Digital Pathology Blog

Executive War College to hold Digital Pathology Symposium

From Dark Daily:

Pathologists Soon to say Sayonara to Glass Slides!

March 26, 2009

Digital Pathology Imaging: Coming Soon to a Pathology Group near You!

Will pathologists soon say "sayonara" to glass slides? Plenty of smart money already bets the answer to that question is "yes"! Every pathologist in the United States and abroad should be watching developments in whole slide imaging and digital pathology systems. That's because digital pathology imaging is a trend with momentum-and it also has the potential to be disruptive, although probably not in the short term.

One powerful sign that digital imaging in pathology is ready to go mainstream is the take-up of digital imaging solutions and digital pathology systems by leading pathology laboratories in the United States and developed countries across the globe. These are academic and tertiary center pathology labs, along with major private pathology companies. As the pathology profession's first-movers and early adopters, it is these laboratories which set the pace for the entire profession. Their acceptance and growing use of digital imaging and digital pathology systems can be taken as evidence that the current generation of imaging and informatics technologies perform adequately.

However, there is another powerful force propelling digital imaging forward in anatomic pathology. It is the emergence of molecular assays which incorporate digital images and use either computer-aided diagnosis (CAD) or pattern recognition software to help the pathologist make a precise diagnosis. By design, these molecular tests require the pathologist to work from a digital image of the specimen. At The Dark Report's  second annual Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics, conducted last February in Philadelphia, examples of these types of emerging assays were abundant.

Thus, the movement to adopt digital imaging and digital pathology systems is propelled forward by three discrete forces:

*One, acceptance and adoption of digital imaging and digital pathology by larger pathology laboratories, with the goal of assisting pathologists' work flow, improving pathologist productivity and quality, and having digital images available to share with other clinicians and to populate an electronic patient record.

*Two, as the foundation for emerging molecular assays and tests, where a digital image of the processed specimen is then assessed by computer-aided diagnosis or pattern recognition software that helps the pathologist make an accurate diagnosis.

*Three, the major vendors of anatomic pathology laboratory information systems (LIS) have already written interfaces that allow the leading digital imaging and digital pathology systems to integrate with their pathology LIS products. These pathology LIS vendors recognize that digital pathology images are now "prime time" for their larger pathology customers.

And don't forget! Last year, General Electric  and the University of Pittsburgh Medical Center  (UPMC) formed a joint venture. Each ponied up $20 million to create Omnyx, LLC, which is developing whole-slide imaging and a fully digital pathology system. At the press conference announcing the formation of Omnyx last spring, GE officials stated that they expect the market for whole slide imaging and digital pathology systems to be $2 billion.

These are important reasons why every pathology practice should be tracking the profession's uptake of digital imaging and digital pathology systems. It is no longer a question of whether or not a group should acquire digital imaging capability. Digital imaging technology is now robust-and some digital systems are affordable even for two- and three-pathologist groups! Rather, today's question is "when" a pathology group will make the investment in capital and time to acquire and use digital imaging and/or a fully digital pathology system.

That is why the upcoming Executive War College on Laboratory and Pathology Management  has organized a special, one-day workshop on Thursday, April 30, in New Orleans, titled: "Saying Sayonara to Glass Slides! Everything You Need to Know about Digital Imaging and Digital Pathology Systems." At one place and in one day, you'll hear case studies from pathology groups already using digital imaging and listen to one of the leading pathology LIS vendors discuss issues and opportunities when interfacing the pathology LIS with either or both digital imaging and digital pathology systems.

Best of all, we've assembled six of the leading companies in digital pathology to introduce you to their products and discuss how they help improve the productivity of pathologists and the precision of diagnoses. Expected to participate, in alphabetical order, are Aperio Technologies, Inc. ; BioImagene, Inc. ; DMetrix, Inc. ; Milestone Medical, Inc. ; SlidePath, Inc. ; and Applied Spectral Imaging, Inc.  (invited). There will also be a special two-hour exhibition where you can meet these vendors and explore the capabilities of their products and systems.

For every pathology group practice and laboratory, this "Saying Sayonara to Glass Slides" event is the perfect opportunity! At one time, gathered in one place, you can learn from users like you, hear from the pathology IT vendors, and see the products and people from all the major companies in this fast-moving field.

