Implementation Of Digital Pathology Research Articles

Introduction to digital pathology and computer-aided pathology

Digital pathology (DP) is no longer an unfamiliar term for pathologists, but it is still difficult for many pathologists to understand the engineering and mathematics concepts involved in DP. Computer-aided pathology (CAP) aids pathologists in diagnosis. However, some consider CAP a threat to the existence of pathologists and are skeptical of its clinical utility. Implementation of DP is very burdensome for pathologists because technical factors, impact on workflow, and information technology infrastructure must be considered. In this paper, various terms related to DP and computer-aided pathologic diagnosis are defined, current applications of DP are discussed, and various issues related to implementation of DP are outlined. The development of computer-aided pathologic diagnostic tools and their limitations are also discussed.

Grossing Technology Today and Tomorrow.

To describe the perspective of grossing technology and highlight the prospective of its development in histology laboratory. Analysis of different components of grossing technology. Increased requirements for a specimen's turnaround time and the advancements in modern processing equipment make the triage of workflow a significant part of a grossing person's responsibilities. The implementation of digital pathology in morphology studies practice requires standardization of fixation, the thickness of gross section, and optimal embedding orientation. To meet tomorrow's challenges, grossing technology should work on embedding automation and gross digital pathology to record gross sections corresponding the microscope slide. Specialization of grossing stations might be beneficial to the quality of processing and smooth workflow productivity. The emerging grossing technologist subspecialty requires development of a special training program. Grossing technology can contribute to new challenges in modern histology laboratory, assuring high-quality microscope slides for the pathologist's diagnosis and research evaluation.

Practical guide to training and validation for primary diagnosis with digital pathology

Numerous clinical pathology departments are deploying or planning to deploy digital pathology systems for all or part of their diagnostic output. Digital pathology is an evolving technology, and it is...

Predicting systemic spread in early colorectal cancer: Can we do better?

Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision can be an attractive option, especially for fragile patients with multiple comorbidities, but it is only safe from an oncological point of view in the absence of lymph node metastasis. Patient risk stratification through careful analysis of histopathological features in local excision or polypectomy specimens should be performed according to national guidelines to avoid under- or over-treatment. Currently national guidelines vary in their recommendations as to which factors should be routinely reported and there is no established multivariate risk stratification model to determine which patients should be offered major resectional surgery. Conventional histopathological parameters such as tumour grading or lymphovascular invasion have been shown to be predictive of lymph node metastasis in a number of studies but the inter- and intra-observer variation in reporting is high. Newer parameters including tumour budding and poorly differentiated clusters have been shown to have great potential, but again some improvement in the inter-observer variation is required. With the implementation of digital pathology into clinical practice, quantitative parameters like depth/area of submucosal invasion and proportion of stroma can be routinely assessed. In this review we present the various histopathological risk factors for predicting systemic spread in pT1 colorectal cancer and introduce potential novel quantitative variables and multivariable risk models that could be used to better define the optimal treatment of this increasingly common disease.

Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings.

Digital pathology (DP) implementations vary in scale, based on aims of intended operation. Few laboratories have completed a full-scale DP implementation, which may be due to high overhead costs that disrupt the traditional pathology workflow. Neither standardized criteria nor benchmark data have yet been published showing practical return on investment after implementing a DP platform. To provide benchmark data and practical metrics to support operational efficiency and cost savings in a large academic center. Metrics reviewed include archived pathology asset retrieval; ancillary test request for recurrent/metastatic disease; cost analysis and turnaround time (TAT); and DP experience survey. Glass slide requests from the department slide archive and an off-site surgery center showed a 93% and 97% decrease, respectively. Ancillary immunohistochemical orders, compared in 2014 (52%)-before whole slide images (WSIs) were available in the laboratory information system-and 2017 (21%) showed $114 000/y in anticipated savings. Comprehensive comparative cost analysis showed a 5-year $1.3 million savings. Surgical resection cases with prior WSIs showed a 1-day decrease in TAT. A DP experience survey showed 80% of respondents agreed WSIs improved their clinical sign-out experience. Implementing a DP operation showed a noteworthy increase in efficiency and operational utility. Digital pathology deployments and operations may be gauged by the following metrics: number of glass slide requests as WSIs become available, decrease in confirmatory testing for patients with metastatic/recurrent disease, long-term decrease in off-site pathology asset costs, and faster TAT. Other departments may use our benchmark data and metrics to enhance patient care and demonstrate return on investment to justify adoption of DP.

Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics.

The benefits of digital pathology for workflow improvement and thereby cost savings in pathology, at least partly outweighing investment costs, are being increasingly recognised. Successful implementations in a variety of scenarios have started to demonstrate the cost benefits of digital pathology for both research and routine diagnosis, contributing to a sound business case encouraging further adoption. To further support new adopters, there is still a need for detailed assessment of the impact that this technology has on the relevant pathology workflows, with an emphasis on time-saving. To assess the impact of digital pathology adoption on logistic laboratory tasks (i.e. not including pathologists' time for diagnosis-making) in the Laboratorium Pathologie Oost Nederland, a large regional pathology laboratory in The Netherlands. To quantify the benefits of digitisation, we analysed the differences between the traditional analogue and new digital workflows, carried out detailed measurements of all relevant steps in key analogue and digital processes, and compared the time spent. We modelled and assessed the logistic savings in five workflows: (i) routine diagnosis; (ii) multidisciplinary meeting; (iii) external revision requests; (iv) extra stainings; and (v) external consultation. On average, >19 working hours were saved on a typical day by working digitally, with the highest savings in routine diagnosis and multidisciplinary meeting workflows. By working digitally, a significant amount of time could be saved in a large regional pathology laboratory with a typical case mix. We also present the data in each workflow per task and concrete logistic steps to allow extrapolation to the context and case mix of other laboratories.

Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States.

The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research. To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth. At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases. We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.

Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.

Digital pathology is becoming technically possible to implement for routine pathology work. At our institution, we have been using digital pathology for second opinion intraoperative consultations for over 10years. Herein, we describe our experience in converting to a digital pathology platform for primary pathology diagnosis. We implemented an incremental rollout for digital pathology on subspecialty benches, beginning with cases that contained small amounts of tissue (biopsy specimens). We successfully scanned over 40,000 slides through our digital pathology system. Several lessons (both challenges and opportunities) were learned through this implementation. A successful conversion to digital pathology requires pre-imaging adjustments, integrated software and post-imaging evaluations.

Routine Digital Pathology Workflow: The Catania Experience

Introduction: Successful implementation of whole slide imaging (WSI) for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. Methods: All (100%) permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D) barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Results: Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Conclusion: Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization ofworkflow processes in the pathology laboratory.

The Technicians´ Role in Digital Pathology Implementation. Searching Optimization.

Background Scanning histological or cytological preparations is a crucial element in the process of digitization of Pathology Departments, along with the traceability of tissue samples and the reports management. The scanning time and the high size of the files are still considered suboptimal for full implementation. In order to optimize time and space a comparative study of the workflow performed by histotechnicians in our center has been carried out. Material & Methods A total of 25 endoscopic samples were selected with the intention of comparing different parameters (scanning time, error rate during scanning and hard disk storage) between the original histological glass slides (group A: 2 slides per case, 50 preparations) and new sections, with levels grouped into a single slide (group B: 1 slide per case, 25 preparations). They were scanned at 20x magnification in routine way using the Ventana iScan Coreo scanner (Roche diagnostics). The process was repeated 4 times to calculate averages. Results The average scanning time was 5 hours 40 minutes (6m 48s / slide) in group A and 5 hours 10 minutes (12m 24s / slide) in group B. The error rate was 6.1% in group A and 3,8% in group B. The space occupied on the hard disk was 11.87 GB in group A and 9.6 GB in group B (475 MB/case vs 385 MB/case, respectively). The average number of tissue sections per case was 7 in group A and 8 in group B. Conclusion There is a clear benefit of standardizing and optimizing the number of cuts per slide in terms of storage (saving 19%), biopsy sampling (14% more tissue) and error rate (37% less), including a not negligible decrease in the scanning time (9%) in the study conducted.

