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Making the transition to digital pathology

In the second part of this blog series, the discussion looked at the key blockers standing in the way of the adoption of digital pathology. Here, our experts discussed the advice they’d give those just starting out on the journey to digital.

If you weren’t able to make the panel discussion, you can watch the recording here.

Peter Hamilton What advice would you give to a lab that is just starting out on this digital journey?

Jo Martin Keep going! We talk about expensive pieces of kit but some of the most valuable pieces of kit are the pathologists. I don’t want to have to go back into the files to look up the pre-implantation biopsy and the first post-transplant biopsy in order to report the third transplant biopsy, which is what I have to do currently. If I can have those at the press of a button, that would save me 30 minutes.

We all know in every single lab, you spend a considerable part of the day trying to find slides on description and having them available is a real prize, so keep going. Get help. Talk to those who have done it already.

And take your colleagues to those other places. When we implemented PACS, we had some clinicians who had difficulties visualizing it. I was director of Pathology and Imaging at that stage, so we bust out a few of our orthopaedic colleagues to another trust where they got the screens up, and there was no further trouble. It was just showing people that it can work and it is working in practice. Again, go out and see it in action. It just flips that switch.

David Snead I absolutely agree with Jo. Keep going. Persist. It’s the future. It’s where things will be. Most people, when they switch to digital, do go through a period where they feel they can’t do it on digital. They have to use a glass slide. Most people will need to look at this case under a microscope.

Actually, what that really means is the case is difficult and you need time to think about it on your own in private. We all recognize as pathologists that we park difficult cases and come back to them a bit later when we have a bit more time to devote to them.

Most pathologists do feel that when they start to change the format of the way they work, they want to go back to what they’re familiar with and what they recognize. It’s a pathway that you have to push through. You have to go through it, go through the pain barrier. Work the case up, and eventually you will realize you can do it. You can see what you need to see, you can make the observations you’re looking for, and you can report the case.

It’s the same now as it’s always been in Coventry when we take pathologists through the pathway from glass to digital, we always go at their pace. We always allow them to report as they want to and we always allow them immediate access to look at the case on glass. But I’m very particular. I ask them to record why they’re going back to look at cases on glass. I ask them to record what the difference is after they’ve looked at the case on the glass.

The key element is they don’t see anything more on the glass with a conventional microscope. You see a little bit clearer. You don’t usually see something you didn’t see before. What you do get though is confidence you’re not missing something you’re worried about. That’s the key bit that the pathologists need to get. They need to feel confident they’re not missing anything. They are seeing a true image of what’s going on and they can make the interpretation of what they see.

Those are things to watch out for, when you’re converting from glass to digital, and it is a different journey for different pathologists, but I tell you the person that took the longest in our lab to convert from glass to digital, did take a long time. And when the system did go down, I tell you the first pathologist banging on my door when it had gone back because they couldn’t use glass anymore was that very same pathologist.

Neil Mesher In addition to the journey that the pathologist goes on clearly, as a manufacturer in this space, we have a vested interest in making sure that that journey is a successful one, but I don’t think it’s just about Philips. There’s a whole ecosystem of different companies.

It’s one of the things that we’ve learned coming through the Innovate UK Process is that we’re creating a new industrial sector that has multiple different players in it, but all of those multiple different players have a vested interest in supporting the pathologist in the lab on this journey. I would look to bring in, support, and collaborate with those players because we have all got a vested interest in supporting the user to achieve this.

Juan Retamero Pathologists are the primary stakeholders in this because at the end of the day in our experience, digital pathology is better for pathologists to start with. If it is better for pathologists, it’s also better for patients. That’s our experience. Our transition period has been surprisingly short. The longest they took in our institution was 2 weeks. Some brave souls were actually ready to sign up cases in as little as 24 hours. It’s not necessarily painful. But obviously, you bring your personality to the table when it comes to transitioning, when it comes to signing out, etc. It’s inevitable.

Largely, it comes from who you are as a person, but the key challenge here is image quality. When the image quality is sufficiently good, you become confident fairly quickly because you start doing the double check-in process that David described and you realize that you’re not actually missing anything out, that the image from digital is as good as that on the microscope.

David Snead is Consultant Histopathologist and Clinical Service Lead, Coventry and Warwickshire Pathology services, Jo Martin is President of the Royal College of Pathologists, Juan Retamero is Pathologist at Granada Hospital and Neil Mesher is CEO of Philips UK and Ireland. With thanks to Philips for sponsoring this discussion.

We are pleased to be welcoming Liron Pantanowitz, Anne Martel and Yukako Yagi to speak at the upcoming Digital Pathology & AI Congress: USA. Take a look at the full speaker list and the topics they’ll be speaking on here

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