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| REVIEW ARTICLE |
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| Year : 2014 | Volume
: 1
| Issue : 1 | Page : 17-20 |
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Digital Pathology Slides in Medical Education
Mithilesh Chandra
Senior Consultant Surgical Pathologist, Director, Pathology Consultancy Services, CEO, Digiscan- A House of Digital Slides and E-Modules, Noida, Uttar Pradesh, India
| Date of Web Publication | 24-Jun-2014 |
Correspondence Address:
Mithilesh Chandra
B-6, Sector-27, Pathology Consultancy Services, Near Jain Mandir, Noida - 201 301, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
Advent of virtual microscopy in the last decade has revolutionized medical education in many countries. Time has come when our country should also adopt this innovative technology to enrich medical education. Keywords: Digital slides, medical education, virtual microscopy
How to cite this article:
Chandra M. Digital Pathology Slides in Medical Education. Indian J Dermatopathol Diagn Dermatol 2014;1:17-20 |
| Introduction | |  |
Health care in India is making rapid strides in every field. Last two decades have witnessed rapid growth and digitalization of the health care. Many aspects of patient care and record keeping are now based on Information and Communication Technology (ICT). This change has resulted in world class medical care in India leading to booming medical tourism. [1],[2]
However, digitalization has not yet become a part of medical education. Hence, there is a mismatch in the training of medical graduates and postgraduates in digital world and the requirement and expectations from them. Young doctors trained in India are at a disadvantage when they go for further training to other developed countries. There is an urgent need to focus on this issue and take remedial measures in the field.
| Digital Slides - Technological Innovation | | |
Virtual microscopy is the process of producing virtual images with the help of an advanced motorized microscope called "virtual microscope". Virtual microscope is a trinocular microscope with robotic control of various adjustments like illumination, movement of mechanical stage in x and y axis, change of objective, coarse and fine focusing of the section. Slide kept on the stage is scanned in the magnification selected and hundreds of pictures are taken of the section by automatic movement of the equipment, which therefore is also called "Digital scanner" [Figure 1]. Each field is auto focused before the capture of image. On completion of scanning, the tiled pictures captured in millions of pixels, are stitched and blended together with the help of software to finally produce a composite picture which is exact replica of the tissue section. The image thus created is automatically stored in the computer. [1]
The image is called digital slide or whole slide image or virtual image or e-slide and has the characteristics of the original section. If the scanning quality of the section was not optimal, quality of the image can be improved in terms of color saturation, brightness and contrast with the help of a software. Digital slide can be viewed on the screen of the PC or laptop in any magnification just like a glass slide is viewed under the microscope and any area of the slide can be viewed. Large size monitors or wall-sized screens are very helpful in teaching in class rooms. Image can be annotated to point out salient features which are very useful for undergraduate teaching. | Figure 1: Scanning microscope with scanning of glass slide under progress. Image of the area being scanned is seen on the computer screen. Source – www.digiscan.co.in
Click here to view |
However, it must be borne in mind that quality of virtual slides depends upon the quality of the original slide being scanned. The glass slides to be scanned have to be free of artifacts such as folds, knife marks, air bubbles, and stain deposits to get the best results.
Most of the vendors provide scanners with facility of scanning traditional slides of 75 × 25 mm size but larger slides of size as big as 200 × 150 mm can also be scanned by some scanners. Many scanners also provide facility for autoloaders where up to 200 slides can be loaded in the racks for automated scanning instead of one slide at a time.
| Digital slides as an adjunct to glass slides | | |
In conventional teaching of histology and pathology to students, glass slides are used which are viewed under the microscope. However, certain problems are encountered by the teachers as well as the students due to various reasons. Glass slides are fragile and break; staining of slide fades with storage; air bubbles, fungal growth, discoloration of mounting medium and other artifacts develop with passage of time necessitating preparation of new glass slide sets at regular interval. In newly established medical and dental colleges where supply of tissues for preparation of slides is not regular, institutions have to depend on purchase of slides from vendors. Sometimes the number of microscopes are much less than the number of students, hence each microscope is shared by two or more students. Due to shortage of staff in many colleges, teachers are not able to explain the slides to every student. Students do not have freedom to view the slides at their free or convenient time, hence are bound by the availability of the microscopes in the class room. [1]
E-slides help in resolving many of these problems as these slides are not breakable, do not fade or develop artifacts and do not need regular preparation of sets. Once prepared or procured from the vendor, slides are stored in computer hard disk and can be retrieved easily. These slides can be annotated showing prominent structures of the lesion for ease of teaching as well as understanding by the students. Students can view slides on their laptop while the teacher is showing the slide from his laptop and thus e-slides promote interactive learning [Figure 2]. There is no constraint of time and space as students can view the slides anywhere and anytime. Therefore e- slides form an excellent tool of self study. [3] | Figure 2: Depicts comparison of traditional pathology with digital pathology. Only one pathologist can see the slide under the microscope at one time. With digital pathology two or more pathologists can see the same images on their computer screens at the same time. Source www.nikon.com
Click here to view |
Though globally e-slides are gradually replacing conventional glass slides for class room teaching, we in India are not yet ready for this technology, which enriches medical teaching of morphological subjects like histology and pathology.
