The Daily Scan

Digital Pathology Adoption Trends by Pathologists

Bruce Friedman is Putting Some Numbers to Digital Pathology Adoption Trends by Pathologists, following a survey article in Laboratory Economics:

Nearly everyone agrees that digital imaging will play a big role in pathology in the future. Academic medical centers, commercial labs and large independent pathology labs are rapidly installing digital pathology systems.  But its use in reimbursable clinical diagnostics is currently limited.  Twenty-two percent of pathology groups and labs currently have a digital imaging system in place, according to LE’s Digital Pathology Trends Survey conducted in June.  Ten-percent plan to add a system within 12 months and another 10% within the next 12-to-24 months.

Today, education and training is the most common use for labs using digital pathology.  The biggest barrier to more clinical use is the cost of scanning digital slides, which don’t eliminate the need to first prepare glass slides.  Among surveyed labs using digital pathology, 72% are using it for education and/or training, according to LE’s Digital Pathology Trends Survey.  Sixty-three percent use it for second opinions and/or consultations, and 62% for quantitative immunohistochemistry for HER2 scoring.  In terms of market share, 44% of digital pathology users have an Aperio system; BioImagene has a 16% share; Ventana, 9%; and Olympus, 8%.  Other vendors have a combined 23% share, including Nikon, Leica Microsystems and Dmetrix.

More than half of surveyed labs without digital pathology cited “too expensive” as a barrier to adoption.  Another 36% said traditional pathology/microscope works fine and 23% had LIS integration concerns.  Only 15% said digital pathology systems were too slow and only 3% had concerns about image resolution.  Meanwhile, Amanda Lowe, principal of Digital Pathology Consultants...believes the limited menu of FDA-cleared tests is a bigger issue than our survey suggests.  “There’s no doubt that if the FDA would ‘gold stamp’ digital pathology on the clinical diagnostic end, it would help significantly,” she says.

Great data.  Naturally we're delighted to see that so many sites adopting digital pathology are using Aperio scanners and software, but equally we are committed to enhancing the value propositions for digital pathology to drive more adoption.  There is a potential network effect underlying adoption of a new technology like this; the more labs adopt it, the more value there is for all labs which have adopted it.

Is the iPad radiology's dream device for mobile healthcare?

On AuntMinne.com, Erik Ridley asks Is the iPad radiology's dream device for mobile healthcare?

The iPad has only been on the market for three months, but it has already generated significant interest and enthusiasm among radiologists and referring physicians. Efforts to define the role of the iPad in radiology are still in their early stages, but a number of researchers and vendors active in developing software applications for the iPad believe it could fulfill a role in bringing access to images and advanced visualization technology to the point of care.

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But don't expect radiologists to ditch their PACS workstations and start interpreting images on iPads any time soon. The iPad would not be suitable for primary diagnosis due to its contrast ratio (maximum luminance/minimum luminance) and calibration issues.

Interesting, of course we at Aperio have been looking at iPads too, trying to figure out if they're useful for viewing digital pathology images.  The panning issues noted in the article are exacerbated by the large image size, and there are also zooming issues in pathology which radiology doesn't have.

As I think about this, there are two considerations.  First, can you use the device - is the image quality sufficient, user interface good enough, etc.  And second, when would you use the device - what is the use case?  I think that the devices probably *are* usable, or if they aren't they will be soon, but I'm fuzzy about whether they're truly useful.  Seems like in every situation where you might use an iPad you could just as well use a laptop.

I'd be most interested in hearing from y'all; please comment if you have a view about whether tablets like the iPad will become important as medical imaging devices.

Veterinary Pathologists Adopting Digital Pathology Faster than MDs

From Steve Potts, CEO of Flagship Biosciences, guest posting on Bruce Friedman's blog: Veterinary Pathologists Adopting Digital Pathology Faster than MDs.

My work with both MD and DVM pathologists has lead me to the following observation: DVM pathologists are "going digital" faster than their MD colleagues. Nearly all of the top 15 pharmaceutical companies have completed multisite-integration with digital pathology. The result of such conversions is that a pathologist working in one location can access slides at any other one or participate in an informal peer review or pathology working group. Veterinary pathologists have proposed GLP [Good Laboratory Practice] standards and agreed on the requirements required of digital pathology vendors in order to meet the FDA compliance guidelines in preclinical testing. The regulations imposed on preclinical toxicology testing prior to first-use in human trials are more strict than clinical trial regulations. Despite this, veterinary pathologists are well prepared for the use of digital slides in these assessments.

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Part of the willingness to adopt digital pathology in pharma companies is economic - the workflow improvements are compelling - but there also seems more willingness to try new technology.

