1. A Visual Pathology Report to Facilitate Communication of Patient- Specific Pathology Information Katherin Peperzak August 17, 2006 University of Pittsburgh School of Medicine David Eibling, MD Department of Otolaryngology, University of Pittsburgh Medical Center

2. Introduction Text-based surgical pathology reports can be sources of miscommunication between pathologists and clinicians –Formatting issues »Concatination of reports in VA system (IT problem) –Attempts by clinicians to create mental images from text descriptions may lead to misinterpretation of the in situ localization of cancers of the region and their orientation within the microenvironment

3. Example Here is an excerpt from a 3 page report describing a tumor in a resected larynx: Tumor extends between the inferior rim of the thyroid cartilage and the superior rim edge of the cricoid cartilage on the right for an additional thickness of 0.6 cm where tumor extends into fibromuscular tissue on the right lateral side of the larynx. The posterior aspect of the tumor extends partially into the right paraglottic space where it undermines the infero-anterior edge of the right arytenoid cartilage. Otherwise tumor only superficially involves the mucosa at the posterior border of the lesion.

4. Example Is this what you pictured?

5. Specific Aims Our goal is to develop a novel visualization- based pathology report that enhances pathologist-clinician communication The interface to the report will include a 3D model of the resected specimen and will enable the user to “explore” –User will be able to zoom in to view photographs and microscopic slides of pathologic sites, margins of interest, and pathologist annotations We are using resected larynx specimens for our prototype

6. Project Components Two main components to the project: –Defining the interface »What information will be included and how will the user view it? »How will the user interact with the model? –Developing a 3D model

7. The Interface Must consider clinician user and pathologist user separately –Interviews and observations used to design a user-friendly interface »Not the typical IT approach! Design plans include: –Allowing the user to use various “clipping planes” on any axis –Incorporation of roller ball mouse for easy manipulation of model –Use of key colors to indicate particular diagnoses

8. The Model Three methods under investigation –Build model CT data –3D reconstruction of macroscopic optical slice images –Build wireframe model of typical larynx and apply photographic/endoscopic data CT-based models are problematic –Have to image each specimen after resection »Not feasible –Or, hand segment larynx from pre-operative CT »Time-consuming

11. Optical Model Requires serial slicing of specimen Each slice photographed on superior and inferior aspect Photographs reconstructed into 3D model

12. Future Work Further investigation of 3D models and their registration to radiographic data and histologic slides Determining how to integrate model annotation into normal pathologic processing without creating a burden on the technician Development of a prototype interface by the Visual Information Systems Center at the University of Pittsburgh Performing formal clinician interviews to evaluate the advantage of the prototype visualization-based report over traditional text-based pathology reports Adapting the visualization-based report to be useful in training future pathologists

13. Thank You Brian Chapman Ken Hupe Ken Sochats Mona Melhem Mike Becich