Digital Pathology Behind the Scenes

Earlier this year, NSH launched a Digital Pathology Certificate Program, a 22 credit, online course, designed to increase knowledge and improve competency in digital pathology/whole slide imaging. You might be familiar with the program from Yungfu Wang’s post about it back in May.

Now that we’ve seen the end product, we wanted to revisit the program, this time going behind the scenes, to get the inside scoop, from the 10-person task force, responsible for the planning, development, and publication of this Certificate Program. This workgroup included: Elizabeth Chlipala, Traci DeGeer, Kathleen Dwyer, Shelley Ganske, David Krull, Haydee Lara, Lisa Manning, Dr. Liron Pantanowitz, Dylan Steiner, and Lisa Stephens, with facilitation from NSH President, Diane Sterchi, and NSH staff, Aubrey Wanner and Connie Wildeman.

NSH interviewed the group to learn more about the work that went into this incredible project. Here’s what the workgroup's members have to say about the purpose behind the program, the challenges they faced in launching, and the ah-ha moments along the way!

NSH: Why was the program developed?

Traci DeGeer and Kathy Dwyer:

Over the last few years there has been an increased interest in learning more about the implementation and use of Digital Pathology in both the clinical and research anatomical pathology lab. This program was developed as a way to provide a comprehensive, basic learning, on essential information needed to get started with Digital Pathology. It provides insight from digital pathology experts throughout the industry, in order to cover the broadest range of topics, including

choosing a system, validation, implementation and regulations.”

NSH: What is your perspective as a pathologist, on the importance of this program to the field of digital pathology and to the education of histotechs/technologists/pathologists and others in this discipline?

Dr. Pantanowitz: Digital pathology has matured to the point where many labs are now routinely using this technology. As a result, several individuals with a variety of backgrounds have been solicited and hired to help with this work. Many of these folks are histotechnologists who have limited experience with digital imaging. If we want the adoption of digital pathology to continuously grow and the standard of practice to improve we need well trained people involved who can perform slide scanning, manage digital imaging systems, participate in complex image analysis, or tackle anything else that may encompass digital imaging. For the first time, the NSH has developed a program to fulfil this need. This is timely, because a recent survey by the Digital Pathology Association revealed that the vast majority of their members felt that a digital pathology certificate program was a good idea. The NSH program will not only increase the knowledge and improve the competency of those individuals who are awarded a certificate, but will also grant recognition to those individuals who are so important to safely using digital pathology in clinical practice and advancing this field.

NSH: Why is learning about Digital Pathology important for histologists?

David Krull: There has been an enormous amount of change in the histotechnology profession since I was board certified 30 years ago! Back then, there was no such thing as digital imaging. Microscopes had 35mm cameras mounted on them and film needed to be developed in darkrooms. Slide presentations were assembled by loading Kodak Carousel Slide Projectors with 35mm slides. “Image analysis” was done by the pathologist who read the tissues directly through the microscope. May times their analysis involved the use of a reticle, hemocytometer and some scratch paper. Fast forward to 2018 where we produce a digital image of a tissue section in minutes! This can then be transferred to multiple reviewers in a few more minutes. In addition, there are now several software vendors who provide algorithms for quantifying cell populations (and more) using tissues samples prepared with advanced assays such as multiplex immunohistochemistry and mRNA In Situ Hybridization. Pathologists are increasing relying on the histotechnologist to provide digital images through whole slide scanning and may even be called upon to perform image analysis. This is especially true for the research histotechnologist. Realizing the need for increased training in this area, the NSH has brought together leaders within the digital pathology community to create the Digital Pathology Certificate Program. NSH members who complete this program will have a solid foundation in digital pathology on which to build further understanding as the technology continues to grow and evolve. This certificate of completion in digital pathology may lead to career advancement, provides diversification in skill set, empowerment to drive digital pathology in their labs, greater job satisfaction and adds value for employers. The program is a great value and has advantage over traditional college course in its delivery, accessibility and its self-paced structure.

NSH: How did you identify the speakers for the presentations?

Dylan Steiner: “Speakers selected for the Digital Pathology certificate program demonstrate leadership expertise in the subject areas of their chosen module(s). Many of them are journal authors, educators, laboratory managers, and past speakers or volunteers with the NSH and DPA professional societies. We carefully chose speakers to represent the diverse membership of both the NSH and DPA. These include KOLs from academic institutions, hospitals, research laboratories, and the pharmaceutical and biotech industries. Speakers were provided with key objectives in each module topic, but were ultimately responsible for what points to emphasize and how to package and present the information in a format that was best for the topic. As many of the speakers are current NSH and DPA members, we encourage Digital Pathology Certificate participants to actively engage with these communities for continuing education and support in this rapidly advancing field.”

NSH: What was the most challenging part of developing and creating the Digital Pathology Certificate Program?

