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Journey to Digital Pathology

Journey to Digital Pathology. Michelle Precourt, BSMT (ASCP) LIS Sr. Manager. The Children’s Hospital of Philadelphia. The Journey Begins…. Gathering Information- API- Association for Pathology Informatics- Digital Pathology Workshop CAP Regulatory requirements RFI- Request for Information

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Journey to Digital Pathology

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  1. Journey to Digital Pathology Michelle Precourt, BSMT (ASCP) LIS Sr. Manager

  2. The Children’s Hospital of Philadelphia

  3. The Journey Begins…. • Gathering Information- API- Association for Pathology Informatics- Digital Pathology Workshop • CAP Regulatory requirements • RFI- Request for Information • Purchase of scanners • Assembling a project team • Hardware/Monitor demo • Storage space calculation • LIS integration • VNA- Vendor Neutral Archive Integration

  4. Pre-Work Education- API- Association for Pathology Informatics- Digital Pathology Workshop- wealth of information shared. RFI- Drafted RFI sent to Leica, Phillips and Ventana Hardware Selection: upgrade PC and Monitors

  5. The winner is…..Leica Aperio • Open file format - .svs format is TIFF with JPG/JP2000 compression and .scn format is a layer TIFF • Z-stack available • Supported output of dicom images • Trade in of our original Aperio scanner • Established relationship- good customer service

  6. Hardware • High performance Levono P530 PC with additional 16GB Ram • Monitor selection- Demo’d 4 monitors • HP 4K monitor -Non Medical grade • Barco 3 megapixel • Barco 4 megapixel Medical Grade Monitors • Barco 6 megapixel

  7. Why Barco Medical Grade Monitor ? • MediCalQAWeb is... • the industry’s first online service for high-grade Quality Assurance. The all-inclusive secured system is your guarantee for consistent image quality and uptime DICOM calibration • automated Quality Assurance • display asset management • problem solving • reporting • Why MediCalQAWeb? • Superior image quality with reliable, intervention-free calibration and QA • Proactive notification of quality issues • Seamless implementation of regional QA guidelines • Standard report distribution and customized reporting

  8. Scanners • 2 – AT2 scanners • 400 slide capacity brightfield scanner.High throughput with small footprint • Z-stacking up to 25 layers • 1- Aperio Versa scanner • IHC, ISH and Fluorescent Tissue whole slide scanning. • Advanced tissue detection for faint for lightly stained brightfield and fluorescent samples • Z-stack capture for thick samples

  9. AT2 and Versa Scanner

  10. Pathologist Monitor set up

  11. Currently using scanned images for look backs

  12. Use Cases • Primary diagnostics- Starting with primary diagnostics for immunofluorescence slides • Secondary use cases: • Consult cases • Historical look back comparison • Conferences • Teaching • Research

  13. Project Scope • Connection of 3 Digital Scanners to E-slide manager (eSM) • LIS integration between Soft and eSM • Establish integration to Vendor Neutral Archive Storage (VNA) • Archive/image repository for research • Validation for Primary Diagnosis • CAP Telepathology Compliance

  14. Incremental Approach- 4 phases • Connectivity of Scanners and Eslide manager (eSM) to network storage • LIS integration • VNA Integration • Upgrade to High Performance Image scope

  15. Digital Pathology Workflow

  16. Architecture and Design LIS/eSM INTEGRATION

  17. VNA Integration Data Flow

  18. Panel tracking for slide stain action

  19. Panel tracking for slide scan action

  20. Interpretation Result Entry

  21. Launch of thumbnail using slide viewer button

  22. When you click on scan manager it open the application viewer eSM. Configuration to open at case level or slide level

  23. Nice to haves • Launch eSM directly from main screen in IRE has been requested by pathologist • Slide viewer available after sign out • Back scanning of slides either ability to enter slide information into eSM and send back to soft or ability to query Soft for information based on slide id

  24. Validating WSI for Primary Diagnosis • Validation per the CAP guidelines (for each Pathologist) • 60 cases—scope of diagnoses seen in the lab for 1 application- Additional 20 cases for each additional application ie special stain • Read by Microscope or Digitally • 2 week washout • Read by alternate modality

  25. OBSTACLES

  26. Obstacles • Dicom standards for Pathology still in development • Archive integration requires professional services where integration standards fall short • Coordination between 4 vendors- SCC, Leica, Illuminate, and Hyland • Large Storage requirement- dwarfs Radiology requirements • Performance concerns • Leica development delays/missed deadlines

  27. Where Are We Now? • We are getting ready to go live with Phase 2- LIS integration • Prepping cases for Pathologist to start validation • consist of 100 cases • 80 cases for light microscopy • 20 cases for Immunofluorescence cases • Waiting for Leica development for • Phases 3- High Performance Image scope (July timeframe) • Phase 4 – Development to start for integration. Will take approximately 17 weeks. Also need version of eSM14 available. Do not have a solid date but it is expected by the end of the year

  28. Questions???

  29. Please remember to take a few moments to fill out the session survey. You can find the QR code in your Conference Brochure as well as hyperlinks to the survey online at www.snuginconline.org with the SNUG 2019 handouts.

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