Precision medicine starts with precision pathology. At UCSF, pathologist are
on track to deliver the promise of better health care to improve patient’s lives.
Adoption of Digital Pathology for Primary Diagnosis
2014
The Department of Pathology working with UCSF Health, under the leadership of Vice Chair of Clinical Services Dr. Grace Kim and Digital Pathology Director Dr. Zoltan Laszik, made a strategic decision to invest into digital pathology (DP). Although the long-term vision was to adopt DP for primary diagnosis to improve patient care and safety, there was also an imminent need to find a solution for the frozen section service of a multisite set-up with the opening of a new hospital at Mission Bay.
2015
The hardware core of DP was in place with one large capacity Philips Ultra Fast Scanner (UFS) at each of the three hospitals and a high-speed network built to secure seamless digital traffic.
Digital Pathology Clinically Permitted
- Reading of frozen sections from remote sites
- Adoption of DP for tumor boards
- Conduction of clinico-pathology conferences between various sites
- Facilitation of intradepartmental consults
Over the next few years, first-hand experience with the ups and downs of early adoption fostered the design of UCSF’s digital future. The guiding principles were to build consensus in the digital adoption and form alliances with the hospital and clinicians for support.
2017
The integration of the Image Management Software with the LIS was completed and working groups were organized with the participation of faculty, trainees, and staff to help with the digital transition. To scale the operation five scanners were placed in the histology laboratory which allows seamless scanning of up to 400,000 slides per year.
2020
Once the secure cloud solution for data storage was in place, a 100% digital workflow with prospective scanning was deployed. This marked a major milestone as UCSF became the first large academic medical center in the US to accomplish this feat.
- Digital Pathology for Primary Diagnosis
COVID-19
The benefits of going live with a 100% digital workflow were recognized immediately; due to DP, UCSF pathologist were able to continue to provide health care to patients while sheltering in place.
The Workflow Evolution of Digital Pathology
Adoption of a fully digital workflow required changes to various aspects of our operational procedures and processes, including the gross room, histology laboratory, and the faculty and trainee workstations.
Gross Room
The Philips UFS has a max scan zone where tissue can be placed which meant that the maximum cut size for tissue sections needed to be updated so that all tissue would fit within the scan zone. To this end, laminated templates of the maximum tissue size allowed in the tissue cassettes were created and placed at every grossing station, allowing those grossing to have immediate feedback regarding tissue size.
Histology Lab
The histology lab creates and digitizes slides 24 hours a day, 7 days a week. Switching from glass to plastic coverslipping was a crucial change which allows slides to be scanned almost immediately after staining is completed. Histology Staff eagerly adapted workflows and worked together as a team to implement and troubleshoot a 100% digital operation.
Workstations
Once scanned, the images are instantly available for review via a web-based Image Management System. The pathologists’ offices were upgraded to support a hybrid digital and analogue workflow. The hybrid workstation consists of two synchronized 30’ high resolution Dell monitors and one double-head microscope. This allows for digital sign-out with a trainee, as well as, access to a microscope in case glass slides need to be reviewed. The resident workstations were outfitted with 27” monitors.
Adoption of digital pathology has allowed us an opportunity to re-evaluate our processes and workflows from the ground up and a means to
re-educate everyone on gross room best practices. There is ongoing communication and teamwork among staff and trainees in the gross room as well as with the histology lab and faculty to ensure that no missteps occur early in the process (i.e., grossing) that may lead to further compounding of problems and ultimately result in poor quality slides and images. Digital pathology has really served as a reminder for us all the importance of continuous process and quality improvement.
Dr. Soo-Jin Cho, Assistant Professor
University of California San Francisco
Even with adoption of digital pathology, the glass slide remains at the heart of pathology, perhaps even more so. Without a glass slide, there is no digital image. And with a poor quality glass slide, there is a poor quality digital image. Therefore, as a laboratory, we continue to strive for quality improvement each and every day as we become more familiar with the digital pathology environment. Without the flexibility and willingness of the staff to adapt to change, this would not be possible.
Dr. Tara Saunders, Assistant Professor; Medical Director of Histology Laboratories
University of California San Francisco
Trainee Experience
Gone are the days of trainees jockeying for the best microscopes in the resident room and sorting flat after flat of glass slides as they are delivered from histology! With the digital pathology workflow, the slides are gathered and sorted in the Philips Image Management System automatically. The viewing experience is also standardized, so even if you’re stuck with an old BX41 microscope, DP provides all viewers of a given slide the same crisp, high-resolution whole slide image. Trainees now have the ability to share a case simply by circling up around one workstation or sharing a case remotely with a colleague at another site,improving their ability to learn from one another as they preview cases. The integration of technologies such as DP will allow us to recruit and train the next generation of pathologists who can integrate tools such as computational pathology and artificial intelligence to drive our specialty forward into the future.
