Picture Perfect: Imaging Strategies in
Pathology
Cerner Health Conference 2005
Orlando, FL
October 9 – 12, 2005
Oncology and Pathology Informatics, UPMC
Why Do Imaging in Pathology?
UPMC Perspective
• Strengthen the reporting of results in anatomic
pathology
• Provide images for tumor boards and build libraries of
images for teaching
• Correlation between microscopic appearance, the
clinical presentation, and gross specimen appearance
• Image on reports as “A Marketing Tool”
Oncology and Pathology Informatics, UPMC
Why Do Imaging in Pathology?
Cerner Perspective
• Promotes a single, central point of data for each
specimen
– Temporary states such as tissues during gross can be
recorded
– Requisitions, diagrams, lab results, consult reports,
plus other pertinent info are tied directly to AP data
– Quicker access to pertinent microscopic information
• No need to request retrieval from storage and relocate area of interest on the slide
• Images access from any enabled workstation can
eliminate tedious slide or paperwork retrieval activities
• Images are directed to permanent storage immediately,
minimizing impact due to misfiling or misplacement
• Images on reports are cool – our clients want cool
reports!
Oncology and Pathology Informatics, UPMC
Overview of our Plan
The 2001 Image Solution Project
• Upgrade UPMC’s Imaging Solution to accommodate:
– Better integration with AP system
• Improve correlation of different phases of the
specimen via image use
– Enhance teaching curriculum via image use by
keeping a file of all interesting cases
– Enhance tumor board presentations exporting
selected images into PowerPoint
– Include images on patient reports
Oncology and Pathology Informatics, UPMC
Challenges Associated with Imaging
• Software-hardware compatibility
– Gross and microscopic camera types
– Scanner types
• Workflow
– EASE of use
• Image storage
– Local Area Network (LAN) support
• Deployment and support of image capture workstations
over the UPMC Health System
• Inability of results interface (HL7) or archival systems
to store and/or manage images
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head-on
Hardware/Software Compatibility
• Assessment of current hardware
– Grossing Stations
• 5 existing Sony Video cameras at became goforward hardware
– Microscopic workstations
• 11 Existing Sony Video cameras would be used
• Added 12 Spot Insight digital camera
workstations
– Scanners
• 3 Scanners used at transcription workstations
• Worked with vendor to find new compatible cameras
• Camera compatibility is on-going issue as technology
changes
Oncology and Pathology Informatics, UPMC
On-Going Technology Changes
Researching New Hardware and Compatibilities
• Research cycle generally follows Bill’s release cycle
– Workstation hardware, OS, and acquisition devices
all need to work together
• Steps undertaken:
– Install PICSPlus on designated Test Environment
workstation
– Acquire new hardware/OS
– Obtain loaner acquisition device of interest
– Test, Test, and Test again!
– Cost justification ever-present challenge
– Staff is happy to get new toys!
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head On (continued)
Needs and Workflow
• Demands from Grossing Bench
– Easy… maintain current standards
• Demands from the Pathologists
– Specific requests for digital cameras in personal
offices
• New workflows investigated and implemented for
scanning
– requisitions
– reports
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head On (continued)
Image Storage
• Image capture predictions were way off
– In actuality, approximately 2300 images are
acquired per month
• We check storage stats daily!
– Expansion of storage space done
• Local Area Network Configuration
– 12 acquisition devices were added
– Images are captured and viewed from 4 out of 9
different hospitals
– Storage is on a single image server
• Image Server Maintenance and Backups
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head On (continued)
Deployment throughout UPMC Health System
• Deployment Plan
– Since we had an existing solution, all workstations
came on-line at same time
• Educating the end-users
– initial one-on-one training for Spot Insight and
Scanner users
– Continuous Education
• High turnover in transcription; staff predominately
takes on this training
• Training is on-going for new residents and fellow
• Image Acquisition “Go Live”
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head On (continued)
Supporting Imaging Workstations and Users
• Support Needs
– At the beginning, support requests predominately
due to training issues
• including my own education
• Once things settled down, now I see
• As cameras age, these issues increase; most
cameras are 5 years old
• White balance is most prevalent issue
– found California vendor to refurbish
cameras, effectively resetting camera’s
standard default setting
Oncology and Pathology Informatics, UPMC
Meeting Challenges Head On (continued)
Interfaces & Other Systems cannot handle Images
• HL7 Result Interfaces are used to transmit results to
hospital system
– We do not transmit reports with imbedded images to
other systems
• Printing Reports with Images
– Consulted with other sites using images on reports for
Printer recommendations
– Lexmark C910 Model
– Our clients are very happy with image-enabled
reports!
Oncology and Pathology Informatics, UPMC
Advances in Imaging: Internet Ready Devices
• Nikon COOLSCOPE:
– Microscope with built-in digital camera: used for
capturing and consultation over the network
Oncology and Pathology Informatics, UPMC
Internet Ready Devices (continued)
• Nikon DS-U1 PC based camera:
– Observation, photography and networking are all
possible with this single unit
Oncology and Pathology Informatics, UPMC
Our Imaging Solution In Pathology
The PICSPlus Advantage:
• Provides a solution for management of macroscopic
and microscopic images and related case information
• Images can be acquired using a wide variety of
equipment: digital and video cameras and TWAIN
compatible devices
• Ability to import send-out report files, annotated
diagrams and imported copies of requisitions
Oncology and Pathology Informatics, UPMC
PICSPlus (v2.4) Use at UPMC
• Server Scalability/Multiple servers available
– 1 server, high acquisition rate that might change
• PICSPlus Maintenance Module
– Image Server and Acquisition Workstation Activity
• Used quarterly to monitor usage
– “Lost” Image detection tools
• Nice to have, hoping I never have to use!
