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Digital Whole Slide Imaging for Patient Care in Toronto

Digital Whole Slide Imaging for Patient Care in Toronto. Dr. Andrew J. Evans Staff Pathologist & Associate Professor Department of Pathology University Health Network, Toronto, Ontario, Canada. Disclosure. Leica Microsystems Aperio Vendor/client relationship only.

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Digital Whole Slide Imaging for Patient Care in Toronto

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  1. Digital Whole Slide Imaging for Patient Care in Toronto Dr. Andrew J. Evans Staff Pathologist & Associate Professor Department of Pathology University Health Network, Toronto, Ontario, Canada

  2. Disclosure • Leica Microsystems • Aperio • Vendor/client relationship only

  3. UHN Whole Slide Imaging Telepathology • Primary frozen section diagnosis • Sub-specialty pathology service to hospitals in Northeastern Ontario • Maintaining 24/7 sub-specialty coverage of transplant pathology services

  4. University Health Network • No on-site pathologist • 2-10 frozen sections • per week (mostly • neurosurgery) ~ 1 mile

  5. TWH Frozen Sections: The Problems to Be Solved Single pathologist traveled to TWH Inefficient process - traveling and waiting Disruptive to workflow – 99% of departmental activity occurs at TGH delays in regular sign-out affecting other UHN patients No possibility for consultation on difficult cases. Compromised diagnostic accuracy Unnecessary deferred diagnoses

  6. Due Diligence In-house training and validation (18 months) Medical Malpractice Insurance Provider (CMPA) UHN Medical Advisory Committee Health Canada – Therapeutic Products Program telepathology does not involve “medical devices” Surgeon Education

  7. The Robotic System: November 2004-October 2006 • 350 frozen sections • accurate • deferral rate < 10% • slow (~ 10 minutes/slide)

  8. Whole-Slide Imaging: October 2006-Present • > 1300 frozen sections • 90% from neurosurgery • 98.5-100% accuracy (month to month) • 14-16 minute turnaround time • 7.5% deferral rate • 2 pathologists review all deferrals

  9. Whole Slide Imaging Telepathology • Easy consultation with colleagues – better for patient care • Essentially no learning curve – transition from robotic in 1 month

  10. Whole-Slide Imaging: Cases Requiring Re-Scanning Image quality is not a problem! < 2% of cases poor-quality slide folds in tissue section too thick freezing artifact No difference with microscope

  11. UHN Partnerships in Northeastern Ontario • Timmins (2005) and Sault Ste. Marie (2006) • Shortage of pathologists, no sub-specialists • No pathologist in Timmins 1-2 weeks/month • Glass slides shipped to UHN • Limitations: • Frozen sections • Lost/damaged slides • Delays with transporting slides

  12. Timmins & District Hospitals - April 2008 • consultations • frozen sections • > 60 patients • completely digital • within 2 years > 400 miles Google Maps 2008

  13. Sault Area Hospitals - October 2008 • consultations > 400 miles Google Maps 2008

  14. Transplant Telepathology at UHN • Orthotopic liver transplant program • ~ 600 post-transplant biopsies/year • 2 – 5 urgent biopsies/week (same day or next morning results) • Practical Issues: • - 3 liver pathologists • - absence for CME activities • - consultation with on-call colleagues after hours

  15. UHN Liver Transplant Whole-Slide Imaging Telepathology • 31 biopsies • 17 for cellular rejection • 3 potential donor biopsies • 11 for non-transplant medical liver disease • Hepatologists and surgeons highly satisfied with service • 1 missed diagnosis: donor liver frozen section • 1AT deficiency on paraffin sections requiring special stain • would not have made this diagnosis on the frozen section with a microscope

  16. Skin Cardiac Other Sub-specialty Consults Renal

  17. Whole Slide Imaging Telepathology:Summary of UHN Experience SAFE, RELIABLE and ACCURATE Tremendous value added: Primary frozen section diagnoses Consultations between colleagues Providing timely service to remote hospitals 24/7 support to transplant programs Similar “niche” applications in the United States most definitely exist.

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