Digital Pathology and access to slides

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UKPathLab

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Hi All,

I've stumbled across your website whilst research bone tumour pathologists.

My company is a UK based laboratory that reports annually 50,000 cases for both the private and public sector.

We have invested in 2 digital scanners with capacities of 500 slides per run and thus report around 65% of our cases through digital pathology.

I understand that in the US, digital pathology is not FDA approved for primary diagnosis - however given that we've accumulated, reported and archived around 30,000 cases - would there be a benefit of gaining permission, anonymising and hosting these cases for educational purposes - or are digital libraries available throughout the States?

Thank You,

S.

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We do have numerous digital libraries here in the US for educational purposes, usually created by universities that are available to anyone worldwide who visits that institutions' website. If your company hosted their 30,000 cases on an independent platform, no permission is necessary as it's equivalent to starting up a website and putting whatever information you like. If your company doesn't have a website/publicly available digital library and doesn't want to create one, then you could offer these cases to a US based digital library and contact them to see if they would be interested in adding it to their collection.
 
We do have numerous digital libraries here in the US for educational purposes, usually created by universities that are available to anyone worldwide who visits that institutions' website. If your company hosted their 30,000 cases on an independent platform, no permission is necessary as it's equivalent to starting up a website and putting whatever information you like. If your company doesn't have a website/publicly available digital library and doesn't want to create one, then you could offer these cases to a US based digital library and contact them to see if they would be interested in adding it to their collection.

Can you tell me a few of these institutional websites that offer free digital slides to review?
 
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Hi All,

I understand that in the US, digital pathology is not FDA approved for primary diagnosis - however given that we've accumulated, reported and archived around 30,000 cases - would there be a benefit of gaining permission, anonymising and hosting these cases for educational purposes - or are digital libraries available throughout the States?

Something you might want to consider is that the regulatory status of whole slide imaging for primary diagnosis could change.

Several years ago, the FDA had put whole slide imaging for primary diagnosis in Class III, meaning that approval would probably require extensive clinical trial data.

Based on a statement last year from the Digital Pathology Association, though,

DPA Recommends Whole Slide Imaging Manufacturers Submit De Novo Applications to the FDA for Primary Diagnosis in the United States

the FDA now appears willing to consider less burdensome regulatory pathways.
 
Major implications.
It actually means a pathologist could be at Quest Diagnostics in India and read the slides.
Quest Diagnostics Locations – Reach Quest Diagnostics

Is this really going to be a threat in the near future? A similar scenario has already been played out in radiology and nothing ever happened because most hospitals/medical groups are not willing to take on the additional liability. I think at best (or worst depending on how you look at things), people in other countries will do preliminary signouts and a US MD will finalize them. This kind of setup is pretty rare in radiology and has had little if any effect on the job market.
 
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Cannot compare with radiology. Most pathology residents are FMGs and most radiology residents are not FMGs. There is a large pool of pathologists who might be willing to work at Quest in India or similar operations after completing a US residency, especially considering the crappy US job market in pathology.
 
Cannot compare with radiology. Most pathology residents are FMGs and most radiology residents are not FMGs. There is a large pool of pathologists who might be willing to work at Quest in India or similar operations after completing a US residency, especially considering the crappy US job market in pathology.

this right here.
the fmgs would probably be happy in going back overseas to live while signing out digital slides for a cut rate. our cut rate is still good money in most other developing countries.
 
Radiology is a very big field, which has had its own "too many graduates for available jobs" crisis in the past few years. And it's still not happening. It's really hard to square the arguments if you think it's going to affect path but not radiology.
 
One other issue with digital pathology, as compared to radiology, is the volume of data. Image file sizes in pathology are very large relative to radiology. Because you don't know ahead of time what parts of a slide a pathologist will want to zoom in on, you need to store the entire slide at high magnification. That the images are color images, unlike in radiology, probably doesn't help either. I think it will take a while before IT infrastructure catches up to what would be needed for wide-scale use of digital pathology.
 
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Radiology is a very big field, which has had its own "too many graduates for available jobs" crisis in the past few years. And it's still not happening. It's really hard to square the arguments if you think it's going to affect path but not radiology.

Radiology doesn't have nearly as many FMGs as pathology.
 
One other issue with digital pathology, as compared to radiology, is the volume of data. Image file sizes in pathology are very large relative to radiology. Because you don't know ahead of time what parts of a slide a pathologist will want to zoom in on, you need to store the entire slide at high magnification. That the images are color images, unlike in radiology, probably doesn't help either. I think it will take a while before IT infrastructure catches up to what would be needed for wide-scale use of digital pathology.

I agree 100%. The IT infrastructure needs to be drastically beefed up in order to handle this sort of workflow. A vast majority of the IT people at my institution don't seem to understand how much network bandwidth is actually needed to simulate practice. Your standard home computer and most workplace computers don't have enough graphics processing power for everyday practice. My worry would be the lack of understanding by IT people and hospital administration in putting the proper infrastructure in place to optimize its use. A half a**ed implementation would mean a step backwards in efficiency and workflow for the pathologist.
 
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