Efficient pathology case distribution leveraging workflow and domain modeling, and flexible definition of policies

Background The value of digital pathology and its potential to improve the current pathology practice are increasingly recognized, with a growing number of examples of successful implementation in a variety of use cases. While current widely-spread uses relate to research, consultation, second opinion and education, success stories are emerging demonstrating outcome and cost benefits of leveraging digital pathology for standard diagnosis as well. In all these cases optimization of pathology workflows, standardization and seamless integration in the environment are emphasized as prerequisites to reaching the desired improvements. Aims We develop workflow-driven applications to enable clinical users to efficiently and effectively leverage deployed digital pathology solutions for faster diagnosis and better patient outcomes. The work addresses information integration requirements, and aims to identify and propose solutions for performance bottlenecks in existing processes. A process with potential for improvement is the case distribution to pathologists for diagnosis. Materials and Methods We propose an approach to workflow modeling and implementation that is open and flexible, and leverages existing standards (BPMN2.0) developed in the context of business process modeling and widely adopted in other domains. This enables efficient implementation and give us access to an existing platform (KIE) that delivers a workflow-engine (jBPM), a rule-engine (Drools), and a constraint satisfaction solver (OptaPlanner). By externalizing the definitions and implementations of tasks within the workflows, we build workflows that are adaptive to the environment and that can incorporate decision models and applications of the desired complexity. We selected case distribution for diagnosis as the first process to optimize and built an application that can be efficiently customized to the needs of each lab with respect to dispatching rules, operational domain model, optimization goals and visual elements. Results We implemented a case distribution application that can be deployed within an integrated workflow implementation to optimize the distribution of cases to pathologists for diagnosis. To automatically assign cases to pathologists according to defined policies, the optimization component applies the defined policy model (scoring rules within the domain model). The schedules are generated according to the desired optimization goals, e.g. to improve throughput or turnaround. This application seamlessly connects with relevant systems in the environment, the LIMS and the IMS, in a loosely-coupled standard way through the integration engine to retrieve all needed data about the cases to be visualized and used in the dispatching decisions, and to provide the case assignation information to the IMS. Conclusions The optimization of the case distribution to pathologists for diagnosis has been identified in the literature as an important area when aiming at workflow improvements and automation of the processes in the pathology labs. A common theme emphasized by previous research identifying user needs and requirements for efficient digital pathology implementation is the use of standards to support adoption and the seamless integration with all relevant systems in the environment. Within a standards-based workflow-driven approach, we implement a case distribution application that optimizes the case assignation for diagnosis by modeling the local workflows and the requirements of each deployment site. The optimization component applies the local policy models (i.e. business rules, domain models with roles and characteristics, and optimization goals) to propose the most suitable solution for distributing the incoming case load among the available pathologists for diagnosis.

Enabling digital pathology in the diagnostic setting: navigating through the implementation journey in an academic medical centre

AimsAs digital pathology (DP) and whole slide imaging (WSI) technology advance and mature, there is an increasing drive to incorporate DP into the diagnostic environment. However, integration of DP into...

Choosing And Implementing The Correct Whole Slide Imaging System

Introduction/ Background The whole slide imaging (WSI) market has developed enormously in the recent years. This evolution has made the selection and the implementation of digital pathology more complicated. Based on a validation process, we developed recommendations that need to be taken into account when implementing whole slide imaging. In addition to selecting the right hardware, one should also focus on laboratory organization, integration, training and handling. Aims The aim is to integrate WSI as efficiently as possible in a standardized process. This should lead to a user friendly workflow for pathologists and must ensure the quality of the diagnosis. Methods We organized on-site demonstrations to test several available WSI systems with a fixed set of histology slides. We evaluated scanning quality, measured the scanning time, the amount of data produced and made a simulation of a routine workflow. We developed a to-be workflow beginning with the scanning process until the final diagnosis of the pathologist. The workflow focused on the integration of the system into the laboratory information system. We standardized the technical laboratory processes to increase the quality of the slides and the efficiency of WSI. The standardization included good labeling, adequate quality, standardized location and correct number of sections on the slide. We introduced a continuous workflow to reduce batch size and to decrease the turn-around-time. The pathologists were only allowed to work with WSI after training in order to manipulate the images as efficiently as possible. Finally we validated the system according to CAP guidelines for WSI for diagnostic purpose in pathology. Results It is very important to determine what the purpose of WSI implementation in the lab is. The different systems show large variations between them and not every set up will fit in the specific workflow of each lab. The workflow simulation gave us an idea of the scanning turn-around-time and made it possible to estimate the amount of scanners that would be necessary in daily routine. Another focus point is the total integration of WSI to find a synergy between the hardware, workflow and the way the system can be integrated into the IT infrastructure of the lab. Beside the bidirectional communication with the laboratory information system, data storage organization and its influence on the lab’s productivity is also very important. Organizing the laboratory with a standardized continuous workflow will reduce the amount of data, increase speed and lower the amount of rescans. To prevent that WSI is used inefficiently, it is crucial to train the pathologists before they start using it. A lack of training will lead to a dislike of WSI due to poor knowledge of the available applications. The pathologists are indicating that it’s crucial to have the correct hardware to manipulate the image in order to ensure diagnostic speed and to lower the threshold towards WSI. We may conclude that choosing and implementing the correct WSI solution needs a systematic approach to succeed on the long term. Defining and optimizing the workflow before implementing whole slide imaging is crucial. Hardware, workflow and IT infrastructure should match to ensure productivity. Training of the pathologists is decisive in order to ensure efficient use.

