Virtual Microscopy

What is Virtual Microscopy?

Virtual Microscopy: E-Learning Platform to Support Learning

The fundamental principles in many of the disciplines within Faculty of Medical and Dental Sciences rely on a complex and integrated understanding of the structure of tissues and organs in both health and disease. The challenges in achieving key learning outcomes in microscopic anatomy, pathology, microbiology and parasitology has been the necessity for specialized equipment (microscopes) and limited amount and access to teaching materials (microscopic sections).

Virtual Microscopy allows on-line access to entire scanned sections of tissue that can be viewed on a computer in exactly the same way as conventional glass slides with a microscope and can be explored by the learner at several magnifications. Virtual Microscopy takes the microscopy experience beyond the classroom by allowing whole slide microscopy at different magnifications in the on-line environment – via  web browser. Unlike traditional microscopic sections on glass slides, digital slides can be securely accessed on-line at anytime from anywhere and cannot be damaged during their use or fade with time.

  1. Digital Pathology
  2. Telepathology
  3. Types of Telepathology
  4. Application of Digital Pathology
  5. Scanning & Hosting
  6. Certificates Digiscan

Students in many countries have enthusiastically adopted the new technologies of e-learning including Virtual Microscopy. Digital slides enable educators with limited computer skills to provide a blended student learning experience that provides students with opportunities to integrate their interdisciplinary knowledge and develop their interpretative skills. It is now time that Afro-Asian countries also adopt this new innovative technology to improve learning by the students.

Virtual SlidesHow the Digital Slides are prepared?

Digital slides also called whole slide images are prepared with the help of digital slide scanner also called virtual microscope.( Monitor screens are also called virtual microscopes since digital slides are viewed on the computer screens on the analogy of light microscopes under which glass slides are viewed).Digital slide scanners are robotic microscopes where soft ware controls  all the functions including control of illumination, focusing of slide, change of objective, continuous movement of stage in x and y axis, photography of each field under the objective and production of composite whole slide image also called digital slide, virtual slide and e-slide.

Virtual SlidesHow a whole slide image is produced?

The scanner takes picture of every field of the slide on the moving stage. Thus every part of the slide is photographed and thousands of pictures are taken. Then these pictures are stitched and blended together by the soft ware  and a composite image is produced called whole slide image. This image can be viewed on computer screen, laptops and android mobile phones just as a glass slide is seen under the microscope. The viewer can see the image in different magnifications and all areas of the slide can be viewed.

What are the advantages of virtual slides over glass slides?

  • Virtual slides have all the information and details contained in a glass slide.
  • Virtual slide can last forever. It does not break and fade or deteriorate on storage.
  • One glass slide is sufficient to prepare virtual/digital slide which can be duplicated in to thousands of  copies. These can be used to teach millions of students on line or off line.
  • More than one virtual slide can be viewed at the monitor screen and images can be compared.
  • With installation of analytic soft ware, complicated time consuming analysis can be performed with ease.
  • Virtual slides can be seen any where any time without time and place constraint.
  • One does not have to prepare teaching glass slide sets periodically as once the virtual slide sted are prepared, these last forever and quality of the slides does not deteriorate.
  • Scanning Virtual SlidesMicroscopes are not required. PCs and laptops are sufficient for learning pathology. Images can be seen even on mobile.
  • The headache of cutting extra sections for slide seminars is the thing of the past. Only one glass slide after digitization is sufficient to conduct hundred of seminars and teaching sessions.
  • Virtual slides can be annotated to explain the features. Making  it easy for teaching and self study.
  • Virtual slides are a boon for self study by residents and undergraduates.
  • Cataloging of digital slides is automatic by the computer and retrieval of cases is easy.


Digital Pathology:

Virtual SlidesWhat is Digital Pathology?

Annotated Virtual SlidesDigital Pathology is an image-based information environment enabled  by Computer technology that allows for the management of information generated by  a digital slide (Wikipedia).

Digital Pathology is enabled in part by Virtual Microscopy which is the practice of converting glass slides into digital slides that can be viewed managed and analyzed on a computer monitor. With the advent of whole slide imaging, the field of digital pathology has exploded and is currently  regarded as one of the most promising avenues of diagnostic medicine in order to achieve even better, faster and cheaper diagnosis, prognosis and prediction of cancer and other important diseases.

What is Telepathology?

Telepthology is the practice of pathology at a distance. It uses telecommunication technology to facilitate the transfer of image rich data between distant locations for the purpose of diagnosis education and research. Many thousands of patients in North America, Europe and Asia have benefitted from telepathology services.

What is the difference between Digital Pathology and Telepathology?Virtual Slides

Telepathology systems are divided into three major types:

  1. Static image systems where still images taken by the referring pathologist are forwarded to the consultant pathologists.
  2. Advantages:    most reasonably priced and usable system.

Draw back: Only selected microscopic fields are captured for off-site evaluation.

Consultation Pathologist does not get the real feel of the slide.

Selection of fields may be biased. Important clues may be missed.

