Digital Imaging in Pathology

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The field of pathology is adopting digital imaging technology. Newer versions of laboratory information systems and anatomic pathology information systems include image capture modules that allow digital pathology images - captured by the digital camera on a microscope - to be appended to patient reports. Early adopters revere digital pathology imaging as a means to gather additional information for clinicians and patients and benefit long-term care. They also talk about the day when pathology images will be integrated into electronic medical records. On the other hand, pathologists resistant to changing their slide-centered world are not yet convinced that these digital images are a necessity in the field.

"There is not a pathology department that does not operate without a laboratory information system [LIS]," says Bruce Friedman, MD, professor of pathology at the University of Michigan Medical School. The LIS and APIS (anatomic pathology information system) acquires numerical and textual information generated in anatomic and clinical pathology, stores it and makes it available to clinicians. Some systems offer image capture modules that allow pathologists to integrate laboratory images into final patient reports. 

Using a high-end digital camera attached to a microscope, pathologists capture static images of small biopsies, tumors and skin biopsies. The images, typically in JPEG format, are appended to the report that is distributed to clinicians, specialists and referring physicians. As informatics continues to play a role in advancing the field of pathology, these images may one day be incorporated into electronic medical records (EMRs).

Is there a need to integrate pathology images into reports and EMRs? It can improve the clarity of communication between pathologists and clinicians, reduce errors and provide medico-legal documentation, says Mark Tuthill, MD, division head, pathology informatics, Henry Ford Health System. "Cost is another benefit: we have to take pictures in pathology for documentation purposes. Digital imaging is superior to traditional film-based photography for several reasons, including cost."

Some pathologists question its clinical relevance, arguing that clinicians, interested in textual information do not need to look at images. From a workflow perspective, pathologists must take extra time to capture representative images that buttress the diagnosis, and this may be seen as a hindrance.

Another piece of information

An image is an important part of a pathology report in complex cases, says Friedman. "Image capture, storage, retrieval and integration into the pathology report and EMR is very important. A digital image can only add to the report," he says.

At Sacred Heart Hospital in Allentown, Pa., pathologists use Psyche Systems' Window Path APIS and its image management module to permit the integration of JPEG pathology images into reports. "I can demonstrate to the physicians who sent the biopsies as to what I am talking about in my diagnosis and why I am calling something malignant or not," says James Chiadis, MD, a pathologist at the hospital. "I can integrate either [digital] microscopic slide images or gross photographs and include that in a report to show to the physician, or even the patient, if he or she so desires."

There are probably two main reasons that the field is interested in incorporating pathology images into reports, says Walter Henricks, MD, director of laboratory information services and a surgical pathologist at the Cleveland Clinic Foundation. "The first of these is primarily a response to market demands. Pathology labs have heard from the referring physician clients that they like to see images in reports.

"The other driver, which is related, is that some clinicians indicate that they consider the images useful for patient education and communication," continues Henricks "Many sites and pathology groups that are capturing images are using them for educational, quality assurance, and or documentation purposes."

At Duke University Medical Center, surgical pathology as well as laboratory information constitutes two thirds of a patient's EMR. Pathology images are not integrated with EMRs; nor are they appended to reports. However, digital gross specimen images and microscopic images are captured for research, teaching and illustration purposes. "We are in the process of looking at an upgrade to our LIS and one of the key features we are looking for is support for images