Is your group thinking about investing in digital imaging or a digital pathology system? Then this is your "must attend" opportunity! Kick the tires of the major vendors. Meet the important players in this field. Learn from pathology groups already using these solutions. Best of all, there is still time to take advantage of the early bird discount on registration. Use this registration and agenda link to guarantee your place at this vital event and benefit from the early-bird discount!

Related Information:

Convergence of In Vivo Imaging and Digitized Pathology Is Under Way
 

Recent article entitled "Digital Pathology is Growing Despite Fears"
 

Dark Report: Momentum Continues for Digital Pathology
 

Brand new! Just released is a full color program agenda PDF. (or paste this URL into your browser: http://www.executivewarcollege.com/PDFs/09brochure.pdf )

Early-Bird Discount Registration now available online

Visit http://www.executivewarcollege.com

Download Full Program Agenda

Four Easy Ways to Register:
1. Register ONLINE
2. Call 800-560-6363. Our friendly staff can register you quickly and easily, as well as answer any questions you may have.
3. Fax this complete registration form to 512-264-0969
4. Mail the one page form with payment to:

THE DARK REPORT
21806 Briarcliff Dr.
Spicewood, TX 78669

It is the first time all these major players in digital imaging and digital pathology systems have assembled in one place at one time, specifically to discuss the advances in this field. It is your perfect opportunity to gather all the information you need to develop your pathology group's strategy.

CAP News

TOP STORIES CAP Electronic Cancer Checklists Now Available in XML Format The College of American Pathologists electronic Cancer Checklists are now even easier to use! The checklists, which assist pathologists in reporting over 60 common and uncommon forms of cancer, are now available in eXtensible Markup Language (XML) format. The new format was chosen for its universal acceptance, its ease of use, and its ability to facilitate the sharing of structure data across different information systems, particularly via the Internet. The new XML format will replace the Microsoft Access database and should result in identical implementations, content-wise. Later in the year, these checklists will be enhanced further. New versions of over 70 checklists will be released, which will include revised and new content from the American Joint Committee on Cancer Staging Manual, 7th edition (currently, the checklists reference the 6th edition). CAP STS offers educational programs and consulting services to licensees for seamless implementation and customization of the checklists. Dennis D. Reinke, MD, FCAP, receives congratulations from Yvonne Hearn, MD, FCAP, and Robert L. Breckenridge, MD, MBA, FCAP. College Names First Recipient of CAP Pathologist Spotlight Service Award Dennis D. Reinke, MD, FCAP, was recognized as the first recipient of the College's Pathologist Spotlight Service Award at the Council on Membership and Professional Development luncheon in Austin, Texas, on January, 17, 2009. He was nominated by colleague Yvonne Hearn, MD, FCAP. When presented with the award, Dr. Reinke said, "I never imagined being recognized for the work I do everyday." Read about Dr. Reinke's recognition. Learn more about the CAP Pathologist Spotlight Service Award at cap.org or send your nominations to publicaffairs@cap.org. Second Laboratory in the United States Becomes Accredited to CAP 15189SM Program Avera McKennan Medical Laboratory of Sioux Falls, South Dakota, recently became the second laboratory in the United States to earn CAP 15189SM Accreditation. This accreditation is based on the ISO 15189:2007 Standard as published by the International Organization for Standardization (ISO) for laboratory technical competence and continual quality management, which focuses on improved patient safety and risk reduction and outlines standards for quality and competence particular to medical laboratories. For additional information on the CAP 15189SM Accreditation Program, e-mail CAP15189@cap.org. Learn more.

