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Digital pathology or whole slide imaging technology in clinical consultation practice to me translates into convenient, effective and efficient communication. A not so old method of communication that we still use today is the wired telephone. As we all know, it has limitations in its usage due to it being “wired” and therefore not convenient to use, say for example, while walking down the street. Search for a better device eventually led to the development of the cellular phone. This provides for the required convenience factor without compromising the other features of the standard telephone. Cellular phones have evolved quite dramatically over the last few years such that the most recent versions of the phone with their numerous applications have become almost indispensable for daily use for many. However, the full potential of this device has still not been realized, especially in the field of telemedicine and telepathology. With the development of the new tablet computer/phone, one may not only read the newspaper but could also view whole scanned slides. Soon, it may be possible to read whole slide scans and also sign them out as one would do in his/her office, essentially from anywhere at anytime, using such portable devices!
When I think of consulting another pathologist in my group in daily practice, I think of getting up from my chair in my office and traversing the office maze to get to the consultant. Valuable professional time is lost for communicating the difficult case to the consultant. It is also very inconvenient for the consultant to be interrupted in his/her work. In the not too distant future, with whole slide imaging, it may be possible to simply drag the difficult case, or more appropriately the whole slide scan icon for the case, and drop it into the consultant’s folder. The consultant would find it very efficient to simply open the folder and view the case(s) at his/her convenience at pretty much any time and from anywhere, even from bed after a hard day at the practice! This technology would also be especially useful when many pathologists from a group are away, for example, for attending a pathology meeting. Their expertise could still be utilized without any compromise in turn-around-time (TAT) or quality of care.
I, not unlike many other pathologists, suffer from certain inertia when I think of sending a case for an outside consultation. The paperwork, recuts and the delay in getting the case across are the major factors. However, now with whole slide imaging and the appropriate software, with as few as two mouse clicks one may be able to have the scan(s)/case reviewed by essentially any pathologist from anywhere in the world.
Essentially, any pathologist in any type of practice can benefit form this. The examples for this are given below.
When one thinks of consultation in anatomic pathology, difficult/rare/challenging cases or difficult frozen sections come to our mind. These certainly would benefit from whole slide imaging; however, there are many other instances for which digital imaging technology would be appropriate. These include:
The methods for enabling global consultation in digital format involve one or more of the following:
PathXchange© is an example of a website on the Internet that allows for uploading of digitized slides. The following are some of its features:
WebEx© is an example of an application that allows for live web conferencing and sharing of one’s desktop. The following are some of its features:
Digital pathology provides quick access to cases, essentially from anywhere in the world and at any time. The ease with which one can view digitized slides provides many scenarios for its applicability in routine clinical pathology practice. At present, there are only a few systems available to share digitized slides with any pathologist from anywhere, some of which can be combined with live conferencing. In the future, more systems will likely become available with multitasking capabilities as shown in Figure 1. System security and regulatory issues (e.g. licensing, billing) would need to be examined as global digital consultation becomes more popular.
Available FREE in open access from: http://www.jpathinformatics.org/text.asp?2010/1/1/17/68334
From the 1st Digital Pathology Summit, New Frontiers in Digital Pathology, University of Nebraska Medical Center, Omaha, Nebraska 14-15 May 2010