• No change in student performance on
  photomicrograph or glass slide exams
• Laboratory space utilization has markedly
  decreased.
• Student interest in Pathology as a career has
  increased

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Cytology Education

• Compelling reason to create cytology virtual
  slides
• Only one, or very few identical glass slides
  can be made especially applicable for testing
  and CE/CME.
• Special technical challenges
• Cytology cells do no lie flat on the slide thus
  z-axis (3-D) viewing is needed
• Light source must be adjustable to see into
  clumps of cells.
• The slide needs to be rapidly and systematically
  scanned by a technologist
• Revisit to previously identified cells is needed
  i.e. marking

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Cervical Cytology Education Project

• Goals of the project
• Evaluate the effectiveness and validity of using
  virtual slides (V.S) in cervical cytology
  education, including testing and distance
  learning.
• Create a public assess educational web site
• Annotated atlas
• Locate and identify exercises
• Self-assessment
• Create a dataset of virtual cervical cytology
  slides which is freely available to educators

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AACR Pathobiology of Cancer Workshop (for
graduate students and post-doctoral fellows)

• Structured similar to Pathology Laboratories in
  many Medical schools
• 6 four-hour labs with
• 18 students per lab
• 10-20 glass slides per lab (105 glass slides
  total)
• A microscope for each student
• Gross displays and photographs
• Faculty
• Illustrate slide content
• Circulate in the lab
• Human Pathology 34430-436, 2003.

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Summary of advantages of virtual slides

• Accessibility
• Removable media or the web.
• Efficiency
• Slides available at the click of mouse with
  proper light and condenser
• students can examine a larger number of slides in
  a shorter time.
• Interactivity
• Integrate into computerized Case Based Learning
• Links to gross, radiology, etc
• Side by side comparison with normal slides, etc
• Annotations for independent learning
• Other
• Self-assessment quizzes
• Computerized practical exams
• Display to large groups

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Why consider alternatives to traditional
microscopy in teaching Histology and Pathology?

• Laboratory time reduced in new curricula,
  virtual microscopy is more efficient and
  accessible
• Cost to replace and maintain microscopes and
  glass slides
• Competition for lab space
• From both computer labs and research labs

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What can you do with traditional microscopy that
you cant with virtual microscopy?

• Teach students how to examine slides with a
  traditional microscope.
• See better detail at low power
• Other
• Discern refractiveness (e.g. eosinophil granules)
• Adjust image with condenser, diaphragm, polarizer

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Should we completely abandon teaching traditional
microscopy to medical students?

• No!
• Students need to have a concept of where the
  histological sections on a computer screen or in
  books and journals come from.
• Office practices frequently use microscopes for
  urine sediment, gram stains and blood smears
• Real microscopes are used in diagnostic pathology
  labs.
• Real microscopes are used in research labs.