2. Digital Pathology, An Introduction From glass slides to digital files and there after

3. process Scanning of glass slides by a scanner--- convert information to a digital format Navigate the digital slide using a software, from any power, on any area of interest, just like a glass slide Data analysis

5. Applications Remote access of slides: Frozen Sections (night calls and remote sites) Telepathology for 2nd opinion Secondslide.com pathxchange.com Multi-institution collaborative studies Retrospective and prospective collections of cases for TMA, case series studies, etc

6. Real time consultation Bioimagene

7. Clinical applications Archival & viewing of data: – Tumor Boards – Quality Assurance (2 nd read on QA cases) – Publications (? digital slide access as a part of case reports and case series in the future?) – Scan in key diagnostic slides for outside review cases, to avoid having to borrow back slides for clinical or academic needs. – Access old cases for comparison for frozen sections and current cases – Teaching sets for rare cases.

8. Extract region

9. Image Management

11. Digital IHC From Aperio tutorial,

12. Bioimagene companion algorithm Breast: ER, PR, Her2neu, ki67, p53 quantitation Prostate: PIN-4 and Ki-67 Brain: Ki67 Heme: quantitation of CD138 labeled plasma cells in bone marrow samples. Carcinoid: BioImagene’s Ki-67 carcinoid algorithm is an aid to pathologists and researchers in the detection and quantitation of stained cells in carcinoid tumors derived from gastrointestinal tissues.

13. Practical issues Cost (machine, software, storage & personal) Time for scan: 15x15 mm tissue – 20x < 1min; 40 x 6-7 min Memory: 20X scan: 250 MB; 40X scan: 800 MB – 1TB can hold 2,070 slides (assuming 500 MB/slide), or 4000 slides for 20x (250 MB)

14. vendors Aperio Bioimagene Olympus (nanozoomer) Omnyx (UPMC+GE) 3DHistech Leica

15. Issues for evaluation Scanned image quality Image management software (interface with LIS system if intend for clinical use) Image analysis software Technical support Stability of vendor in the market Good fit between your need and vendor’s strong points