YOUR COLLEGE NEWS 2009 CAP Meritorious Service Awards Program—Call for Nominations Members are invited to nominate recipients for the following CAP Meritorious Awards: CAP Distinguished Patient Care Award CAP Distinguished Service Award CAP Lifetime Achievement Award CAP Outstanding Communicator Award CAP Public Service Award Award criteria as well as instructions and a nomination form are available on the CAP Web site in either Microsoft Word or PDF formats. Nominations are due on or before March 9, 2009. Recipients will be invited to accept their awards in person during CAP '09 – THE Pathologists' Meeting™, which will take place October 11-14 at the Gaylord National Resort in Washington, DC. Learn more. Download the February NewsPath® Podcast and Latest Article February NewsPath® podcast on "Diagnosing Genital Herpes Simplex Virus Infections," which is based on the NewsPath® article by Zsolt Jobbagy, MD, PhD, FCAP, and presented by CAP Spokesperson Noel A. Brownlee, MD, PhD, FCAP. Read the February article on the "Use of Quantitative PCR in the Monitoring of Patients with Chronic Myelogenous Leukemia," written by Jason D. Merker, MD, PhD. NEW Additions to the CAP Transformation Web Site Don't miss the latest pathologist story of Yvonne Hearn, MD, FCAP, whose recent vacation to the South Pacific gave a child a much—needed diagnosis. Now available—Mara Aspinal's CAP '08 presentation on Personalized Medicine. Also, read about the latest trend in on-line auctions for radiologist services. CAP Spokesperson Patricia A. Thomas, MD, FCAP, Featured on FOX for Black History Month in February Patricia A. Thomas, MD, FCAP, was featured on the award-winning show, Americans in Focus, which ran on the FOX Sports Network during Black History Month in February. Emphasizing the importance of overcoming obstacles and how her hard work helped her become a Harvard graduate and a pathologist, Dr. Thomas' message is a great example of transformative behavior, highlighting the success one can achieve by setting one's mind to the goal. Watch the 90-second segment, which appeared on the FOX Sports Network television programming throughout February as well as on the national FOX Sports Network Web site. Dr. Thomas is identified as a pathologist, and she is in great company! Attend Futurescape III June 12–14 in Rosemont, Illinois. Just Added—Pre-Conference Workshop Personalized medicine focuses on using new tools that will enable pathologists to generate new information for improved patient care. The advent of biomarkers, their correct interpretation, and the integration of data from disparate information systems are essential to getting the right treatment to the right patient at the right time. The CAP Foundation invites you to attend Futurescape III, Transforming Pathology: Information as a Disruptive Technology. For more information, please contact Arlene Strong at 800-323-4040 ext. 7324 or visit futurescape.cap.org. Learn more. Renew Your 2009 Membership Dues Renewing your 2009 CAP membership online is quick and easy. You can pay by credit card or check. Plus, you will receive a detailed receipt suitable for reimbursement or processing by your institution. Learn more. Sign Up for CAP '09 and Take Advantage of the Early Bird Savings Sign up now for CAP '09 – THE Pathologists' Meeting™, October 11–14, at the Gaylord National Resort in Washington, DC, and receive the best price guaranteed! Pay $899 and save 20% off the $1,125 global fee. No deposit required. Visit cap2009.org today and save.

EDUCATION OPPORTUNITIES CAP ’09 Abstracts Program Consider submitting an abstract or case study. The CAP '09 Abstracts Program is a competitive program that is designed to promote a broad range of research in pathology. The program provides a unique opportunity to enhance research skills and contribute to the literature and advancement of pathology. Everyone is encouraged to submit abstracts, and CAP Junior Members are eligible for cash awards for their presentations. Submissions to the Abstracts Program will be accepted Monday, February 2, through Friday, March 27, 2009. Visit cap2009.org for more information.

PRACTICE MANAGEMENT CMS Announces Internet-Based Medicare Enrollment Available in All States and in the District of Columbia The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow pathologist to initiate, change, view, and check the status of their Medicare enrollment via the Internet. This new system is designed to be faster, easier to use, and secure. Physicians need their National Provider Identification (NPI) National Plan and Provider Enumeration System (NPPES) User ID and password to use the PECOS system. More information is available on the CMS Web site. View the New and Updated Practice Management Resources The following is a list of new and updated practice management resources at cap.org/practicemanagement, and each resource is listed by practice management topic area. Coding and Reimbursement CMS NCDs - Laboratory National Coverage Determinations ICD9Data.com - A free Web site to lookup ICD-9-CM codes ICD-10 - World Health Organization's ICD-10 listing Compliance and Risk Management Compliance Issues for Pathologists – A November 2008 Practice Managers Forum audioconference. Finance/Governance/Business Operations Consolidation of Physician Practices – A paper covering issues to consider when consolidating practices.