ACR takes on Walter Reed radiologic-pathology course

I've posted a number of times here about the value of combining radiology and pathology information for clinicians (some would say, for "diagnosticians").  In recognition of this, The American College of Radiology (ACR) has launched the American Institute of Radiologic Pathology (AIRP), a four-week course, which will fulfill the requirements previously completed by Walter Reed Army Medical Center's radiologic-pathology correlation course. 

In a series of lectures, case reviews and world-renowned guest speakers, the course is a comprehensive review of radiologic imaging with pathologic correlation. The eight sections of the course include gastrointestinal radiology, genitourinary radiology, musculoskeletal radiology, neuroradiology, pediatric radiology, cardiovascular radiology, breast imaging and thoracic
radiology.

This is interesting, too:

ACR plans to incorporate innovative technology, like an iPad or similar tablet tool, to "enhance" residents' experience.

This seems like the right conclusion:

"The importance of the program is the breadth of the teaching that's delivered there," Freedman says.

Consideration of the Underlying Forces that Promote Pathology Insourcing

Bruce Friedman: Consideration of the Underlying Forces that Promote Pathology Insourcing.

I have come to the conclusion that major drivers are operating to accelerate the trend toward specimen insourcing:

• Diminishing importance of hospitals.
• Complacency and culture of hospital-based pathologists
• Insourcing as a source of new positions for "local" pathologists
• Changes in academic training programs

Whether you think pathology insourcing is good or bad for the field, it seems evident that it is taking place.  Smart pathologists will realizes this and move to adapt to the change.

Sylvia Asa Announced as Pathology Visions Keynote Speaker

SYLVIA ASA, MD, PhD, ANNOUNCED AS KEYNOTE SPEAKER Pathology Visions is pleased to announce Sylvia Asa, MD, PhD, as the 2010 Keynote Speaker. Dr. Asa is the Pathologist-in-Chief and Medical Director of the Laboratory Medicine Program at the University Health Network. As head of the largest pathology department in Canada, Dr. Asa has made innovative changes to the practice of the discipline. To read more about Dr. Asa, click here. PATHOLOGY VISIONS ABSTRACT DEADLINE - ONE WEEK LEFT! The deadline to submit abstracts for oral and poster presentations is June 15! To submit your abstract, click here. Poster presenters will be given a two-day display opportunity. Outstanding posters will be eligible to receive complimentary conference registration. As a presenter, you can share your experiences and discuss potential uses for digital pathology in the future. Submission topics include: Business Case/Reimbursements Cytology Diagnostic Pathology Disease-Specific Drug Development Education Frozen Sections Hematopathology Image Analysis Immunohistochemistry (IHC) Informatics IT Personalized Medicine Research Applications Telepathology Toxicologic Pathology Validating Algorithms To submit your abstract, click here. ABOUT PATHOLOGY VISIONS Pathology Visions is the annual meeting of the Digital Pathology Association, held October 24-27, 2010, at the Sheraton San Diego Hotel and Marina on the beautiful San Diego bay. Enjoy thought-provoking discussions on digital pathology applications and enrich your conference experience through the following: Exciting presentations on new applications Peer-to-peer discussions on digital pathology Hands-on workshops Scientific poster sessions Digital pathology demonstrations Networking events ABOUT THE DIGITAL PATHOLOGY ASSOCIATION (DPA) The mission of the DPA is to facilitate awareness of digital pathology applications in healthcare. Members are encouraged to share best practices and promote the use of the technology among colleagues in order to demonstrate efficiencies, awareness, and its ultimate benefits to patient care. To learn more or apply for membership, visit www.digitalpathologyassociation.org.   For more information, visit www.pathologyvisions.com

The Treatment: the search for cancer drugs

The New Yorker has a wonderful article by Malcolm Gladwell: The Treatment, about the search for cancer drugs.

The article accurately captures some of the challenges, and the difference between working backward from genetic knowledge of cancer to a possible compound that can fight it and just trying a bunch of possible drugs to see which ones could work.  The difficulty of assembling and testing "cocktails" with multiple drugs is also discussed.

And of course Gladwell is a terrific writer; even if his subject wasn't so inherently interesting, his story about it would be!

MD Anderson: Pathology: Investigating the nature of cancer

From MD Anderson comes this interesting survey article: Pathology: Investigating the nature of cancer.

No MD Anderson patient bypasses pathology.

Without the knowledge that this science provides there can be no solution — no diagnosis, no course of treatment, no cure.

Simply put, pathology is the branch of medicine that deals with the nature of disease, especially the structural and functional changes it causes in the body.

Though seldom seen by the patient, pathologists take the first look at a tumor and draw on their education, expertise and the latest technology to evaluate what they discover.

They help answer the all-important questions for clinicians and other health care providers: Does the patient have cancer? What type of cancer? What stage? What treatments might work?

It's great to see the field featured this way.  The article is accompanied with a picture of Dr. Janet Bruner, Chair of the Department of Pathology, examining a frozen section of a brain specimen.