Rapid on-site evaluation ties a pathologist to the procedure room. Washington University moved the image instead of the person – and got roughly a workday a week back per pathologist.
The numbers behind the cytopathology staffing shortage are not subtle. The United States has roughly 65 pathologists per million people, around 1,000 pathologist posts sit unfilled, and only about 450 new pathologists enter the profession each year. Cancer incidence is rising and molecular testing volumes are growing. The gap is widening from both directions at once.
Rapid on-site evaluation makes that gap harder to manage than most services. ROSE requires a pathologist to be physically present while a specimen is collected, so a single case can occupy far more of a pathologist's day than the reading itself takes. At Washington University School of Medicine, pathologists were spending substantial time travelling between procedure rooms - time that came directly out of diagnostic work.
Professor Hannah Krigman and Associate Professor Suzanne Crumley approached this as a logistics problem rather than a staffing one. Rather than move the pathologist to the specimen, they moved the image.
A Grundium Ocus 40 scanner sits in the procedure room itself, small enough that it needs no dedicated space. A cytotechnologist scans each slide immediately after preparation. The image is transmitted to the cloud and opened in a browser by a pathologist who may be in another building, another city or another state. A live view function allows real-time viewing without waiting for a complete scan, and the pathologist and on-site team stay in contact by phone or secure messaging.
The Ocus 40 captures at 40x magnification, which is the standard for diagnostic cytology - an important detail, because a workflow that compromises on image quality does not survive contact with real casework.
By 2023, Washington University School of Medicine had extended digital ROSE coverage to six locations, including two hospitals in Illinois.
The clearest result was time. Removing travel between sites reclaimed approximately one additional workday of diagnostic time per pathologist per week - without adding a single member of staff.
Three other effects followed. Immediate adequacy assessment prevented unnecessary repeat biopsies, because the question of whether a sample was sufficient could be answered while the patient was still in the room. Slide preparation became more consistent across the network, as remote review surfaced variation that had previously gone unnoticed. And clinicians received preliminary diagnoses faster.
Evidence from elsewhere points the same way: at Intermountain Health, a comparison of digital frozen sections against glass slides found 94 of 96 reads in full agreement.
The conclusion is that subspecialty expertise no longer has to be tied to a building. A pathologist who can read from anywhere can cover several facilities, and the facilities that gain most are the ones least able to recruit dedicated cytopathology staff in the first place – rural hospitals, satellite clinics, and regional networks operating at the edge of their capacity.
That does not solve the shortage. It does make the pathologists already in post considerably harder to run out of.
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Originally published in The Pathologist in January 2026. Read the full article.
Dr. Hannah Krigman (Washington University) delivered an engaging presentation on “Using telecytology for ROSE,” sharing practical insights and real-world examples.
