miscroscope view through LCD monitor

[usr]

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hello

I suppose about 90% of the work of a pathologist is to look tissues in the microscope, which for me, is very tiring

I wonder if watching the picture in a monitor is accurate and convenient enough, so that he would never or hardly look in the microscope and just work on his pc monitor

I know already some orthopedic surgeons use LCD monitors to view X-rays, but I don't know if this is as accurate as looking at them with their eyes

I would like to know the present and future of tissue observation, so if you know from your lab experience or if you know any paper about this subject please feel free to post it

thanks

 

[HRantz]

Has most of your experience been on the other side of the microscope (looking while someone else drives?). Because I find that to be more tiring than looking at slides on my own.

I think 90% is much too high, but you do use a scope a lot.

Digitizing slides is happening, but it's probably never going to fully replace the traditional microscope.

 

[Matte Kudesai]

Digitizing slides is happening, but it's probably never going to fully replace the traditional microscope.

I hope you are right but never say never.....

Lots of pressure from certain sectors to optimize this technology for signing out.

People thought that about conventional photography vs. digital photography. Now 8 to 10 pixel cameras are about 200 bucks.

Think about about where networking, encryptions, band width capability were a mere three years ago.

How about the price of memory. The jump from giga to tera was pretty fast don't you think?

 

[yaah]

We have had a couple of experiments with digital slides in my program. The med student labs that we help out in are digitized. A couple of slide conferences have also been conducted with digitized slides (for the purposes of previewing, followed by multihead scope review for the actual conference). Personally, I am having a hard time getting used to them. The slides are pretty and work excellent for taking pictures from them. But despite the speed and ease of use it is still cumbersome. It works well for small images but if it is a large section or a slide of multiple levels or tissue sections, it takes much longer than looking under the scope. No doubt things will improve, but as of now I felt like I missed a lot by using the virtual slide.

 

[Matte Kudesai]

We have had a couple of experiments with digital slides in my program. The med student labs that we help out in are digitized. A couple of slide conferences have also been conducted with digitized slides (for the purposes of previewing, followed by multihead scope review for the actual conference). Personally, I am having a hard time getting used to them. The slides are pretty and work excellent for taking pictures from them. But despite the speed and ease of use it is still cumbersome. It works well for small images but if it is a large section or a slide of multiple levels or tissue sections, it takes much longer than looking under the scope. No doubt things will improve, but as of now I felt like I missed a lot by using the virtual slide.

Scanned slides are definitely way too irritating to use for signing out. The technology has improved and substantially better than even three years ago in terms of general speed and quality. Compression algorithms are improving and there will be an interface in the future that will better approximate the microscope. The 3D focus defocus thing will take time because it will require multi plane scanning hence more memory.

 

[Path or bust]

I wonder if watching the picture in a monitor is accurate and convenient enough, so that he would never or hardly look in the microscope and just work on his pc monitor

Some versions are starting to come out. You do get accustomed to the microscope with time. I found it very irritating at first...it becomes second nature very quickly.

http://www.kvision.nl/digitalcamera/HC-300Z_camera_system_PC.jpg

 

[cytoborg]

I think a lot of people find the microscope tiring at first. I got headaches and my eyes got tired in the first couple of weeks of my first surgpath elective as a student. However I did get used to it. If you are unable to get used to it after a month or so rotation then maybe you would find yourself struggling with it in residency as well.

I will still occasionally get tired eyes but usually only after a marathon 6+ hour signout.

I agree that technology is advancing fast, so who knows. Right now, even a nice monitor can't replace a slide.

 

[Matte Kudesai]

I think a lot of people find the microscope tiring at first. I got headaches and my eyes got tired in the first couple of weeks of my first surgpath elective as a student. However I did get used to it. If you are unable to get used to it after a month or so rotation then maybe you would find yourself struggling with it in residency as well.

I will still occasionally get tired eyes but usually only after a marathon 6+ hour signout.

I agree that technology is advancing fast, so who knows. Right now, even a nice monitor can't replace a slide.

Tired eyes can be reduced during a marathon sign out by using filters, dimmer lighting, and scheduled breaks.


I do not recommend incense or scented candles though....😀

 

[malchik]

Please take my advice:
open up the tired eyes.