The Role of the Technicians in the Digital Pathology Implementation. Searching Optimization

Introduction/ Background Scanning histological or cytological preparations is a crucial element in the process of digitization of Pathology Departments, along with the traceability of tissue samples and the reports management. The scanning time and the high size of the files are still considered suboptimal for full implementation. Aims In order to optimize time and space a comparative study in our center has been carried out. Methods A total of 25 endoscopic samples (5 esophageal, 5 gastric, 5 duodenal, 5 colonic inflammatory, and 5 colonic neoplastic) were selected with the intention of comparing different parameters (scanning time, error rate during scanning and hard disk storage) between the original histological glass slides (group A: 2 slides per case, 50 preparations) and new sections, with levels grouped into a single slide (group B: 1 slide per case, 25 preparations). They were scanned at 20x magnification in routine way using the Ventana iScan scanner Coreo (Roche diagnostics). The process was repeated 4 times to calculate averages. Results The average scanning time was 5 hours 40 minutes (6m 48s / slide) in group A and 5 hours 10 minutes (12m 24s/slide) in group B. The error rate was higher than it had been found in previous studies (2-3%) with 6% errors in group A and 3,9% errors in group B. The space occupied on the hard disk was 11.87 GB in group A and 9.6 GB in group B (475 MB/case vs 385 MB/case, respectively). The average number of tissue sections per case was 7 in group A and 8 in group B. Conclusions : There is a clear benefit of standardizing and optimizing the number of cuts per slide in terms of storage (saving 19%), biopsy sampling (14% more tissue) and error rate (35% less), including a not negligible decrease in the scanning time (9%) in the study conducted.

How to implement digital pathology in tissue-based diagnosis (surgical pathology)?

Background Digital pathology has proven to become a reliable tool to be applied in pathology education and experimental measurements. However, it is still waiting at the front door of routine surgical pathology or tissue – based diagnosis. Why? Definitions Tissue – based diagnoses includes all diagnostic tools and algorithms that serve or can serve for diagnostic purposes in general. Any medical diagnosis procedure maps a panel of “findings” to a set of discrete diseases that include recommendations for the most efficient treatment. In surgical pathology, the “findings” include data that are derived from a) image content information, b) clinical history, c) expertise of the pathologist, d) knowledge about the disease. These are transferred using a statistical decision algorithm (neural network, discriminate analysis, factor analysis, etc.) into a diagnosis. Image content information (ICI) Several commonly not well trained pathologists assume that microscopic images or any morphology is representative for all kinds of diagnoses. They overestimate ICI which includes the information that can be derived from an image without any external knowledge. In fact, a disease can manifest with different morphologies and vice versa. Therefore, a correct diagnosis has to include all contributions of information, especially when computerized algorithms are used. Electronic communication is a useful tool to collect all available information for diagnostic purposes. Such a system should consider the different clinical impact and the level (details) of a stated diagnosis. It ranges from crude diagnosis such as cancer, infection, etc. to predictive diagnosis or even the evaluation of a disease risk (beast cancer associated genes) prior to its manifestation. Preparations of image content information measurements Any measurement is a communication to transfer image information to interpretation. This procedure has to be standardized by pre - analysis algorithms. They include optical issues (shading, gray value distribution, image size, object size, etc.) and issues of interpretation (regions of interest, object features, structures, and texture. They can be used to control and improve the laboratory’s quality. Conclusions Digital pathology offers numerous tools that can be composed to an effective and appropriate diagnosis system. The tools should collect data from all contributing information sources, standardize the collection and interpretation algorithms and grade the obtained diseases in appropriate disease levels that direct the available treatments. The coordination and standardization of the essential factors seem to be a main constraint of digital pathology implementation into routine pathology.

