Efforts are moving forward at Yale New Haven Health to convert histology glass slides into digital whole slide images as tens of thousands of slides have already been scanned, said Sudhir Perincheri, PhD, MBBS, Assistant Professor of Pathology and Director of Digital Pathology.
“We have close to 60,000 slides scanned right now, but that’s a small number and we are very early on in the process,” said Dr. Perincheri, who is leading the digital efforts. “Instead of focusing on numbers, what we are trying to do is optimize things for our workflow.”
That includes scanning slides in the Yale New Haven Hospital (YNHH) system as well as those that come from outside institutions, including cases from patients and physicians seeking continued and higher-level care at YNHH or a second opinion from Yale pathologists.
“We send these slides back to the referring institution,” Dr. Perincheri said. “We’re scanning those before we send them back so we have a record we can refer to, if needed.”
Although the conversion is in its early stages, it will have clinical and educational implications as digital images can be accessed and shared electronically, he said. The digital conversion will also solve the issue of where to store the many slides Yale Pathology produces each day.
Dr. Perincheri said the effort will enhance patient care by allowing for faster diagnosis, which leads to quicker implementation of treatment plans, and will enable pathologists to use digital specimens in educational settings and clinical conferences such as tumor boards.
“There’s a validation process that we are in the beginning steps of, but once we do the validation, our pathologists can sign out cases using the computer instead of the microscope. Also, if I want to present at a tumor board, I don’t have to pull the slides. I can just go to the computer. If I want to show a case to someone, I don’t have to physically carry the slides.”
Making slides digital may also improve the ability to glean information from a specimen.
“Although we are not fully there, there are things that you can do digitally that are more precise. I might eyeball a specimen on the scope and say, ‘It’s this size.’ But it’s much more precise with a digital slide. There’s a potential to be a lot more quantitative than you would be with a glass slide,” Dr. Perincheri said. “Digitizing slides also opens up the exciting possibility of computer-aided diagnosis using artificial intelligence algorithms in clinical workflow.”
Yale Pathology recently acquired a license for a presentation platform called PathPresenter that enables digital slides to be used for educational purposes.
“The PathPresenter platform will allow us to teach using these digital slides, and when our faculty attend conferences, they can use it to make presentations,” Dr. Perincheri said.
Funding from the Yale New Haven Health System enabled the acquisition last summer of two high-volume scanners and software to view and analyze the newly created digital files.
“It took us a while to get up to full speed. There were issues with imaging-viewing software training and other troubleshooting that had to be done,” Dr. Perincheri said.
After those problems were resolved, the team turned their focus early last summer to scanning slides, an ongoing process. The bulk of the scanning has been done by Drew Mason, a technologist in the Slide Room who also played a key role in troubleshooting issues during implementation, along with help from personnel in histology including Wenifer Diggs, a Clinical Technologist, and Cindy DeRiso, Senior Pathology Manager in Histology.
They have received assistance from Peter Gershkovich, MD, MHA, Associate Professor of Clinical Pathology and Director, Section of Pathology Informatics and Cancer Data Science, the Pathology ITS team, and the YNHH CIT team.
“Digitizing the slides is one thing, but you also have to enable workflows on the back end, so Dr. Gershkovich and his team have developed applications that help us in our clinical work and presentations of these slides,” Dr. Perincheri said.
The scanners are located in the Histology Laboratory and the Immunohistochemistry Laboratory. Kara Hyatt, who joined Pathology earlier this year as the Digital Scanning Operations Manager, recently demonstrated how the scanner works, placing slides into a cartridge that holds several slides. The cartridge then goes into a carousel inside the scanner. Dozens of slides can be placed in the scanner at once, she said. The scanner reads and digitizes the slides. Hyatt then uses a remote laptop to call up the slides, which are permanently in digital form at the conclusion of the process.
Dr. Perincheri said that although the process is in its infancy, it’s viewed as an important step along a digital pathway that leads to better patient treatment through faster, more accurate diagnoses.