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Pathology Visions 2010. Regional Telepathology in Fraser Health Authority: A multisite, multimodality, multidiscipline deployment. Dr. I. Scott Cornell Medical Lead, FHA Telepathology Project. Project Team. Sponsor: Minnie Downey IT: David Izzard Gagan Atwal

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Pathology visions 2010 l.jpg

Pathology Visions 2010

Regional Telepathology in

Fraser Health Authority:

A multisite, multimodality, multidiscipline deployment.

Dr. I. Scott Cornell

Medical Lead, FHA

Telepathology Project


Project team l.jpg
Project Team

Sponsor: Minnie Downey

IT: David Izzard

Gagan Atwal

Technical Coordinator: James Owen

Lab Scientists: Janet Tunnicliffe – Anatomic Path

Val Horak – Hematology

Kulvinder Mannan – Microbiology

Physicians: Scott Cornell – AP & Medical Lead

Lawrence Haley - Hematology

Dale Purych - Microbiology

Project Manager: Julie Harrison


Introduction l.jpg
Introduction

  • Presentation of our 5 year project

  • Results and conclusions to date.

  • Our current deployment.

  • Our take on the future.



Map of fraser health authority l.jpg
Map of Fraser Health Authority

  • 12 Hospital sites.

  • 150km or 95 miles wide

  • Serving 1.5 million people

  • Over 1750 acute care beds


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11,500

Pathology Hub Sites

Surgical Pathology Total Accessions 92,000

19,500

37,000

24,000


The promise of digital pathology l.jpg
The Promise of Digital Pathology

  • Diagnostics

  • Consultations

  • Conferencing

  • Teaching

  • Quality Assurance

  • Archiving

  • Image Analysis

  • Efficiencies



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Project Goals

  • Evaluate the use of digital imaging technology as part of the Intraoperative Consultation process

  • Evaluate the potential transition of the technical duties from the pathologist to a qualified Histotechnologist.



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Project Background

  • Funded:

    • Provincial Laboratory Coordinating Office (PLCO)

    • Canada Health Infoway (CHI)

    • FHA

  • Phase 1 – 2005 to 2007

    • Technology review

    • Business case (Project Budget)

    • RFP for equipment and software


Building the team preparing for rfp l.jpg

LIS Manager

Financial aspects

IT Liaison

AP Lab Scientist

Technical requirements

Work flow

IT Input

IT Manager

Hardware Specialist

Privacy & Security Specialist

Technical Architect

Business Case Specialist

Building the Team:Preparing for RFP


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IM/IT

Pathology

Admin


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IM/IT: Project Needs

  • Image Quality & Workflow

  • Hardware & Software Evaluation

  • Compatibility with Enterprise

  • Business Case & RFP Development

  • Provincial Advisory Group & Standards Group


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IM/IT: Enterprise Needs

  • Streaming Impact

  • Storage Impact – integrate with PACS

  • Server Requirements:

    • Standard

    • Compatible with FHA desktop

  • Compatible with “Live Meeting” & “Communicator”

  • Security & Privacy Impact


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IM/IT: Specifics Tasks

  • Hardware & Software Evaluations:

    • Standards

    • Security

    • Impact on network

    • Authentication compatibility

    • Scaleable across our enterprise


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Phase 2a Focus

Image Quality

  • WSI

  • Streaming

  • Still


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Project

AP IOC: RCH

Single Site Deployment

  • Largest FS volume

  • Proximity to OR

  • Proximity to path lead & team

  • Tech training: enroll all Pathologists

    Hem & Micro: RCH

    Single Site Deployment

  • Evaluate all imaging modalities


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Building the Team

Technical Coordinator

  • Histopathology skills

  • IT skills

  • Project experience

  • Motivated

  • Interpersonal skills

  • Enthusiasm for concept


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Phase 2a

August 2007 to April 2008

  • Evaluation of digital imaging for Intraoperative Consultations (IOC) at RCH

    • Technology – hardware, software, and network

    • Role of Technical Coordinator

    • Collection of IOC metrics

    • Development of operating and training documents

  • Enhancements

    • Initial review by Hematology and Medical Microbiology

    • ? expansion to other FHA sites / users




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Whole Slide Scans

  • Slide scanner: Aperio

  • Image management software: Apollo PathPACs


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Streaming Image

  • Live video

    • Gross (macro) image presenter

    • Microscope camera

  • Capture FOV





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Image Quality vs. Concordance level

(for TP vs. IOC)

Image Score 1=Unacceptable,

2=Below Average,

3=Acceptable,

4=Exceeds expectations


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Image Quality Score of Less Than 3

Out of 54 cases, 21 cases had image score <3




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Phase 2a Findings

  • Concordance of WSI to glass was promising

  • Technical issues identified:

    • Stain consistency

    • Section consistency

    • Resolution / 1st time capture

    • Image magnification

  • TC role - skilled histotechnologist is essential

  • Time to acquire image

  • Storage capacity

  • Remote grossing appeared advantageous


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Conclusions

We are unable to recommend at this time implementation of this technology for provision of routine frozen sections during intraoperative consultations.