RESIDENTS SECTION Attend Residents Forum Meeting in Boston on March 7 You can still register to attend the Residents Forum. It's easy to do by sending an e-mail to RF staff. Join your resident colleagues for the Welcome Reception on Friday evening and for the all-day Saturday session, which includes continental breakfast and lunch! For more information, visit CAP for Residents at www.cap.org. If you have any questions or comments, contact Jan Glas.

SPOKESPERSONS NETWORK IN THE MEDIA AND IN THE COMMUNITY Forensic Pathologist Stresses Importance of Recognizing Signs of Depression in Children Stephen J. Cina, MD, FCAP, spoke with reporter Bob Roberts of WBBM News Radio, a CBS news station in Chicago, Illinois, about what a forensic pathologist looks for to determine if a death is a suicide—this after a fifth grader was found dead in a Chicago-area school. Dr. Cina offered tips to help parents and teachers recognize signs of depression, even in grade school children, to prevent future tragedies. Listen to the interview on WBBM's Web site, which became available as a news story download on February 4, 2009. Learn more.

Pathology Atlas from Medting on Tissuepathology

On the right sidebar you will find a link for a Pathology Atlas which takes you to a seperate page within the blog to an atlas of pathology images hosted by Medting.  To date, I have uploaded over 6000 pathology images, gross and microscopic with a search function for all types of images.  My goal is to upload nearly 25,000 I have collected to date. 

Medting is a no cost service for doctors to share medical content (medical media and clinical cases) and has some special viewers that can be embedded in other web pages seperate from their own as shown on the Pathology Atlas page.

You can navigate into the images, review and perform searches.  You can also go to the source image stored at Medting and rate and comment on the images. Enjoy!

Many thanks to Medting for their support of the blog.  I encourage you to check out their application and offerings.

Comparison of virtual and glass microscopy in dermatopathology testing

I recently came across this abstract presented in October at the American Society of Dermatopathology meeting in San Francisco.  There was an accompanying news item on the story in a nursing news journal online of all places on the presentation and subsequent discussion as well.

Little is published on the use of virtual microscopy as an educational tool or as a testing tool, particularly among students or residents from a single institution, let alone several institutions. 

One item of interest in the accompanying news story is mention of 23% of residents between dermatology (who receive histopathology training in their course of their residency) and pathology having experience with virtual slides.  Certainly that number is at least 20% more than 5 years ago and will continue to increase with increased exposure with more medical school and resident program adoption.  Increased exposure online will increase this percentage and use as well.

Presumably these were dermatopathology cases and it is not clear what vendor(s) scanner or viewer(s) were used to share these cases.

The study provides one more objective and subjective piece about the use of whole slide images in education and for testing. 

If a manuscript is published about the study would be particularly interested in break down of number and opinions of dermatology residents compared with pathology residents.  The subjective complaints of the participants seem to be more related to PC and monitor issues rather than the tecnology itself.

_____________________________________________________________________________________

L. Koch1; J. Woosley2; J. Lampros1; L. Delong3; S. Chen3

1Eastern Virginia Medical School, Norfolk, VA, USA 2University of North Carolina, Chapel Hill, NC, USA 3Emory University, Atlanta, GA, USA

Virtual microscopy is currently being used in medical schools, in resident education, in-training examinations, and certification examinations. There are, however, no randomized studies comparing the diagnostic accuracy and acceptability of virtual microscopy to traditional glass microscopy among resident physicians. The current study compared diagnostic accuracy using virtual and glass slide microscopy at the resident level. Dermatology and pathology residents at 14 institutions were given a randomized combination of 10 virtual and 10 glass slides of dermatopathology disorders and were asked to correctly select the diagnosis from a list of foils. They were also asked to report their subjective experiences with virtual microscopy. 132 residents performed equivalently (p=0.90) in making diagnoses with virtual microscopy (5.49, SD 1.76) compared to traditional glass microscopy (5.46, SD 2.07). The order of administration of virtual versus glass slides did not affect performance.

