Pathology Image Exchange. Paul J van Diest, MD, PhD UMC Utrecht

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1 Pathology Image Exchange Paul J van Diest, MD, PhD UMC Utrecht p.j.vandiest@umcutrecht.nl

2 Digital pathology: the UMC Utrecht 2016 solution scanning macro imager order form scanner database LIS VNX Image/data server HIS U-DPS PATHOLOGY storage RADIOLOGY pathology users clinical users

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4 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

5 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 efficacy efficacy patient safety/efficacy patient safety patient safety patient safety patient safety efficacy efficacy efficacy efficacy efficacy efficacy patient safety/efficacy efficacy patient safety patient safety/efficacy patient safety clinician satisfaction environmental pathologist satisfaction student satisfaction

6 Dutch digital pathology labs full digital diagnostics UMC Utrecht LabPon 1 lab partly digital diagnostics Heerlen Dordrecht 2 regional consortia with digital infrastructure Den Bosch/Nieuwegein/Arnhem Alkmaar/Zaandam/Hoorn 7 academic labs with scanners for research/teaching 16 labs with digital pathology infrastructure and many more working on it! Radboud, Eindhoven

7 Dutch digital pathology 2016 increasing need of digital lab2lab communication? Subspecialization within regional networks Covering superspecialties between academic centers Revisions Consultations Expert panels Research Teaching

8 Revision When referring patient, reassess pathology material Quality control Reformulate results in local and up to date jargon Compare to new material Material for demo at multidisciplinary meetings Further testing Volume ~ per year in The Netherlands

9 Consultation Second opinion from collaegue in a difficult case Patient stays at original hospital Volume ~ per year in The Netherlands

10 Logistics revisions and consultations Lab A Lab B Dig up slides from archive or desk pathologist To administrative office Printen report Wrap To post office From post office to department Unwrap Register Assess Make report

11 Logistics revisions and consultations Lab B Print report Wrap report and slides To post office Lab A From post office to department Unwrap Report to pathologist Append to report Slides back to the archive

12 Logistics revisions and consultations Process takes 3-14 days (50% > 4 days) Patient has to wait for definitive result and treatment Stress, loss of productivity and quality of life Optimal mail logistics: process 2 days Digitally: same day?

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14 Logistics digital revisions and consultations Lab A Lab B Scan slides Upload to server Message through PALGA to other lab Log into server Assess Make report Report to requesting pathologist through PALGA Done on the same day

15 Panels 6-15 pathologist and residents Travel for many kilometers Often during rush hour/traffic jams Hugh loss of productivity Frequency 1/month

16 Logistics digital panels All cases digitally scanned/uploaded when registered No more slide sending Preparation beforehand remotely Straightforward cases closed digitally by consensus Difficult cases discussed f2f

17 Dutch digital pathology 2016 increasing need of digital lab2lab communication! Time for a solution Local? National!

18 Optimal, future proof platform for safe exchange of digital images between Dutch pathology labs Rapid, low threshold revision, consultation, panels Increase quality of diagnostics

19 Patient safety Dutch national pathology archive All labs connected since 1990 Unique infrastructure for national pathology initiatives

20 Revisions and consultations central solution message message Lab A Lab B image upload Log in

21 Panels central solution message message Pathologists Pathologist A Lab A image upload log in B C D E F..

22 Tender issues Must haves Speed DICOM (scanner vendor independent) Security Uptime Connections PALGA, LMS, UDPS/Sympathy etc Storage

23 Where are we? PALGA project foundation setup Security issues solved (Lab2lab communication) Tender finished (5 bids) Best value procurement Professionally managed (Medical Phit, Mitopics) Sectra has created the platform Tests ongoing Manual upload Automatic upload

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25 Tender issues Assets Video? Sound? Image analysis? Speech recognition? MDM tool? Mobile device functionality?

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