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Future Plans

  • Deploy software to all surgical pathologists at RCH & select users at other sites

  • On-going evaluation of H&E staining

  • Incorporate 40X images routinely

  • Use of WSI for AP rounds

  • Heme & Micro expanded evaluations

  • Assess PathPACs and LIS integration


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Phase 2b Goals

Anatomic Pathology

  • IOC’s:

    • Expand WSI correlations to

      • 3 pathologists

      • 200+ cases

    • TC role: encourage greater use of skills by Paths

    • Encourage use of remote grossing & WSI viewing during an IOC

  • Evaluate off site remote grossing

  • WSI for all AP rounds


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Phase 2b Goals

Heme & Micro

  • Deploy to multiple sites

  • Evaluate role for

    • consultations

    • teaching

    • conferencing/rounds









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AP Conclusions

  • Diagnostic Accuracy WSI

    • Acceptable

  • Image Quality

    • Acceptable


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AP Conclusions

  • Software:

    • Well acceptable

    • Minimal training

    • Easy to operate

  • Well Trained Technical Coordinator Essential

    • Technical quality

    • Hardware/software expertise

    • Time efficiency


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AP Conculsions

  • Remote Gross Specimen Viewing

    • Well accepted

    • Time efficient

  • Education & QA Rounds

    • Enhanced plus

    • Continue & expand



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Hematopathology

  • Case Review Rounds (6 pathologists at 3 sites)

  • Pathologist to Pathologist Consultations

  • Tech to Tech Consultations

  • Educational Rounds


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Heme: Modalities Trialed

  • WSI up to 83X oil

  • Streaming – dry + oil

  • Static: still camera

    FOV from streaming


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Heme: Conclusions

  • All modalities unacceptable at this time for definitive diagnosis

  • Streaming images – images of choice

  • WSI not useful at this time

  • Static images less useful, less flexible

  • Will not currently replace existing rounds system


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Microbiology

  • Case Review Rounds

  • Pathologist to Pathologist Consultations

  • Educational Rounds


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Micro: Modalities Trialed

  • WSI up to 83X oil

  • Streaming: gross with Elmo

    micro to 100X oil

  • Static: still camera

    FOV from streaming


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Micro: Conclusions

  • Major role at this time - Educational Rounds & Documentation

  • Images by all modalities are not yet adequate for diagnostic uses

  • Imaging not yet adequate to incorporate into routine use

  • Static image capture: still camera best

  • WSI: good for general impression of specimen quality and general morphology





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Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours


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Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: Speed


Conclusions64 l.jpg
Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: Speed

    Storage


Conclusions66 l.jpg
Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: Speed

    Storage

    Work Flow



Conclusions68 l.jpg
Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: Speed

    Storage

    Work Flow

    Redundancy


Conclusions70 l.jpg
Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: Speed

    Storage

    Work Flow

    Redundancy

    Cost


Conclusions72 l.jpg
Conclusions

  • WSI provides images that satisfy most diagnostic purposes in AP

  • WSI does not yet provide images suitable for diagnostic purposes in routine hematology and microbiology

  • WSI - an immature technology not yet suitable for routine surgical pathology in a practice setting like ours

    Issues: - Speed - Work Flow

    - Storage - Redundancy

    - Cost

  • WSI is suitable for diagnostic purposes in certain niche applications

  • Telepathology in general, using streaming gross & microscopic images has a broad range of applications for routine uses that are cost effective and efficient


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The Promise of Digital Pathology

  • Diagnostics

  • Consultations

  • Conferencing

  • Teaching

  • Quality Assurance

  • Archiving

  • Image Analysis

  • Efficiencies


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The Promise of Digital PathologyTomorrow

  • Diagnostics

    • Anatomic Pathology

      • Intraoperative Consultations at RCH

      • Trial scanning of daily pathology workload

      • Capture of gross room specimen images

      • Surgical Pathology off site gross images

  • Consultations

    • AP

      • WSI and Streaming

    • Hematopathology

      • Streaming images between Hematopathologists


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The Promise of Digital PathologyTomorrow

  • Conferencing

    • Anatomic Pathology

      • Weekly surgical pathology conference

      • Breast conference

      • Combined gastrointestinal / surgical pathology conference

      • Regional AP conference ( Web access or Live Meeting)

    • Hematopathology

      • Multi site conference

  • Teaching / Education

    • Hematopathology and Medical Microbiology

      • Teaching archive

    • Anatomic Pathology

      • Teaching archive – Residents, laboratory staff, laboratory students

  • Quality Assurance

    • Anatomic Pathology

      • Internal technical QA review

      • Breast Receptor

      • Immunohistochemistry


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The Promise of Digital PathologyTomorrow

  • Archiving

    • Medical Microbiology

      • Images for procedure / documentation

  • Image Analysis

    • Immunohistochemistry – Prognostic markers

  • Efficiencies

    • All departments

      • Interface to laboratory Information System

    • Anatomic Pathology

      • Frozen section gross completed from office

      • Surgical pathology scanned images available to view by off site pathologist

    • Hematopathology

      • Multisite pathologist consultations


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THE

END


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