While performance was equal, traditional glass slides were preferred by 119 of the respondents. The majority of residents endorsed the use of virtual microscopy as a learning tool while fewer favored its application as a testing tool (76% vs. 43%, respectively). While residents may currently prefer glass slides, this study supports the use of virtual microscopy in testing.

_____________________________________________________________________________________

Medical residents made similarly accurate diagnoses using virtual microscopy or traditional glass microscopy, but said they’d prefer glass slides when being tested, results of a randomized study of 132 residents found.

The dermatology and pathology residents at 14 institutions diagnosed neoplastic and inflammatory skin conditions after examining slides in virtual (computerized) and glass format. Each of 20 cases appeared in both virtual and glass slides, but the order in which the residents saw them varied among randomized subgroups of participants.

Residents correctly diagnosed a mean of 5.5 cases on glass slides and 5.6 cases on virtualslides, Dr. Laine H. Koch and associates reported at the annual meeting of the American Society of Dermatopathology.

The order in which slides were viewed did not change diagnostic accuracy between groups. The rate of correct diagnoses increased with each additional year of residency, but did not differ between same-level residents based on the use of virtual or glass microscopy, said Dr. Koch of Eastern Virginia Medical School, Norfolk.

When asked their opinions of the experience in an 11-item questionnaire, however, 79% of residents said they think virtual microscopy is useful for learning, but only 47% said it is useful for testing.

Approximately 40% complained of one or more problems during virtual microscopy. Complaints from 31% of residents pointed to fuzzy images on the computer screen, while 10% reported poor color on the screen, 9% said the image froze on the screen, and 8% complained of poor contrast. Four complaints each were reported by less than 5% of participants: difficulty starting the computer, inability to adjust the screen, computer failure, or power failure.

At one institution, all residents complained of problems with image clarity, while another institution produced no complaints about clarity, and responses varied from the other 12 institutions. It may be that fewer image problems occurred when all residents completed the exam in a computer lab, compared with using the technology on a computer of their own choice, Dr. Koch said.

Glass slides have been considered the highest standard for diagnosis and for medical education in histology and pathology. They are easy to prepare and are part of learning to use light microscopes, but can be expensive to purchase, maintain, store, and distribute for educational purposes. Virtual slides can be duplicated endlessly and inexpensively, stored and catalogued easily, and can be made available to many people in a variety of locations.

As a result, medical schools increasingly are incorporating virtual microscopy into curricula, and in some programs virtual microscopy has replaced traditional microscopy entirely, Dr. Koch said.

At the start of the study, 23% of residents reported some experience with virtual slides, usually from online or Internet sources. Diagnostic accuracy after examining virtual slides in the study did not differ significantly between residents who had or had not used virtual slides before.

Few studies have looked at the performance of students using virtual or glass microscopy. One study that randomized first-year medical students to teaching and testing using virtual or traditional microscopy found no significant differences in testscores (Clin. Anat. 2007;20:565-70).

Investigators in the current study prepared glass slides using standard hematoxylin and eosin staining techniques. Virtual slides were created using a slide-scanning machine and were distributed to the medical schools on compact discs. Dr. Koch and her associates have no association with the company that makes the scanning machine, but are considering negotiating an educational discount to obtain a one, she said.

One dermatology resident in the audience who participated in the study said the main problem with virtual microscopy was the slow speed of loading images. “Any time you moved around [in an image], it was like waiting for the dial-up connection to have your Internet,” she said. “It was really cumbersome. Once that’s straightened out, I think it will be super.”

CAP Earns Award

Most pathologists in the US are members of The College of American Pathologists (CAP), www.cap.org, a medical society serving more than 17,000 physician members and the laboratory community throughout the world.  It is the world’s largest association composed exclusively of pathologists and is widely considered the leader in laboratory quality assurance. The College is an advocate for high-quality and cost-effective medical care.

The CAP recently earned an education award - recent press release below

The Accreditation Council for Continuing Medical Education (ACCME) has awarded the Education Division of the College of American Pathologists (CAP) the status of Accreditation with Commendation as a provider of continuing medical education for physicians.

The Accreditation Council for Continuing Medical Education (ACCME) has awarded the Education Division of the College of American Pathologists (CAP) the status of Accreditation with Commendation as a provider of continuing medical education for physicians.