 

[Matte Kudesai]

Please take my advice:
open up the tired eyes.

Who are you and what have you done with Spock's brain?

 

[malchik]

I'm Neil Young.

 

[djmd]

I have seen (ok I HAVE) a DP20 which does a 1600x1200 image live (15+fps) to any digital source. It is almost as good as the occulars.. Almost.

But it still isn't as good as the occulars... and your field of view is more limited.

And that is (as far as I know one of the best systems for live images).


If looking at the scope is tiring your eyes, check to make sure you are focused properly. Adjust those occulars....

 

[Matte Kudesai]

I have seen (ok I HAVE) a DP20 which does a 1600x1200 image live (15+fps) to any digital source. It is almost as good as the occulars.. Almost.

But it still isn't as good as the occulars... and your field of view is more limited.

And that is (as far as I know one of the best systems for live images).


If looking at the scope is tiring your eyes, check to make sure you are focused properly. Adjust those occulars....

That will likely be the main limitation of these systems (field of view).
Who knows what breakthrough will solve this...
Some kind of special goggles that recapitulates what you would see through a scope?

That might look goofy though. Maybe they can make them really stylish glasses.

 

[djmd]

That will likely be the main limitation of these systems (field of view).
Who knows what breakthrough will solve this...
Some kind of special goggles that recapitulates what you would see through a scope?

That might look goofy though. Maybe they can make them really stylish glasses.

Well the limitation is the camera's field of view. So it would have to be optics on the microscope/camera to solve the problem...


But if you want to wear some goofy goggles.. I won't stop you.

 

[Matte Kudesai]

Well the limitation is the camera's field of view. So it would have to be optics on the microscope/camera to solve the problem...


But if you want to wear some goofy goggles.. I won't stop you.

I will only wear them if I can have a goatee and hold a mug of beer.😀

I thought you were talking about scanned digital slides like the ones in the virtual slide box... http://www.uscap.org/

 

[Adrian Cocot]

The big drawback to digital imaging isn't the technology, but the fact that not a single intuitive user interface has been designed yet. If you were comfortable with a system, you could be OK signing things out with a camera that delivers good 800 x 600 resolution. Hell, I've seen a Logitech Quickcam jerryrigged to a microscope ocular that gave a fair quality image.

as for special goggles: http://cgi.ebay.com/CTA-PORTABLE-EY...goryZ3281QQtcZphotoQQcmdZViewItem?refid=store

I think I saw a pair of those in a Skymall magazine a while back.

 

[Matte Kudesai]

The big drawback to digital imaging isn't the technology, but the fact that not a single intuitive user interface has been designed yet. If you were comfortable with a system, you could be OK signing things out with a camera that delivers good 800 x 600 resolution. Hell, I've seen a Logitech Quickcam jerryrigged to a microscope ocular that gave a fair quality image.

as for special goggles: http://cgi.ebay.com/CTA-PORTABLE-EY...goryZ3281QQtcZphotoQQcmdZViewItem?refid=store

I think I saw a pair of those in a Skymall magazine a while back.

It seems the interface is a problem for most. To make signing out feasible the technology should at least approximate the speed and ease a slide can be slapped onto a stage and rastered (for lack of a better word).

I have used those goggles. They gave me a headache. I was watching a movie though.

 

[djmd]

The big drawback to digital imaging isn't the technology, but the fact that not a single intuitive user interface has been designed yet. If you were comfortable with a system, you could be OK signing things out with a camera that delivers good 800 x 600 resolution. Hell, I've seen a Logitech Quickcam jerryrigged to a microscope ocular that gave a fair quality image.

What exactly would you feel comfortable signing out at that resolution?
Tubular adenomas, hyperplastic polyps, fibrocystic disease?

Sure easy diagnoses would be conceivable, but then how long does it take to sign those out on a glass slide..

 

[Adrian Cocot]

What exactly would you feel comfortable signing out at that resolution?
Tubular adenomas, hyperplastic polyps, fibrocystic disease?

Actually if you are familiar with the drawbacks of a telepath system, you could sign out 90+% of your routine cases -- the military did on a Trestle that runs a 640x480 live image, which is Webcam-quality these days. Even the DP20 like you have only allows remote viewers an 800x600 resolution, and all the staff I've tested it with (viewing intradepartmental consult type cases) have no problems with the image whatsoever.

