The Use of Scanning The Use of Scanning Virtual Microscopy for Virtual Microscopy for Pathologist EducationPathologist Education

Peter M. Banks, M.D.Peter M. Banks, M.D.

Director of HematopathologyDirector of Hematopathology

Carolinas Medical CenterCarolinas Medical Center

Charlotte, North CarolinaCharlotte, North Carolina

Adjunct Professor of PathologyAdjunct Professor of Pathology

UNC-Chapel HillUNC-Chapel Hill

First CME Course Based onFirst CME Course Based onVirtual Microscopy for Cases:Virtual Microscopy for Cases:

Lessons LearnedLessons Learned

Historical outlineHistorical outlineCourse organizationCourse organizationFirst presentationFirst presentationConclusions, recommendationsConclusions, recommendations

Historical TimelineHistorical TimelineASCP – over 40 years education courses ASCP – over 40 years education courses 2002 – 2 of 4 mainstay courses in 2002 – 2 of 4 mainstay courses in

hemepath retiredhemepath retiredFall 2002 – proposal for new course from Fall 2002 – proposal for new course from

Banks/Dunphy – comprehensive, based Banks/Dunphy – comprehensive, based on virtual microscopy for caseson virtual microscopy for cases

November 2003 case scans dueNovember 2003 case scans dueJanuary 2004 – faculty weekend: scan January 2004 – faculty weekend: scan

cropping, rehearsalcropping, rehearsalFebruary 2004 – debut presentationFebruary 2004 – debut presentation

Course Concept:Course Concept:Comprehensive Review of Hematopathology Comprehensive Review of Hematopathology

by WHO Classificationby WHO ClassificationHemic and LymphoidHemic and Lymphoid

Logistical Challenges with HemicLogistical Challenges with HemicProcesses for CME Courses: Small Cellular Processes for CME Courses: Small Cellular

Smear/imprint Preparations - NonreproducibleSmear/imprint Preparations - Nonreproducible

MarketingMarketing

Case Scan GatheringCase Scan Gathering

Faculty given 6 month deadline to submit Faculty given 6 month deadline to submit slides for scanning, review for QC.slides for scanning, review for QC.

70 total cases70 total casesCellular smear preparations (marrow, Cellular smear preparations (marrow,

blood) required 60x oil scansblood) required 60x oil scansTissue sections required 40x scansTissue sections required 40x scansTrade-off: large enough scans to be Trade-off: large enough scans to be

representative, small enough for packagesrepresentative, small enough for packages

Case Scan GatheringCase Scan Gathering

File format for registrants’ take-home sets:File format for registrants’ take-home sets: CD’s CD’s (700 MB). How many too many?(700 MB). How many too many?

Faculty meeting 2Faculty meeting 2ndnd weekend January - 4 weeks prior to weekend January - 4 weeks prior to course debut(!) - cropping scans and rehearsing course debut(!) - cropping scans and rehearsing presentations.presentations.

Last-minute rescans required for 3 cases:Last-minute rescans required for 3 cases: critical critical areas out of focusareas out of focus

Annotations/coordinates for hard-to-find foci Annotations/coordinates for hard-to-find foci in scansin scans

Master scans submitted for duplication and packagingMaster scans submitted for duplication and packaging

Selection of Field to be ScannedSelection of Field to be Scanned

Uncompressed – 4.1 GBUncompressed – 4.1 GB

Compressed – 169 MBCompressed – 169 MB

Uncompressed – 508 MBUncompressed – 508 MB

Compressed – 28 MBCompressed – 28 MB

PackagingPackaging

February 9February 9thth 2004 2004

Course DebutCourse Debut Course oversold (85 for 80 capacity)Course oversold (85 for 80 capacity) Introductory explanation of system (20 min)Introductory explanation of system (20 min) Demo laptop set-up at back of roomDemo laptop set-up at back of room Simultaneous (2-screen) presentations - Simultaneous (2-screen) presentations -

PowerPoints by lecturerPowerPoints by lecturerVirtual by assisting colleagueVirtual by assisting colleague

Only 10 of 80 brought laptopsOnly 10 of 80 brought laptops Evaluations: 75% favored virtual over glass Evaluations: 75% favored virtual over glass

slides for casesslides for cases Many complained that 2-screen presentation Many complained that 2-screen presentation

too much, hard to followtoo much, hard to follow

Conclusions - RecommendationsConclusions - Recommendations

Great advantage realized: any cases can Great advantage realized: any cases can be used no matter how small the samplingbe used no matter how small the sampling

Savings in time, cost for producing glass Savings in time, cost for producing glass slide sets; scans more durableslide sets; scans more durable

Requires one-time extra effort in selecting Requires one-time extra effort in selecting field for scan, proofing master scans in field for scan, proofing master scans in detail prior to duplicationdetail prior to duplication

Needs faculty rehearsal for facile Needs faculty rehearsal for facile presentationpresentation

PostludePostlude

Subsequent courses based on scanning Subsequent courses based on scanning virtual microscopy cases:virtual microscopy cases:

PMB AAOMP PMB AAOMP (San Antonio 2006 (San Antonio 2006 - through 2009)- through 2009)

ASCP Pulmonary Pathology (A. Churg)ASCP Pulmonary Pathology (A. Churg)(first offering 2006)(first offering 2006)

USCAP Specialty conferences and someUSCAP Specialty conferences and someshort courses beginning 2006short courses beginning 2006