This Accreditation is a significant accomplishment as only about six percent of all providers seeking accreditation or re-accreditation are awarded this highest level of distinction.

“To ensure optimal results and patient safety,” said William F. Hickey, MD, FCAP, chair of the CAP Council on Education, “the CAP prides itself on providing pathologists with the highest caliber of timely, practical continuing medical education. Therefore, recognition of our efforts by an external accrediting body is most encouraging.”

The College was awarded a six year accreditation, a rating that indicates optimal compliance with the AACME standards. This rating demonstrates overall excellence in the delivery of continuing medical education program activities and recognizes the CAP’s performance as exemplary.

“We are very proud of having attained this level of recognition,” said Constance Filling, CAP vice president of education. “As our goal is to help our members excel in all areas of laboratory medicine and ensure the highest caliber of patient care, this award certainly attests to the effectiveness of our efforts.”

Education, offered in the areas of anatomic and clinical pathology, practice management, and laboratory procedures, focuses on practical education for both pathologists and laboratorians. CAP education is offered via a broad range of formats, including online training, audio conferences, podcasts and live events.

Virtual Microscopy at Indiana University

Microscopes at Indiana University have virtually gone digital. Thanks to Mark Braun and Anthony Mescher, professors at Indiana University's Bloomington campus, students in their respective classes can study and examine various slides of microscopic tissue samples on their laptops via a virtual microscope instead of looking at textbook examples.

"It's not just that a textbook example doesn't require any search and discovery," said Braun of the slide images. "No patient or disease knows to look exactly like the textbook example every time. This provides real-world learning."

The program, which Braun has used in his human pathology -- or "sick" condition -- class for second-year medical students, was introduced to Mescher's histology class -- which teaches the healthy or "normal" condition -- for first-year medical students last semester.

Both professors believe the virtual microscope program enhances the students' learning in several ways.

The high-tech program allows students to collaborate and view slides as a team, says Braun, a physician and a clinical professor of pathology in the medical science program at IU. Previously, team collabaoration could be a cumbersome and tedious task. Now, instead of having to show students one by one how to examine a slide, Braun can project his actions for the entire class to see at once.

It's a resource for which Mescher, a professor of anatomy and a senior fellow at the IU Institute for Molecular and Cellular Biology, shares Braun's enthusiasm.

"Scanning our slides into the digital microscope program is a technical breakthrough we're very excited about," said Mescher. "I didn't think it would work several years ago, but Mark was so successful with it in his classes that we decided to incorporate it into histology. It is a wonderful tool for the students to have."

The program, produced by Bacus Laboratories in Lombard, Ill., provides an exact replica of the physical slides which have been used in class for decades. The virtual slides can be examined and studied with the same magnifications and clarity available from a traditional microscope. (To see the program in action, visit Braun's website at http://medsci.indiana.edu/c602web/602/c602web/toc.htm.)

"I'm continually impressed with the clarity and resolution of the slides," said Mescher. "It's equivalent to working with lenses of the cleanest microscope."

Each slide owned by the department underwent a series of high resolution pictures -- 20,000 for each slide -- taken at the eight magnification levels available on traditional microscopes. The Bacus program organizes the pictures so that students can manipulate them exactly as if they were using a microscope. Each slide is about two gigabytes in size, and together all of the slides comprise an entire terabyte, or 1,000 gigabytes, of data.

Now, with the last batch of slides from Mescher's histology class recently completed, second-year students can review healthy samples from their first year and compare them side-by-side to the sick samples they are currently studying. Additionally, students can view slides from home rather than relying upon a lab microscope being available when they want to review for a test. Plus, they don't have to worry about microscope maintenance, dirty lenses or breaking expensive slides.

The virtual microscope program doesn't replace physical microscopes, however. Students still learn how to use them and are assessed on their abilities to do so, because once they graduate to hospitals and research labs, they will rely upon the tried and true instrument. The scanning process required to use virtual microscope program is simply too slow for a fast-paced diagnosis lab.

Although the software that streams the images is proprietary and does come with a yearly fee, the university saves money on microscope maintenance and new slides, which can easily be broken or scratched. Both Mescher and Braun think the program is well worth the money.