It seems the interface is a problem for most. To make signing out feasible the technology should at least approximate the speed and ease a slide can be slapped onto a stage and rastered (for lack of a better word).

I don't think creating the initial virtual "overview" image is the problem, as that process can be automated before the pathologist ever gets involved. Navigating the image seems to be the biggest pain, and I haven't seen any of the major players come up with a decent way of doing it so far.

 

[djmd]

Actually if you are familiar with the drawbacks of a telepath system, you could sign out 90+% of your routine cases -- the military did on a Trestle that runs a 640x480 live image, which is Webcam-quality these days. Even the DP20 like you have only allows remote viewers an 800x600 resolution, and all the staff I've tested it with (viewing intradepartmental consult type cases) have no problems with the image whatsoever.

I guess in my mind the concept of the consult with 800x600 (or 640X480), and S/O are two different things.

And I will concede that ones comfort level could dramatically increase the cases you would be willing to S/O.

The DP20 does only do 800*600 remotely, but we use it for local display, for radiologist and clinicians.. Of course they don't need 1600*1200. It is also not bad for consulting between multiple pathologists, but the scope is still better image..

 

[Adrian Cocot]

I guess in my mind the concept of the consult with 800x600 (or 640X480), and S/O are two different things.

I can't blame you for doubting an anonymous internet forum post, but a pubmed search on the experience of the US Army, UPMC or the University of Arizona ought to change your mind. Adequacy of current telepath systems for frozen section, general and subspecialty signout has already been documented.

The DP20 does only do 800*600 remotely, but we use it for local display, for radiologist and clinicians.. Of course they don't need 1600*1200. It is also not bad for consulting between multiple pathologists, but the scope is still better image..

Of course the scope is better, faster, and easier to control. But the point being that the difference in image quality between glass oculars vs. digital image nowadays is negligible in the context of signing cases out, regardless of difficulty level.

 

[djmd]

I can't blame you for doubting an anonymous internet forum post, but a pubmed search on the experience of the US Army, UPMC or the University of Arizona ought to change your mind. Adequacy of current telepath systems for frozen section, general and subspecialty signout has already been documented.



Of course the scope is better, faster, and easier to control. But the point being that the difference in image quality between glass oculars vs. digital image nowadays is negligible in the context of signing cases out, regardless of difficulty level.

I didn't doubt the authenticity of your statement regarding anyone signing out cases that way (which is why I said " And I will concede that ones comfort level could dramatically increase the cases you would be willing to S/O.")

To me it seems like the resolution isn't there than baring unusual circumstances S/O via screen would be reasonable alternative to using the scope... but that is my personal impression.

 

[Matte Kudesai]

I don't think creating the initial virtual "overview" image is the problem, as that process can be automated before the pathologist ever gets involved. Navigating the image seems to be the biggest pain, and I haven't seen any of the major players come up with a decent way of doing it so far.

This is precisely what I mean. The interface is not intuitive and often irritating at best.

How about designing a pseudoscope... a scope that looks real but with a digital interface and touch responding stage????🙄

 

[djmd]

This is precisely what I mean. The interface is not intuitive and often irritating at best.

How about designing a pseudoscope... a scope that looks real but with a digital interface and touch responding stage????🙄

Uhh What with like oculars you look through? That would sort of defeat the purpose of using an LCD screen.

Now you could argue for a specialized input device that was something like a microscope base... (and could work, if you used the dials (for moving a slide with the stage clips)

But many pathologists don't use the stage slide clips and drive the slide by hand...

Really if you were building a specialized input device a trackball based system with button to change objectives would most likely make the most sense...

 

[Adrian Cocot]

This is precisely what I mean. The interface is not intuitive and often irritating at best.

How about designing a pseudoscope... a scope that looks real but with a digital interface and touch responding stage????🙄

Nikon has something like that for the CoolScope (http://www.coolscope.com/coolscope/eng/index_e.htm). It mimics the microscope base using dials for X and Y navigation and buttons for coarse/fine focus and changing objectives. I played with it a while back when someone from Nikon demoed it at our institution and found it to be big, clunky, and ridiculously expensive. 👎

To me it seems like the resolution isn't there than baring unusual circumstances S/O via screen would be reasonable alternative to using the scope... but that is my personal impression.

