DIGITAL PATHOLOGY
Image Exchange [PIE], 48 sites) underway with many leading hospital groups already using whole-slide imaging (WSI) for primary diagnosis, such as LabPON in the East Netherlands region and UMC Utrecht (which achieved 100% anatomic digitisation in 2016). As laboratories in this market begin to mature, it’s worth keeping an eye on where investment turns to next, and how institutions choose to evolve. For example, UMC Utrecht has recently released an analysis of its DP activities, revealing that diagnostic turnaround had decreased by up to two days post-digitisation. Looking ahead, the laboratory plans to implement the DICOM standard across all of its images (something the UK is also supporting) but also will explore digitisation of its cytology samples.
Cytology has traditionally taken a back seat in clinical digitisation efforts in favour of tissue-based pathology, and an even smaller proportion of cytology workflows are digital today. Observers yet to tackle cytology workflows would do well to watch implementations like these for nuances relevant to their own organisations.
Questions such as: ‘Will the current fleet be able to support high-volume scanning for cytology?’ (not all scanners today can produce Z-stack images); and ‘How will cytology departments approach image analysis differently?’ (Arguably cytology processes such high volumes of cases, that AI can help aid diagnosis merely by triaging cases for review and filtering out negative results, a lower-risk approach to AI adoption) will become increasingly commonplace in procurement planning meetings. The process for digitising cytology samples is very different to anatomic samples, as for example scanning times can be much longer for the former due to higher resolutions being required over a larger scan area. This fact has been further pronounced by the relative divide between digital vendors in the market today which usually specialise in one or the other.
In the UK market, vendors are beginning to note an increasing desire for cytology digitisation and so for those considering making this transition in the near-term it would do well to keep an eye on peers also embarking on this step.
n South Korea Interoperability with digital pathology Whilst most laboratories in South Korea have yet to digitise, in March of this year Samsung Medical Center achieved a world first, by being awarded a Stage 7 DIAM (and EMRAM) grading.
The ‘Digital Imaging Adoption Model’ 48
Instead of going fully digital, many private laboratories worldwide have chosen to adoption DP for a subsegment of applications that allow DP AI to support workflows.
(DIAM) is a model intended to measure maturity within medical imaging IT – jointly developed by the Healthcare Information and Management Systems Society (HIMSS) Analytics Europe and the European Society of Radiology (ESR). Stage 7 requires that the majority of image-producing service areas are exchanging and/or sharing images and reports and/or clinical notes based on recognised standards with care organisations of all types, including local, regional or national health information exchanges. This enables multidisciplinary interactive collaboration whilst also supporting patient access. In particular this garnered attention as the Center was acknowledged during this evaluation as a ‘world leader’ in digital pathology, with authorities noting: “This is the most comprehensive use of integrated digital pathology we have seen.” Samsung uses a single, cloud- native solution to support its digital images, underpinned by 5G infrastructure. This reportedly allows turnaround time for frozen test consultations to be reduced by around half compared to without the network.6
Whole-slide images created for DP can be between 2-4GB per slide (x20 magnification) or even 12-15GB per slide (x40 magnification), which places increased pressure on networks and can create delays through latency. The NHS is starting to trial 5G implementations across different settings, with applications for support beginning in August 20237
, but consideration should also be given to laboratories
which will likely have to handle file sizes much larger than in most other sectors of healthcare. Software investments can be the most advanced available today, but if they aren’t underpinned by robust enough infrastructure there will always be problems for users.
n Spain
A national approach to storage Elsewhere in the world, whilst Spanish implementations are relatively rare, regional tenders and investment in the region is increasing. The Intercentre Provincial Pathological Anatomy Unit of Granada is considered the first fully digitised unit in Spain, and some large implementations do exist, such as the Catalan Health Institute (ICS) which operates within a network of eight hospitals producing over a million slides each year. This network, whilst large, has so far only digitised its oncology department, but has publicised its journey well.
Implementation in this region is noteworthy as Spanish institutes reportedly are more likely to retain images indefinitely. In particular, the ICS has done so with a view to annotate, standardise and ultimately use its WSIs to produce AI algorithms to support internal research initiatives. The Spanish government has
reportedly made a limited amount of pre-existing object storage available for Spanish laboratories to utilise, thus encouraging its institutions to store images. Object storage is a term used to describe architecture designed to
APRIL 2024
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