University Medical Center Utrecht (UMCU) is the first hospital in the Netherlands—and one of the first hospitals in the world—that has completely switched to digital pathology. Not only do they have a scanner and a viewer, they have digitized their entire workflow. Based on their experiences, here is a list of the greatest benefits seen after digitization.
All tissue sections, stainings and reports are in one place. You can no longer accidentally exchange a slide or a report as the image is automatically linked to the correct report via a unique number. Even if multiple stainings are requested, they are automatically linked to the correct number. In addition, slides can no longer be lost and missing images can be marked so that incomplete numbers are no longer accidentally reported.
Digitizing the workflow makes the process more efficient and therefore faster. Collecting a request, a slide and a report takes a lot of time in the non-digital world. In a digital workflow, these components are automatically linked together, so that nothing is lost. Physical slides, on the other hand, often have to be searched for as they may lie on desks or somewhere in the department. In addition, the physical slides are stored in archives. As a result, it takes a lot of time to fetch and find slides when preparing for discussions or multi-discipline team meetings. Also, collecting these slides is not a very rewarding job.
Pathologists get a better overview of their work. In a digital worklist, they can see exactly which tissue section they need to review, which have been reviewed already and which to prioritize. It is also possible to see exactly how many tissue sections and stainings have been made per examination. Slides that need to be close at hand can be placed in a digital worklist, instead of being left on a desk.
The entire slide can be viewed at once on the monitor, and you can zoom in to view the different areas. With a microscope, it is impossible to see all the tissue at once, even at the lowest magnification. This can cause you to miss something. For example, if you look at a slide with six lymph nodes and examine them one by one, there is a risk that you may look at the same gland twice and thereby miss one. By doing this digitally, such mistakes are almost impossible to make. Furthermore, you can easily keep track of which images have been viewed and which areas have been viewed at which magnification, so that at the end of a case with multiple images you can see exactly whether an adequate review has been made.
By using a chat function, it is very easy to consult with colleagues. You no longer have to walk down the hallway to a colleague only to realize he or she is not there or is busy with something else. Instead, the colleague can look digitally when it suits him or her.
You can show up to four images side by side in the viewer. This makes it easier, for example, to compare multiple stainings with each other.
Measuring is much more accurate on digital images than on physical slides, and can also be annotated much more extensively and easily. As a result, the diagnostic process becomes more transparent and makes deviations more traceable.
Digital slides can be stored forever. With some other techniques, the staining is lost over time, making the slide useless to keep. You also need a special microscope to view certain stainings, which may not be present during discussions, making the report the only available resource. And even in revision, pathologists have to rely solely on a colleague’s report. With digital pathology the images are always available and can also be viewed on any computer with a viewer.
An advantage of building an archive by preserving digital slides for a long time is that you can gain deeper learning. By searching these large databases for patterns using machine learning applications, new insights can be obtained and this can help the pathologist to make a faster and better diagnosis.
If several labs work digitally, exchanging slides between the labs, for example, for second opinion or consultation, is much easier. Panel discussions for difficult cases can also be more efficient.
Digital pathology images can easily be viewed together with the radiology images, which improves the diagnostics for both departments. The digital images can become part of the electronic patient record, so that all specialists—and even the patients—can view and share the images.
Digital pathology enables pathologists to work from anywhere at any time. It is easy, for example, to work from home. Also, if you need to take over work from a colleague, for example, in case of illness, you can stay at your own workplace instead of walking to his or her desk to find the correct slide.
Digitization offers great opportunities for education and supervision. Residents have three choices for each report they make: authorization, control and supervision. If they are sure of their assessment, they opt for authorization; if they have a slight doubt, they opt for control; and if they want to discuss a slide, they click on supervision. This way they can gradually work more independently. For the accompanying pathologist, it is nice that the slide and report are immediately next to each other on one screen. Furthermore, training of medical students and biomedical sciences can be done digitally, with locked annotations on uniform images and interactive elements with questions and feedback. This is not only more effective, but also more valued by students than traditional microscopy practicals with glass sections.
Working digitally causes fewer neck and back problems, as it allows for better ergonomics. That way you can work longer and stay more focused.
Working digitally saves a lot of paper.
For the sake of patient safety, digital pathology has to be considered
Prof. Paul van Diest, head of the department of pathology at UMC Utrecht, concludes:
“The benefits of digital pathology for patient safety are so great that you have to seriously question whether you can deny your patients these new possibilities. You should at least investigate digital pathology and make your own action plan. It is not something you can ignore in the years to come.”