"The university was wonderful in supplying us with a $15,000 high-speed Internet II grant through the Abilene Project several years ago to cover the initial costs," said Braun. "We wouldn't be where we are today without that generosity."

The virtual microscope is just one tool in Braun's impressive Web site. Continually updated, it boasts annotated slides, virtual quizzes, audio lectures, practice exams and clinical cases.

The clinical cases provide real-world examples of how to diagnose a patient. Each case provides a set of facts, a movie interview with the "patient," and access to x-rays, virtual slides and other tests. The Web site allows students practice in diagnosing patients.

Although some of the Web site's content is password protected, much of it is available to anyone. Braun has received e-mails of thanks for his Web site from Poland, France and even a Pakistani student studying in China.

"Today's students come from a virtual world," said Braun. "It's time we face that fact and join it."

Baylor College of Medicine Using Virtual Slides for Teaching

Digital Diagnosis by Graciela Gutierrez

From Baylor College of Medicine Solutions Magazine Online

http://www.bcm.edu/solutions/v3i2/tissues.html

Clay Goodman, M.D., is excited about the benefits of an emerging technology that allows doctors to view tissue samples using computers instead of microscopes.

In pathology, computers are replacing microscopes, resulting in faster diagnoses for patients and improved education for students.

Television's gone digital, as has phone service. When was the last time you needed film for a camera? As digital technology invades daily living, it's no surprise that it is helping doctors and researchers improve patient care.

Baylor College of Medicine is one of the first medical schools to begin using digital slides in its pathology department.

"It's just like using a microscope," said Clay Goodman, M.D., Professor of Pathology at BCM. "Instead of one person putting his or her eye to the microscope, a number of different doctors can view the sample on a computer screen."

This allows patient's tissue samples to be viewed easily by a number of different doctors to help create more efficient consulta-tions and diagnosis. It also provides better training for future doctors.

The process starts with a traditional glass slide. Tissue samples from patients are routinely made into slides so specialists can help diagnose a disease or illness. A doctor sends the sample to a pathology lab, where technicians create the slide by preparing thin slices of the samples. Each sample can result in as many as 20 slides, and it's not unusual for a hospital to create 200,000 slides a year.

"Now we can take a glass slide and scan it, but it's more than just making a copy," said Francis Bui, Administrator of Computer Systems of Pathology at BCM. "Each scan is so detailed it takes about four hours to make sure the image is copied correctly under different magnifications."

The scans are made with a specially equipped microscope. They are then stored onto a secure internet server that doctors can view wherever they have Internet access. There are multiple layers of security where log-on information is needed so personal medical records are protected. Patient information is not transmitted in a way that can be linked to the image.

MICROSCOPES GATHER DUST
Doctors are using their microscopes less often these days thanks to leading-edge technology that creates amazing scans of patient tissue samples, which can be viewed on the computers of experts to speed the diagnosis process for patients.

"So if a patient in Houston needs a specialist who happens to be in New York or even Europe, all that specialist has to do is log on, and he or she has a detailed microscopic view of the sample," Bui said.
Many times, the pathologist at BCM will talk on the telephone to the consulting pathologist while both are viewing the digital image from their own computers.

"We can both manipulate the computer image just like a microscope during a consult," Goodman said. "We can change the magnification and also move the image as you would move a slide. It's really amazing."

Without this program, glass slides are shipped to the different doctors. There is always a chance the slide might break, be lost, or get damaged in some way. It's also time consuming if a doctor needs to view the slide again, or send it off to another expert. With a digital image, the original slide doesn't risk damage and doctors always have instant access to a high-quality image. With critical patients, every second counts.

The digital slides are also being used in the classroom. Histology students at BCM began using digital slides in 2006. Goodman said students usually share microscopes, but by viewing the image on a computer screen, students and professors can interact without having to take turns with a slide.

The digital slides can also be copied onto a DVD so students can view them on their home computers to help in their studies. There is no patient information attached to the slides students use, and privacy is always protected.

BCM pathology residents who did not have this technology while they were students are offered a weekly session so they can get experience with the program and digital slides.

"We are only going to keep moving forward with the use of technology in medicine," Goodman said. "We would be doing a disservice to our students and patients if we didn't expose our future doctors and researchers to this sort of technology."