Not sure how exactly that is supposed to read. Originally, you expressed doubt about signing cases out at lower resolutions. Your personal opinion aside, that's already been shown not to be a hindrance, although I'm not sure what you mean by "unusual circumstances."

 

[levels x3]

I get how digital microscopy, slide scanning, etc., can have some real world uses for things like teaching, archiving, and perhaps consultation. I have yet to be convinced that it's a viable alternative to simple light microscopy for everyday use, however. We've had a number of different vendors give quasi educational conferences in our department about these technologies and I'm just not seeing the point yet. We aren't talking about spectral imaging here, which truly may change the world of pathology someday...someday.

Every fifth post here in this forum ends up focusing on some aspect of how our healthcare system has run out of money, reimbursements are dropping, and pathologists are working at Wendy's. Yet nobody talks about the cost increases caused by going digital. Perhaps I'm being too cynical, but these vendors are out there to make money, and I bet they're counting on long-term maintenance to do it. They'll sell you their $250,000 whiz-bang slide scanner (or $30,000 desktop imaging system) and tell you how much it will improve efficiency. But wait, we forgot to tell you that you need a $5000/year license for each PC it's connected to and you'll need to do a software update every year or so for $10,000 and since everything inside the black box is proprietary, you'll have to contract with us for service as well.

Maybe I'm not thinking long-term enough, but a lot of this smells of marketing, pure and simple.

 

[yaah]

It's totally marketing. Seems like half of the booths at USCAP involved digital slide viewing of some sort. Digital slides also take up an extraordinary amount of memory as it stands now, particularly if they have to be at diagnostic-level quality. Several GB. Memory is not cheap either. The sheer logistics involved in scanning every slide in for diagnostic purposes is rather overwhelming at this point - and it involves far more than an effective slide scanner and user interface.

Digital microscopy is obviously going to be important in the future, it just remains to be seen at what level. For archival purposes? For diagnostic purposes? Teaching only? In order for it to become widespread in use, it has to become not only more efficient and useful but more cost effective than making a slide on glass and putting in under a scope. It is going to need a lot of work to get there. In a sense, it is up to the vendors to try to improve on this. For all the bells and whistles and potential benefits that slide scanning involves, ultimately it will come down to cost benefit analysis. If slide scanning requires expensive software and frequent updates and repairs, it isn't going to last.

 

[Matte Kudesai]

It's totally marketing.

Not sure what this means. Not too long ago everything was accessioned on hand written triplicate carbon copy paper. Blocks were labeled by hand.

There was no such thing as an auto stainer. No automated immunostainers.

No flow cytometry. No PCR's. No FISH, no CISH, etc.
These were not developed just because of the inventors benevolence and altruism.

 

[Matte Kudesai]

Really if you were building a specialized input device a trackball based system with button to change objectives would most likely make the most sense...

I've used a trackball interface on a Zeiss EM 910 electron microscope. It worked quite well.

 

[yaah]

Not sure what this means. Not too long ago everything was accessioned on hand written triplicate carbon copy paper. Blocks were labeled by hand.

There was no such thing as an auto stainer. No automated immunostainers.

No flow cytometry. No PCR's. No FISH, no CISH, etc.
These were not developed just because of the inventors benevolence and altruism.

Well, those things also developed because they served a need or improved procedures - Flow helped characterize disease better than traditional methods, so did the other methods. What I was saying is that currently digital microscopy doesn't really add much value to clinical practice. One of the things that we are taught is that clients (i.e. the patient or the physician ordering the test) will pay for something if it adds value - FISH clearly adds value. Digital microscopy does not add value. It doesn't help you make the diagnosis any better. Potentially it could help you diagnose certain things faster (like frozens) or allow you to share them faster with experts. Thus, digital microscopy could potentially add value to a consultation practice - but the problem is the scanner, memory, etc, would have to be present at the outside client end.

When I said it was all about marketing I was agreeing with the above post in that there aren't a ton of tangible benefits to digital microscopy as it pertains to current diagnostics. And a lot of the "hype" is related to marketing, not necessarily to practical use for diagnostic purposes.

