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Implementation of Subspecialty Whole Slide Image Teaching Sets for Residency Education

Implementation of Subspecialty Whole Slide Image Teaching Sets for Residency Education. Bryan Dangott , M.D. University of Utah Hematopathology Fellow. The UPMC Health System. Diversified environment ( academic hospitals, community hospitals) 19 hospitals with another 18 affiliations

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Implementation of Subspecialty Whole Slide Image Teaching Sets for Residency Education

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  1. Implementation of Subspecialty Whole Slide Image Teaching Sets for Residency Education Bryan Dangott, M.D. University of Utah Hematopathology Fellow

  2. The UPMC Health System • Diversified environment ( academic hospitals, community hospitals) • 19 hospitals with another 18 affiliations • 2 million + outpatient visits per year

  3. University of Pittsburgh Medical Centerwww.upmc.com 29 Western PA Counties 19 Hospitals 40 Cancer Center Locations

  4. Pathology Centers of Excellence (COEs) at UPMC UPMC Presbyterian Dermatopathology ENT/Thyroid Pathology Gastrointestinal Pathology Hematopathology Neuropathology Thoracic/Mediastinal Pathology Transplant Pathology UPMC Shadyside Pathology Informatics Genitourinary Pathology Bone/Soft Tissue/Melanoma Pathology UPMC Magee-Womens Hospital Breast Pathology Gynecologic Cytopathology Obstetric/Gynecologic Pathology UPMC Childrens Hospital Pediatric Pathology

  5. Background • UPMC is a multi-site institution • Residents rotate at different facilities • Problems with glass sets • Only available to one person at any given time • Missing slides • Broken • Disorganized • Degradation (cover slip adhesion, stain quality)

  6. Digital Teaching Material • AP Teaching Site (http://path.upmc.edu/cases/index.html) • 700 cases • Prepared by the residents • Gross images, microscopic snap shots • Comprehensive discussions

  7. TELE-EDUCATION: Online Conferences

  8. Creating Whole Slide Image Sets • Scanning began in 2005 with GU • Over 2900 whole slide images • General Unknowns collection • Genitourinary • Head and Neck • Thoracic • Hematopathology • Under Development • GI, Bone and Soft tissue, Cytology

  9. Infrastructure • Storage space • Storage Area Network for image files • 20 terabytes. • Supplemental file storage space. • Web hosting space.

  10. Servers • Image server • Aperio ImageServer • Webscope, Flash viewer • ImageScope, Desktop Application • Zeiss, Java viewer • Web servers • Apache • IIS • ColdFusion

  11. Database Backend • Oracle • Unknowns • GU • Thoracic • Head and Neck • Microsoft Access • Hemepath • Testing Interface

  12. Front End Language • ColdFusion • Database searching • Page presentation and formatting • Javascript • Used to selectively display portions of the page • Selects the viewer to launch based on link

  13. Basic Procedures • Gather data • Clinical Information • Diagnostic Material • Slides • Radiology • Gross Images • Flow, Cytogenetics, Molecular data • De-identify data

  14. Scan Hardware • Aperio Scanscope XT (120 slide loader) • Aperio Scanscope CS (5 slide loader) • Zeiss Mirax MIDI (12 slide loader) • Hamamatsu (210 slide loader)

  15. Scanning Challenges • Tape style cover slips • Scratched / damaged slides • Uneven tissue sections • Very thin sections of fatty tissue. • Peripheral smears / Aspirate smears • Cytology specimens

  16. Scanning Challenges • Cytology and hematopathology • Focus points • Depth of field • Scan time • 40x hemepath • 30 bone marrow aspirate slides (~24 hrs) • Batch scanning

  17. Personnel • Web Developer – Thomas Harper • Slide Scanning – Jon Duboy • Server Administration – Ishtiaque Ahmed • Project Coordinator – Doris Dayoub • Project Oversight – Anil Parwani, MD, PhD

  18. Implementation by Subspecialty

  19. Stats by Subspecialty

  20. Capabilities

  21. Challenges • Managing images, web page code, clinical data sources. • Customization of individual sites • Each of the subspecialties has different needs

  22. From Template to Flexible • Hemepath vision • More slides • Higher magnification (40x minimum) • More slide area (smears) • More data types

  23. Two Projects at a Time • Hemepath teaching set was built simultaneously with a testing interface. • Required architecture flexibility • Required more involvement with the developers

  24. Hemepath Data Types • CBC • Differential counts • Molecular data • Immunophenotyping • Flow Cytometry • Cytogenetics

  25. Hemepath Database Design • Access • Up front design required a lot of interaction • Hemepath wanted to manage the database • This eliminated building a web interface for data entry • Allowed additional development to enhance data entry

  26. Work Flow Improvements • Batch data download from APLIS • Tab delimited text file • Batch data processing • Vbscript • Notepad++ vs Excel • Data Entry • Copy and paste data fields • Link integration

  27. Hemepath File Naming • File naming conventions • CASE# - TYPEID - FREETEXT • WSI • 001-CBX-HE • Supplemental Files • 001-FLO-CD2,CD3,CD4,CD8

  28. Hemepath File Naming

  29. Special Features

  30. Testing Interface

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