Digital Imaging
Behind the Scenes
Stacey Yates
Overview
• Implemented Workflow
• Challenges/Solutions
• Added Value
• Future Plans
Telepathology
Where are we coming from?
Trestle robotic microscope installed for acrosscampus frozen section consults
Problems:
▫ Too Cumbersome for everyday use
▫ Scanning too slow for real-time review
 Approximately 1 minute per slide
▫ Scan not retained from slide to slide
Telepathology
Where are we coming from?
Needs:
▫ Capability to view multiple slides at once from
anywhere
▫ Quickly and easily find images to be used for
teaching and research
▫ Ability to reference images from past cases
without waiting for requested slides.
▫ Enhance the learning experience for trainees.
Starting the Process
• Digital Imaging Committee
▫ Pathologists, Residents and
IT Staff
• Evaluated multiple scanners
and database management packages
• Important Requirements:
▫ Simple Database Management
▫ Ease of Use
▫ Speed and Quality of images
Equipment/Infrastructure
Aperio ScanScope
• ScanScope XT: 120 slide
capacity.
• All clinical scanning
• 20x and 40x Magnification
BioImagene
• iScan
• 20X
• 160 slide capacity
• Currently research only
• Not linked to clinical image
database
Storage
• Dell MD3000 PowerVault
▫ 15 - 300gb Harddrives
• Dell MD1000 PowerVault
▫ 15 – 300gb Harddrives
Total Clinical Image Storage = 7.5 Terabyte
• Dell PowerEdge 2970
▫ Runs server software and services
• Dell PowerVault TL2000
▫ Backup Tape Library
Network
gigabyte
3 blocks apart
Lets Get Started….
February 2008
• Scanned only research and conference slides
• Became comfortable with the scanner and
database
• Began instructing users on how to use Spectrum
• Small group of “Power Users” utilized Spectrum
for conferences
Oops!
• Problems found:
▫ Scanning process long and tedious
▫ Manually entering patient/case information into
Image Database from LIS
▫ Equipment Downtime and Storage Space
▫ Learning curve for finding images
 Residents embraced the technology
 Pathologists did not want to use two separate systems
▫ Image interface not good for educational purposes.
Learning Curve
You want me to do what?
• The Plan:
▫ Group and individual training sessions
• The Result:
▫ Confusion
▫ Lack of interest
• Solution:
▫ Viewing images directly from LIS
Scanning Process
Marriage of the LIS and Image Database
Before the marriage could
take place Barcoding had to
be implemented.
Barcode contains:
Inside Accession #
Block #
Slide #
Scanning Process
Marriage of the LIS and Image Database
1. Histology is entered to create a label with
barcode for each slide.
2. The barcode is temporarily attached to the
slide.
Scanning Process
Marriage of the LIS and Image Database
3. Each slide must be cleaned and free from dust
and fingerprints
4. Once the slides are loaded a snapshot is taken
of each of the slides.
Area of
Interest
Scanning Process
Marriage of the LIS and Image Database
5. Once the image is scanned an HL7 message is sent
to our LIS containing the link to the image on the
server and the barcode id.
6. The LIS then sends a message back to the Image
database with identifying information:
▫
▫
▫
▫
▫
▫
▫
Medical Record Number
Patient Name
Birth date
Hospital
Part Type
Accession Number
Stain
Scanning Process
Marriage of the LIS and Image Database
7. Image Database uses the information to file the
slide under a new patient or attaches it to an
already existing patient.
▫
The MRN number, patient name, date of birth
and hospital must match.
8. Each slide is reviewed for quality, the label is
removed and sent back for filing or returned to
referring institution.
9. Verify each slide is linked to LIS and the
information sent to Spectrum is correct.
Scanning Process
The Workflow
Slides Received
Slides Returned to
Referring Institution
Case Signed Out
Slides
Reviewed
Diagnostic Slides
Selected
Slides
Scanned
Barcode
Printed
Timeline: Start to Finish
• 20X
▫ Label Slide with barcode = 1 minute
▫ Prep slide for scanning = 1 minute
▫ Scan slide = 6 minutes
 Total = 8 minutes per slide
• 40X
▫ Label Slide with barcode = 1 minute
▫ Prep slide for scanning = 1 minute
▫ Scan slide = 33 minutes
 Total = 35 minutes per slide
• Most scans are between 500,000 mb and 1 gb
• Turn around time usually 48 hours
Scanning Process
Problems Solved by LIS Integration
▫ LIS integration increased productivity and took
away some of the manual data entry
▫ Ensured slides where filed with the correct patient
information
▫ Pathologists only used one program to access
slides
▫ Over 12,000 digital images linked to LIS
Learning Curve
Viewing Images through LIS
Learning Curve
Viewing Images through LIS
Equipment Downtime
• Over the past 2 years
▫ 5 days of complete scanner downtime
▫ 6 days of manual scanning due to scanner
hardware malfunction
▫ 2 -3 days to catch up after downtime
• Back-up Plan?
▫ Bring 2nd Scanner on line
Image Storage
• April 2010
▫ Original 7.5 tb full
▫ 18,078 images
• Today
▫ Added 25 tb
▫ Currently 23,663 images
• Will we need more storage?
Education
Study Sets
▫ Faculty can create sets of digital images
▫ Used as teaching tool for residents and fellows
Education
Quiz
▫ Quizzes are created to evaluate progress
Education
Case of the Week
▫ Weekly case is presented
▫ Trainee’s get a chance to review
▫ Diagnosis is posted at the end of the week
Added Value
• Availability: immediate access to images for
increased efficiency in patient care, education
and research
• Permanent: no lost or broken slides
• Portable: send images instead of slides for
consults, legal requests
• Conferences: Ability to take images to
conferences instead of actual slides
• Teaching: Create teaching sets and quizzes using
digital images
Future Challenges
• Viewing images remotely through Citrix
▫ Citrix will not work for viewing images through
LIS
▫ Citrix will allow the searching of the Spectrum
database and opening of images through
Spectrum using ImageScope but is extremely slow
• Continue to build teaching sets to aid in the
education of residents and students.
▫ Evaluate software to manage the educational and
clinical aspect of digital imaging
Future Challenges
•
•
•
•
Currently requires one full-time position
Continue to build an image repository.
Image Analysis
Ability to search for images based on diagnosis
without opening each case in LIS
• De-identified searches for education and
research purposes
Thank you!
Digital Imaging
Behind the Scenes
Stacey Yates