| Digital slides in medical education | | |
Digital whole slide images are going to bring revolution in medical education and usher in era of e-education. Futuristic class rooms will be devoid of microscopes and will be equipped with PCs or laptops. Professors will be showing whole slide images or virtual e-slides instead of glass slides and students will be viewing the images on their laptops. This technology will be highly effective for self-learning. [3],[4],[5],[6],[7]
The virtual slide will become an instrument of bringing uniformity of teaching in various institutions as images will be duplicated and distributed in colleges across the country. Only one slide will be sufficient for teaching millions of students. Next few years are going to witness improvement in the quality of medical education and bring it at par with global centers of excellence.
| Storage and cataloging of teaching material | | |
Digital slides will completely revolutionize storage of slides in the departments of histology and pathology. Instead of glass slides, E-slides will be stored in the computer disks. Compilation of slides will be computerized and retrieval will be easy. Physical space will not be required for storage of slides. Digital slide libraries will be excellent for self study by the residents.
| Second consultation in pathology | | |
This application is the most popular for pathologists and oncologists. Opinion on difficult and cancer cases is sought from renowned expert pathologists located across the world. Our center has also been seeking opinion from experts by sending digital images over web server to expert pathologists [Figure 3]. Opinion is obtained within hours via internet. If need is felt to discuss the case, this is done through Skype and final report is prepared. | Figure 3: Photograph depicts how images transmitted by the web server are seen by different pathologists or students at the same time in remote places. This tool is excellent for second consultation and medical education. Source – www3.gehealthcare.ca
Click here to view |
This method of getting second opinion has become very popular among clinicians as they do not have to wait for long to obtain international opinion and they can start appropriate therapy. In addition, patients are benefitted since they do not have bother about sending duplicate slides and blocks overseas with its risk of loss during transit. Most importantly, the period of anxiety for the patients and their families is tremendously reduced and treatment is received by the patient at the earliest. Use of digital pathology is highly recommended for second opinion.
| Scientific presentations | | |
Digital slides are a great tool for presentation of scientific data in seminars, symposia and conferences. I have been personally using digital images for conducting slide seminars in conferences, continuing medical education programs and workshops. Digital images give the freedom of showing different areas under various magnification from panoramic view of the lesion to the highest magnification. This gives transparency in presentation as there is no bias in area selection by the presenter.
For conducting slide seminar, there is no need to prepare glass slides. This tool is very helpful for discussion of rare cases for which only one slide is available or for small endoscopic and core biopsies where tissue is not sufficient for multiple sectioning. Time is not far when instead of glass slides, digital slides will be demanded for evaluation of scientific data and for purpose of publication in research journals.
At present high cost of the scanners is the main reason for slow adoption of digital pathology by institutions and laboratories. It is believed that the cost of scanners will come down with increasing volumes of business, which will help in rapid growth of digital pathology for various applications in our country.
| References | | |
| 1. | Chandra M. Virtual microscopy- Technology of new millennium. J Odontol Res 2013; 1:1-3. 
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| 2. | Kumar N, Chandra M. Whole slide imaging in medical and dental education. J Med Erudite 2013;1:45-51.
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| 3. | Betigeri AM, Aparna P, Pasupathi P. Could India become the digital pathology hub of the future? A consideration of the prospects telepathology outsourcing. Int J Biol Med Res 2010;1:300-2.
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| 4. | Samraj T. Virtual microscopic method of teaching histology. J Orofac Health Sci 2011;2:43-4.
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| 5. | Baruah MK. The practice of telepathology in India. J Postgrad Med 2005;51:316-8.
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| 6. | Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, et al. Overview of telepathology, virtual microscopy, and whole slide imaging: Prospects for future. Hum Pathol 2009;40:1057-69.
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| 7. | Dee FR. Virtual microscopy in pathology education. Hum Pathol 2009;40:1112-21.
[PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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