Digital Pathology
for Improved Patient Care
Ole Eichhorn
Chief Technology Officer, Aperio
ole@aperio.com
Pathology Visions
October 2010
2
Digital Pathology…
Optical Microscopy
Digital Pathology
glass
slide
•
•
•
•
•
•
•
Requires microscope to view
One slide at a time
Limited to manual analysis
Burdensome archival & retrieval
Remote viewing not possible
Standalone
A “piece of the puzzle”
Digital
slide
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•
•
•
•
•
•
View via computer monitor
Multi-slide integrated viewing
Analyze by software algorithms
Instant archival & retrieval
View anywhere, anytime
Integrated with LIS
Supports consolidated viewing
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… for Improved Patient Care
Education
Research
Clinical
4
Education
applications for Digital Pathology
• Digital Teaching Sets
• Annotations
• Interactive Teaching Tools
• Remote Viewing /
Conferencing
5
Research
applications for Digital Pathology
• Drug Discovery
• Tissue Microarrays
• Biomarker Analysis
• Peer Review
• Preclinical Studies
• Predictive Toxicology
• Automated Screening
• Remote Viewing / Conferencing
• Clinical Studies
• Propagate Standards
• Remote Viewing / Conferencing
6
Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
7
Lab Anatomic Pathology Workflow
For clinical and educational use
Tumor Board
Lab AP Workflow
post-diagnosis
Internal /
External
Consult
Start
here
Histology Lab, In-hospital or outsourced
Sample
Sample*
Collection
Gross Exam
Slide
Preparation
Case
Assembly
Case Review
Release Result
Present
Present
Diagnosis to
to
Diagnosis
Patient
Patient
Incoming
Order
Additional
Tests
Inter-Operative
Frozen
Consults
Sections
pre-diagnosis
prognostic
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Algorithm
Analysis
Retrieval of
Past Cases
Patient
Referrals
At academic center, resident reviews
case prior to anatomical pathologist
Discuss Case
with Clinician
Outgoing
reporting
Storage and
Archiving
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Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
9
Archival / Retrieval
save consult cases – risk management
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10
Archival / Retrieval
manage active cases
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Archival / Retrieval
resident teaching sets
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Archival / Retrieval
case archives – decision support
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Archival / Retrieval
value of Digital Pathology
• Risk Management
• Easily retrieve all case information
• Decision Support
• Instantly retrieve / compare to previous cases for same patient
• Quality Control
• Simplifies selection / routing of cases
for internal overreads
• Clinician Communications
• Improves turn around time for patients
• Education
• Involve residents in review of cases
when not physically present
13
pathology reading lab, major medical center
14
Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
15
Intra-Operative Consults
reduce travel, simplify logistics
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Intra-Operative Consults
remote interpretation
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Intra-Operative Consults
value of Digital Pathology
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•
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Enables remote interpretation
Reduces travel / simplifies logistics
Enables realtime consultation with colleagues or specialists
Save / replay sessions for resident training
surgical pathology lab at major cancer center
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Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
19
Tumor Boards
preparation
19
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Tumor Boards
remote access / participation
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Tumor Boards
value of Digital Pathology
• Reduce time / simplify process for preparation
• Enable remote access / participation
• Improve presentation of case information
access all slides for case, display interactively
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Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
23
Consultations
shipping and handling
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Consultations
routing
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Consultations
value of Digital Pathology
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Faster turn around time, leads to competitive advantage
Improved workflow
Save cost / effort of mailing cases
Permanent record of consultation
Physical slides never lost
consult cases ready to ship at major medical center
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Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
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IHC Quantification
workflow and accuracy
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IHC Quantification
value of Digital Pathology
• Faster turn around time,
leads to competitive advantage
• Improved workflow
• More accurate results,
leads to improved patient care
• Attractive reports
Digital IHC quantification is U.S. FDA approved
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29
Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
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Digital Signout
Pathologist’s cockpit
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31
Clinical
applications for Digital Pathology
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification
• Digital Signout
32
Digital Pathology for Improved Patient Care
Education
•
•
•
•
Digital Teaching Sets
Annotations
Interactive Teaching Tools
Remote Viewing / Conferencing
Research
• Drug Discovery
• Tissue Microarrays
• Biomarker Analysis
• Peer Review
• Preclinical Studies
• Predictive Toxicology
• Automated Screening
• Remote Viewing / Conferencing
• Clinical Studies
• Propagate Standards
• Remote Viewing / Conferencing
Clinical
• Archival / Retrieval
• Risk Management
• Decision Support
• Quality Control
• CAP / CLIA Compliance
• Clinician Communication
• Education
• Intra-Operative Consults
• Tumor Boards
• Consultations
• IHC Quantification