Digital Pathology Blog

MEDTING Atlas viewer

I have posted about MDPIXX before.  The company has recently changed their name to MEDTING to better reflect their desire to host and share content for collaboration.  Their platform and tools allow users the opportunity to have several forms of media hosted and shared for public viewing or private consulation. 

I had the opportunity recently to meet with their CEO, Mr. Miguel Cabrer whose background is in health IT and more recently in Health 2.0 initiatives, such as this. 

To date, I have uploaded over 4,000 gross and histologic images to their site for viewing. His team of programmers has created this embedded viewer using a flash application for image viewing.

Secured consultations, VTC, file sharing or public sharing, such as this are among the suite of applications they develop and support. 

The images can be key worded and searched or indexed with SNOMED terminology.

Upcoming CAP Foundation Grants—October 1st Deadline

The CAP Foundation is the leading philanthropic organization for pathologists and residents-in-training. The Foundation’s research, training, and leadership development grants and awards benefit promising pathology researchers, advance technology innovations, develop new pathology leaders, and provide humanitarian aid related to pathology. We urge you to invest in your future by taking advantage of the grant opportunities listed below.

How to Apply

For additional descriptions, eligibility requirements and guidelines for completing an application, visit the CAP Foundation Web site. You can also send an email, or call          800.323.4040       extension 7324 for more information.

Grants for Advanced Training

Advanced Training – General Elective
Sponsored by:  CAP Foundation
Deadline:  October 1, 2008

Award Amount:  $2,000 per month to support travel and living expenses.

Purpose:  To support travel and living expenses for the training period.

Advanced Training Elective in Molecular Diagnostics
Sponsored by:  Abbott Molecular
Deadline:  October 1, 2008

Award Amount:  $2,000 per month to support travel and living expenses.

Purpose:  To support travel and living expenses for the training period.

Advanced Training Elective in Molecular Diagnostics for Individualized Cancer Treatment Decisions
Sponsored by:  Genomic Health
Deadline:  October 1, 2008

Award Amount:  Allowance provided for travel and living expenses.

Purpose:  To provide additional exposure to advanced molecular diagnostics techniques and quantitative testing (e.g., PCR, ER, PR, Her2).

NEW – Advanced Training Elective in Molecular Pathology
Sponsored by:  Sakura Finetek USA, Inc.
Deadline:  October 1, 2008

Award Amount:  Allowance provided for travel and living expenses.

Purpose:  To provide a rotation aimed at pathology residents and fellows in training who are interested in learning cutting-edge technology used at high throughput surgical pathology departments.

Advanced Training in Pathology Informatics
Sponsored by:  CAP Foundation and McKesson Provider Technologies
Deadline:  October 1, 2008

Award Amount:  Allowance provided for travel and living expenses.

Purpose:  To offer background and experience to pathology residents to introduce and implement advanced informatics technology in the clinical laboratory. This elective must be completed within May 1 – August 31, 2009.

NEW – Advanced Training Elective in Translational Diagnostics
Sponsored by:  Ventana Medical Systems
Deadline:  October 1, 2008

Award Amount:  Allowance provided for travel and living expenses.

Purpose:  To gain additional exposure to novel antibody and probe development, new machines, technology, partnerships for developing companion diagnostics and related areas. This elective must be completed by December 31, 2008.

Conference Travel Awards

2009 Lab InfoTech Summit (March 16 - 18, 2009, Las Vegas, NV)
Sponsored by:  CAP Foundation and the Pathology Education Consortium

Award Amount:  Recipients will receive complimentary registration and will be reimbursed up to $1,000 for travel expenses.

Purpose:  To attend a conference focusing on information technology for the clinical laboratory.

Grants for Quality Assurance

John H. Rippey Grant for Laboratory Quality Assurance
Sponsored by:  CAP Foundation
Deadline:  October 1, 2008

Award Amount:  $10,000

Grants for Research Projects

Scholars Research Program
Sponsored by:  CAP Foundation and Seracon Diagnostics Company
Deadline:  October 1, 2008

Award Amount:  Up to $12,500 for six months and up to $25,000 for one year.

Purpose:  To provide funding for translational research in pathology.

NEW – Scholars Research Cervical Cancer Fellowship
Sponsored by:  Hologic Health
Deadline:  October 1, 2008

Award Amount:  $25,000

Purpose:  To allow a principal investigator to address a research question that focuses on the current FDA approved screening of women from age 30+ (HPV in conjunction with a PAP test.)

Research in Telepathology – Nikon
Sponsored by:  CAP Foundation and Nikon Instruments
Deadline:  October 1, 2008

Award Amount:  $5,000 to cover expenses incurred during the grant period, and for travel to attend a national meeting to present an abstract/paper summarizing study results.

