This document discusses the role of digital imaging in pathology. It begins by defining digital pathology and whole slide imaging. It then discusses how digital imaging is replacing traditional glass slides and allows for transmission of images for consultation and education. Whole slide imaging allows entire slides to be digitized and has applications in education, research, and clinical pathology. Telepathology allows remote diagnosis by viewing digital images rather than glass slides. The document outlines the components of a telepathology system and discusses advantages and limitations of both digital and glass slides for education.

1. ROLE OF DIGITAL
IMAGING IN PATHOLOGY
PRESENTED BY- DR. SRISHTI RATIYA
MODERATOR- DR. PRATIBHA MAAN

2. INTRODUCTION
• A dynamic , image based environment that enables the acquisition,
management and interpretation of pathology information generated from a
digitized glass slide.
• Often used interchangeably with virtual microscopy.
• Telepathology- pathology service component of digital pathology.
• Whole slide imaging (WSI)- Single, high magnification digital image of an
entire microscopic slide.

3. ● Digital imaging is rapidly replacing photographic prints and Kodachromes for
pathology reporting and conference purposes.
● Advanced systems linked to computers allow greater versatility and speed of
turn-around as well as lower costs, allowing the incorporation of macroscopic
and microscopic pictures into routine pathology reports and publications.
● Digital images allow transmission to remote sites via the Internet for primary
diagnosis, consultation, quality assurance and educational purposes and can
be stored and disseminated in CD-ROMs.

4. ● Total slide digitisation is now a reality and has the potential to replace glass slides
to a large extent.
● There are extensive applications of digital images in education and research,
allowing more objective and automated quantitation of a variety of morphological
and immunohistological parameters.
● Three-dimensional images of gross specimens can be developed and posted on
websites for interactive educational programs And preliminary reports indicate that
medical vision systems are a reality and can provide for automated computer
generated histopathological diagnosis and quality assurance.

8. TELEPATHOLOGY
• Practice where pathologists render diagnosis from a distance by viewing
electronically transmitted images rather than an examination of glass slides by
themselves using a light microscope .
• Ronald S Weinstein coined the term- Telepathology(1986).
• Today: Fourth generation telepathology system (also called virtual slide
telepathology system), are used for education applications.

9. Advantages of Telepathology
● Faster diagnoses and consultations – Frozen section diagnosis can be made rapidly by
providing remote pathologists with immediate access to the images. Telepathology
consultations can be provided through subspecialists, including dermatologists, renal
pathologists, and neuropathologists.
● Better quality evaluations – Virtual imaging permits pathologists to look at the entire slide
with better clarity. With just a single slide and a portion of the entire series, pathologists
have an easier time evaluating the whole pathological history. Human error is reduced
significantly because the diagnostic process is driven by software.

10. ● Evaluation of slides from a distance – Thanks to real-time telepathology, it is possible to evaluate an
entire slide from a distance. Pathologists can use different levels of illumination, change focus, and use
magnification to evaluate an entire slide from a distance. This is particularly useful when it comes to
slides that should not be exposed for extensive periods of time due to the threat of contamination.
● Live video Collaboration – Real-time telepathology makes it possible to transfer images as a live video
feed to various monitors. Different pathologists can observe the images as a part of a live video feed at
the same time. Based on the live video feed, a pathology team can come to a single consensus
regarding a diagnosis.
● Improved Communication – The live video feed promotes communication across teams. Different
teams can study a live video feed and then use an online conferencing facility to communicate with
each other and share conclusions. Even if the teams are in different locations, they can observe cases
simultaneously.

11. TELEPATHOLOGY
● Original specimens usually a glass slide; image
must be digitised before transmission.
● Original quality of images may be lost as a
result of digitisation of images.
● Criteria still being established.
● No comparable requirement of training and
assessment in digital imaging techniques in
histopathology.
● Histopathology selected areas viewed at a
very wide range of magnifications ; larger
number of data files.
TELERADIOLOGY
● Produces images that are already in digital form.
● None of the original diagnostic information has
been lost or degraded.
● Well-established international standards in
radiology for image acquisition, storage and
transfer.
● Radiologists trained to understand factors that
influence digital image quality.
● Images viewed at a relatively limited range of
magnification; fewer data files.

