Virtual slide box of Histology

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					       Slide Digitization:
Taking Things to the Next Level

                     Michael B. Cohen, MD
                   (thanks to: Fred R. Dee, MD)

                       Department of Pathology
                         The University of Iowa

Virtual slide education at Iowa has been supported by:
    UI Carver College of Medicine educational developmental funds
    UI Student Computing Fees Award
    Universities Associated for Research and Education in Pathology
    National Library of Medicine

I have no financial or consultative relationship with any commercial entity, nor
   have I had any in the past
 Course Implementation atIowa
First year Histology (~110 annotated virtual slides + on-line syllabus)
    Virtual Histology Laboratory
  Heidger P, Dee FR, Consoer D, Leaven T, Kreiter C. An Integrated Approach to Teaching
  and Testing in Histology with Real and Virtual Imaging. The Anatomical Record (The
  New Anatomist) 269:107-112, 2002.

Second year Pathology (stand alone course for two semesters)
   Case Analysis
   Virtual Slidebox of Histopathology
  Dee (Dick) FR. Web-based Virtual Microscope Laboratories. Pathol Education 25:58-62,
  2001. (a GRIPE publication)

  Kumar RK, Velan GM, Korell SO, Kandara M, Dee FR, Wakefield D. Virtual microscopy
  for learning and assessment in Pathology. Journal of Pathology 204:613-618, 2004. (in
  collaboration with Univ. of New South Wales)
             Case Analysis
 In lieu of of “Path Lab” we teach morphology in
  pathology case based learning exercises
 22 two-hour sessions
 ~3-4 cases/week
 Eight students + one “facilitator”
 Students prepare cases before class (~2-4 hr) and then
  students present in small group
 Students examine ~70 slides in the 2 semester course
 Case Analysis content is integrated with about 76
Traditional Case Analysis materials 1970-1999
Preparation for small group before and after 2000
Virtual Slidebox of Histopathology

 An atlas of 570 “core” virtual
  histopathology slides for medical students
 General Path slides are annotated
 Students use this resource to
   prepare for Case Analysis
   Independently study morphologic objectives
    that are not covered in Case Analysis
           (Histology and Pathology)

 A significant increase in efficiency and accessibility
  expressed by both students and faculty.
 Increase in student skill in presenting morphologic
  findings on “slides” in Case Analysis (subjective
  evaluation by their facilitator)
 Students continue to learn traditional microscopy in
  Microbiology and Histology and are tested in Histology
 No change in student performance on
  photomicrograph or glass slide exams
 Laboratory space utilization has markedly decreased.
 Student interest in Pathology as a career has increased
              Cytology Education

Compelling reason to create cytology virtual slides
  Only one, or very few identical glass slides can be made ––
  especially applicable for testing and CE/CME.
Special technical challenges
       Cytology cells do no lie flat on the slide thus z-axis (3-
        D) viewing is needed
       Light source must be adjustable to see into clumps of
       The slide needs to be rapidly and systematically
        scanned by a technologist
       Revisit to previously identified cells is needed – i.e.
      Cervical Cytology Education Project

Goals of the project
      Evaluate the effectiveness and validity of using virtual
       slides (V.S) in cervical cytology education, including
       testing and distance learning.

      Create a public assess educational web site
       Annotated atlas
       Locate and identify exercises
       Self-assessment

      Create a dataset of virtual cervical cytology slides which
       is freely available to educators
AACR Pathobiology of Cancer Workshop
 (for graduate students and post-doctoral fellows)

  Structured similar to Pathology Laboratories in many
     Medical schools
     6 four-hour labs with:
          18 students per lab
          10-20 glass slides per lab (105 glass slides total)
          A microscope for each student
          Gross displays and photographs
          Faculty
              Illustrate slide content
              Circulate in the lab

  Human Pathology 34:430-436, 2003.
   Summary of advantages of virtual slides

 Accessibility
    Removable media or the web.
 Efficiency
    Slides available at the click of mouse with proper light and condenser
    students can examine a larger number of slides in a shorter time.
 Interactivity
      Integrate into computerized Case Based Learning
      Links to gross, radiology, etc
      Side by side comparison with normal slides, etc
      Annotations for independent learning
 Other
    Self-assessment quizzes
    Computerized practical exams
    Display to large groups
Why consider alternatives to traditional
 microscopy in teaching Histology and
 Laboratory time reduced in “new” curricula,
  virtual microscopy is more efficient and

 Cost to replace and maintain microscopes and
  glass slides

 Competition for lab space
   From both computer labs and research labs
What can you do with traditional microscopy that
      you can’t with virtual microscopy?

     Teach students how to examine slides with a
      traditional microscope.

     See better detail at low power

     Other
        Discern refractiveness (e.g. eosinophil granules)
        Adjust image with condenser, diaphragm, polarizer
        Should we completely abandon teaching
      traditional microscopy to medical students?


 Students need to have a concept of where the histological
  sections on a computer screen or in books and journals
  come from.

 Office practices frequently use microscopes for urine
  sediment, gram stains and blood smears

 Real microscopes are used in diagnostic pathology labs.

 Real microscopes are used in research labs.