• Selectable image quality for reports
– Default quality setting works well for us
• Updated Acquisition Module Implemented
– Need for this dictated by hardware problem
Oncology and Pathology Informatics, UPMC
Image Acquisition
Updated Acquisition Features
Gained
• Report linkages indicated in
Gallery
• Streamlined Matrox acquisition
• Template definition per
workstation
Oncology and Pathology Informatics, UPMC
Image Acquisition
• Acquisition of images through the image gallery
manager window
• Provides a simple key stroke to acquire images into the
gallery
• Ability to switch options, import from TWAIN, import
from file or import from Matrox
Oncology and Pathology Informatics, UPMC
Image Gallery Manager
Oncology and Pathology Informatics, UPMC
Image Gallery Manager
PICSPlus Gallery Manager contains the following
components:
• File Menu – close manager and return to CoPathPlus
• Edit Menu – delete selected image file(s)
• Attachment Menu – import from file,export from file,
import from Matrox, import from TWAIN
• Option Menu – select default templates (PICSPlus
Template Dictionary, gross image, microscopic image,
etc.) and import action (import from File, TWAIN or
Matrox) per workstation
• Parameters – assigned to selected image file
• Linked to Reports – indicates whether an image is
included on any patient reports and the report status
Oncology and Pathology Informatics, UPMC
Importing Reports
Oncology and Pathology Informatics, UPMC
Importing Diagrams
Oncology and Pathology Informatics, UPMC
Image View Manager
PICSPLus View Manager contains the following components:
• Zoom controls – allows you to increase of decrease the
size of the image in the viewer
• Annotation feature – objects placed on images to focus
on a specific area of interest
• Copy to Clipboard – ability to copy the image with
annotations to the Clipboard
• Burn Annotations – allows you to PERMANENTLY apply
the annotation to the image
Oncology and Pathology Informatics, UPMC
PICSPlus Report Gallery
No specific guidelines
for acquisition volumes
and report assignments
Oncology and Pathology Informatics, UPMC
Images on Patient Report
Oncology and Pathology Informatics, UPMC
Reporting Considerations
Report Manager Functionality
• Report image gallery displays all the image(s) selected
to be on the patient’s report
• To transfer image(s) from the image gallery to the report
gallery, click and drag!
Benefits and Cautions
• Image(s) on reports is a very effective marketing and
educational tool
• Clinicians are warned that image(s) on reports are for
reference purposes, not clinical diagnosis
Oncology and Pathology Informatics, UPMC
Thank You
Any Questions or
Comments?
We have Cerner experts in
the audience to handle
solution-specific questions
Oncology and Pathology Informatics, UPMC
Oncology and Pathology Informatics, UPMC
PICSPlus v2.5 Features
Preview of Coming
Attractions
Oncology and Pathology Informatics, UPMC
PICSPlus General Features
• 2 new activities streamline workflow and
reduce window painting requirements:
– PICSPlus Image Entry/Edit
– PICSPlus Report Image
Select
Oncology and Pathology Informatics, UPMC
PICSPlus Image Entry/Edit
Oncology and Pathology Informatics, UPMC
Updated Image Gallery
Oncology and Pathology Informatics, UPMC
PICSPlus Report Image Select
Oncology and Pathology Informatics, UPMC
PICSPlus Report Manager
Oncology and Pathology Informatics, UPMC
Gallery Review Feature
• Gallery Review functions cycle through slides in
sequence as found in respective gallery
– Image Gallery Review shows PICSPlus Gallery images
– Report Gallery Review shows Report Gallery images
• Use timed review or press spacebar to move
• Display Setup configures:
– Timer
– Magnifier height, width, and shape
– Times Magnification
Oncology and Pathology Informatics, UPMC
Image Gallery Review with Setup Window
Oncology and Pathology Informatics, UPMC
Image Gallery Review with Right-Click Menu
Oncology and Pathology Informatics, UPMC
Image Gallery Review with Magnifier
Oncology and Pathology Informatics, UPMC
PICSPlus View Manager Features
• Redesigned Image Review and
Annotation features:
– Four tabs of data and tools in View Manager:
Marks, Process, Color, and Info
– Updated annotation tools
– Orientation options to Flip and Mirror with
degrees designated
– Moving magnifier in maximized view &
Gallery Review
– Picture in Picture Mark, can use to add lab
logo
– Undo operations
Oncology and Pathology Informatics, UPMC
View Manager: Marks Tab
Oncology and Pathology Informatics, UPMC
View Manager: Process Tab
Oncology and Pathology Informatics, UPMC
View Manager: Colors Tab set Blue
Oncology and Pathology Informatics, UPMC
View Manager: Info Tab
Oncology and Pathology Informatics, UPMC
Images on Signed Out Cases
Image on Report
Image not on Report
Image Annotations
• NOT allowed if image on S/O report
• Allowed if image NOT on S/O report
Oncology and Pathology Informatics, UPMC
Tools and Utilities
• New install is more “gentle” and straight-forward
– when activating a PICSPlus Add-on in Wkstn Setup, the
system tells you when to run Workstation Add-on Install
– Nothing is assumed, add each desired component
• JPEG-2000 compression schema recovers disk
– Scheduled Background conversion
– “Just in Time” conversion
• Support of 26 major file formats for import
– Previously just jpeg, tiff, and bmp were supported
• Multi-page tiff images supported
Oncology and Pathology Informatics, UPMC