Adopting a digital whole-slide-imaging system for pathology clinical service is deceptively simple. It is actually far more than the purchase and installation of the slide scanner. It is a complex endeavor involving equipment, software, skill acquisition, workflow design, process integration, and operation management. This synoptic review highlights eight determinants for the successful implementation of a whole-slide-imaging system and summarizes them as "eight, S words" as follows:
Sponsorship: This signifies the support from the top leadership. It should result from a strategic decision to adopt whole slides imaging. Although the capital budget is the key component, other resource supports are also very important.
Space: The digital slide scanner requires a designated space for the scanner as well as related operations. In general, ample space with a low-traffic, clean, minimal floor vibration is desired.
Staffing: Designated staffing is required for the operation. This includes histotechnologists or laboratory aides as well as staff with adequate training for operating the scanner, troubleshooting, and quality assurance.
Storage: The whole slide images in pathology service need secured digital storage with large capacity and easy quick retrieval system for active service and long-term storage. The 20-year retention policy mandate will lead to a mammoth volume of digital information.
Scanners: As the core component of the whole slide imaging system, scanners not only generate digital images but can also impact workflow, maintenance, etc. The scanner can be viewed in two aspects. The first is directly related to its output, including its capacity, scan speeds, scanning size, flexibility in scan area, live view, the Z-stack capability, color mode, image file format, etc. The second aspect is related to its interface and connectivity such as interface with lab information system, image management system, remote accessibility, built-in monitoring, and reporting capabilities, etc. Scanners are different in these technical and connectivity features. There is no uniform guide or criteria for choosing scanners.
System: The system determines how different components are integrated to achieve the goals of whole-slide imaging adoption. This includes software, hardware, human operators, workflow processes, etc. For example, how the scanner interfaces with the laboratory information system critically impact the system architecture, workflow, and related processes. It is important to remember that a complex system that works invariably evolves from a simple system that worked (so-called, Gall's Law). Following an established model or template proven to work before is a reliable safe bet.
Service and maintenance: Effective issue detection with prompt troubleshooting is an important consideration and is vital for the efficient operation of the whole-slide-imaging system. Support from scanner vendors may include remote access to the scanner, 24 7 alert services, regional techniques support, etc. Some of the support may be determined by the features of the scanner (such as built-in reporting and monitoring function, remote access, etc.).
Structured execution: Because of the complexity of this endeavor, structured execution is vital, and early management involvement can secure the successful adoption of this technology and ultimate operation effectiveness. With time and money, the adoption would be eventually achieved but the differences between unplanned, trial-and-error methods and structured execution are hundreds of thousands of dollars and months or even years of time.
Summary in Keywords: The eight S words.
Sponsorship, space, staffing, scanner, storage, system, service, and structure.
(544 words)
Listen to the Audio
Key References
Hanna, Matthew G et al. “Integrating digital pathology into clinical practice.” Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc vol. 35,2 (2022): 152-164. doi:10.1038/s41379-021-00929-0
Zarella, Mark D et al. “A Practical Guide to Whole Slide Imaging: A White Paper From the Digital Pathology Association.” Archives of pathology & laboratory medicine vol. 143,2 (2019): 222-234. doi:10.5858/arpa.2018-0343-RA
Comments