DIGITAL PATHOLOGY
in the scanning process regularly takes priority over more sophisticated software deployments, resulting in a high proportion of ‘bundled’ scanner software purchases (which are more cost-competitive than separate software sales). Once roll out has been completed and a department begins to mature in its use of the new workflow, further investments are often made in software to create a more sophisticated IT solution which is more intuitive for the end user. If enough budget is not available, or was not sequestered previously, this can leave pathologists having to compromise between price and functionality. Another example lies in the fact that departments in the UK are now beginning to digitise cytology departments after successful anatomic deployments, only to find that scanners previously selected are not able to accommodate shifting from tissue to liquid samples. This can result in additional scanner purchases, which can significantly reduce budgets or delay timelines.
Given even less priority, however, are the storage requirements and protocols which need to be associated with a digital image.
Why image storage is important Cardiology and radiology departments in a hospital have long had established archiving practices. From a technical perspective however, the digitalisation of pathology whole-slide images is significantly more challenging. The size of data generated from pathology imaging is magnitudes greater than the largest radiological image, with an average mid- sized hospital (~100,000 cases per year) predicted to require over 1PB in storage annually for a fully digitised department. A petabyte (PB) is equal to 1,000 terabytes (TB) or a million gigabytes (GB). Associated budgets for storage, even using typical methods preferred in other
2000
Worldwide market for digital pathology Hardware
Software 1500
40% Service Annual growth 35% 30% 25% 1000 20% 15% 500 10% 5%
Fig 2. Revenues for digital pathology products from 2019-2022, forecast until 2027. 0
2019 2020 2021 2022 2023 2024 2025
imaging departments, would also be magnitudes greater, and it’s important to note that the pathology department, unlike radiology, receives no cost-savings from the digitalisation process and is still required to retain physical slides. Funds therefore cannot be transferred and must be considered in initial budgets. Table 1 shows in brief a range of storage options that pathology departments can explore. Each tactic has its own unique benefits and appeals to different types of providers; however, the market is extremely heterogeneous in its approaches today.
In the past, deletion and external hard drives have been popular, as they offer the least costly solution for providers with constrained budgets. As scanning volumes begin to scale and departments begin to rely more heavily on digital diagnosis, a shift in direction is occurring towards solutions which allow storage to scale more easily. Both on-premise archives (like VNAs (vendor neutral archives)) and cloud
Purchase Scanner:
Initiative Begins: Budget
determined. Timeline outlined.
Lower throughput scanners may be appropriate for occasional use, some scanners will be inappropriate for cytology slides.
Trial Logistics:
Determine ergonomics of process, training regimes, if slide preparation requires adjustment, quality control processes…
Rollout:
Minor adjustments made, circumstances fixed for next few years.
0% 2026 2027
hosting are being increasingly utilised in DP to scale storage with minimal difficulty. Diagnostic IT departments should already be well familiar with on-premise storage deployments through radiology and cardiology imaging. Those departments currently utilise on-premise PACS and VNAs to host data, however worldwide cardiology and radiology IT is also slowly beginning to convert to the cloud. The main drivers of this are that it offers easier scaling capabilities, involves outsourced security measures, and comes with automatic recovery protocols. Table 2 shows the expected transition over the next five years within different hospital departments to cloud storage models.
As shown, DP is also expected to
increase its adoption of cloud storage, both in the UK and abroad. One major driver here is that the UK government is championing cloud adoption across the NHS; through funding support for technology innovation and establishing a cloud first policy for procurement of
Determine DP Utilisation: i.e Teleconsults, Breast cancer diagnosis, MDTBs, full scale primary diagnostics…
Select IMS:
In early adoption where budgets are often constrained, scanner purchase is prioritised. Once institutions mature, they typically seek more sophisticated software.
Fig 3. The digital pathology adoption process 28 JUNE 2023
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Involve IT Departments: Determine integration necessary, evaluate infastructure. Who
requires access? Are there security concerns? Image storage chosen.
Post-Rollout: Reflection and
evaluation. 6+ months, image analysis/AI consideration and planning.
Revenues (USD M)
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