DIGITAL PATHOLOGY
to work from home. “You do have the possibility for more flexible work,” Bjerkestrand said. And importantly, a more flexible work environment can help laboratories find qualified pathologists from a broader talent pool. By eliminating the need to hunch over microscopes, digitisation improves the ergonomics of diagnostic work, which makes it easier for hospitals and laboratories to retain more tenured pathologists, some of whom may need physical accommodations.
Unexpected benefits These work-life balance benefits for employees may not show up in financially focused ROI calculations, but they are important to factor in over the long term; along with other future-proofing considerations. At Vestfold, for example, digitisation also led to unexpected improvements in patient care in the broader clinical setting.
After evaluating digital scanners in a blinded trial for image quality and characteristics including focus, colour matching, and sharpness relative to glass slides, the pathologists at Vestfold hospital chose the Aperio GT 450 digital pathology slide scanner from Leica Biosystems.
DP benefits
But change of this nature also brings major benefits. The Digital Pathology Association’s calculator includes savings resulting from increased staff efficiency related to slide retrieval, transport, and sharing. At Vestfold, Suhrke found that digital whole-slide images enabled faster case sharing for second opinions and collaboration on difficult cases compared to glass slides. The laboratory staff spent less time handling slides, searching archives, and delivering slides to pathologists. There are also longer-term upsides
that are harder to quantify but equally important to consider. “The next frontier, which is fast approaching, is AI,” said Suhrke. “If you’re planning to take part in that transformation, then you of course have to have a digital workflow established.” The Digital Pathology Association does not yet include AI in its calculator, though it plans to add it as a consideration in the near future. Laboratories that adopt DICOM image standards now will be well positioned to explore and integrate the breadth of AI tools and applications as they come online. Benefits related to interoperability and IT infrastructure are harder to measure but are critical to consider for long-term flexibility and digital expansion.
52 Of course, upfront ROI calculations
are imperfect and only a best guess at the costs of digitisation. The only way for a laboratory to truly understand the financial costs and benefits of digitisation is to take the plunge and carefully track how the implementation plays out.
Moving forward When Suhrke got the green light to move forward, team member Ane Bergsli Bjerkestrand was tapped to help evaluate digital scanners in a blinded trial for image quality and characteristics including focus, colour matching, and sharpness relative to glass slides. The evaluation eventually led the laboratory to select and move forward with the Aperio GT 450 digital pathology slide scanner from Leica Biosystems, based on superior image quality and performance. Initially, Bjerkestrand said, laboratory members not involved in the evaluation were apprehensive about image quality, but those fears turned out to be unfounded. “I was happy – and also a little bit surprised – with how good the digital images were in comparison to glass slides. The image quality was excellent,” she said.
The change also brought unexpected benefits for talent acquisition and retention; for example, creating the attractive opportunity for pathologists
Bjerkestrand noticed that digitisation made pathology more relevant to other clinicians for the simple reason that it made it easier to share cases and contribute valuable clinical insights during multidisciplinary meetings such as tumour boards. “We have always shown images of the cases through video microscopy, but this sharing required identifying the appropriate glass slide, placing it under the microscope, selecting the representative field of view, and finally, dialling in the right magnification and focus,” Bjerkestrand said. “By the time we had a good image on the screen, the surgeons and radiologists had in many instances already wrapped up their discussion and were ready to move on to the next case.” Now, the pathologists can retrieve and project cases instantly, as well as providing additional information on topics of increasing relevance and interest like immunohistochemistry testing, immune cell infiltrates, and correlation with genomic studies. In its digitisation journey, Suhrke’s laboratory took the time to plan ahead, and that foresight is paying off. The long-term return on investment will take time to fully realise; but the benefits are already overwhelmingly clear. As Suhrke emphatically shares: “There’s no going back!”
Reference 1 Ardon O, Asa SL, Lloyd MC et al.
Understanding the financial aspects of digital pathology: A dynamic customizable return on investment calculator for informed decision-making. J Pathol Inform. 2024 Apr 10;15:100376. doi:10.1016/j. jpi.2024.100376.
FEBRUARY 2025
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