Abstract
Background: Whole slide Imaging (WSI) has been touted by many as the future of pathology, with estimates of full adoption occurring sometime in the next 5 to 15 years. While WSI devices have become increasingly capable since their inception, there has been little consideration of how WSI will be implemented and subsequently affect the workflow of high volume histology laboratories.Methods: Histology workflow process data was collected from a high-volume histology laboratory (Massachusetts General Hospital) and a process model developed using business process management software. Computerized workflow simulations were performed and total histology process time evaluated under a number of different WSI conditions.Results: Total histology process time increased approximately 10-fold to 20-fold over baseline with the presence of one WSI robot in the histology workflow. Depending on the specifications of the WSI robot, anywhere from 9 to 14 WSI robots were required within the histology workflow to minimize the effects of WSI.Conclusion: Placing a WSI robot into the current workflow of a high-volume histology laboratory with the intent of full adoption is not feasible. Implementing WSI without making significant changes to the current workflow of the histology laboratory would prove to be both disruptive and costly to surgical pathology.
Highlights
Since the introduction of whole slide imaging (WSI) in 1999, the technology surrounding this field has advanced to the point where placing a Whole slide Imaging (WSI) device, or robot, into the traditional pathology workflow does not seem as inconceivable as it once was
To investigate the effects a single whole slide imaging robot on clinical histology workflow, the baseline process model was compared to one with a WSI robot placed between the end of slide creation but before slides were distributed to pathologists (Fig. 4)
Simulations were run on this “WSI robot” model using four different slide scanning time ranges, based on both the scan times claimed by a variety of WSI vendors and user experience of the authors (60–180 sec, 90–180 sec, 60–240 sec, and 120–240 sec) and laboratory TAT was measured
Summary
Since the introduction of whole slide imaging (WSI) in 1999, the technology surrounding this field has advanced to the point where placing a WSI device, or robot, into the traditional pathology workflow does not seem as inconceivable as it once was. Whole slide imaging was plagued by technological barriers that made it difficult to implement within pathology laboratories, such as slow scan times at clinically relevant slide magnifications, the inability to deliver multiple reliable focal planes (z-axis planes), extremely large file sizes, and no support for the Digital Imaging and Communications in Medicine (DICOM) standard for medical image sharing [1, 2] These barriers were significant enough that WSI was largely relegated to the “post-diagnostic” phase of pathology, with glass slides scanned only after the pathologist had finished with them and rendered a diagnosis. While WSI devices have become increasingly capable since their inception, there has been little consideration of how WSI will be implemented and subsequently affect the workflow of high-volume histology laboratories
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