The project SecundOS V2.0
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The digital pathology platform, Erasme Hospital, Brussels, Belgium.
Mission Statement:
SecundOS is a pilot project for applying virtual pathology to microscopic diagnoses requiring a second opinion. The main goals are: demonstrate feasibility; identify and solve implementation issues; measure the benefits; make recommendations for roll-out. This project is financed by the Foundation Yvonne Boël, whose essential contribution is gratefully acknowledged.
Background :
Virtual Pathology (VP) refers to the numerical imaging of microscopic tissue slides and the use of such images. It has been enabled in the last 5 – 10 years by the development of microscopic scanners and software to generate, view, transfer and manipulate Whole Slide Images (WSI). A variety of hard and software equipment and vendors now exist.
The pathology labs face a number of pressures, partially amenable to conventional solutions:
• Increasingly complex diagnosis, due to scientific progress
• Increasingly personalised medicine, with fine diagnosis conditioning treatment choices
• Resultant specialisation of pathologists, while their numbers are dropping
• Health system cost containment, leading to expert centres and linking access to diagnosis
As a result, the need for second opinions in pathology diagnosis is growing. It arises when a generalist pathologist calls on a specialist (often on another site) for help or referral. In this case, the specialists are almost invariably from different hospitals and potentially from different European countries. These referrals may be on a voluntary or statutory basis. In Belgium for instance, the federal agency KCE is defining mandatory second and third tier diagnosis procedures for (rare) cancers. It has been estimated that between 2 and 15% of pathology reports contain inconsistencies (sometimes of serious consequence). It is believed this figure could be significantly reduced by a more frequent use of second opinions.
Widespread resorting to second opinions and the interaction of multiple experts are incompatible with today’s practices (sending glass slides by post, with the inherent delays and breakage risks, or pathologists travelling). Virtual pathology can potentially provide Improved quality of service through enhanced access to expertise for consultation and education. Collaboration between pathologists with dramatically improved turnaround times. Improved speed, efficiency and the required collaborative, remote working practices. It may also ensure better patient data protection and traceability compared to manual systems, thereby further increasing diagnostic quality.
Currently, The Erasmé pathology department is in the early stages of implementing this technology and its use for patient care trying always to improve our institution‑specific protocols and experiences.. Robust best practices and standards will eventually be developed as more centers implement telepathology on national and international level.
Benefits of success :
Mission Statement:
SecundOS is a pilot project for applying virtual pathology to microscopic diagnoses requiring a second opinion. The main goals are: demonstrate feasibility; identify and solve implementation issues; measure the benefits; make recommendations for roll-out. This project is financed by the Foundation Yvonne Boël, whose essential contribution is gratefully acknowledged.
Background :
Virtual Pathology (VP) refers to the numerical imaging of microscopic tissue slides and the use of such images. It has been enabled in the last 5 – 10 years by the development of microscopic scanners and software to generate, view, transfer and manipulate Whole Slide Images (WSI). A variety of hard and software equipment and vendors now exist.
The pathology labs face a number of pressures, partially amenable to conventional solutions:
• Increasingly complex diagnosis, due to scientific progress
• Increasingly personalised medicine, with fine diagnosis conditioning treatment choices
• Resultant specialisation of pathologists, while their numbers are dropping
• Health system cost containment, leading to expert centres and linking access to diagnosis
As a result, the need for second opinions in pathology diagnosis is growing. It arises when a generalist pathologist calls on a specialist (often on another site) for help or referral. In this case, the specialists are almost invariably from different hospitals and potentially from different European countries. These referrals may be on a voluntary or statutory basis. In Belgium for instance, the federal agency KCE is defining mandatory second and third tier diagnosis procedures for (rare) cancers. It has been estimated that between 2 and 15% of pathology reports contain inconsistencies (sometimes of serious consequence). It is believed this figure could be significantly reduced by a more frequent use of second opinions.
Widespread resorting to second opinions and the interaction of multiple experts are incompatible with today’s practices (sending glass slides by post, with the inherent delays and breakage risks, or pathologists travelling). Virtual pathology can potentially provide Improved quality of service through enhanced access to expertise for consultation and education. Collaboration between pathologists with dramatically improved turnaround times. Improved speed, efficiency and the required collaborative, remote working practices. It may also ensure better patient data protection and traceability compared to manual systems, thereby further increasing diagnostic quality.
Currently, The Erasmé pathology department is in the early stages of implementing this technology and its use for patient care trying always to improve our institution‑specific protocols and experiences.. Robust best practices and standards will eventually be developed as more centers implement telepathology on national and international level.
Benefits of success :
- Improve the quality of diagnosis for patients (accuracy, speed, traceability)
- Demonstrate feasibility and quantify benefits of platform specifically for 2ndopinion applications and other clinical uses of the digital technology which are in our scoop.
- Our platform used for numerous educational activities, including multidisciplinary graduate and professional education, virtual tracking/tutoring, performance improvement programs, and medical examinations, and is being incorporated as “illustrations” in journal articles and textbooks. In these settings, virtual slides offer several advantages over conventional glass slides. Digital slides are more interactive, instantaneously available to multiple remote users, can be easily annotated, and promote standardization of training materials (ie, identical slide sets are available for all trainees).
- Integration of Artificial Intelligence tools to obtain diagnosis added value.
- Enriching our biobank database by increasing digital diagnosis data is of paramount importance for patient care, researchers and other stakeholders. Image size, data stocking and retrieval remain difficulties need to be effectively fixed.
- Visibility: for the sponsors (Boël Foundation) ; for the hospitals ; for the pathology departments
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Challenges :
- Resource availability. A large challenge in the hospital environment could be addressed by good planning and preparation, by engaging the project team and by task focus.
- Purchasing Procedures. Beyond a limit, hospital investments are subject to tender procedures that add complexity and delay. For a pilot project, it may be possible to stay below the tender threshold and renting will also be evaluated.
- LIMS interfacing will require IT resourcing and is highly site dependant. This is why it was of major importance the interfacing with our LIMS (Diamic) and the choosing the appropriate imaging management software.
- To operate at a high level of availability and effectiveness. Both are major technical and financial challenges. These can be achieved in a number of ways, but the final configuration will depend on the designated use (intraoperative pathology consultation, primary diagnosis, second opinion and others) and the available funding.
- Extension of the network for the second opinion through the creation of new connections or energizing the established ones.
- Setting up the use of the platform in order to improve intraoperative consultation. Recently, a new scanner dedicated for teleconsultation and Macro-pathology technique found their way to our Lab.
- Integration of more artificial intelligence tools for the identification, characterization and validation of specific tissue based biomarkers. Image normalization, tumour cell density estimation, proliferation index computation, biomarker co-localization and compartmentalized IHC quantification using deep learning are among our developed methods.
- Establishing a virtual library with the different sources of the available clinical diagnosis data.
- Our department has engaged in many world class researches separately or in collaboration with other research colleagues.
