Digital pathology: the UMC Utrecht experience
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1 Digital pathology: the UMC Utrecht experience Paul J van Diest, MD, PhD Professor and Head, Department of Pathology University Medical Center Utrecht PO Box 85500, 3508 GA Utrecht The Netherlands p.j.vandiest@umcutrecht.nl
2 Digital pathology UMCU 2015 Scanners written off Tape archive full and written off No cytology No fluorescence Hardly telerevision/teleconsultation Not all MDMs done digitally Still slide searching, which could be in the scanner! No quality controls of scans, error rate 2-4% Time for the next step!!!!!!!!!!!
3 Digital pathology UMCU 2016 The next step new bulk storage (EMC, hospital wide, incremental) new faster scanners (Hamamatsu) fluorescence big slides z-stacks for cytology quality control of scans, automatic rescan upfront scanning in the lab all slides digitally available all MDMs digital no more slide searching allows digital diagnostics worfklow platform (Sectra) implement image analysis (Sectra/Visiopharm)
4 Digital pathology: the UMC Utrecht 2015 solution scanning macro imager order form scanner database LIS VNX Image/data server HIS U-DPS PATHOLOGY storage RADIOLOGY pathology users clinical users
5 Scanners 140 slides per hour during peak production ~1400 slides per day cytology big slides fluorescence frozen sections/priority
6 Sectra is watching you..
7 Sectra is watching you.. Uptime > 99.9%
8 Implementation process Hardware Software Lab issues Workspace Change management
9 Implementation: hardware VNX server cluster hosting the workflow Stand alone Integration with Radiology later Network connections and switches Computers Graphics cards CPU speed Big screens Climate control Temperature, noise, ozon 2-D barcodes
10 Implementation: software Connections Integration with PALGA Integration with G2 speech recognition Integration with LMS Integration with bulk storage Integration with Radiology PACS
11 System design PALGA Saltro VPN PACS worklist and desktop sync with UDPS U-DPS PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
12 System design: connections PALGA Saltro VPN PACS worklist and desktop sync with UDPS Sectra core U-DPS PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
13 System design: connections PALGA Saltro VPN U-DPS PACS worklist and desktop sync with UDPS slide archive PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
14 System design: connections PALGA Saltro VPN U-DPS PACS worklist and desktop sync with UDPS pathology reporting PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
15 System design: connections PALGA Saltro VPN U-DPS PACS worklist and desktop sync with UDPS PACS worklist lab management system ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
16 System design: connections PALGA Saltro VPN PACS worklist and desktop sync with UDPS scanners U-DPS PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
17 System design: connections PALGA Saltro VPN U-DPS PACS worklist and desktop sync with UDPS PACS worklist hospital information system ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
18 System design: connections PALGA Saltro VPN U-DPS PACS worklist and desktop sync with UDPS image analysis PACS worklist ChipSoft HiX and Cloverleaf ORM status update ImageServer/fs EMC isilon ILM Rules Technician prepares and stores results for pathologist LIMS Finalist Analysis performed and show result? ORM exam info and status updates Sectra Core Image import request ID, block & stain NAS/SAN ImageServer/s Import Service(SPIS) Image analysis Aperio Archive Launch from viewer Slide Scanners Slides
19 Implementation: software Smart storage 40x 20x Conversion of old Aperio images to DICOM
20 Slide production Perfect central mounting Restrictive mounting No glue remnants (Neoclear xylene) Quick slide drying Workflow Implementation: lab issues Slide cleaning Quality control & rescan Development scanning protocols single layer vs Z-stacks HE vs. special stains/ihc/defatted big slides fluorescence
21 Implementation: lab issues Case assembly and release Filling folders Incomplete cases Double workflow (temporary) Adapt LMS Wanna see the slides button Rescan slide button
22 Implementation: workspace Screens Gizmos
23 Storage Short term storage on the scanner Mid-term storage on the image server Long term storage UMCU: EMC Isilon solution (hard disk based, backup) 800 TB of image data seven years archive scalable permanent
24 Change management Clear mission and vision Explain the why Regular plenary meeting and updates Dealing with dinos Big bang vs. smooth transition Convince yourself Incentives Residents Training Pathologists Residents Technicians Secretaries Working groups involvement! influence
25 Project management structure Control Project organization Monitoring planning and deliverables Decisions Planning, coordination, communication Safeguard issues and risks Rapport to steering committee Steering committee Project group End responsibility project Allocation resources Final decisions Escalation channel Working group quality Create training plan Define acceptance criteria Create test plans Coordination SOPs Coordination acceptance tests Working group digital workspace Working group image analyse Working group workflow Working group technology Ergonomics workstation Workspace design PACS Workflow, worklist, viewer Storage Roll out clients Perform acceptation tests Test image analysis software Advise on changes Integration LMS Perform acceptation tests Define acceptation criteria Processes Rearrange lab to house scanners Perform acceptation tests Emergency procedures Architecture and integration Hardware Storage (archive) Installation PACS & Scanners 2D Barcodes Roll out clients, install workspace Backup, Recovery & Monitoring Migration Aperio images Perform acceptation tests Functional PACS maintenance
26 Chat Our new workflow Worklist folders Reporting module Thumbnails of slides associated to current case Very fast viewer Thumbnails List of current & prior submissions Request form Overview of slide
27 Annotations and measurements
28 Annotations and measurements
29 Changing slides
30 Viewing slides side by side
31
32 Integration of image analysis Wish list Mitoses Nuclear area Metastases finder Immune infiltrate quantification Tumor vs. stroma quantification IHC membrane scoring IHC % positive nuclei scoring etc
33 Advantages of digital pathology no more case assembly in the lab quicker diagnostics easy and more accurate measurements and counting better overview of tissue present flagging missing slides tracking viewing automatic linking of images/reporting/lms MDM: quicker preparation, anywhere, show images easier making annotations easier taking snapshots no more slide searching no more archive digging multiple observer viewing quicker and easier consultation quicker revision integration of image analysis remote digital diagnostics (including consultation) integration with radiology integration of images in EPF allows working paperless better ergonomics teaching is easier and better appreciated
34 Issues to solve cytology implementation (birefringence) optimize viewer (tracking viewing) teaching new residents to use the microscope keeping storage affordable nationwide consultation and revision full integration of image analysis integration with radiology remote digital diagnostics business
35 Optimal, future proof platform for safe exchange of digital images between Dutch pathology labs Rapid, low threshold revision, consultation, panels Increase quality of diagnostics
36 Consultations, revisions: PIE message message Lab A Pathology Image Exchange Lab B images Log in
37 Forget about the business case! efficiency goes up quality and patient safety goes up flexibility goes up employee satisfaction goes up business will increase teaching is more and better appreciated not that much money (3% of our budget, including storage) DON T THINK TOO MUCH
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