Being fully digital: perspective of a Dutch academic pathology laboratory

Abstract

The introduction of fast and robust whole slide scanners has facilitated the implementation of 'digital pathology' with various uses, the final challenge being full digital diagnostics. In this article, we describe the implementation process of a fully digital workflow for primary diagnostics in 2015 at the University Medical Centre in Utrecht, The Netherlands, as one of the first laboratories going fully digital with a future-proof complete digital archive. Furthermore, we evaluated the experience of the first 2 years of working with the system by pathologists and residents. The system was successfully implemented in 6 months, including a European tender procedure. Most pathologists and residents had high confidence in working fully digitally, the expertise areas lagging behind being paediatrics, haematopathology, and neuropathology. Reported limitations concerned recognition of microorganisms and mitoses. Neither the age of respondents nor the number of years of pathology experience was correlated with the confidence level regarding digital diagnostics. The ergonomics of digital diagnostics were better than those of traditional microscopy. In this article, we describe our experiences in implementing our fully digital primary diagnostics workflow, describing in depth the implementation steps undertaken, the interlocking components that are required for a fully functional digital pathology system (laboratory management, hospital information systems, data storage, and whole slide scanners), and the changes required in workflow and slide production.

Keywords: diagnostics; digital pathology; digital primary diagnostics; implementation; laboratory management.

Figure 1

The University Medical Centre Utrecht scanner room.

Figure 2

Differences in the quality of whole slide images between 4 μm and 3 μm in thickness. Left image: slide, 4‐μm section. Right image: 3‐μm section. Note the increase in contrast and how much easier it is to distinguish between individual nuclei.

Figure 3

The University Medical Centre Utrecht pathology ‘cockpit’ for digital diagnostics.

Figure 4

Overview of the different connections between the components of the University Medical Centre Utrecht digital pathology diagnostics solution.

Figure 5

Overview of the various panels in the PACS information screen.

Figure 6

Influence of gamma correction on the quality of fluorescent images. Left: image with gamma set at 1.0. Right: image with gamma set at 1.8. Note how many more structures are visible after the gamma value is changed.

Figure 7

Viewing different stains side‐by‐side in the PACS viewer. Multiple images can be synced in the same view pane, and changes in magnification applied to one image are automatically apply to all other images.

Figure 8

Example of annotations in the PACS viewer.

Figure 9

Example of a digital case chat.

Figure 10

Dr Stefan Willems, the first microscope‐less pathologist at the University Medical Centre Utrecht.