2. 數位教學經驗分享交流會 14h June, 2011 陳玉昆， Y-K Chen Department of Oral Pathology, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, TAIWAN 虛擬顯微鏡於口腔顎顏面 病理學實驗課程之應用 An Application of Virtual Microscopy to the Teaching of Oral Pathology Laboratory Course

3. 參 考 資 料參 考 資 料 1.Evans AJ, et al. Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience. Human Pathology 2009;40:1070-81. 2.Dee FR. Virtual microscopy in pathology education Human Pathol 2009;40: 1112-21. 3.Weinstein RS, et al. Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Human Pathol 2009;40:1057-69. 4.Kaohsiung Medical University, Department of Oral Pathology. 5.Marchevsky AM, et al. Self-instructional “Virtual Pathology” laboratories using web-based technology enhance medical school teaching of pathology. Human Pathol 2003;34:423-9. 6.Chen YK, et al. An application of virtual microscopy to the teaching of oral and maxillofacial pathology laboratory course. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:342-7. 7.Hanks CT, et al. Internet- and DVD-based instruction in oral pathology for dental students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:195. 8.Farah CS, et al. The e-evolution of microscopy in dental education. J Dental Edu 2009;73:942-9. 9.Dotslide, Olympus company catalogue

4. Virtual microscopy: emulate traditional light microscopy using digital image files (virtual slides) manipulated on a computer screen using microscope emulator software Refs. 4, 9 Whole slide imaging: create digital images of the entire area of a glass slide Hard Copy Soft Copy 顯微影像數位掃瞄系統 Automate scan process - 50 slides

5. Ref. 4 OlyVIA 閱片 Dot slide 掃瞄、閱片 Procedures of whole slide scanning (1) Dot slide

6. Ref. 4 New slide Procedures of whole slide scanning (2) Dot slide

7. Ref. 4 Overview image Procedures of whole slide scanning (3) Dot slide

8. Ref. 4 Procedures of whole slide scanning (4) Dot slide

9. Ref. 4 Edit scan area Procedures of whole slide scanning (5) Dot slide

10. Ref. 4 Procedures of whole slide scanning (6) Dot slide New area

11. Ref. 4 Live (active) Procedures of whole slide scanning (7) Dot slide Autofocus

12. Ref. 4 Procedures of whole slide scanning (8) Dot slide

13. Ref. 4 Live (active) Procedures of whole slide scanning (9) Dot slide

14. Ref. 4 Procedures of whole slide scanning (10) Dot slide

15. Virtual slide viewer: use iconic representations of 4×, 10×, 20×, and 40× objective lenses and select the magnification of choice by clicking on one of these icons with a computer mouse Ref. 4 OlyVIA

16. Refs. 4, 9 Net Image Server/Web Server, Dotslide and OlyVIA Dot slide/ OlyVIA Dot slide/ OlyVIA Lan/Internet Dot slide/ OlyVIA Dot slide/ OlyVIA Net Image Server Dot slide Web Server WorkstationClients

17. Telepathology: practice of pathology at a long distance, has advanced continuously since 1986 Robotic control of microscopy Ref. 1 Frozen Section Telepathology UHN Toronto Ontario Canada

18. Virtual microscopy or telepathology - attractive to educators due to: (1) nearly perfectly simulates the pan & zoom characteristics of conventional microscopy (2) versatility of computer-assisted education Refs. 3, 8

19. Medical schools in the US: entirely digital for pathology courses, discarding light microscopes, and building virtual slide laboratories UCLA School of Medicine’s Center Ref. 5

20. UCLA School of Medicine’s Center Ref. 5 Table 1. Mean Ratings of Attributes of Virtual Pathology Based on a Likert Scale (1, Not at All Useful to 5 Very Useful), n = 72 Attributes of the Virtual Pathology ModuleMean Standard Deviation Quality of images4.40.69 Image description4.10.87 Case histories framing the slides4.10.88 Pretest3.51.05 Posttest3.70.98 Feedback on posttest3.21.33 Overall format of presentation40.89 Ease of navigation4.60.63 Overall gain in learning4.00.81 Presence of experts to assist me4.20.75