 

[Matte Kudesai]

Well, those things also developed because they served a need or improved procedures - Flow helped characterize disease better than traditional methods, so did the other methods. What I was saying is that currently digital microscopy doesn't really add much value to clinical practice. One of the things that we are taught is that clients (i.e. the patient or the physician ordering the test) will pay for something if it adds value - FISH clearly adds value. Digital microscopy does not add value. It doesn't help you make the diagnosis any better. Potentially it could help you diagnose certain things faster (like frozens) or allow you to share them faster with experts. Thus, digital microscopy could potentially add value to a consultation practice - but the problem is the scanner, memory, etc, would have to be present at the outside client end.

When I said it was all about marketing I was agreeing with the above post in that there aren't a ton of tangible benefits to digital microscopy as it pertains to current diagnostics. And a lot of the "hype" is related to marketing, not necessarily to practical use for diagnostic purposes.

Agreed.

 

[Adrian Cocot]

I get how digital microscopy, slide scanning, etc., can have some real world uses for things like teaching, archiving, and perhaps consultation. I have yet to be convinced that it's a viable alternative to simple light microscopy for everyday use, however. We've had a number of different vendors give quasi educational conferences in our department about these technologies and I'm just not seeing the point yet. We aren't talking about spectral imaging here, which truly may change the world of pathology someday...someday.

Exactly! Most of these nascent technologies seem to have been created only for large academic centers to buy them (because... well, they can), then promptly shove them in a corner to gather dust. And then once someone begins to use it after a few years, the service contract is expired and you need to shell out another couple of grand to bring it back online.

Only telepath has practical patient care applications so far, and it's limited to Europe and the US military (remote frozen sections, international consultations).

Virtual microscopy is useful for teaching/testing, but only at large courses like ASCP, USCAP, or something like that. It feasibly saves money if you scan a slide and make 100+ copies of it on a DVD than making tons of recuts, especially on biopsies where tissue is limited. But right now, the digital revolution is about as useful as a 450hp engine in a yugo.

 

[yaah]

We had one of those web-accessible microscopes for the frozen section room so that attendings could look at frozens without having to come all the way over to the OR (some have offices that are a 5-10 minute walk) or from home in the evening if they were on call. But nobody used it. They decided they would rather just come in, it wasn't worth the hassle because you never knew if it actually was going to work well. Now the microscope is gone and nobody cares.

 

[horrendoma]

Hi all,
My attending bought a 22 inch LCD TV with S-video, HDMI, VGA inputs as well as the standard old-school Red,Yellow,White composite video inputs. we tried running the video-out from the little console thing that comes with an Olympus DP12 camera into the TV via the Red, yellow White (yellow only in this case- as there is no sound obviously. I wished slides had sounds, dont you think? 😀. , and the image looks like dog crap, very low res (you can actually see the pixels).
Now, I'm betting that if we had some way of using the SVideo/hdmi or VGA input, the image would be much better. Anybody know how to connect a DP12 to a consumer-type Circuit City LCD TV and not have the image come out as dog crap?
If we could bypass that little console thing with its sorry little single video cable, that would be great.
Problem is, the cable coming out of the DP12 is some monstrous, thick cable and doesn't look like anything commercial..... I dont think there are adapters for that as well.
Anybody can help?

 

[djmd]

Hi all,
My attending bought a 22 inch LCD TV with S-video, HDMI, VGA inputs as well as the standard old-school Red,Yellow,White composite video inputs. we tried running the video-out from the little console thing that comes with an Olympus DP12 camera into the TV via the Red, yellow White (yellow only in this case- as there is no sound obviously. I wished slides had sounds, dont you think? 😀. , and the image looks like dog crap, very low res (you can actually see the pixels).
Now, I'm betting that if we had some way of using the SVideo/hdmi or VGA input, the image would be much better. Anybody know how to connect a DP12 to a consumer-type Circuit City LCD TV and not have the image come out as dog crap?
If we could bypass that little console thing with its sorry little single video cable, that would be great.
Problem is, the cable coming out of the DP12 is some monstrous, thick cable and doesn't look like anything commercial..... I dont think there are adapters for that as well.
Anybody can help?

A quick google search seems to indicate that the RCA cable is your only option for output...

The DP20 uses a similar (vaguely similar) control box. But I don't think the two are interoperable..

Your Olympus rep may know better...