The process of reading dermatologic slides has gone digital, giving way to several applications, including medical student and resident teaching, teleconsultations, multidisciplinary conferences, live interactive webinars, continuing medical education, and research.
An expert in the use of virtual dermatopathology (VDP), Ellen Mooney, MD, director of the Nordic Institute of Virtual Dermatopathology, Hafnarfjördur, Iceland, described the technology, its usefulness and challenges, and future applications during an interactive session Friday.
The first automated, high-resolution, whole-slide imaging system was developed in 1999. Today’s technology provides software-assisted manipulation of high-definition digital images of tissue sections, simulating the experience of examining glass slides under a standard microscope and allowing magnification up to 40 times.
“Because the technology is digital, viewing and consultations can be done on a computer, over a network, or over the Internet,” Dr. Mooney said.
She also noted that retrieval of previous skin biopsy digital images and split-screen comparison of two or more images from the same case or different cases with VDP will further help physicians make diagnoses.
VDP is not without challenges.
“Digital slides scanned by different brands of scanners and the software used for viewing the images may be incompatible. However, several types of software can accommodate most types of digital slides, regardless of origin, ” Dr. Mooney said. “Software using Flash Player is currently incompatible with certain tablet computers, including the iPad.”
VDP is ripe for the classroom.
“It provides students with access to slides from rare cases they would not traditionally see — and without the risk of breaking valuable glass slides,” Dr. Mooney said.
She shared several other teaching benefits, including:
- The addition of clinical information and photographs is useful in clinico-pathological correlations
- By attaching a discussion, multimedia, Web links, and references, usefulness of the images as a teaching tool and for CME can be enhanced further
- Once images and ancillary material are online, they can be accessed for review and further study
- With software, VDP can provide instant feedback, allowing participants to assess their performance and accrue CME.
Dr. Mooney has used VDP in directing resident courses, online CME courses, and live CME courses. She and her co-investigators published two research studies in the May 2011 issue of “Skin Research and Technology” and the August 2012 issue of “Journal of Cutaneous Pathology.” Antoinette Hood, MD, professor of dermatology and pathology, and director of dermatopathology at Eastern Virginia Medical School, Norfolk, was among the co-investigators of the second study.
There was no significant difference in the participants’ diagnostic ability using virtual slides compared to glass slides and in using virtual dermatopathology compared to photomicrographs.
She added that the FDA is expected to approve digital whole-slide imaging for routine surgical pathological/dermatopathological diagnosis to replace diagnosis using conventional light microscopy.
“Once approved, regulatory agencies in other countries will certainly follow suit,” Dr. Mooney said. “In the future, integrating the workflow of dermatopathologists with electronic medical records, including transmission of digital images to patients’ electronic charts and other links, will be achievable.”