digital pathology

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OsteoGASDOC

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how long do you guys think it'll take to make pathology digital like radiology and cardiology?
 
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OsteoGASDOC said:
Hey guys,

I'm a MS-1 currently exploring different fields of medicine that i might be interested in. Can you guys answer a few burning questions I have?

1. How long do you guys think it'll take to make pathology digital like rads and cardiology?

2. How much time do you guys spend in lab behind a microscope?

3. Do pathologist usually prep the slides or do histotechs and path assistants?

Thanks!!
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We will never be signing out cases on the beach or in our pajamas like the telepathology sales reps promise. Pathologists are too important to be away from the medical center like that. It is for this reason that pathology can't be outsourced to India or some place like that in any significant sense. It is too managerial to ever be sent off like that.

Looking down the scope is about half the job.

Pathologists prepare some slides by making touch preps and smears
 
This is a good question. Radiology more easily lends itself to digital transmission because the images are simpler and--let's face it--the diagnoses tend to be either obvious or CYA vague/hedgy. You can't get away with radiologic diagnoses in pathology. Pathology has its share of quick and easy cases that could lend themselves to telepathology, but there's never a guarentee the next slide won't require a protracted workup on the block of tissue to render an adequate daignosis.

You'd have to limit yourself to simple specimens that seldom require special stains or top-quality resolution, and enough of those to justify the cost. I think there's going to be a place for telepathology, but not the wholesale adoption you see in radiology.
 
I think the biggest reason why path won't rely on digitization as mush as rads is simply because radiological images are constructed digitally to begin with. in path, the glass slide will never go away, so that will always be a limiting factor in terms of time and energy spent processing and mounting etc.

that being said, digitizing slides can/will save tremendous $$ in terms of storage costs in the future; and, yes, it will enable easier consults once everyone gets wired up. but it will never be as efficient as rads (see earlier point).

but it is certainly something to remain optimistic about and ambitious toward
 
use your searchfu please...we go over this topic usually 2-3 times a year and we have a tons of threads devoted to this (assuming Yaah allows thread necromancy still)

short answer: likely never aside from specialized niche areas. Odds of pathology being outsourced like rads: never. lots of anecdotal evidence also is showing that the Nighthawk type services are in decline and will continue to decline as medical staffs demand on site rad experts more and more.

CRNAs are also in heavy decline.

so many of these so called doomsday trends have imploded recently.
 
Have posted about this before, but the key thing about digital slides now is that they are made from glass slides. Thus, you can't bypass any step of normal pathology diagnosis now by going to digital images. It is far quicker to just look at the slide under glass and then make a diagnosis then take said slide, scan it in, and then fumble with the massive image in an interface. The only ways, at least for now, that it shows promise are with consults (scan in your slides and send them electronically to an expert - saves transport time and $$$), frozen sections at remote sites, and possibly for slide archiving.

Pathology slide images are orders of magnitude more complicated and large than digital radiology images. One slide is many GB.
 
i for one am very excited about digital pathology

[youtube]http://www.youtube.com/watch?v=eEVjNl3xFPs[/youtube]

[youtube]http://www.youtube.com/watch?v=3n_fj9ot9-M[/youtube]


[YOUTUBE]http://www.youtube.com/watch?v=6M8Ecp3S_Bk[/YOUTUBE]
 
OsteoGASDOC said:
how long do you guys think it'll take to make pathology digital like radiology and cardiology?
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This is the correct question to ask, how long until pathology is more digital, rather than will pathology become digital. This is similar to living in New England or Michigan and asking when will it snow, rather than Will it snow this winter?

However, the issue of digital pathology is complicated. Parts of anatomic pathology will become digital, but as others have pointed out it is unlikely that all glass slides will automatically be converted to digital images. This would place an extra step in the diagnostic process and there would need to be clear "value added" to always including the extra step. If the $14.00 glass slide of the biopsy provides the correct diagnosis, there needs to be a compelling reason for any exta work.

There was an interesting NY Times article on a completely different subject, the use of chain markers to determine first downs. http://www.nytimes.com/2009/01/01/sports/football/01chains.html?_r=1&scp=1&sq=football chains&st=cse

The conclusion was that the old technology would be for some time, because it works.

Digital pathology has been discussed ever since I began my training back in 1982. It has arrived in limited form, it will expand, and it represents an advance for the field. Pathologists should keep abreast of the technology.

Dan Remick
Chair of Pathology, Boston University School of Medicine and Boston Medical Center
 
So has anyones program been talking about actually switching over into the Omnyx system when it comes out??
 
I'm trying to revive this thread about digital pathology work flow. please do not get this confused with telepath outsourcing.

from this recent dark daily article it looks like a lot of momentum is building for the rapid adoption of digital path. I think this looks cool and would be much more useful than counting positive nuclei myself. The article mentions that academic instituions are adopting this first. Since I will be applying to residency programs this coming cycle, I am curious to know if anyones program is adopting this kind of technology?
 
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Never bet against technology...that being said the capitalist in me still can't see a compelling $$ reason to dramatically change the current practice model. Whatever digital changes that do occur in the future will be slow enough for us to adapt as they'll likely start in hot spots and spread from there....
 
HESC said:
I'm trying to revive this thread about digital pathology work flow. please do not get this confused with telepath outsourcing. The article mentions that academic instituions are adopting this first. Since I will be applying to residency programs this coming cycle, I am curious to know if anyones program is adopting this kind of technology?
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Check out MGH
http://www2.massgeneral.org/pathology/informatics.htm

We have an informatics fellowship, and Imaging Lab with whole slide scanners. It's definitely a field which is growing exponentially, and there are tons of opportunities for projects/research/practice implementation/telepathology as a resident and as a fellow. We had a couple of posters at USCAP about it (including one about 3D microscopic anatomy using whole slide imaging). Plus, our chair is invested in this as well. A great conference to think about it attending is APIII (AP Triple I).

http://apiii.upmc.edu/

Our informatics fellow is AWESOME (props to him! 🙂) and has set up an informatics gateway
http://path.mgh.harvard.edu/
and Case of the Month (in conjunction with others in the department)
http://case.path.mgh.harvard.edu/
 
What level of computer proficiency is necessary in a pathology informatics fellowship?
 
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