The advent of whole-slide imaging in digital pathology has brought about the advancement of computer-aided examination of tissue via digital image analysis. Digitized slides can now be easily annotated and analyzed via a variety of algorithms. This study reviews the fundamentals of tissue image analysis and aims to provide pathologists with basic information regarding the features, applications, and general workflow of these new tools. The review gives an overview of the basic categories of software solutions available, potential analysis strategies, technical considerations, and general algorithm readouts. Advantages and limitations of tissue image analysis are discussed, and emerging concepts, such as artificial intelligence and machine learning, are introduced. Finally, examples of how digital image analysis tools are currently being used in diagnostic laboratories, translational research, and drug development are discussed.
Background: QuPath is an open-source digital image analyzer notable for its user-friendly design, cross-platform compatibility, and customizable functionality. Since it was first released in 2016, at least 624 publications have reported its use, and it has been applied in a wide spectrum of settings. However, there are currently limited reports of its use in placental tissue. Here, we present the use of QuPath to quantify staining of G-protein coupled receptor 18 (GPR18), the receptor for the pro-resolving lipid mediator Resolvin D2, in placental tissue. Methods: Whole slide images of vascular smooth muscle (VSM) and extravillous trophoblast (EVT) cells stained for GPR18 were annotated for areas of interest. Visual scoring was performed on these images by trained and in-training pathologists, while QuPath scoring was performed with the methodology described herein. Results: Bland–Altman analyses showed that, for the VSM category, the two methods were comparable across all staining levels. For EVT cells, the high-intensity staining level was comparable across methods, but the medium and low staining levels were not comparable. Conclusions: Digital image analysis programs offer great potential to revolutionize pathology practice and research by increasing accuracy and decreasing the time and cost of analysis. Careful study is needed to optimize this methodology further.
Objectives To describe the Advocacy Journal Club, a novel method to expose pathology residents, fellows, and faculty to critical regulatory and policy issues that affect the practice of laboratory medicine and the importance of involvement in advocacy initiatives. Methods Six voluntary conferences were held for UNMC faculty, local pathologists, and residents during a 1-year period. Each featured a unique, 50-minute interactive discussion led by a faculty member on a topic related to systems-based practice, public health, and/or legislative reform in health care. The six topics included Stark Law, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Laboratory Developed Tests, Executive Branch Influence on Health Care, Local Coverage Determinants, and Protecting Access to Medicare Act of 2014 (PAMA). In addition, all participants completed an 8- to 10-question pre- and posttest. After the completion, a survey to assess the quality and efficacy of the series was administered. Results Between 5 and 11 residents attended each session. Both residents and faculty demonstrated a marked increase in their posttest scores. In the final survey, 92% stated they gained an understanding of how policy affects their local laboratory and 100% a better appreciation of how involvement in pathology organizations’ advocacy efforts impacts the laws, rules, and regulations that affect laboratory medicine. Most (92.3%) reported that topics of the Advocacy Journal Club are important to pathology training and 100% reported that the format was effective. Conclusion The journal club format is an effective method to teach both residents and faculty about health policy and other issues impacting laboratory medicine and the critical role that participation in the advocacy efforts of pathology societies plays in affecting the future of the specialty.
Objectives To describe a method of educating pathologists about health policy. Methods The Advocacy Journal Club was a series of six conferences. Topics were of those in the news or affecting local practice. Participants reviewed preparatory readings, completed a six- to 10-question pretest, attended an interactive presentation stressing advocacy groups’ efforts, and completed a posttest. All were invited to complete a survey after the sessions. Results Faculty and residents had increased posttest scores following each presentation with a significant difference in four and three sessions, respectively. More than 80% agreed they could discuss the topics with others and understood how regulations affect practice. More than 90% agreed that they gained an understanding of how involvement in organizations’ advocacy initiatives affects policy. Conclusions We present a method for educating pathologists about policy and the role of professional societies that could be implemented by nearly all graduate medical education programs.
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