1. XML-Based Virtual Slide Box for Teaching Histology and Pathology Jeffrey Fine, M.D. Cleveland Clinic Foundation

2. Background Virtual Microscopy (VM) –Use of digital imaging to produce “digital slides” that simulate light microscopy Delivery of slides most common via web browser software (Internet or CD-ROM) Increasing use in medical education

3. Background II Cleveland Clinic Lerner College of Medicine –Innovative Problem-Based Learning curriculum Web based Students have laptops and wireless campus –Histology curriculum utilizes virtual microscopy

4. Challenges Organization of digital slides (~730 slides) –Includes slides from University of Iowa (93%) Maintenance of virtual slide boxes –Study resource for students –Curriculum management for faculty Digital Slides (730) Medical Student Other sources (books, etc.)

5. Technology VM Software –Neuroinformatica (MicroBrightField, Williston, Vermont) Digital slide database, Annotation software, and Java-based viewer software Web-based Curriculum –Windows Server 2003 –HTML and Active Server Pages (ASP)

6. Technology II Both VM and Curriculum support XML –XML file export of VM database –Script-based support of XML on Web server

7. Design Digital Slides (730) Medical Student Other sources (books, etc.) XML ASP XSL Virtual Slide Box

8. Naming Convention Consistent keywords for curriculum topics –Neuro, Renal, Cardiovascular, etc. Keywords for histology versus pathology Other words –Site –Diagnosis –Technical details (special stain, etc.)

9. Generation of XML file Export the VM database into XML file –After changes to the database (new slides, etc.) XML file is transferred to a directory on the server –XML Slide Boxes requires no further effort to update –Amenable to automation via script in the future

10. XML (excerpt)

11. Utilizing XML “XML does not DO anything” –W3 Schools (http://www.w3schools.com) eXtensible Stylesheet Language (XSL) –Analyzes XML file and outputs HTML –Each slide box has a unique XSL file XML Path Language (XPATH) –Syntax for addressing parts of an XML file

12. XPATH XSL

13. XML

14. Check each slide Slide labeled as “Neuro”? Slide labeled as normal? Example: List of normal neurohistology slides Add slide to list NO YES

15. Utilizing XML, XSL, and XPATH Active Server Page (ASP,.asp) –Executes the script on the server –End user browser sees only HTML

16. Example http://cclcm.ccf.org/vm/slide_box/neuro/slidebox_neuro_main.htm

17. XML Slide Box XML ASP XSL Virtual Slide Box (Neuro) ASP XSL Virtual Slide Box (Renal) ASP XSL Virtual Slide Box (Skin)

18. Future Directions Expansion –Resident education –Additional study sets Improvement –Student Feedback –Usage Information

19. Conclusions Provided simple solution to a daunting problem –XML easy to learn and implement –Transparent technology for the end user Facilitated VM for teaching histology and pathology Gained valuable, real world XML experience

20. Acknowledgments Dr. Henricks Dr. Prayson Pavel Ermakov (CCLCM Web team) Dr. Dee (U. Iowa) Doug Hoppes (MicroBrightField)