Multidisciplinary team (MDT) meetings, or tumor boards, are a cornerstone of cancer care, and the practice of holding such meetings is increasing greatly. Several studies  clearly demonstrate that MDT meetings provide significant value to patient diagnosis and treatment in terms of reduced error rates and selection of the right treatments .
However, these meetings are expensive and there are considerable challenges in keeping both the preparations and the actual meetings efficient. A common enterprise imaging platform for radiology and pathology diagnosis enhances efficiency by allowing specialists to easily communicate before the meeting—both directly, but also by accessing each other’s images and reports. Access to all relevant clinical information enables a team approach to the care process and reduces the risk of errors. It ultimately results in a lower cost for the care provider and better decision-making regarding patient diagnosis and treatment.
Enhance the MDT experience with modern technology
Pathology and radiology are key disciplines in cancer diagnosis and their collective findings serve as the basis for patient treatment and its outcome. Both specialists are highly dependent on adequate clinical information in order to provide accurate and useful reports for the clinician, surgeon, oncologist or patient. However, the exchange of information between the two groups is today often limited by the lack of joint workflows and IT infrastructure. Their IT systems are usually completely separate. For example, it is often the case that no IT support exists to facilitate communication between the radiologist and pathologist before a meeting, to correlate and discuss findings or identify discrepancies.
Several modern applications are often available when a care team, comprising surgeons, pathologists, radiologists, oncologists, etc., meets that can be used to increase the flexibility and effectiveness of the discussions. For example, we have seen wide adoption of video conferencing systems, which creates opportunities for virtual meetings. More IT systems in healthcare also support universal viewers allowing physicians to use any device connected to the network to show images and patient information or to participate in meetings. Also, radiology has since its digitization been able to access its PACS from the meeting room to facilitate presentations.
However, when a large portion of the relevant images in cancer care, namely the pathology slides, are not digital, it may not be convenient, or even practical to display them at a meeting. Some argue that there is no value in showing pathology images to the team since they do not make any sense to anyone but the pathologist. But, it is my firm belief that showing other specialists the pathology images would increase the understanding of the patient case and improve the learning of diseases. It would also be beneficial to pathologists since they could look up any slides during the meeting itself to confirm or reject specific questions from the team.
Digitizing pathology would enable pathologists to display images and share reports at the meeting in a same way as radiologists do today. This is important for clinical engagement, it facilitates collaboration and makes the meeting itself more efficient.
Preparation: the main benefit of a shared solution
From my experience, the greatest benefit of using a joint platform for radiology and pathology is not in the meeting itself, but in the preparation. For the pathologist, traditional preparation can be very time-consuming, involving for example a manual selection of appropriate glass and the need to ship or carry the glass to the meeting. The preparations often involve both the pathologist and a secretary, and a lot of manual steps with risk for errors. The need to ship glass always brings a risk of the glass being lost, broken or mixed up, all of which are minimal if digital images are used.
Using a digital pathology solution part of a joint rad-path platform allows images to be added to the list of a scheduled meeting in conjunction with the review instead of afterwards, saving a great deal of time. The digital preparation workflow also means that a case can be sent to a colleague via a link to ask for an opinion or communicate with the radiologist to order an extra biopsy before the actual tumor board. Furthermore, images can be prepared to be presented in a certain way for the specific meeting, for example, displaying results from grading, zoom in to a specific area in advance or showing a display window with multiple stains.
A joint platform can enhance these workflows even further since images from pathology, radiology, nuclear medicine, etc. can be put together in the same window to create a full diagnostic overview. Tools for tumor tracking over time to follow up treatment response can be used and progress visualized. This type of integrated diagnostic workflow is enabled by allowing pathologists and radiologists to add images to the same MDT worklist during the actual review. The annotations, measurements and image settings performed during the review would then be applied automatically, streamlining the preparation workflow. When appropriate, colleagues can also access the complete presentation materials to ensure that the proper information is available at the meeting and compare reports prior to the meeting to detect incongruities.
At the meeting
At the meeting, digital pathology allows the team to view images and reports. Images can be called up without having to physically move slides or manually navigate a slide under the microscope; it can take a lot of time to find particular features on glass slides.
In some cases where digital pathology is being used in meetings today, poor standalone viewers are used rather than a vendor-neutral enterprise imaging system. In such settings, the performance of on-the-fly retrieving of case information and images is often slow, making the image lag and pixelate. In addition, standalone viewers are often unable to show images from different scanner vendors.
With a common enterprise imaging platform for pathology and radiology diagnosis, all prepared images and documents can be accessed and viewed by logging into either the radiology PACS or the digital pathology solution, thereby avoiding potential problems with connecting different systems and the change between presenting monitors. A particular advantage is minimizing the risk of irritation among participants and reducing patient waiting time.
Increased adoption of digital pathology is enabling fully digital MDT meetings that can enhance efficiency and allow more patients to benefit from being investigated at these meetings. By using a joint enterprise platform for both radiology and pathology diagnosis, hospitals can reduce the time needed for preparation and presentation—and, at the same time, provide better treatments and reduce medical errors.
 Review of ‘The Dream MDT’: Measuring and improving high quality lung cancer outcomes. UKLCC, December 2014
 Benefits of multidisciplinary teamwork in the management of breast cancer, Cath Taylor at all, August 2013
 Experiences of Establishing and Managing a Clinical Multidisciplinary Team Meeting, Deb Rawlings, April 2007
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