2.Real Time Robotic Microscopy System: Consultant actively operates a robotically controlled motorized microscope located at a distant site changing focus, illumination, magnification and field of view at will.

Advantages: Consultant Pathologist has the opportunity to evaluate histopathology slides in their entirety from a distance. Either analog/digital  camera is used for real time microscopy. It offers higher diagnostic accuracy.

Drawback: System employs internet network and performance may suffer during high network traffic. The system is costlier then static image system.

Referring pathologist and consultant pathologist have to be present simultaneously which may pose a problem due to different time zones between countries.
 

This system work better for Local Area Network (LAN).

3.Virtual Slide System:  Virtual Slide system utilized automated slide scanners that create a

digital image file of an  entire glass slide (whole slide image). This file is stored on a computer server and can be navigated at a distance, over the internet using a browser. Digital imaging is required for virtual microscopy. This system forms part of Digital Pathology.

Advantages: Consultant pathologist has the advantage of evaluating the histopathology slides in their entirety. Consultant pathologist has the freedom to evaluate the slides at his convenient time without the need of presence of referring pathologist.

Draw back: System depends on high speed internet, net works. Cost of the scanning microscopes is a concern.

 

Virtual SlidesApplications and Uses of Digital Pathology

Digital pathology is currently being used for a wide spectrum of clinical applications including Diagnosis  of frozen sections, primary histopathological diagnosis, second opinion diagnosis, Subspecialty  pathology  diagnosis, education, competency assessment and research.

Digital Pathology technology has applications in histology, pathology, oral pathology, oral histology,  forensic medicine, veterinary pathology, zoology, botany and other biological sciences. We are going to concentrate here on applications in  medical , dental and paramedical sciences.

  • Pathology Consultation/Second opinion
  • Presentation in conferences, seminar/symposia
  • Departmental Digital Slide Libraries and slide boxes
  • Medical Education
  • Analytical Pathology and Research
  • Competency assessment
  • Primary diagnosis

1.Pathology Consultation / Second opinion:

Digital Pathology using Virtual slides are gradually becoming the mainstay of second consultation in pathology in many countries and more and more countries are in the process of adopting this highly innovative and convenient technology.

HOW IT IS Done:

Any pathology slides on which opinion of expert pathologist is desired situated far away from the local hospital / laboratory / city / country, glass slides are scanned under the scanning microscope. Whole slide images are produced which represent the whole section which was present on the slide. Whole slide image is also called digital slide or virtual slide or e-slide.

Digital / Virtual slide thus prepared is uploaded on the Web server and link is provided to the pathologist. Clinical history and pertinent clinical details are also uploaded or emailed.

The uploaded image reach the consultant pathologist within minutes. The expert pathologist view the image and communicates his /her diagnosis or opinion. If he / she requires more investigations like immunohistochemistry  and molecular markers etc, that recommendation is forwarded to the referring pathologist who provides the fully worked up case and receives final diagnosis.
 

But opinion cab be obtained from transcountry expert pathologists by sending the slides and paraffin blocks by surface mail also ?

yes it can be done and this is the method which has been used by all for decades. But this method has certain shortcomings.

  • The slides and Wax blocks take long time to reach the destination. In some cases it may be a week or even more.
  • There is risk of loss of material during transit. Slide and block of an important case are lost forever.
  • There is great risk of slide breaking away and Wax block getting damaged during  the transits.
  • Final report from expert pathologist easily takes 15-20 days which is a long period.
  • Patient and his / her family are anxious to know the final report and their waiting period and hence anxiety period is long.
  • Institution of appropriate therapy is delayed.


Virtual SlidesWhat are the advantages of Digital Pathology for Second opinion over conventional method of surface mai?:

  • It is easy to understand that there are many advantages of obtaining second opinion by Digital Pathology or using Digital Slides.
  • The slides reach the consultant pathologist fast, within hours of receiving the slides.
  • Final report can be obtained in as short a period as a day from any country in the world.
  • Multiple consultations can be obtained at the same time by sending the image link to many pathologists simultaneously.
  • Anxiety period of patient and the family is marked reduced.
  • Treatment can be started early without wasting precious time.
  • No risk of losing important case material during transit.
  • Who is providing this facility of Digital Pathology in India?
  • Pathology Consultancy Services, highly acclaimed pathology laboratory from the group of companies of Digiscan is providing the facility of Digital Pathology or remote pathology diagnostic services.
  • Pathology Consultancy Services is the First Laboratory in India not only providing facility of Second Consultations by National and International world leaders in Pathology but is also leading the movement of promoting Digital Pathology in the Country.
  • Many laboratories of the country are collaborating with Pathology Consultancy Services to spread the benefits of digital pathology to wider areas in the country with the aim of providing better and faster health care to the public.
     

Pathology Consultancy Services has many Pathology Leaders on its panel and provides opinion of these world leaders to the patients. Pathology Consultancy Services can be reached thru www.pcsindia.net; www.pathologyconsultancy.com;
email-pcsindia.net@gmail.com
 

2.Participation in conferences,seminars/symposia:

Digital pathology is finding a very respectable place for scientific presentations of pathology in conferences and conduction of seminars and symposia. Main advantage of presenting whole slide images is that the viewer gets to see the whole lesion and there no bias in selection of fields.

