1. High Volume Slide Scanning Architecture and Applications
Picture: First (?) Leitz photo microscope, Museum Boerhave, Leiden, The Netherlands
Dr. André Huisman
Department of pathology
UMC Utrecht, The Netherlands

2. Department of pathology UMCU
UMC Utrecht
>1,000 beds
>10,000 employees
Department of pathology:
surgical pathology cases
glass slides (histology, cytology, IHC)
15 pathologists, 10 residents

3. Digital pathology - advantages
Digital Archiving
Instant access from multiple locations by multiple people
No searching for slides
Constant quality
Telepathology
Consultations, revisions and panels
Education
Research
Automated image processing
Difference between

4. Project background Clinico pathological conferences:
900 meetings every year
No (multi headed) microscope needed
Quicker preparation of meetings
No retrieval of glass slides from archive

5. Digitize all diagnostic slides we have (prospectively)
Aim (2007)
Digitize all diagnostic slides we have (prospectively)

6. Challenges Scanners Image size: up to 1 GB x 500 slides per day
No existing infrastructure present for storage of this size at our facility
Image presentation and software integration
Logistics

7. Scanners Different manufacturers: Speed Focusing method
Acquisition technique
z-stack acquisition
File format policy
Application integration
2007: 3D Histech (Zeiss), Aperio, Hamamatsu, Olympus (US: Dmetrix, BioImagene)
2010: Leica, Menarini, Philips, Omnyx, BioImagene

8. Scanning logistics 3 Aperio XT scanners (120 slides per scanner)
Morgue assistants
Mark slides after scanning
6 Hours per run at 20x magnification (~3 minutes/scan)

9. Storage – HSM HSM = Hierarchical Storage Management
Sun Microsystems (Oracle)
6 TB available on very fast fibre channel disks
120 TB available on tape (750 GB each)
2 Tape drives
Completely transparent archiving and retrieval (robot)
Access time from tape: minutes

10. Linking systems 1D Barcodes U-DPS: reporting system
LMS: Laboratory Management System
Spectrum: Aperio’s image management solution
Storage system
Own development: integration layer

11. Scanner workflow LIS Image / Data server U-DPS Scanning Database
Other images
(e.g. macro)
Scanning
Order form
scanner
Database
LIS
Image / Data server
U-DPS
Speech
recognition
HSM
120 TB on tape
6 TB fast disks
Storage
pathology users

12. Validation Aim: validate diagnostic use of digital slides
Method: reevaluate diagnosis with same pathologist on scanned slide after washout period (1 year) for several organs
Gold standard: original diagnosis using ‘traditional’ microscopy

13. Preliminary results validation
GI tract (%)
Skin (%)
Same 92 94
Similar 7 5
Discrepant 1
GI tract discrepancy
Different interpretation of abnormality
Glass slide and WSI contained same information
Skin discrepancy
Clinical information not used for interpreting digital slide

14. Pitfalls of digital archive
Costs
Huge storage needs – 40 TeraByte per year (over 57,000 CDs)
Largest storage in the UMCU
Logistics of scanning up to 500 slides per day
Currently scanning almost 24 / 7
Place of scanning in process
Speed of image retrieval
Image compression (JPEG 2000?)
Backup

15. Education All students view the same “best slide”
Slide images can be integrated with
Annotations
Questions
Macroscopic images
Other multimedia
Most UMCU microscopy practical sessions are digital
Student satisfaction is high

16. Teleconsultation Place (small) slide scanners at different labs
Upload digital slides to UMC Utrecht
Aurora mScope Clinical
Upload new media

17. Digital slide panel discussions

18. Image processing research
Image processing applications on virtual slides:
Detecting mitotic figures in breast cancer slides
Use texture features
Establishing histological grade in breast cancer
Segmentation of individual nuclei (on H&E stained slides)
Detect points of interest
Use marker-controlled watershed segmentation
Post processing

19. Conclusions Routine scanning is possible and makes sense
Future of pathology is digital
Digital pathology is expensive
Digital pathology is just starting..
Together we are shaping Pathology 2.0

20. Discussion Limitations current system Cytology Speed
Magnification (20x / 40x incidental)
Backup
Quality Control

21. Discussion Archive heavily used Educational use still growing
Teleconsultation network growing (
Need for standards
DICOM / JPEG 2000
Images, annotations and reports
Mixing scanners and integration with other software platforms (middleware?)
Image management central in workflow for pathologist?
Other platforms = LIS, PACS, HER, reporting software, speech recognition

22. Questions?! a.huisman-4@umcutrecht.nl
Huisman et al., Creation of a fully digital pathology slide archive by high-volume tissue slide scanning, Human Pathology, 2010 May; 41(5): 751-7