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Design and Implementation of a Clinical Whole Slide Imaging System for Diagnostic Anatomic Pathology Applications
Jonhan Ho MD1 (hoj@upmc.edu); Jeffrey L Fine MD; Anil V. Parwani MD PhD1,2; Drazen Jukic MD PhD1,2; John R Gilbertson MD3; 1Centers for Pathology and Oncology Informatics, University of Pittsburgh; 2 Department of Pathology, University of Pittsburgh Medical Center; 3 Department of Pathology, Case Western Reserve University School of Medicine
Context: Whole slide image (WSI) systems are rapidly undergoing technical refinement and are now being evaluated with clinical validation studies. Large scale clinical application of WSI technology will also require integration with pathology workflow as managed by laboratory information systems (LIS). We integrated a commercial automated imaging device, and then created and evaluated a prototype integration system. Finally, we provided feedback to the industry for broader acceptance, development, and growth of WSI.
Technology: An Aperio (Aperio Technologies, vista CA) T2 automated batch whole slide image scanner was interfaced with the APLIS (Cerner CoPath, Cerner, Kansas City MO) using middleware created by using Microsoft’s .NET 2.0 framework, and served using Microsoft’s Internet Information Services 6.0 (Microsoft, Redmond WA).
Design: The prototype consisted of a middleware application that interfaced with the LIS, the imaging device, security servers, and the pathologist. Key characteristics of the application included messaging capability between the imaging devices and the LIS (matching patients, accessions, and slides), and the ability to create and transfer WSI to an independent archive.
Results: The system successfully interacted with other critical systems and provided an integrated WSI experience that closely simulated a traditional glass sign-out experience, but with more accessibility to patient information and the ability to integrate multiple tasks of a sign-out process. Pathologists provided feedback through an iterative development cycle that resulted in an accession-centric, internet browser-based WSI interface that was launched directly from within the LIS without redundant patient data entry.
Conclusions: Data integration between the LIS and imaging devices – through bar coded slides and middleware -seems to be important in large scale clinical use of WSI. The LIS should remain the major workflow engine of pathology, and clinically effective systems should present textual (LIS) and image (WSI) data on the same user interface.