21. UCLA School of Medicine’s Center Ref. 5 Table 2. Mean Ratings of Student Perceptions of Virtual Pathology Based on a Likert Scale (1, Not at All Useful to 5 Very Useful), n = 72 Criteria for Student PerceptionsMean Standard Deviation I enjoyed working on the web-based slide presentation3.40.62 This format was an effective way to learn the given content3.40.62 I was able to complete all of the sections within the time limit3.70.46 The petest helped me in focusing on what I did not know3.00.85 I prefer this interactive format to a lecture presentation3.20.76

22. Oral Pathology Laboratory course for dental students at University of Michigan - converted from a microscope-based course to an internet-accessible virtual histopathology ‘‘laboratory.’’ (2003) Ref. 7 University of Queensland, School of Dentistry (Brisbane, Australia) implement VM technology (Aperio Systems’ ImageScope) into its courses of Oral Biology (2006) & Oral Pathology (2008) Ref. 8

23. 口腔病理學 ( 含實驗 ) - KMUOP 1. 屬於基礎範圍，為提昇同學學習之興趣，於 2006 年開 始應用網路及多媒體教學，架構口腔病理科教學網頁 2. 假設虛擬顯微鏡，將口腔病理教學玻璃切片轉換成高解 析度的數位影像檔，置放於本科網站中。下載 OlyVIA 軟 體，使用網路閱覽口病教學切片。 Refs. 4, 6

24. Ref. 4

28. ………. Log in User name Password administrator Ref. 4

29. Open Ref. 4

33. Refs. 4, 6 高醫牙科口腔病理學實驗切片線上教學 小組線上教學 發表文章： An application of virtual microscopy in the teaching of an oral and maxillofacial pathology laboratory course. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:342-7 線上考試

34. 高醫牙科口腔病理學實驗切片線上教學

36. Advantages of virtual microscopy vs traditional microscopy Ref. 2 Accessibility - Access can be anywhere anytime there is computer (and the Web) available - One slide can be viewed by many or duplicated and shared Multiple recuts are not needed - One-of-a-kind slides that cannot be recut can be duplicated into an unlimited number of copies and shared with others, e.g. fortuitous cut in following case

37. Advantages of virtual microscopy vs traditional microscopy Refs. 1, 2 Efficiency - Focus, proper condenser adjustment, and lighting are not required -Technical competence in viewing is easier to achieve and less frustrating for trainees who do not have an aptitude for traditional microscopy - There is rapid access to the next slide in the slide box

38. Advantages of virtual microscopy vs traditional microscopy Refs. 2, 4 Pedagogic - Very-low-power over (<<x4) allows to better visualize relationship of pathologic to normal tissue - A thumbnail & location box allows trainee to remain oriented to the whole slide while viewing a high magnification

39. Advantages of virtual microscopy vs traditional microscopy Ref. 2 Pedagogic - Marking x-y & magnification coordinates of multiple key areas & movement among these areas at the click of the mouse is possible

40. Advantages of virtual microscopy vs traditional microscopy Ref. 2 Pedagogic - Side-by-side viewing, annotation overlays, & integration with descriptions, case scenarios, gross & radiological images or digital photomicrographs is possible

41. Advantages of virtual microscopy vs traditional microscopy Ref. 2 Pedagogic -Group discussion is enhanced as each computer screen can serve as a multihead microscope Conference

42. Disadvantages of virtual microscopy vs traditional microscopy Ref. 2 Pedagogic -Trainees do not learn how to use a traditional microscope if virtual microscopy is used exclusively Technology - Low magnification has less resolution when viewed on a standard computer screen - Refractile objects do not refract well - Original glass slide tissue artifact and imperfections are difficult to scan - Virtual focus acquisition & viewing is inefficient, especially over the Web

43. 감 사 합 니 다감 사 합 니 다 謝 謝