NDER: A novel web application using annotated whole slide images for rapid improvements in human pattern recognition

Abstract

Context:Whole-slide images (WSIs) present a rich source of information for education, training, and quality assurance. However, they are often used in a fashion similar to glass slides rather than in novel ways that leverage the advantages of WSI. We have created a pipeline to transform annotated WSI into pattern recognition training, and quality assurance web application called novel diagnostic electronic resource (NDER).Aims:Create an efficient workflow for extracting annotated WSI for use by NDER, an attractive web application that provides high-throughput training.Materials and Methods:WSI were annotated by a resident and classified into five categories. Two methods of extracting images and creating image databases were compared. Extraction Method 1: Manual extraction of still images and validation of each image by four breast pathologists. Extraction Method 2: Validation of annotated regions on the WSI by a single experienced breast pathologist and automated extraction of still images tagged by diagnosis. The extracted still images were used by NDER. NDER briefly displays an image, requires users to classify the image after time has expired, then gives users immediate feedback.Results:The NDER workflow is efficient: annotation of a WSI requires 5 min and validation by an expert pathologist requires An additional one to 2 min. The pipeline is highly automated, with only annotation and validation requiring human input. NDER effectively displays hundreds of high-quality, high-resolution images and provides immediate feedback to users during a 30 min session.Conclusions:NDER efficiently uses annotated WSI to rapidly increase pattern recognition and evaluate for diagnostic proficiency.

RecutClub.com: An Open Source, Whole Slide Image-based Pathology Education System

“…[2223] In addition to text and static images, WSI offers enhanced value to the learner. [2425] Evaluation of eye movements among residents in radiology as well as in pathology have offered preliminary data to suggest that users with higher training are able to hone into diagnostically relevant areas of an image; these data can be used to perfect a trainee's search strategy and image analysis skills. [2627]…”

Novel Diagnostic Educational Resource: Use of a web-based adaptive learning module to teach inflammatory reaction patterns in dermatopathology to medical students, residents, and fellows

“…The technical features of NDER have been previously described. 8 A brief survey to record participant characteristics and familiarity was administered prior to completing the module (see below). The module itself consisted of a 20 question pre-test, 200 training slides, and a 20 question post-test.…”

“…Novel Diagnostic Educational Resource (NDER) is an open source tool designed specifically for training rapid pattern recognition with annotated WSI. 4 , 8 NDER modules are adaptive, adjusting to each learner’s unique performance by changing the display time of an image based on cumulative user accuracy. A series of unique images is used to avoid recall bias and encourage the learner to extract knowledge on common features and patterns rather than memorize specific examples.…”

Digital vs traditional: Are diagnostic accuracy rates similar for glass slides vs whole slide images in a non‐gynaecological external quality assurance setting?

“…Use of WSI also allows for the potential for annotation, hot‐linking or incorporation into online interactive modules . Virtual cytopathology is already well established in the educational setting, and is developing in the diagnostic setting .…”