Digital Pathology Consultations—a New Era in Digital Imaging, Challenges and Practical Applications

Abstract

Digital pathology has grown dramatically in the last 10 years and has created opportunities to not only support the triaging of difficult cases among specialists within an organization, but also enable remote pathology consultations with external organizations across the world. This study investigated one organization's need for a vendor agnostic Digital Pathology Consultation workflow solution that overcomes the challenges associated with the transfer of large studies across a local area network or across the Internet. The organization investigated is a large multifacility healthcare organization that consists of 20 hospitals spread across a wide geographical area. The organization has one of the largest academic pathology departments in the USA, with more than 100 diagnostic anatomic pathologists. This organization developed a set of web-based tools to support the workflow of digital pathology consultations and allow the viewing of whole slide images. The challenges and practical implementations of two different use cases are addressed: the occasional end user (professional or patient) requesting a second opinion and the external laboratory or hospital looking for an established consultative relationship with a large volume of cases. The solution presented in this study addresses the challenges associated with the distribution of large images and the lack of established imaging standards, while providing for a convenient and secure portal for pathologist report entry and distribution.

A Systematic Analysis of Discordant Diagnoses in Digital Pathology Compared With Light Microscopy

“…[4][5][6] Implementation barriers include the cost-benefit of digital pathology, current lack of regulatory approval from the US Food and Drug Administration, a paucity of evidence validating the diagnostic concordance of WSI and light microscopy, and low acceptability of digital pathology among pathologists. 1,[7][8][9][10][11] If digital pathology is to be implemented for primary diagnosis on a large scale, regulatory bodies, both international and national; departmental heads; and individual pathologists will have to be confident that a diagnosis made on a digital microscope is equivalent to a diagnosis made by the same pathologist on a light microscope.…”

Diagnosing Pathological Prognostic Factors in Retinoblastoma: Correlation between Traditional Microscopy and Digital Slides

“…As the histopathology specimen has tissue sections of known thickness, real-time focus adjustments determined by software algorithms were utilized to keep the resulting images in focus. The objective lens determines the output resolution of the images and also the overall speed of capture, with a higher resolution resulting in smaller fields of view and longer scan times [4]. The resulting image was represented in 24-bit real color with dimensions of thousands of pixels in both width and height.…”

“…WSI in ocular pathology not only supports triaging of difficult cases among specialists within an organization, but it also enables remote pathology consultations with external organizations around the world [4] . In order to analyze and compare WSI to traditional microscope-based pathology, we reviewed retinoblastoma (RB) cases.…”

Validation of Whole-Slide Imaging for Histolopathogical Diagnosis: Current State

“…These scanners are the basis of virtual microscopy or whole-slide imaging (WSI), which allows navigation across the virtual slide and visualization at different magnifications, allowing the computer to be used as a CLM. However, the image quality of the initial scanners was limited, and the costs of implementation of the technology, including the scanner, monitors and suitable computers, were very high, thereby restricting the use of WSI to certain areas, such as teaching and teleconsultation, and excluding routine diagnosis [10,13,14,15,16,17]. …”