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

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Digital Imaging in Education and Distributed Pathology Practice

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

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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
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8
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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
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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
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17
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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
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22
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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
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