Purpose:  To further developments in and use of information technology for the practice of pathology.

Research in Telepathology – Olympus
Sponsored by:  CAP Foundation and Olympus America
Deadline:  October 1, 2008

Award Amount:  $5,000 to cover expenses incurred during the grant period, and for travel to attend a national meeting to present an abstract/paper summarizing study results.

Purpose:  To further developments in and use of information technology for the practice of pathology.

NIH head to step down

The New York Times (9/25, A22, Harris) reports that Elias A. Zerhouni, M.D., "director of the National Institutes of Health (NIH), who shook up the agency when he barred scientists from consulting for drugmakers, announced that he would leave at the end of October." That "ban was unpopular among many agency scientists, who said it would make recruiting top scientists difficult. But, in the wake of continuing Congressional investigations, a growing number of medical schools and medical groups are now cracking down on the outside consulting relationships of their faculty and staff members." At NIH, Dr. Zerhouni "pushed scientists to focus more on patient care and less on basic research, and he forced the agency's independent institutes to cooperate on common projects," even as he "faced a stagnant budget that has curtailed research around the country and demoralized scientists." Although Dr. Zerhouni "told Congress that the President's policy" on stem-cell research "was hindering scientific progress," his continued support from "the White House despite this public disagreement is noteworthy."

"Health and Human Services Secretary Mike Leavitt praised Zerhouni in a statement," The Hill (9/25, Young) adds. "Elias has been a powerful voice for the medical research community as the head of NIH," Leavitt said. Dr. Zerhouni "rejected characterizing his departure as a resignation." He would have had to resign when the next President takes office, and he "explained that he wanted to depart before then, so Bush's successor has to act quickly to replace him." He pointed out that "President Bush is 'completely supportive, and understands' why he is leaving."

Bloomberg News (9/25, Lauerman, Larkin) quotes White House press secretary Dana Perino as saying that, during Dr. Zerhouni's "tenure, the NIH has accomplished groundbreaking work in the area of genetic research, including mapping the human genome, and also helping to ensure the passage of genetic non-discrimination legislation."

CQ (9/25, Reichard) points out that Dr. Zerhouni "generally won raves on Capitol Hill for his stewardship of the medical research agency." He is "perhaps best known for his articulate advocacy of expanded funding for NIH, and his willingness to buck the Bush administration's Aug. 9, 2001, policy limiting federal funding for embryonic stem cell research." While the ban held, "his descriptions of the exploding potential of medicine based on discoveries of the genetic mechanisms underlying disease built up a reservoir of goodwill toward NIH among lawmakers," as well as "a strong sense of the agency's potential to produce medical breakthroughs with additional funding."

According to the AP (9/24, Neergaard), "Despite an era when NIH's budget seldom kept up with inflation, behind the scenes" Dr. Zerhouni "engineered a major reorganization of the behemoth $29.5 billion agency designed to speed how basic science discoveries are turned into treatments -- and to spur creative research ideas that might otherwise languish." The UPI (9/25), the National Journal (9/24, Munro), Modern Healthcare (9/25, Lubell), MedPage Today (9/24, Peck), and the GenomeWeb Daily News (9/24) also covered the story.

BioImagene accelerates digital pathology

BioImagene, the Silicon Valley based digital pathology solutions provider, introduced the next generation of the iScan(tm) Slide Scanner with version 2.0. The new iScan delivers high quality images at faster
speeds and increases operational efficiency.

The iScan is BioImagene's premier desktop slide scanning system for easy digital pathology. It allows unattended batch scanning up to 160 slides, freeing up the histotechnologist's time to complete other tasks.

Dave Pauluzzi, President and COO, PLUS Diagnostics said "People perceive digital pathology scanners as complicated, bulky instruments that occupy a lot of lab space. Contrary to conventional perception the iScan combines a compact footprint, high slide volume and powerful technology to deliver a variety of laboratory, pathologist and clinician benefits that translates to better patient care.  PLUS Diagnostics prides itself on being committed to science and innovation and our relationship with BioImagene enables this priority for us."

The new iScan produces images with excellent resolution at faster scan times of 3 minutes a slide. A session management module has been added to allow users to save and restore scanning sessions, and allows recovery of the last scanning state in the event of a power blackout.

Enhanced feedback and status messages, provides the users with time estimates for scanning batches, for better time management and efficiency. Users will also appreciate the greater security and the setting of personalized preferences provided by the user management module.

Gregory Loney, VP Engineering, Instruments, commented "The next generation of the iScan was developed incorporating feedback from pathologists using the first generation of the iScan system. The iScan
and our proprietary software accelerates adoption of digital pathology applications like image analysis, online pathology education, remote collaboration, and second opinions." 

