February 23, 2020Isis Ricaño-Ponce, PhD
Clinical labs have been slow to adopt digital pathology, mainly due to technical limitations such as low-resolution imaging, high bandwidth requirements, and instability of the operating systems. But now with better computers, faster networks, cheaper storage, and better image resolution, clinical labs can perform digital pathology with fewer roadblocks. Follow these seven steps to make your lab’s transition to digital pathology as smooth as possible.1
1) GET THE LAB STAFF INTERESTED
The first step of moving to digital pathology is convincing the pathologists and the rest of the lab staff to accept the change. How can you convince staff? With facts. Ask your staff to read digital pathology-related articles, case studies, and best practices. Let them come to understand the benefits of digital pathology based on the evidence.
2) FIND AND INTEGRATE A DIGITAL PATHOLOGY SYSTEM
Find an adequate digital pathology system for the size and requirements of your lab that can be integrated with your laboratory information system. This step is crucial as it will save plenty of time and avoid human errors in the handling and processing of the samples. Do not forget to determine all the infrastructure that you will need to accommodate a digital pathology system, including network, storage, and security.
3) IDENTIFY YOUR AIMS AND HOW TO ACHIEVE THEM
Define the aims of each of your workflow stages, how they will be carried out, and who will carry them out. Establish a check list as an internal quality control for each of the stages.
4) VALIDATE EACH STEP OF THE WORKFLOW
Validate whether the entire workflow is working and improving the efficiency of the lab. The validation can be performed in three steps: First, the technical aspects of the digital pathology system alone must be checked; second, its integration with the laboratory information system (communication and speed) should be examined; third, it is important to determine how well the staff are executing the new system and how the system works in the context of the lab, including extreme scenarios.
5) TRAIN THE STAFF
Provide adequate hands-on training for lab personnel. A week-long intensive training period of 15 hours to cover the key essentials, followed by online access to complementary material and manuals, has been suggested.1 Remember that there will be a learning curve for staff, resulting in a period during which there might be discrepancies and slower results from digital pathology-based diagnosis compared to glass slides.2 Full conversion to digital pathology takes time.
6) COMPARE THE NEW AND OLD SYSTEMS
Prior to full adoption, compare the new digital pathology system to the previous system. Once the digital pathology system is in place and each step of the process is working correctly, it is necessary to validate the quality of the scans and ability of the new system to read the whole slide imaging (WSI). In this step, pathologists should review the same slide first using glass slides and again two weeks later using WSI. Concordance between the two methods should be tested, and turnaround times should be compared. Depending on the results, the digital workflow might need to be further refined.
7) EVALUATE THE PROCESS
Designate an individual to continually evaluate the digital pathology system after implementation. This person should keep track of the daily incidences— such as slide preparation problems, laboratory information system communication issues, and problems with the equipment—and document the benefits of the system and staff satisfaction, and provide feedback to the lab manager.
1. Cheng, Chee Leong, et al. “Enabling digital pathology in the diagnostic setting: Navigating through the implementation journey in an academic medical centre.” Journal of Clinical Pathology 69.9 (2016): 784-792.
2. Van Es, Simone L. “Digital pathology: semper ad meliora.” Pathology 51.1 (2019): 1-10.