Digital Pathology in Sweden- Next Generation. Anna Bodén

Transcription

1 Digital Pathology in Sweden- Next Generation

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3 Notice of Faculty Disclosure In accordance with ACCME guidelines, any individual in a position to influence and/or control the content of this ASCP CME activity has disclosed all relevant financial relationships within the past 12 months with commercial interests that provide products and/or services related to the content of this CME activity. The individual below has responded that he/she has no relevant financial relationship(s) with commercial interest(s) to disclose:, MD

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5 Digital vs traditional pathology ROS Sympathy LIS xxxx IDS7 PACS Scanner

6 Pathology diagnostic process Patient and physician Lesion Selection of tissue Tissueblock Slide Histopathology

7 Sweden population: Area: km² (22,07 habitants/km² ) 23 pathology departments 213 pathologists (400) Östergötland: Area: 9979 km² (44 habitants/km²) Requests at the department Histopathology Cyt autopsy MO Screening cyt 20 senior pathologists 6 training pathologists Linköping municipality Habitants:

8 Linköping whole slide scanning and diagnostic in routine > 1, 700, 000 slides 331 TB All histopathological slides 2015: about slides 2015: requests, 6694 was digitally diagnosed (21%) Combination diagnostics Reviews Multidiciplinary meetings Cytology (ROI) for MDT meetings

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10 Both macro and microimages are available at the same time

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12 Diagnostic process Signing up for a case Assembling information Screening, diagnostic work annotations Qalitative and quantitative measurements Cancer administration, quality registers Signi ng out Comlementary staining, grossing Reviwing older material

13 Improve the pathology diagnosis 1. The pathologist s knowledge, experience and training, 2. Clinical correlation, 3. Use of ancillary confirmatory testing, 4. Use of standardized criteria for diagnosis and reporting standardized elements and 5. Selectively reviewing cases to assure accuracy Nakhleh et al. Error reduction and prevention in surgicalpathology Springer 2015 ISBN Use of integrated digital pathology Primary diagnostic Laboratory work flow Immunohistochemistry Molecular Control tissue Increased quality reassurance Reviewing Signing out Quality assesments Multidiciplinary meetings Education students Quality/internal education Communication Research

14 2016 workstations for both diagnostic modalities

15 Digital system in laboratory environment

16 Sten Thorstenson, Jesper Molin, Claes Lundström. Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences J pathol Inform

17 Processmap histopathology process Sample registered Grossing and embedding dehydration emebedding sectioning reorder staining He scanning Turning out after quality check diagnostic Writing report Signing out Multidiciplinary conferences

18 Two phases Secure implementation Define Techincal specification System adaptation and innovation Investment Verification/valid Workprocess Development of working strategies of the next generation digital system Secure Effective Reproducability New diagnostic criteria

19 Implementation Scanner Scan rout. Share Diagnos. routine Lab adjustment Inte- gration LIS Viewer Work station

20 Scanning routine

21 Laboratory adjustments, image quality issues! Less tissue on each slide and in each block Tissue placement on the slide Reduce space on slide Coverslide and media Label Dried slides necessary, 60 o C for 1hour

22 Scanner Ewerlöv ; Hamamatsu NanoZoomer-XR 320 slides Hasselblad ; Hamamatsu NanoZoomer-XRL, 160 large slides Aspelöv and Lindelöv ; Aperio Scanscope AT, 400 slides About 1000 slides/day slides/year > slides have been scanned so far Turn around time is increased in the initial laboratory workprocess Rescanning first and second less than 1%

23 Scanner routine workflow Labscan team Loading the slides into the trays/racks Loading and unloading the scanner Confirmation that all tissue on the slide is captured Other QA image issues Signing out the slide/case Confirmation that the case is complete according to LIS information Real slides +Virtual slides

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25 Image Quality

26 Functional system map Date of birth LID Case number Block Stain Sympathy LID Microimages Macroimages Worklists Showcases Conferences Quality issues IDS7/PACS LID Diagnostic Annotations Diagnostic aidtools Viewer

27 Shortterm 2 TB About 1 day Longterm archive 331 TB +10/month

28 Surveillance -Sectra and Eizo is watching Sectra is montoring our servers and the prestanda of the digital system Eizo is monitoring the monitors

29 Workstation Specification Work station Skärm (Granskningsskärm) Modell Typ Upplösning Eizo Radiforce RX850 Color TFT LCD Panel (IPS) 4096 x 2160 (17:9 visningsvy) Skärm2 (Administrationsskärm) Modell Regionstandard Övrigt Standard tangentbord HP med kortterminal. Standard mus 3D-mus Spacemouse Pro 3DConnection Dator Model: HP Z640 CPU: Intel (R) Xeon (R) CPU E GHz 2.40 GHz RAM: 12gb DISK: 128gb SSD Grafikkort: nvidia quadro k4200

30 Screen size, pixels, color Work station 6 Mp 6 8 Mp 4 Mp

31 Different screens and settings Work station

32 Screen settings Medical displays with locked presettings srgb Gamma=2.2 and 6500K 500cd/m2

33 Viewer

34 Diagnostic issues Diagnos routine Digital image is not equal to microscopic image Microsopic image is neither equal depending on microscope! Knowledge of the image and system Scanner type Scanner settings QA control of images Practical knowledge of how to work digital Validation of new diagnostic routine?!

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36 Diagnos routine Aperio scanned 20x Hamamtsu scanned 40x

37 Medical validation. Diagnostic licence? Diagnostic area Individual Scanning settings Precaution Verifying secure diagnostic routine

38 Example basic training Scanner area first scan Second scan

39 Example stage one validation test set Mix of Morphology Sample material Diagnostic challenges Gradings Color differences High power findings Digital vs microscopic image Clinical outcome

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41 CAD Human in the loop, HITL

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43 2030 is the cityregion Linköping-Norrköping one of the most attractive innovation region in Europe within visualisation, synthesis and analysis of visual information in all formats and implementation areas.

44 DigITal position 2016 in Linköping We see the advantages of having digital pathology integrated at the laboratory not only for primary diagnostic issues New technical system for share, store and viewing Laboratory and image QA issues have been integrated but needs further improvement for optimal workflow and diagnostic work Digital diagnostic routine needs to be integrated with the whole laboratory work process Going into digital pathology is a collaboration between IT and pathology knowledge! Research and development of diagnostic tools are becoming reality

45 Thank you! Darren Treanor Hélen Richard Carl Clasén Claes Lundström Jesper Molin Karin Skoglund, Arrigo Capitanio, Stina Garvin, Fredrik Bäckström Ann-Charlotte Mengel, Martin Hallbeck, Robert Ring Sten Thorstenson