Digital imaging is changing pathology by making it easier to identify and diagnose diseases. Pathologists are now able to use digital images to examine tissues and organs more closely, which has led to more accurate diagnoses. In addition, digital imaging is helping to improve the quality of pathology reports by providing clearer images of tissues and organs.
Pathology is the study and diagnosis of diseases. A pathologist examines tissue or fluid samples to establish a diagnosis on if and how a sample is affected, and what causes the findings. This branch of medical science has been around for about 200 years, and it has traditionally been done by studying samples under a magnifying microscope. An expert pathologist trains for years to discern visual cues of anomalies in samples. Because the number of diseases potentially affecting a specific tissue is very high, diseases keep mutating and changing, and far from all diseases have so far been successfully identified, pathologists usually specialize in one or a few types of tissue and diseases. The ability to see what is normal tissue or fluid, and knowing what causes an anomaly makes an experienced pathologist an expert in their trade.
It takes a career of learning for a pathologist to become an expert. With our increasing medical knowledge and ageing populations, the amount of pathology work is growing globally. There just aren’t enough pathologists to handle the number of cases, and this is a global problem. There isn’t enough interest in pathology from medical students to fill all positions, and even if there were, they simply couldn’t be trained fast enough to meet the ever-rising demand.
Not every hospital and clinic has its own onsite pathologist. To examine and diagnose the samples under a microscope, a pathologist must then either travel to the hospital where the samples are taken or, more often, send the samples prepared on glass slides to the pathologist. This means the pathologist is spending much of their time traveling, or the hospital is waiting for the slides to reach an expert. Sometimes slides get misplaced, lost, or delayed.
The delay in getting a diagnosis is both costly and arduous. For example, a cancer patient may come in for surgery to have malignant tissue removed. The surgeon carefully removes all tissue they think contains cancer, has sample slides prepared and sent to a pathologist, and the patient is sent home to await diagnosis, which can take weeks. If the pathologist then determines there is still cancerous tissue left in the samples, the patient is called back for follow-up surgery. This puts incredible stress on both the healthcare system’s resources, but most notably, it causes anxiety for the patient who is awaiting news on their state of health.
Digital pathology is the practice of pathology by viewing the tissue or fluid samples as high-resolution digital photographs or video on a computer screen instead of through the eyepiece of a conventional microscope. The most notable benefit of digitizing the samples is the possibility of viewing and sharing them online. The pathologist doesn’t need to be onsite, and the actual, physical slides no longer need to be shipped. This eliminates delay in the process, meaning a cancer surgery can potentially be concluded with a diagnosis, doing away with any need for a follow-up surgery. Without a need to travel, the expert pathologist can work from wherever they choose, spending their time and energy on what they do best: diagnosing. More time spent on the actual study of disease leads to a steeper learning curve for the expert and, therefore, a higher collective knowledge within pathology. Telepathology also means every single case can potentially be diagnosed by the leading global authority of its specific variety of disease studies online.
While the global pathology community agrees digital pathology is the future of this medical discipline, many pathologists still aren't ready to adopt it immediately. With healthcare systems overloaded worldwide, making time for changing processes, tools, and workflow is complicated.
Each clinic has ways of keeping afloat; even a tiny change in the process can cause problems when resources are already stretched thin. For a pathologist used to viewing slides on a microscope, switching to looking at a computer screen may seem trivial, but humans are creatures of habit, and change is demanding.
A far bigger issue than personal preference is that of workflow and process management. Moving from meticulously documenting, recording, and storing every glass slide for years to filing gigabyte-sized images on computer servers is, on its own, not simple. Making sure the process is well-designed, the information secure, all employees trained, and all equipment up to date is a very big undertaking.
Almost all clinics have a computerized laboratory information system (LIS), but they can each vary from the next. Therefore, for a lab to go digital a complete overhaul is often both the most logical and sensible way to go, but at the same time the least desirable from the point of view of those using it in their fast-paced daily work.
Understandably, implementing a digital workflow in a pathology laboratory can be very expensive too. Multislide scanners can cost hundreds of thousands of dollars, and they might require a dedicated space with specified air conditioning and vibration dampening.
A scanner often comes with its own software running on dedicated computers. All staff who work the scanner may require special training, with repeat sessions whenever the scanner system gets updated.
The global COVID-19 pandemic forced people to adopt remote work on an unprecedented scale. In pathology, the pandemic fast-forwarded legislation and regulatory guidelines to make it easier for people to not travel between healthcare points of service. In the face of necessity, there was a shift in attitudes as well, and the adoption of digital workflows and tools grew.
More and more laboratories will make the shift to digital in the foreseeable future. Digital tools in pathology save a lot of time for both the patient and the healthcare professionals. The reduced cost is, however, what will ultimately push the change forward, past the threshold of changing the workflow. Clinics can choose between overhauling their entire system at once or gradually updating it piece by piece. Both approaches have their pros and cons, and it is up to each clinic to decide which model is best for their workflow, patients, and business model.
The next logical step forward from digital pathology is including computer vision and artificial intelligence as tools for more efficient diagnosis. Computers and AI will not make human experts obsolete anytime soon but will instead make their work better by removing tedious and repetitive tasks.
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