Michael Dictor, MD, PhD Pathologist

Monica Haglund Business Strategist Department of Pathology, Lund, Sweden

University and Regional Laboratories

Digital pathology: the Swedish project

Venice 2012

Digi$zing'pathology'in'southern'Sweden'

'''Mission&impossible? X

Kris%anstad*

Lund*Malmö*

Helsingborg*

Department of Pathology University and Regional Laboratories Region Skåne

Our combined 4 labs in the Southern Healthcare Region offer:

• Full service pathology for 1.2 million people in the primary healthcare area + 400 000 people in the secondary referral area.

• Extensive clinicopathological conferences usually with visual presentations, representing all medical & surgical specialties.

• Research facilities.

2009: One organization 4 pathology labs

~ 220 employees

Pathologists ~ 40 Resident physician ~ 20 Biomedical scientists ~ 90 Lab technicians ~ 4 Autopsy technicians ~ 12 Medical Secretaries ~ 35 Others ~10

IHC in the same period increased by ~50%, PCR analyses by ~140% and therapy-directed analyses for colon and lung cancer increased from year 2009 to 2010 by 160%.

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05 06 07 08 09 10 11

No.

of s

lides

Production in histopathology

No.

Total slides

Case consults

Year Year

1450

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05 06 07 08 09 10 11

Slides/workday

Why digitize pathology? •  Lack of qualified pathologists, ineffective

backup coverage •  Increasing work loads with more and

complex analyses per specimen •  Quality Assurance demands •  Suboptimal work flow despite extensive

computerization •  Now is the time to modernize anatomical

pathology!

The solution?

•  Equipment upgrades

•  Faster workflow

•  Redistribution of tasks among work groups

and now •  Digital imaging

We have focused on….

Can scans replace microscopes for diagnostic work?

Mantle cell lymphoma scanned with 20x objective

Do scans show enough detail for close diagnostic work?

H&E Anti-HP

Helicobacter gastritis scanned at 20x

LIMS process control work%list%for%the%pathologist%

Specimen Status No. slides

No. scanned

Pathologist Surname First name Patient ID Group Accession date

PL233-12 stained 7 4 MD/TC Björk Hans 420517-3513 thorax 03-15-12

PL267-12 embedded 0 0 Nilsson Gunilla 720809-5624 gyn 03-16-12

When is a case ready?

How to distribute cases?

Dynamically updated, including supplementary stains

Future digital pathologist working at home?

Image labels are derived from LIMS block labels + stains

LIMS Specimen Status No.

slides No. scanned

Pathologist Surname First name Patient ID Origin Accession date

PL233-12 stained 7 4 MD/TC Björk Hans 420517-3513 thorax 03-15-12

PL267-12 embedded 0 0 RH/IS Nilsson Gunilla 720809-5624 gyn 03-16-12

Terabyte server

Scanning Image acquisition database

20x or 40x

Dictation using voice recognition software

1A: Lat. margin 2A: Tumor CD31

3A: Sup. margin 4A: mediastinal tumor

Labeled thumbnails

PL233-12 4A: Mediastinal tumor

Goals Process-oriented LIMS

Technical support for the specimen flow and imaging (including traceability of slides/blocks)

All histopathological slides (cytology to be determined) will be scanned, just over 90,000 cases/year (>420,000 slides/year).

Images will be archived in perpetuum, long-term strategy to be determined.

Main advantages Distribution of diagnostic work based on capacity and expertise Work conference processing, remote consulting/conferencing

Upgraded skills through greater collegial interaction

Equipment 10 scanners, each 400 slide capacity + 4 scanners, 5 slide capacity (incl. Supermega)

50 diagnostic image monitors, 30’’ 4-6 Mpix + 50 text monitors for LIMS Imaging database

Quantitative image analysis algorithms VoIP with presence indicator

2 server installations, fully duplicative Initial 110 TB + increase by 110 TB every 8 months

A work in progress

Digital image analyses

apps for HER2, ER, PR etc

Digital slide conferencing Create live conferences connected to LIMS

Connection to modern LIMS Automatic patient-secure connection to LIMS with

block/slide tracking

Education, training, quick reference

Remote diagnostics Total access to medical data as well as digital

slides, private alternatives, work at home

Acute remote diagnostics Connect surgery and pathology from different

hospitals (SN)

Research

Features and advantages

Routine diagnostic work Sufficient quality

Second opinion Domestic & foreign

Thanks for your attention!

Michael Dictor and Monica Haglund