Digital Imaging in Education and Distributed Pathology Practice - PowerPoint PPT Presentation

About This Presentation
Title:

Digital Imaging in Education and Distributed Pathology Practice

Description:

Digital Imaging in Education and Distributed Pathology Practice Elizabeth H Hammond MD Professor of Pathology University of Utah and Intermountain Healthcare – PowerPoint PPT presentation

Number of Views:136
Avg rating:3.0/5.0
Slides: 35
Provided by: lde85
Category:

less

Transcript and Presenter's Notes

Title: Digital Imaging in Education and Distributed Pathology Practice


1
Digital Imaging in Education andDistributed
Pathology Practice
  • Elizabeth H Hammond MD
  • Professor of Pathology
  • University of Utah and Intermountain Healthcare
  • Executive Editor for Pathology
  • Amirsys, Inc.

2
Is Digital Imaging Critical or Is it Just
a New Toy?
  • Value in Pathologist Education
  • Value in Pathology Practice

3
Pathology Education Deficiencies
  • Teaching methods limited in teaching certain
    disciplines and skills
  • Some skills cannot be taught by current methods
  • Some skills not examined by self assessment, a
    requirement of MOC.
  • Pathologists accessibility requires better
    electronic tools

4
Skills Required in Diagnostic Pathology
  • Searching
  • Identification
  • Classification
  • Comparison with previous experience by observer

5
Searching Skill
  • Searching
  • Finding areas of interest
  • Skill developed by experience
  • Strategies are not taught but are learned
  • Time to diagnosis less for skilled versus
    unskilled observers
  • Can be detected by evaluating and comparing eye
    movements of novices and experts
  • Not taught or glossed over because of limits of
    time

6
Whole Slide Imaging is Highly Valuable in
Searching
  • Static images are often poor at low magnification
    where searching occurs.
  • Since static images include the lesion, the
    searching skill is bypassed.
  • Observation of skillful observer by a novice
    promotes learning of searching skills

7
(No Transcript)
8
(No Transcript)
9
Whole Slide Image Heart Transplant Biopsy
10
Identification Skill
  • Skills needed to identify areas of interest using
    low power visual clues
  • Visual clues may not be obvious without training
  • Areas on IHC exam to select for HER2 FISH
  • Vascular lesions in transplant biopsies
  • Areas of lobular carcinoma in breast

11
Value in Identification
  • Skilled observer can be instructed to define in
    words how the identification occurs while the
    less skilled observer is watching
  • Areas of confusion or misidentification can be
    carefully reviewed and discussed
  • Artifacts can be defined
  • Limited preselected images do not fill this need

12
(No Transcript)
13
Whole Slide Image HER2 Stained Slide
14
Classification Skill
  • Ability to compare test object with correctly
    classified objects reproducibly
  • Can be combined with identification skill in
    learning
  • Requires many high quality images of variously
    classified objects

15
Value in Classification
  • Combination of identification and classification
    skills is enabled
  • Based on interaction with learners, various
    classification clues can be focused on
  • Quality of static imaging is improved for
    documentation or teaching
  • Number of images that can be easily obtained is
    high.

16
(No Transcript)
17
(No Transcript)
18
Whole Slide Image HER2 Stained Slide
19
How Can Such New Technology Be Deployed
Effectively?
  • Video microscopy sessions at meetings
  • Use unknowns to enhance conversation
  • Describe process while doing it
  • Webcasts with other members of department as
    intradepartmental consults
  • Sessions with resident and staff at time of
    diagnosis.

20
Accessibility
  • Digital Imaging allows pathologist to practice
    skills
  • Any place
  • Any time
  • Method can be incorporated for self assessment to
    help pathologist define their areas of deficiency

21
(No Transcript)
22
(No Transcript)
23
Whole Slide Image Heart Transplant Biopsy
24
Distributed Practice Issues
  • Consistent interpretation required because
    Intermountain is a quality healthcare system
  • Variable skill and knowledge by group members
  • Variable availability of expert resources
  • Occasional manpower issues
  • Wide geographic separation

25
Practice Demographics
  • 5 pathology groups
  • Distributed over 450 miles
  • Group sizes
  • 17 most specialties (4 hospitals)
  • 4 Dermpath, Hematopath (2 hospitals)
  • 3 (x2) Hematopath
  • 2 None

26
Process
  • Pathology groups are separate entities
  • Intermittent consultation
  • Sharing of expert resources for technical
    functions and some professional functions
  • Sharing during manpower shortages
  • Communication via phone and courier
  • Collegial environment

27
Potential Utilities of Whole Slide Microscopy
  • Intragroup consultation of specialists
  • Intergroup consultation between sites and for
    double read situations
  • Intergroup consultation for frozen sections
  • Professional sign out of immunohistochemistry
    with or without expert consultation
  • Tumor board presentations to clinicians
  • Education sessions to improve consistency of
    interpretation and speed of integration on new
    members

28
Specialty Consultations
  • Faster turn around time because couriers not
    involved
  • More common consultation because of increased
    availability
  • Opportunity for learning of others because of
    multiple viewing options

29
Intragroup Consultation
  • Requirement for double reading in many cases
  • New diagnosis of cancer
  • Prostate needle biopsies
  • Difficult cases which might benefit from
    consultation
  • Difficult with multisite groups so that
    appropriate second reader might not be used

30
Frozen Section Consultation
  • Difficult frozens benefit from second opinions
  • If no other pathologist on site, this is not
    utilized
  • Diagnoses could be improved by having this
    capacity at each hospital

31
Sign Out of IHC
  • Currently, all IHC done in three sites and slides
    shipped to other sites
  • Turn around time 24 hours for off site locations
  • Could consolidate technical functions if virtual
    microscopy was available
  • No option for dual viewing in difficult cases
  • No option to educate new members of group

32
Tumor Boards And Clinical Conferences
  • One or two each day in largest group
  • Slides that need to be included may not be
    available
  • Lost in pathologist office
  • Only at another hospital
  • In process of filing
  • Significant time required by pathologist to take
    required static images or drag photoscope to
    conference room

33
Education of Group Pathologists
  • Intermountain operates by developing standards
    which are transmitted throughout the system using
    data on provider behavior
  • Pathologists expected to be consistent and
    complete in reports (data system)
  • Education of pathologists required
  • Nottingham Score
  • HER2 scoring

34
Summary
  • Digital imaging has great value in improving
    pathology education
  • Improving diagnostic skills
  • Improving accessibility
  • Digital imaging has great value in practice
  • Allowing flexibility in sign out and consultation
  • Allowing distributed conference functions
  • Decreasing courier related process delays
Write a Comment
User Comments (0)
About PowerShow.com