The iScan provides an end-to-end digital pathology solution for viewing, acquiring, managing, searching, reporting and sharing images in a pathology laboratory, when used in conjunction with BioImagene's
proprietary image analysis and management software.

Revving Up QA in Anatomic Pathology

Digital pathology can streamline how lab directors view and implement compliance procedures

There is a recent publication in Advance for Administrators of the Laboratory written by an Aperio senior marketing manager entitled "Revving up QA in Anatomic Pathology".

There is no question that one of the greatest deliverables, suitable for small and large groups alike is the ability to share material in a cost- and time-effective manner.  This speaks to having proforma QA, rapid access to subspecialists and the ability to review material seamlessly at the same time with colleagues. 

All of this is part of routine surgical pathology practice and may be streamlined and more effectively managed in the digital space with improved deliverables, such as archiving material, reviewing the same slide(s) at the same time and having the capability to share material without physical transfer of slides. 

The article addresses what digital pathology is and the applications for QA, proficiency testing, consultation, risk management and conferencing abilities.

American Society of Cytopathology - Future of Cytopathology Forum

In 2006 the American Society of Cytopathology (ASC) appointed a "New Profession for Cytotechnologists Task Force" to address ASC members’ concerns regarding emerging trends that threaten to reduce Pap test volumes.

The ASC hired The Forbes Group to assess market forces that would support a new cytology profession. The report opened up the discussion and forced the ASC’s Executive Board to focus on the changes occurring in the field, not just cytotechnology but cytopathology.

The Multidisciplinary Steering Group was formed and has developed eight topics that will be discussed on The Future of Cytopathology Forum (Bulletin Board). The invited individuals, as well as the membership, are encouraged to participate in the discussions on the Forum.

I am co-chairing the Global Medicine/Telemedicine committee with Dr. David Wilbur, Director of Cytopathology and Associate Professor of Pathology at Massachusetts General Hospital.  The group is headed by Dr. Barbara Crothers, Chief of Cytopathology and my former Chief of Anatomic Pathology at Walter Reed Army Medical Center.  She and Dr. Wilbur helped co-author a publication on internet-based gynecologic telecytology.  As developments occur

At this year’s ASC’s 56th Annual Scientific Meeting in Orlando, the Multidisciplinary Steering Group will give a presentation on the findings in The Forbes Report and the responses on the Forum. In November 2009, the Group would like to sponsor an all-day forum at the ASC’s 57th Annual Scientific Meeting in Denver to discuss the outcomes and develop a strategic look into the future of cytopathology. For more information, please contact the ASC National Office at (302) 429-8802.

Comment on Post from Past

Much like whole slides themselves, blogs I am finding have some of the same characteristics for different reasons - they are persistent, consistent and efficient.  One can choose to get daily feeds or follow on a reader seamlessly.  Each blog and blogger has his or her own style that covers what is important to them whether they be personal, technical or cover particular topics or fields of interest to them.

One of the deliverables of the blog I find most interesting is receiving comments to past posts with new ideas or questions long after I have thought of them or posted on the subject that allows me to re-visit these topics. 

Recently I received a comment to a posting from June of last year on the issue of outsourcing of digital slides and the implications of such based on a paper written by the president of ASCP.  The original post touches on my thoughts on this issue which I think presents opportunities rather than threats to pathology.

The comment submitted reads "I'm a big fan of outsourcing medical readings of digital slides and imaging to India. Once you have a resource in India that is proven to be respected and trustworthy it makes sense to outsource, especially at night. I think it would be amazing if doctors allowed patients to request readings from a 3rd party if they so chose (discounted option). Sort of like hotels offering basic rooms vs Penthouses in terms of service. What do you think?"

No doubt that second and third consultations are commonly sought by patients and their families seeking additional opinions to help them decide the best course of action that suits them.  Clinicians, pathologists and patients alike continually seek help from one another for appropriate answers and solutions to help guide diagnosis, therapy and follow-up for their patients or themselves.  It is one advantage we all have, providers and patients alike to not only "real" in-person consultation, referrals - whether they be slides mailed or patients referred to other clinicians for their opinion but also "virtual" or "electronic" consultations for patient care or radiology/pathology interpretations. 

As I posted initially, workflow and demands in pathology do not necessitate the middle of the night coverage demanded in radiology.  Furthermore, if you look at these kinds of practices in radiology, often times they are US trained radiologists providing coverage for an institution where they have practiced or are credentialed to practice in performing the same work they would do on-site but negating the need for on-call radiologists. 

I think the idea that slides, once put into a format that can be transferred more readily in a digital form compared to a physical form, will be read by someone arguably at the same quality but discounted price is not a business model that threatens pathology.  I have suggested work be in-sourced from those who need help given the expertise and still relatively low cost in this country. 

