Digital pathology is one of the main topics and areas of consideration for most pathology laboratories today. Every facility, whether a hospital, IDN (integrated delivery network), pathology group or specialty lab, either knows they need to get there or already have a plan or evaluation process in place for deploying digital pathology. Most pathologists are excited to make the move to digital pathology for diagnosis and appreciate the value that “going digital” brings to the profession as well as to their lives. This includes: faster diagnosis, improved efficiencies, streamlined workflow, better/higher quality images, automated and user-friendly diagnosis, instantaneous collaboration and secondary consults, flexibility of workflow and location, and ease of workload balancing, and on and on.
However, what is behind the curtain of the process in a slide going from glass to digital? Is it trustworthy? Is the image truly as good as, or better than, glass and is using a monitor to view this new file format truly equivalent to using a microscope to view the original glass slide?
Digitized images taken from a whole slide scanner are comprised of a series of pixels—tiles that are electronically “stitched together.” The slides are scanned and stored in what is known as a pyramid fashion. The pyramid allows an image to be zoomed into and out of, mirroring or simulating the process of a microscope going from one magnification to another and back again. The mainstream software equivalent or analogy would be of one using a program like Google Earth where you can zoom into a location and see a specific building, street view, etc., and then be able to move around in order to see different perspectives.
When you consider that a Google Earth image is as good as it is when taken from space, the quality of image correlation can be assumed when knowing that a whole slide image is taken from a scanner when their apparatus is a mere inch or so away from the glass specimen.
What could possibly go wrong and what are the possible pitfalls? The biggest one that you hear about is from pathologists who either get eye fatigue or complain of seasickness. How does this happen? Both of these scenarios can be experienced when either loading an image or panning and zooming, which causes an image to appear pixelated, and you can see the pixels coming together to form the entire image. We commonly see this when a picture taken with our cell phone or a digital camera is delayed coming into focus when you change the magnification of it. This effect is caused by the image loading. It does not happen in all cases or with all hardware and software solutions. It is therefore something to consider when choosing both the glass whole slide imaging scanner and the image viewer software solution as you are making the decision to deploy digital pathology.
One of the more common causes of this pixelized loading, or tiling, is the bandwidth of the connectivity between where the image is stored, or being rendered from, and the location of the viewer, or where the pathologist is working. This can easily be remedied by ensuring that you have uninterrupted and high-speed bandwidth with reliable internet provider(s).
Another cause, and this is one to be considered when doing your evaluation of vendors, is the whole slide imaging scanner’s file format as well as how that image is stored within the scanner. Which compression and packaging methods are used to form the pyramid that allows the zooming is another consideration, and yet another item to evaluate is how that image is then either sent to, or retrieved by, the digital viewer that the pathologist is using.
The best way to understand the capabilities and the experience the pathologist will have in practice is to ask for, and see, a detailed demonstration of each piece of the digital solution in practice. Many hardware vendors will offer a demonstration of their scanners using your glass slides. Many software solution providers will offer a demonstration of the use of their viewer so that you can see a digital image of a specimen being loaded, and navigated, to include panning and zooming.
Be sure you evaluate vendors who can show you their specific capabilities to be sure the digital pathology solution pieces you choose will provide the experience you expect. Digital pathology is a huge step in our industry’s technological capabilities and is already having a positive impact on patient diagnosis and treatment, as well as pathologist satisfaction. Make sure you choose the best components for your facility to ensure all the benefits aren’t dampened by a disappointing user experience.
I recommend that you get pathologist champions to oversee the review process and engage directly with the vendors you decide upon during the deployment of digital pathology. These pathologists should also serve as the initial adopters (if your adoption plan is a scaled one) as you begin your onboarding of digital. This has proven to be a recipe for a seamless and well-integrated process.
Lisa-Jean Clifford is the COO and Chief Strategy Officer for Gestalt Diagnostics. With almost 20 years of experience in healthcare and laboratory technology companies, she is focused on providing innovative solutions and services to improve laboratory efficiencies and patient outcomes through technology.