12. COMPONENTS OF TELEPATHOLOGY SYSTEM
• A conventional microscope (optional- motorised optics and stage)
• A method of image capture.
• Telecommunication links between sending and receiving sites.
• Workstation at the receiving site with high quality monitor to view the images.
• Mechanical Hardware to allow the receiving pathologists to control the
microscope from a distance and view the entire slide in ‘Real time’.

15. Telepathology for Macroscopy
(Gross Pathology)

16. ● Digital photography has changed the face of the pathology report significantly, allowing the
incorporation of colour prints of the gross specimen as well of relevant microscopic features,
arguably enhancing the documentation and reproducibility of the findings.
● As there are essentially no running costs, there is no limit to the number of images used, so
that it is possible to replace or supplement traditional, often lengthy, descriptive prose with
high quality images.
● There have been a few descriptions of home-made systems using general consumer digital
cameras linked to computers for routine use in surgical and autopsy pathology.
● An optimal set-up for gross photography must have a remotely controlled camera to avoid
contamination, and downloading of images and specimen/accession number recognition
should be automatic.
● While it is possible to obtain good digital images with many of the lower end cameras that
produce 3–5 megapixel images, automatic downloading and remote control are much more
difficult to achieve.

21. WHOLE SLIDE IMAGING (WSI)
• A single, high magnification digital image of an entire microscopic slide.
• How does it work?
➢ An automated microscope “knits” smear images together into a single large image.
➢ This WSI is stored usually in a digital slide repository

22. WSI Types
o Bright field
• Most common and least expensive
• Used in- H&E, IHC, CISH
o Fluorescence
• used in FISH
o Multisectoral
• Combination of both

23. Application of Whole slide imaging (WSI)
(1)PATHOLOGY CLINICS
• Primary/Remote frozen section diagnosis.
• Teleconsultation.
• Virtual IHC.
• Archival of cases.
• Tissue transplant assessment.
• Automated cytology smear & blood film
analysis.

24. (2) EDUCATION
• Pathology training/E-learning
• Publications
• Teleconferencing
• Virtual tracking and workshops
• Tumour boards
(3) RESEARCH & BIO-INDUSTRY
• Tissue banking
• Biomarker development
• Image analysis
• Personalized oncology suite for
immunotherapy
• Human genome project
• Doing study

25. PROS & CONS OF GLASS VS. DIGITAL SLIDES IN EDUCATION ENVIRONMENT
GLASS SLIDES
• Existing infrastructure.
• Carry-over skill practice
VIRTUAL (DIGITAL SLIDES)
• Faculty time saver
• Annotate-able
• Rare features made widely viewable
• Adaptable to groups or individual
study
• Access anywhere, anytime
• Makes lab space multi use
• Adapts to testing easily
• Thumbnail view for orientation
ADVANTAGES

26. GLASS SLIDE
• Faculty time intensive
• Slide maintenance
• Feature selection limited by need
for many cuts
• Student time demanding
• Physical storage space
VIRTUAL (DIGITAL) SLIDE
• Investment in software &
equipment
• Diminished faculty contact to
model pathology
• Device & network speed may
lead to slow slide loading.
DISADVANTAGES

28. ● High Resolution images
● Relatively short time of scanning
● Easy image portability & retrieval
● Support online teaching & self-learning
● Easy to handle
● Fast image analysis
● Act as permanent record even if glass slide are
sent out for any other purposes
● High cost of scanner
● Need for uninterrupted internet & power
supply
● Extra time & effort for validation
● Process & training pathologists & technicians
● Difficulty to manage large digital files
● Difficulty to scan large tissue sections & thick
smears
● Need of special data protection system
Advantages & Disadvantages of WSI
Advantages Disadvantages

38. THANK YOU