This presents an opportunity using technology to leverage the expertise and need that benefits all involved rather than commoditizing anatomic pathology services.

AFIP looking ahead

For those of us who trained and/or spent time at the Armed Forces Institute of Pathology (AFIP) during our careers have wonderful memories of the experience and the wealth of material and expertise at "windowless buidling" on the campus of Walter Reed Army Medical Center in Washington, DC. 

Fortunately the institution survived the BRAC closing slated in 2005 and will be reorganized as the Joint Pathology Center which I have posted about before.  It is still not known whether or not this will be a DOD facility or be established in or as another federal agency. 

There are a number of issues that the AFIP has faced and will continue to face given their mission of education, consultation and research within the constraints of the systems they are required to operate in. 

While the AFIP was a leader in morphology and classification for a long period of time, I always thought they failed to make the leap into emerging and advancing technologies such as molecular pathology, genomics, proteomics and bioinformatics given the resources available to them. 

Nonetheless, there appears to be some movement in that direction. 

The Director of the Armed Forces Institute of Pathology (AFIP), Florabel G. Mullick, MD, sees a future that will rely heavily on pathology informatics. The data collected will include clinical tests, anatomic pathology reports, image files, telepathology data, and large-scale experiments to include gene, tissue array, and molecular diagnostics testing. Therefore data will need to be collected, examined, reported, plus large complex sets of data from clinical, anatomic pathology, or research labs will need to be stored.

Dr. Mullick sees additional challenges in dealing with the increased volume of information because new subspecialties will be developed in the future. This will result since smaller biopsies will be performed, lesions will be detected earlier, new therapies are on the horizon, and new diseases will affect more of the population but especially hit the aging population.

However, according to the Director, there are challenges facing AFIP. The challenges of the Base Realignment and Closure mean that despite the uncertainties of BRAC, AFIP must continue to look forward and be committed to providing world-class research, diagnoses, and education.

Dr. Mullick reports that the 2008 Defense Authorization Act was signed requiring the Joint Pathology Center (JPC) to be established. JPC will function as the reference center in pathology for the Federal government. There are uncertainties in establishing JPC and it is not absolutely certain that JPC will be established in the Defense Department as it could be established in another Federal agency.

A Joint Pathology Center Working Group will determine if JPC can be part of DOD and if so, how it will be structured and where it will be located. Dr. Mullick wants to see JPC established as part of DOD, as this will be a great opportunity for AFIP, and would transform AFIP into the premier pathology center of excellence of the 21st century.

AFIP’s Office of the Armed Forces Medical Examiner (OAFME) is the home of the first forensic CT scanner to be used to aid the autopsy process by providing higher resolution and more data. The scanner is able to do 3D reconstruction of wounds and determine their pathways to efficiently recover projectiles. Using the scanner can bring out injuries that you wouldn’t see with an x-ray or at autopsy.

Navy Captain Craig Mallak, Director, OAFME points out that by sharing knowledge obtained from the analysis of forensic CT scans, this technology will help DOD agencies design new generations of body armor and vehicles. It will be possible to modify current equipment to turn deadly injuries into potentially survivable injuries or almost no injury at all.

According to Captain Mallak, if they can make this scanner technology smaller and less expensive, I think every medical examiner’s office in the country would want the new technology. It would be an efficient and effective triage tool for mass casualty events.

Digital Pathology in Preclinical Research Arena

In the September 1 edition of Genetic Engineering & Biotechnology News there is a story by Steve Potts, Ph.D., who is the worldwide director of biopharma at Aperio Technologies .

The article starts with:

The vast majority of drug compounds fail in the preclinical stage, and pharmaceutical and biotech companies are continuously looking for preclinical process improvements to better manage costs and identify candidate failures as soon as possible. Digital pathology is an emerging technology that provides an image-based environment for managing and interpreting information generated from a digitized glass slide.

The process starts with high-resolution whole slide images—pathology slides from a study that have been scanned at 20x, 40x, or even 100x resolution, and stored in a searchable database. Users can search for slides, organize and annotate slides, conduct virtual peer reviews, and run quantitative immunohistochemistry and morphology algorithms on digitized, virtual slides. Researchers access a secure internet-based environment for annotation, sharing, and analysis of the images.

Full story

Dr. House meets HAL

Through the Critical Section I came across a link to an article by a tech blogger by the name of Dana Blakenhorn who has been a business journalist since 1978 and has covered technology since 1982. 

Here is a short take entitled "Dr. House meets HAL" and his view of the digital pathology market.

Fans of House, MD like myself know House is never wrong.  The best part about the show is the blue flourescent light about the lab that spells "PATHOLOGY".

Here is a story about a real Dr. House.