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Case Review of the Future
Every patient’s battle with cancer begins with their diagnosis. Pathologists are the physicians who render this diagnosis. Unfortunately, the current process to do this is overly cumbersome, so Inspirata has developed a Digital Pathology Workflow solution to support more rapid and accurate diagnosis.
Getting a diagnosis of cancer often starts when a patient goes to see their physician when they have some symptoms… bleeding, a lump, etc.
The physician may order a biopsy or a surgical excision that removes tissue from the body. The tissue is the sent to a Histology Laboratory. The Histology Laboratory is responsible for preserving that tissue, cutting very thin slices … 4-5 millionth’s of a meter … and placing that tissue on a microscope slide. They also stain the tissue to create contrast so it is interpretable by a pathologist.
Current State (Gray Area)
Today…, if you follow the gray lines, there’s a circuitous path a pathologist must follow to render an ultimate diagnosis. As samples leave the Histology Lab, they are distributed to a pathologist’s mailbox. The pathologist will pick up a group of cases of microscope slides from their mailbox early in the morning and then as they open each individual case, they will access data related to that case. This helps them understand why those microscope slides from that patient are on their desk that day. They’ll look at that patient’s clinical history and the molecular makeup when that data is available. For certain use cases, they will look at Radiology or Endoscopy information. They’ll look at the patient’s Electronic Health Record and the Laboratory Information System. They may look at the Intraoperative Notes from the surgeon as the tissue was removed from the patient. This data resides in disparate information systems and is time consuming to access; however, it gives the pathologist the necessary background information to begin to understand why that patient’s tissue samples are being reviewed.
The pathologist will then put those microscope slides under the microscope to examine the specimens at the cellular level and, with the background information that was previously accumulated, he or she will begin to formulate a diagnosis. This often queues the need for additional information from the Histology Laboratory. This could be a request for deeper sections. It might be ancillary studies with different stains to give them more information about the sample. Essentially, a pathologist at this stage is like a detective. The more clues about what exactly they’re looking at, the more confident they can be in their final diagnosis. So, with this additional information coming from the Histology Lab, the pathologist may be able to render a diagnosis.
However, in more complex cases, there may be a need for multiple pathologists within the department review the case. This is considered an “Inside” or “Intramural” or “Intradepartmental” Consult. This can happen in a few different ways. It can be the pathologist walking down the hall and knocking on a colleague’s door to ask for a second opinion. It also can be something more formal like a Consensus Study where a number of pathologists try to come to agreement about what is being observed under the microscope. Or, the case may require and Outside Consult from a specialist at another institution. Ultimately, though, with these additional opinions, the original pathologist can be confident enough to complete a final diagnosis for that patient.
And, as you can see, there is a lot of opportunity for the acceleration of this workflow. Essentially, the way many pathologists interact with the Histology Lab today is by paper and/or running back and forth between their office and the lab. Scheduling a number of pathologists to get together for a Consensus Study can take a considerable amount of time. It’s disruptive for a pathologist to walk down a hall to knock on a colleague’s door to ask for a second opinion. And, when cases leave the hospital for an Outside Consult, it can add a week to two weeks to the turnaround time for the patient to receive their diagnosis and then start their therapy. This waiting period is a very challenging time for the patient, so anything that can accelerate this process is advantageous for everyone involved.
Inspirata’s workflow solution picks up at the point when samples are leaving the Histology Lab. What Inspirata offers is the opportunity to collect digital images of the glass slides before they’re placed in pathologists’ mailboxes. This is done by working closely with each institution to understand the current workflow and then providing a completely resourced Scan Lab solution that includes all of the hardware, software and staffing needed to be able to acquire whole slide images. The number of scanners and staffing levels are calculated to be able to handle peak-load slide volumes. The high resolution digital images acquired by the Scan Lab are instantly available to any pathologist in the department in our Smart Cockpit. This distribution process can help to balance the workload among pathologists without slowing down the process of getting the glass slides into their respective mailboxes.
The pathologist can use the Cockpit in tandem with the glass slide and microscope to render their diagnosis. Ways in which this helps to accelerate their decision making include the integration of each information system in one place—allowing the pathologist to focus on the diagnosis rather than searching for information. Furthermore, integration with the Histology Lab facilitates expedited requests for deeper cuts and/or different stains. Reporting also is performed in the Cockpit, making it the single touch point for pathologist’s diagnostic process.
Tagging specific slides of interest for tumor board presentations, personal libraries, teaching or research data sets is made easy with a click of a button.
The Cockpit also enables the pathologist to share images instantly with other pathologists either inside or outside their department, thus alleviating travel times, interruptions or scheduling conflicts. Telepathology encourages pathologists to share cases with other specialists in their field. Enlisting the help of a number of pathologist who are qualified or subspecialized to help the referring pathologist make his or her final diagnosis facilitates a more accurate diagnosis.
Computer Aided Prescreening
What can be enhanced even further is the ability to use that digital image in ways that a glass slide cannot be used today. Computer algorithms can be used to prescreen the digital images of the microscope slides for suspicious lesions as samples are leaving the Scan Lab. Computer-aided prescreening can enable the pathologist to see which cases may have malignancies prior to sorting their cases for the day. This intelligent sorting mechanism enables pathologists to select the most challenging cases to review first so that any ancillary tests can be ordered and received earlier to reduce the overall turnaround time. In addition to triaging cases for review, the prescreening algorithms also identify the individual slides within a case that are of most concern and then direct the pathologist’s eye to the area of concern on the individual slide by displaying a circle around abnormal cells. This process helps the pathologist to focus directly on the cancer they need to review and spend less time searching for suspicious malignancies.
These are just some of the ways the Cockpit and the Digital Pathology Workflow solution form Inspirata can accelerate the overall time to diagnosis and allow pathologists to consult instantly with collaborators around the world.
To learn more about Inspirata’s digital pathology workflow solution, please visit, https://www.inspirata.com/transforming-digital-pathology/