Distance reporting in digital pathology: A study on 950 cases

Background: Increased workload, case complexity, financial constraints, and staffing shortages justify wider implementations of digital pathology. One of its main advantages is distance reporting. Aim: A feasibility study was conducted at our institution in order to achieve comprehensive pathology services available by distance. Methods: One senior pathologist reported 950 cases (3,650 slides) by distance during 19 weeks. Slides were scanned by ScanScope AT Turbo (Aperio) and digital images accessed through SymPathy (Tieto) on a 14” laptop. Mobile phone, mobile broadband, broadband over Wi-Fi and broadband were used for internet connections along with a virtual private network technology (VPN). Lync (Microsoft) was tested for one case consultation and resident’s teaching session. Larger displays were accessed when available. Effects of ergonomics and working flexibility on the user experience were observed. Details on network speed, frequency of technical issues, data usage, scanning, and turnaround, were collected and evaluated. Turnaround was compared to in-office microscopic reporting, measured from the registration to sign off. Results: Network speeds varied 1–80 Mbps (median download speed 8–65 Mbps). 20 Mbps were satisfactory for the instant upload of digital images. VPN, image viewer, and laptop failed on two occasions each. An estimated data usage per digital image was 10 MB (1–50 MB). Two cases (15 slides) were deferred to microscopic slides (0.21/0.41%) due to scanty material and suboptimal slide quality. Additional nine cases (15 slides) needed to be rescanned for various reasons (0.95/0.41%). Average turnaround was shorter, and the percentage of cases reported up to 3 days higher (3.13 days/72.25%) comparing with in-office microscopic reporting (3.90 days/40.56%). Larger displays improved the most user experience at magnifications over ×20. Conclusions: Existing IT solutions at our institution allow efficient and reliable distance reporting for the core pathology services in histology and cytology. Stable network speeds, fully integrated laboratory information management system, technical reliability, working flexibility, larger displays, and shorter turnaround contributed to the overall satisfaction with distance reporting. A further expansion of our pathology services available by distance, diagnostic and educational, rely on gaining experience in digital reporting and marginal IT investment. Adjustments to the organization of pathology services may follow to fully benefit from the implementation of digital pathology.

Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $ll,000/case, respectively, and extrapolated to $21,500/case for other cancer types. Conclusions: The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.

The First Congress of the International Academy of Digital Pathology: digital pathology comes of age.

The First Congress of the International Academy of Digital Pathology (IADP) was held August 3–5, 2011 in Quebec City, Province Quebec, Canada. The IADP aroses as an evolution of the International Academy of Telepathology (IAT). The IADP is a non-profit organization whose mission is to advance information technology in the practice of pathology. The IADP aims to promote the standardization of digital pathology; promote research, innovation, development and good practice of information and communication technologies in pathology; exchange information between research scientists and pathologists through establishment of digital pathology networks; and provide education, research and development to enable the effective implementation of digital pathology in developing countries. The Congress held in Quebec City met the mission and aims of the IADP. It had presenters and attendees from eighteen (18) countries, with a broad range of professionals; including pathologists, researchers and engineers. There were a total of sixty-two (62) presentations at the Congress, including forty-nine (49)

Color standardization and optimization in Whole Slide Imaging

IntroductionStandardization and validation of the color displayed by digital slides is an important aspect of digital pathology implementation. While the most common reason for color variation is the variance in the protocols and practices in the histology lab, the color displayed can also be affected by variation in capture parameters (for example, illumination and filters), image processing and display factors in the digital systems themselves.MethodWe have been developing techniques for color validation and optimization along two paths. The first was based on two standard slides that are scanned and displayed by the imaging system in question. In this approach, one slide is embedded with nine filters with colors selected especially for H&E stained slides (looking like tiny Macbeth color chart); the specific color of the nine filters were determined in our previous study and modified for whole slide imaging (WSI). The other slide is an H&E stained mouse embryo. Both of these slides were scanned and the displayed images were compared to a standard. The second approach was based on our previous multispectral imaging research.DiscussionAs a first step, the two slide method (above) was used to identify inaccurate display of color and its cause, and to understand the importance of accurate color in digital pathology. We have also improved the multispectral-based algorithm for more consistent results in stain standardization. In near future, the results of the two slide and multispectral techniques can be combined and will be widely available.We have been conducting a series of researches and developing projects to improve image quality to establish Image Quality Standardization. This paper discusses one of most important aspects of image quality – color.