  • Presentation of digital slides is becoming popular in conducting slide seminars for the following reasons.
  • Why conduct Digital  slide Seminar instead of Conventional Glass Slide seminar:
  • Digital slide seminar has many advantages over glass slide seminar.

1a) During traditional slide seminar, slides are many times sent to the conference secretariat 8-10 days before the seminar so that participants can study the slides 1-2 days in advance in special 1-2 days allotted for microscopy.

Disadvantage is that the presenter has to prepare extra sections which may not be possible in cases of core or endoscopic biopsies. Further, there is risk of loss or breakage of slides during transit.

1b) or presenter brings the slides to the conference and special microscopy session is organized where all the delegates see the slides. Time is short for everyone and department do not have enough number of microscopes. Also there risk of mishandling of slides and breakage.
 

Virtual SlidesAdvantages of Digital Slide seminars:

In digital slide seminar, virtual slides of cases being presented are uploaded on the server and participants can view the cases on browser. Cases can be made available much in advance so that participants have sufficient time to study the cases. This makes slide discussion more interactive.

There is no need of special microscopy session. Conference organisers get more time for presentations and scientific sessions as time of microscopy session is saved. Microscopes are not required. Unlimited number of participants can view the virtual slides and participate in the seminar.

Presenter does not have to prepare extra slides. Only one slide is sufficient for conducting as many seminars as one wants to. Generally the slides used for making diagnosis are used for digitization so there is no discrepancy of features between what presenter saw in the original slide and what participants see in the slide given for viewing as many time some areas are lost on deeper and repeat sectioning of the block.


Slide seminars and teaching sessions on small biopsies, core biopsies and endoscopic biopsies are conducted without cutting extra sections.
There is no risk of loss or breakage of precious slides.

For conducting cytology slide seminar, all these points become all the more important as unlike histopathology sections, cytology smears can be prepared in limited numbers only and some times only a single smear may be available.

3. Departmental Digital slide Libraries and Slide Boxes:

Digital libraryEvery pathology department has slide boxes of interesting cases, case studies and rare cases for training of residents. Glass slides are stored in the boxes for training. These have the inherent disadvantages of deterioration of quality upon storage and breakage.

Digital slide boxes and libraries do not have these problems. Residents can make copies of cases and have their personal collections. Residents do not require microscopes to revise their slides.

Sharing of material by resourceful institutions can create unimaginable wealth of study material which can be instrumental in creating pool of talented pathologists globally.

MEDICAL EDUCATION:
Digital slides are proving to be boon for education of undergraduate students and residents the world over. Teaching can be imparted on line or off line. Virtual slides can be annotated for ease of explanation. Ineraction between the teacher and the student is better as both are seeing the same slide on the screen and histological features can be explained with better understanding by the students.

Large wall sized monitors are being used in the class rooms for teaching. Microscopes have been replaced by computer screens.
 

WHAT IS THE SCENARIO IN INDIA?

Virtual microscopy is in the nascent stage in India and teaching in medical and dental colleges is being imparted in the traditional way at present. However electronic revolution is taking place  in India and e-learning is become popular in schools and other disciplines. Day is not far when medical and dental students will force the colleges to adopt e-education for improvement of education. Pathology will be taught using digital slides and budding Indian pathologists will be in no way less technologically skilled than their counterparts in the world and will be using digital pathology in all its applications.

Is there any local source of educational material in India?

In India , DIGISCAN is the first  and only company to recognise the need of imparting e-education in pathology and oral pathology and has the mission of making teaching material available for study of undergraduate and postgraduate students in the subjects of histology, oral histology, pathology and oral pathology. at present. It aims to provide material for microbiology, veterinary pathology and zoology in phases.

Digiscan has produced teaching sets of digital slides on various topics of pathology and oral pathology and the slides have been annotated for ease of understanding by the students and residents. The sets are available on line on nominal subscription.

5. ANALYTICAL PATHOLOGY AND RESEARCH:

Digital pathology has extremely important role in analytical pathology and research. Comparisons of two or more slides can be made simultaneously. Complex analysis of various parameters and computations can be performed easily and accurately by using appropriate soft ware.

COMPETENCY ASSESSMENT:
Digital pathology is being used for conducting competency assessment and EQAS programmes and practical examinations in pathology with obvious advantages of digital slides over glass slides as detailed above.

Primary pathology Diagnosis:
Digital pathology has well established application in the diagnosis of frozen sections. Pathology departments with deficiency of staff trained in interpretations of frozen sections seek diagnosis from pathologists in advanced centres by sending digital whole slide images.

Many medical centres in America and Germany are having projects to evaluate efficacy of digital pathology for primary diagnosis. While all agree that the accuracy of diagnosis by digital slides is comparable to the glass slide diagnosis. Some centres have replaced microscopes with pathoscopes which have table sized monitor screens and many colleagues can discuss the pathology.

It is to be seen how much digital pathology becomes popular for primary diagnosis in coming times.