Going digital is the only option for the future of clinical pathology, and I feel privileged to be in the frontline of developing it.
As one of five university hospitals in Finland, KUH provides high-quality care in all medical specialties to nearly a million patients. It also conducts internationally-renowned research, and trains the top experts of the future. The mission is clear: KUH wants to become one of Europe’s most modern hospitals in the coming decade. As a result, they decided in 2015 to digitize its pathology department.
“In the beginning, we had to convince not only the pathologists, but all the people working at the department that digital pathology is the only way forward, and that we should be part of the development and lead the innovation,” says Dr. Vesa Kärjä, chief physician at the department of clinical pathology. “Starting to do diagnostics from a computer screen instead of using a conventional microscope is a giant leap for pathologists. Fortunately, all our consultants were open-minded and we were able to get this project started.”
At KUH, the clinical pathology department is part of the Diagnostic Imaging Center, which also includes the departments of radiology, clinical physiology, nuclear medicine and neurophysiology. Close cooperation with all specialties is at the core of its operations.
“Altogether, we are 250 employees with an annual volume of 220,000 different diagnoses and exam reports,” Dr. Kärjä continues. “At my department, we are six consultant pathologists and two resident doctors, and we have 28 technical bio scientists working in our recently built, modern lab. We perform approximately 20,000 histological cases, 5,000 cytological cases and 150 autopsies annually.”
Natural step to expand existing radiology imaging system into pathology
The radiology department at KUH began its digital transformation around the turn of the millennium, and it has been using a Sectra PACS for radiology imaging since 2002. When initiating the digital pathology project, talking to Sectra felt like a natural choice to Dr. Kärjä and his team.
“We had seen how well the Sectra PACS worked for the radiology department, and—since we are both part of a joint imaging center—it made no sense for us to build two separate systems when we could actually enjoy even more synergies.”
KUH ultimately selected Sectra’s Digital Pathology Solution and now has the same PACS implemented for both radiology and pathology. This allows for an even tighter rad-path collaboration and enables ’integrated diagnostics’, meaning full access to everything from referral information to images and reports, for increased efficiency and quality in the review process.
We have already experienced a remarkable change in the tumor board process.
Already reaping the benefits of integrated diagnostics
So far, the department has one Hamamatsu scanner in production and another one on its way in. A seamless integration of the QPati LIS and the Sectra PACS is in place, which allows the pathologists to work completely digitally and increase reading efficiency. The team has now completed the process of validation, done according to CAP (College of American Pathologists), and Dr. Kärjä is pleased with the outcome.
“We were surprised how similar the images were—there was no significant difference between a scanned, digital image compared to the view in a microscope. If the glass is scanned, I never use the microscope nowadays. And the integration with the LIS is working really well, which is absolutely essential.”
He continues to describe how the workflow has changed for the pathologists.
“We have introduced a quality assurance step where the person responsible for the scanning ensures that the images have good focus all over. This means that the pathologists never see any bad scans. And instead of the slides and referrals, the pathologists now immediately get electronic work lists and can get to work without delays.”
With the solution, the pathologists have access to new image analysis tools that support their diagnostic work, and they can easily do annotations directly on the image. Especially distance measurements and drawing tools are used a lot, not least to prepare for the multi-disciplinary team (MDT) meetings, or tumor boards. And with just one click, the pathologists can look at a patient’s histological and radiological images in the same system, which Dr. Kärjä says is very useful.
“We have started to check the radiology images with bone tumor diagnostics, and with breast cancer cases we check the x-ray image of the resected tissue. It’s also nice that the report of the radiological exam is available with images.”
The most remarkable change in the way of working so far, according to Dr. Kärjä, has been experienced in the process for the MDT meetings, which are now completely digital. The pathologists can start to prepare for the MDT when they have a work list, and they no longer have to carry physical slides around to meeting rooms. This saves time also for the secretaries, who no longer have to search for and bring glass slides from the archive, the laboratory or the pathologists’ offices, and after the meeting they do not have to return the slides to the archive.
“Digital images are easy to show in the MDTs—for the first time in my career I can show the whole slide on a screen, which has been much appreciated. These low-power magnifications are very informative to the clinicians, and it is easy, for instance, to demonstrate surgical margins. If any questions arise, it is also easy to access previous slides for the patient during the actual meeting.”
Moreover, the centrally stored images are available for review from any location, even remotely, or for discussion among experts, which may be crucial, especially in complex cancer cases.
In my opinion, an open and scanner vendor-neutral solution is the best option.
A vendor-agnostic approach—amongst the advice to others considering going digital
The focus for KUH has so far been on scanning slides for the tumor boards and example cases for cancer archives, but they are now preparing for broader use of digital pathology for primary diagnostics. There are still some unresolved questions regarding long-term archiving for the large amount of data; which format, how to pack the files smarter, archiving costs, etc. But Dr. Kärjä believes that these remaining issues will be solved within a few months’ time.
“When these problems are solved, we can take our digital pathology project to completion. In a perfect situation, all the old glass slides would be digitized too. And I’m already looking forward to getting access to even more image analysis tools to get help with the diagnostics.”
Dr. Kärjä describes the cooperation so far with Sectra and its local distribution partner Commit as straightforward.
While he is satisfied with their own choice of vendor and solution, he also stresses the importance of openness and a vendor-agnostic approach.
“There is not just one right solution for everyone, but many different possibilities. You have to decide what you need and what your local demands and restrictions are. But in my opinion, an open and scanner vendor-neutral solution is the best option. Your needs may change over time, and I don’t believe it is wise to tie yourself to one product or one vendor, no matter what.”
When asked to share some more advice with other clinics and pathology departments that are considering going digital, or that are just getting started, Dr. Kärjä quickly responds.
“Discuss with other people who have actually gone through a process like this; you can learn a lot from them. And make sure you have enough human resources and money, and that your whole staff share a positive attitude towards digitization—that’s fundamental for succeeding, in my opinion.”
“To be honest, going digital is the only option for the future of clinical pathology, and I feel privileged to be in the frontline of developing it,” Dr. Kärjä concludes.