After the introduction of the first high-throughput whole-slide imaging (WSI) systems in the early 2000s, the idea of a full-scale transition to digital pathology, in which an institution would routinely scan all glass slides, drove the development of systems capable of digitizing 300 to 400 glass slides at a time.
But over the past 20 years, we have come to find that there doesn’t have to be an all-or-nothing approach to digital pathology. Full adoption of digital pathology has great value when employed in the right settings, but most hospitals and pathologists simply don’t need, and can’t afford, to go full scale.
Take a typical Academic Medical Center (AMC), for example. Even when allowing for substantial changes in laboratory workflow, an AMC is likely to require multiple, expensive high-capacity scanners to achieve full digitization of all samples. There are also considerable infrastructure modifications and resources required, including a costly dedicated imaging lab and technician, to support the digitization and subsequent storage of petabytes of acquired data.
Scan only the slides that matter
In reality, a significant percentage of slides are normal and don’t need to be scanned. In most real-life workflows, scanning is only employed for interesting or difficult cases that require secondary opinions from remote subspecialists. Many clinical organizations that have invested in high-cost, high-volume WSI systems have found their typical use case fails to fully utilize the purchased capacity of these systems, resulting in wasted expense. Several organizations we surveyed reported that even 3 years after adoption, their scanning volumes remain steady at <3% of their total slide production.
For most clinical applications, a phased approach to digital pathology is the most practical, as many labs in both AMCs and community hospitals have discovered. Using a low-throughput system, which is a fraction of the cost of a high-capacity scanner, you can scan only the slides you need for the most common clinical applications, such as remote frozen sections, consultations, tumor boards, medical education, and archival for easy retrieval.
Telemicroscopy as the path to adoption
Another alternative is live telemicroscopy, which is the remote review of glass slides in real-time using a robotic microscope. With a telemicroscopy device, remote pathologists can provide results quickly on the numerous “normal” slides they see every day without having to travel and without the need for scanning. Not only does this make telemicroscopy an even lower cost solution when compared with high-capacity whole-slide scanners, but it also places the device in the same regulatory category as a traditional microscope, removing the FDA clearance required for clinical use of scanning technology.
Should a hospital want to scan interesting slides for storage, research, or educational purposes, they can also opt for a hybrid system, which includes a robotic microscope and a low-throughput scanner all in one device. After reviewing normal slides using telemicroscopy, they can scan samples of interest using the low-throughput scanner located in the same device as the robotic microscope. This flexible approach allows organizations to meet actual demand based on case criteria rather than the scan-every-sample approach and drastically reduces the cost incurred with high-capacity scanners.
The benefits of digital pathology within the pathology community—and ultimately for patient care—are vast and indisputable. You can experience them as well using a phased adoption approach that includes telemicroscopy and low-capacity scanners, in a manner that best fits your needs and budget.