Lisa Manning: “My biggest challenge in developing and creating the digital pathology certificate program was time. When people started brainstorming ideas for this course, I was extremely excited to get involved so I could share what our labs experienced when we entered into the new arena of digital pathology. I was also thrilled to have the ability to connect with world leaders in the digital pathology field to assist our team in developing the various components of the certificate program. Unfortunately, once the group had formed and I started working on my section, my father was hospitalized and my “free” time was taken up helping my parents manage this difficult time. At the same time, we were rolling out a new LIS in one of our labs which was 125 miles away. This meant that I was out of office for large periods of time working very long days, trying to implement the new LIS system. All these competing priorities made this very challenging, but our Digital Pathology Workgroup was extremely patient with me. Due to the support of the NSH Digital Pathology Certificate Workgroup and my colleagues at the Digital Pathology Association (DPA) we have successfully completed this new certificate program.”

NSH: What surprised you most about working on this committee, did you have any “ah ha” moments?

Shelly Ganske: “In the beginning, since someone else had put my name forth to the committee and I had missed the first meeting we had, I thought I was just contributing to a chapter in a book like I would write a section in a paper to be published. I soon realized that I was way off base and I was to create content for a module that spanned much more than I felt like I had the expertise to complete. And yes, I could even teach a section if I was willing…via webinar! I felt small in the group like I didn’t have as much to offer as was required for my entire module but once we began, I realized that everyone had a piece of their own expertise that they could offer and when we all worked together, we were able to create an amazing tool. When I didn’t have an answer for something that was under my portfolio, I reached out to the group and others jumped in with ideas of support. The staff at the NSH office were pivotal in keeping the group on track and putting everything together. The world of DP is very dynamic, but I realized that any experience with this vast and very powerful technology was useful in creating educational material that we could share with others.”

NSH: Tell us about your experience with digital pathology in your workplace? Have you been through implementing the systems described in the course?

Lisa Stephens: As a Surgical Pathology Technologist, I was studying for my HTL and I learned of an open position in the ePathology department. It was an entirely new perspective on pathology. When I began, the big three uses (Clinical, Education, Research) were already in place, but have evolved considerably since. In research, scanning and performing image analysis is becoming more popular. AI is ramping up and comprises most of our current projects. As a teaching hospital, the residents find our library of images a priceless resource.

In the realm of clinical scanning, the implementation of interfacing the scanned images with our LIS is becoming sought-after by many pathologists. With more and more focus on the availability and flexibility of the patients’ EMR, our hospital is becoming receptive to the possibility of scanning slide images as part of this permanent record. Another big change, clinically, is the increased implementation of international digital consults. Our consults have doubled over that past year, bringing with it the challenge of using multiple software networks and image formats.

Just as important as implementing these systems is understanding the learning curve and comfort level of the pathologists in reading clinical cases digitally. It takes some adjustment and not everyone takes to it right away. Patience, with the formation of workflow and proof of the benefit to patients and pathologists, is key.

While having an entire department dedicated to digital pathology is the exception, rather than the rule, basic knowledge of this topic is essential for every histotech’s career. After all, the histotech’s job is to support the pathologist in order to heal the patient!

NSH: Is there anything that was new to you, that you learned while working through this project?

Haydee Lara: Plenty! I come from a cell and molecular biology background and started learning about Digital Pathology very recently myself. Participating in the development of the Program allowed me to organize all of what I have learned in the past 2 years and to identify and fill the knowledge gaps. It also helped me to familiarize much more with all the jargon and the concepts that make me able to explain Digital Pathology to my clients and collaborators. Additionally, it was good to learn how different the challenges are that the technology poses in the Clinical arena (patients need to know really quick!) compared to Research and how easy Digital Pathology is making education and collaboration between researchers across the world. And very importantly, I learned how I can implement easy to use equipment to teach kids how cool science is, no need to bring your heavy and expensive microscope to the science fair, bring your monitor!

NSH: What are the future plans for the Digital Pathology Certificate Program?

Liz Chlipala: Since it’s important to keep the content of the program up to date and relevant, the Committee will meet in late 2018. The Committee will review the current content, comments from individuals who have taken the course and will monitor new and emerging trends within the space and update and add new modules as necessary, with the potential for those additional modules/updates to be released in 2019. The program will be featured in a couple of publications and educational meetings. Later this year an article will be in CAP Today, followed by an editorial in the Journal of Pathology Informatics. Dr. Marilyn Bui, president elect of the DPA, has been invited to present on the program at the 17th annual Japanese Society of Digital Pathology meeting in Hiroshima, Japan and I have been invited to present in the digital pathology track at Molecular Med Tri-con in San Francisco in 2019.

If you’re interested in learning more about the Digital Pathology Certificate Program, it is available on NSH’s Online Learning Center, https://learn.nsh.org/c146522/Digital-Pathology-Certificate-of-Completion-Program . There is a $100 discount for NSH and DPA members.

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