Digital pathology: an unknown territory to many labs. With benefits such as time- and labor-savings and direct patient benefits such as shorter time to diagnosis and quicker onset of treatment, champions of digital pathology are perplexed why it hasn’t taken off like its counterpart radiology did in the 1980’s. Radiology started its transition to digital picture archiving and communication systems (PACS) with the first computed radiography (CR) system in 1987, opening the industry to a new technology to replace analog film. The first digital radiography solution extensively adopted in the hospital market was CR technology. Orthopedic physicians, imaging centers, and urgent care facilities soon followed the momentum. Almost two decades after the introduction of CR, the radiological industry welcomed a new advanced, more efficient, easy to use technology called direct radiography (DR). In this blog post, we’ll touch on radiology’s move from film to digital and what pathology can learn from this transition.
Radiology’s pre-PACS Pain Points...Sound Familiar?
Radiology’s pain points prior to DR implementation sound strikingly similar to what pathology labs experience today. The hard copy film library had to be managed; pathology lab staff laboriously file and fetch glass slides throughout the day. Radiology costs included film transportation and prime storage space; pathology have costs associated with vendor slide transport and storage. Radiology dealt with lost films; pathology experiences missing or broken slides. Radiology experienced patient backlog; pathologists routinely have a mountainous pile of cases they need to evaluate. Radiology overcame these pain points by going filmless; pathology has the opportunity to overcome these same pain points by going digital.
Full Speed Ahead: 100% Digital
Hammersmith Hospital, a renowned teaching and research hospital in the United Kingdom, was one of the first to choose to move from film-based operation to filmless all at once to avoid the running costs of dual systems and the inefficiencies that go along with it. Pathology labs implementing or considering implementing a digital pathology system (DPS) should follow suit. Why? Let’s imagine a pathology lab with a digital workflow alongside a manual workflow to ease the transition. How is it determined who is on digital duty and when? The chances are high for slides being lost or misfiled when they were meant to be digitally imaged, or vice versa. To avoid mix-ups, you may just have to both manually and digitally prepare slides; everyone loves double work right? And asking a pathologist with a pile of cases on his or her desk to switch back and forth between evaluating cases with a microscope and a monitor-- simply unreasonable. This is all beyond inefficient.
It’s important to also consider training. Humans are inclined to gravitate to what is familiar to them. Moving away from film and going fully digital all at once enforced training because there was no other working alternative. With dual systems, training on a DPS would be inadvertently thwarted by lab staff who follow their natural tendencies to continue their manual workflow, however cumbersome it may be. The DPS may be abandoned altogether, leaving a costly system underutilized with no return on investment. The route isn’t dual systems -- the route is digital! So let’s go for it.
The best benefits from the move to DR are passed on to patients - and we can imagine pathology moving to digital experiencing the same. Cutting out film saves a lot of time - time originally used to transport and archive film is transferred to time actually treating patients. Pathologists and lab personnel would no longer be bogged down by the filing and fetching of glass slides and could pass that time on to patients and higher priority tasks. Just as with teleradiology, telepathology could be readily incorporated to make way for phone consults with specialists to better treat patients with critical or difficult cases. Digital radiology increases productivity of devices and technicians and provides overall time-savings for physicians and radiologists. The powerful impact of DR is most evident by the decreased patient backlog. Since images are available for review within seconds after exposure, the average exam time is decreased from ten minutes to one and a half minutes, making room for more patients to be treated. If digital slide review results in a similar-scale change in exam time, the increased efficiency should also allow significantly more patients to be treated. DR provides evidence that digital systems can handle significantly more patients than screen-film systems, without a compromise in image quality. Radiology moving from film to digital catalyzed a revolution in imaging technology and we expect a similar trend to occur when pathology goes digital with imaging in microscopy.
Yes, the results of pathology going digital are numerous and include the desirable benefit of increased revenue due to decreased backlog and quicker patient turnaround times in addition to cost savings from reduction in slide storage and transport. But at the end of day, it’s about the patient waiting anxiously for his or her biopsy results to come in. More leaders and change makers in the clinical setting should be championing the necessary move to digital slide imaging. The revenue comes in because more patients can be served. More biopsy evaluations, more diagnoses, quicker treatment. When you look at it from this point of view, should going digital even be an option?
Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit https://instapathbio.com/tech/ or contact us at email@example.com.
Fang YC, Yang MC, Hsueh YS. Financial assessment of a picture archiving and communication system implemented all at once. J Digit Imaging. 2006;19 Suppl 1(Suppl 1):44–51.
An Inside Look Into Digital Radiography: The History and Where It’s Headed in 2017. Medlink Imaging LLC, 2017.
Sack D. Increased productivity of a digital imaging system: one hospital's experience. Radiol Manage. 2001;23(6):14–18.