Digital Pathology Tumor Boards – “Be Like Mike”

At Tumor Board several months ago, I watched my radiologist friend, Mike, present.  He would zoom back and forth from digital image to digital image.  He could correlate mammogram, ultrasound and MRI images.  When asked, he could easily call up past studies on a patient and show the changes over time, side by side.   You could almost hear the oncologists and surgeons ooh and aah.  His radiology digital image viewer and PACs system allowed Mike to be a star.  I said to myself, “I wish I could be like Mike.”    This reminded me of Gatorade’s commercials starring Michael Jordan

When I prepare and present pathology at Tumor Boards, I spend hours preparing for a single Tumor Board.  Like all pathologists, I have to review the slides and reports on all patients, including the previous relevant biopsies, if they are available.  Then, depending on at which hospital I am working that day, I have either to circle regions of interest on several slides to project using a microscope with a video camera or I have to take several static microscopic images and insert these images into a Powerpoint presentation.  This is then repeated for the next 5 or 6 patients.  I then have to take thumb drive or multiple cardboard trays of slides to the Tumor Board.

Mike, the radiologist, while no Michael Jordan, can move in and out of his list of patients to present like an iTunes playlist while I am still using paper.  I have to fumble with slides trying to find the region interest, quickly, before I lose the audience.  I think sometimes people observing get a bit sea-sick from my moving around the slide, changing objectives and trying to get in focus. Mike’s images can be annotated ahead of time to save time at presentation.  If a radiation oncologist asks for a tumor size, he can precisely tumor size in real time.  I can’t do that.  If asked, he can pull up previous imaging studies from the radiology PACs, the patient’s.  Most of the time, I do not have the patient’s previous slides.  My friend Mike once confided to me that the Radiology PACs system was so smooth that his preparation was only about 30 minutes compared to my 1-2 hours.

But, I could “be like Mike”, the radiologist if I had digital whole slides.  My patients would be in an iTunes like list.  I could zoom from very low to high power magnification effortless.  I images are always in focus and bright.  I could annotate on the fly.  I could find and show previous biopsies.  I could cut and paste images and send them to surgeons or oncologists.  The secretaries and lab assistants would not have to look for all those slides each week.

What would it take to “be like Mike?”  I would need: a whole slide scanner, a viewer or image management solution and an interface with my LIS.  If I were only using it for tumor board presentations, I would only need a low volume scanner.  There are several vendors available, such as Leica/Aperio, Philips, Optrascan, Hamamatsu, 3DHistech, Huron Digital Pathology, Objective Imaging, as well as others.  Many of the above vendors also will sell and promote their own Viewer/Manager but they are specific to their scanners.  There are also independent and agnostic viewers available.  By agnostic viewer, I mean a viewer that can read and display the image formats from multiple vendors.  The agnostic viewers include: Gestalt Diagnostics, Corista, ViewsIQ, Sectra, as well as others.  Then I would need an interface between my laboratory or anatomic pathology Lab Information System and the image management/image viewing system.  Who knew it would  be so easy to  “be like Mike.”

Image attributions:  1        https://labblog.uofmhealth.org/rounds/solid-tumor-board-changes-childhood-cancer-treatment-courses  2.  https://www.youtube.com/watch?v=47bdNiw2pIA  3.  Gestalt Diagnostics

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