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 (2000-2006) 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 lectures Traditional Case Analysis materials 1970-1999 Preparation for small group before and after 2000 Virtual Slidebox of Histopathology www.path.uiowa.edu/virtualslidebox 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 Outcomes (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 cells. The slide needs to be rapidly and systematically scanned by a technologist Revisit to previously identified cells is needed – i.e. marking 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 Pathology? Laboratory time reduced in “new” curricula, virtual microscopy is more efficient and accessible 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? No! 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.