Michael Dictor, MD, PhD Pathologist
Monica Haglund Business Strategist Department of Pathology, Lund, Sweden
University and Regional Laboratories
Digital pathology: the Swedish project
Venice 2012
Digi$zing'pathology'in'southern'Sweden'
'''Mission&impossible? X
Kris%anstad*
Lund*Malmö*
Helsingborg*
Department of Pathology University and Regional Laboratories Region Skåne
Our combined 4 labs in the Southern Healthcare Region offer:
• Full service pathology for 1.2 million people in the primary healthcare area + 400 000 people in the secondary referral area.
• Extensive clinicopathological conferences usually with visual presentations, representing all medical & surgical specialties.
• Research facilities.
2009: One organization 4 pathology labs
~ 220 employees
Pathologists ~ 40 Resident physician ~ 20 Biomedical scientists ~ 90 Lab technicians ~ 4 Autopsy technicians ~ 12 Medical Secretaries ~ 35 Others ~10
IHC in the same period increased by ~50%, PCR analyses by ~140% and therapy-directed analyses for colon and lung cancer increased from year 2009 to 2010 by 160%.
0
50.000
100.000
150.000
200.000
250.000
300.000
350.000
400.000
450.000
05 06 07 08 09 10 11
No.
of s
lides
Production in histopathology
No.
Total slides
Case consults
Year Year
1450
1500
1550
1600
1650
1700
1750
1800
1850
1900
1950
05 06 07 08 09 10 11
Slides/workday
Why digitize pathology? • Lack of qualified pathologists, ineffective
backup coverage • Increasing work loads with more and
complex analyses per specimen • Quality Assurance demands • Suboptimal work flow despite extensive
computerization • Now is the time to modernize anatomical
pathology!
The solution?
• Equipment upgrades
• Faster workflow
• Redistribution of tasks among work groups
and now • Digital imaging
We have focused on….
Can scans replace microscopes for diagnostic work?
Mantle cell lymphoma scanned with 20x objective
Do scans show enough detail for close diagnostic work?
H&E Anti-HP
Helicobacter gastritis scanned at 20x
LIMS process control work%list%for%the%pathologist%
Specimen Status No. slides
No. scanned
Pathologist Surname First name Patient ID Group Accession date
PL233-12 stained 7 4 MD/TC Björk Hans 420517-3513 thorax 03-15-12
PL267-12 embedded 0 0 Nilsson Gunilla 720809-5624 gyn 03-16-12
When is a case ready?
How to distribute cases?
Dynamically updated, including supplementary stains
Future digital pathologist working at home?
Image labels are derived from LIMS block labels + stains
LIMS Specimen Status No.
slides No. scanned
Pathologist Surname First name Patient ID Origin Accession date
PL233-12 stained 7 4 MD/TC Björk Hans 420517-3513 thorax 03-15-12
PL267-12 embedded 0 0 RH/IS Nilsson Gunilla 720809-5624 gyn 03-16-12
Terabyte server
Scanning Image acquisition database
20x or 40x
Dictation using voice recognition software
1A: Lat. margin 2A: Tumor CD31
3A: Sup. margin 4A: mediastinal tumor
Labeled thumbnails
PL233-12 4A: Mediastinal tumor
Goals Process-oriented LIMS
Technical support for the specimen flow and imaging (including traceability of slides/blocks)
All histopathological slides (cytology to be determined) will be scanned, just over 90,000 cases/year (>420,000 slides/year).
Images will be archived in perpetuum, long-term strategy to be determined.
Main advantages Distribution of diagnostic work based on capacity and expertise Work conference processing, remote consulting/conferencing
Upgraded skills through greater collegial interaction
Equipment 10 scanners, each 400 slide capacity + 4 scanners, 5 slide capacity (incl. Supermega)
50 diagnostic image monitors, 30’’ 4-6 Mpix + 50 text monitors for LIMS Imaging database
Quantitative image analysis algorithms VoIP with presence indicator
2 server installations, fully duplicative Initial 110 TB + increase by 110 TB every 8 months
A work in progress
Digital image analyses
apps for HER2, ER, PR etc
Digital slide conferencing Create live conferences connected to LIMS
Connection to modern LIMS Automatic patient-secure connection to LIMS with
block/slide tracking
Education, training, quick reference
Remote diagnostics Total access to medical data as well as digital
slides, private alternatives, work at home
Acute remote diagnostics Connect surgery and pathology from different
hospitals (SN)
Research
Features and advantages
Routine diagnostic work Sufficient quality
Second opinion Domestic & foreign
Top Related