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Implementation of Virtual Microscopy in Histology and Pathology Courses 45

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Now in 2001 the microscope laboratory is just a mouse click away. Virtual Laboratories (web) ... Consortium of Pathology Departments -house staff training ... – PowerPoint PPT presentation

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Title: Implementation of Virtual Microscopy in Histology and Pathology Courses 45


1
Implementation of Virtual Microscopy in Histology
and Pathology Courses 45
  • Fred R. Dick, MD
  • Department of Pathology
  • The University of Iowa, Iowa City, Iowa, USA.

2
Definition
  • A virtual slide is a facsimile of a
    histological slide, acquired by merging thousands
    of contiguous high power microscopic views of the
    slide into a single digital image.
  • A zoom viewer, by accessing these virtual slides,
    can closely emulate the examination of a
    microscopic slide with real microscope.

3
  • Outline of Presentation
  • Demonstration
  • Technical details to acquire and deliver virtual
    slides
  • Virtual slides in medical student education
  • Evaluation and implementation in Histology and
    Pathology Courses
  • Public domain Virtual Slide Boxes (a work in
    progress)
  • Other educational applications for virtual slides
  • Workshops and Tutorials
  • CME and Proficiency testing
  • Web based publishing
  • Consortium of Pathology Departments (house staff
    training)
  • Why create virtual slide sets for medical student
    education?
  • Should we completely abandon traditional
    microscope laboratories for medical student
    education?
  • Acknowledgments

4
(No Transcript)
5
Now in 2001 the microscope laboratory is just a
mouse click away
  • Virtual Laboratories (web)
  • Image of computer lab

6
Acquisition and web page development
7
Technical Details Acquisition of virtual slides
(1999-2hr / 2001-15min)
1200 40x images
jpg compression(Flashpix file format) 100MB
file
seamless tiff image 1GB file
8
Technical details (cont.)
  • Web Delivery Viewing of Iowa virtual slides
  • Served with Windows 2000 server - MGI software
  • Viewed with a plug-in for Explorer or Netscape
    (free)
  • PC works better than Mac
  • A network connection or cable modem is required.
  • Each image has a web address which can be added
    to the source code of any HTML page or frame
  • Cost per virtual slide 100-300
  • Unlimited copies and distribution
  • (Cost of 100 traditional glass slides 300)

9
Technical details (cont.) Virtual slide systems
(currently used at Iowa)
  • Acquisition
  • Bliss (BacusLabs)
  • Virtual Slice (MicroBrightField)
  • Abintra (Interscope Technologies)
  • ScanScope (Aperio Technologies)
  • Delivery Display
  • QuickTime-VR
  • Zoom Server/viewer (MGI)-FlashPix file format
  • WebSlide (BacusLabs)
  • Virtual Slice (MicroBrightField)(annotator)
  • ImagePump (Xippix) (Interscope Technologies)
  • Mr Sid (Lizardtech)
  • Interchangability/commonality in virtual slide
    acquisition and delivery is the key to the future
    success of virtual slides in Pathology
    informatics.

10
Implementation in the Spring 2001 Histology
Course at Iowa
  • The entire laboratory of 110 slides and syllabus
    were digitized and placed on an intranet.
  • Slides and syllabus materials were made available
    to students in both traditional and computer
    laboratories with instructors present, who had
    computer projectors .
  • Virtual Lab content was exactly the same as in
    the traditional lab
  • Results
  • Regular laboratory use was lt10 of that of the
    computer laboratory.
  • gt50 of virtual laboratory access was outside of
    laboratory time
  • There was no decrement in mean student
    performance on practical examinations 85 in
    2000 and 88 in 2001.

11
Student evaluation
  • Virtual microscope was preferred (p lt .05) over
    the regular microscope in terms of
  • Accessibility
  • Optimizing content for efficient use of their
    time
  • No difference between the virtual and regular
    microscope
  • Image quality
  • Directions for use
  • Navigation of the slides

12
Student evaluation Summary of recurrent comments
  • Always in focus and properly adjusted light
    condenser
  • Everyone sees the best slide
  • Multiple students and instructor can view the
    slide on the monitor.
  • Additional resources are a click away
  • Zooming and scanning capability of the virtual
    slides is better than (digitized) kodachromes
    however, put arrows with explanations on the
    virtual slides.
  • The Virtual Laboratory should not replace real
    microscopes.

13
Implementation in the Fall 2000 Pathology Course
at Iowa
  • Course structure did not change
  • 79 Lectures
  • 20 Case Analysis sessions (2hr/week)
  • 4 cases / week
  • 8 students / facilitator
  • students prepare independently (4h) before small
    group from case materials
  • microscopic slides (67 total for the year)
  • patient history
  • gross and radiological displays
  • Students present/analyse cases in small group
  • All case materials including virtual slides were
    put on the web.
  • All case materials were also still available in
    the traditional lab.

14
Use of traditional materials markedly decreased
in favor of the Virtual Laboratory (web) for
both students and faculty. lt25 used the
traditional materials
15
Faculty and students preferred the Virtual
Laboratory for presentation in small group.
16
(No Transcript)
17
Public domain Virtual Slide Boxes of core
teaching slides for medical students.
  • Work in progress
  • Histology - 150 slides
  • http//www.medicine.uiowa.edu/pathology/nlm_histol
    ogy (web)
  • Histopathology - 300 slides
  • http//www.medicine.uiowa.edu/pathology/uarep_hist
    opathology (web)
  • Perl scripted MySQL database is under development
  • Supported by a National Library of Medicine
    Information Systems Grant (2000-2003)


18
Public domain Virtual Slide Boxes of core
teaching slides for medical students (cont.)
  • Course directors can
  • Use the Virtual Slide Box as you would any box
    of slides for student labs or faculty
    demonstrations.
  • http//www.medicine.uiowa.edu/pathology/uarep_hist
    opathology (web)
  • Incorporate the address of individual virtual
    slides into the source code of HTML pages of
    their own web-based programs such as PBL cases.
  • Between the body tags (between ltbodygt and
    lt/bodygt)
  • ltembed srchttp//129.255.241.428087/?fifusc_pa
    thology/au5a/au5a_40xr.fpx" align"left"
    width"545" height"545" backgroundcolor" 255,
    255, 255"gt
  • Take screen shots of any field of view from the
    slides in the Virtual Slide Box and use them in
    their own web pages, PPT presentations, or
    convert them to 2x2 slides.
  • note the 100MB fpx and GB tiff virtual slide
    files cannot be downloaded but can be shared via
    DVD

19
Other educational applications
  • Proposed or under development
  • Pathobiology of Cancer Course (web)
  • Virtual microscopy Teaching Dermatopathology
  • Prostate CA- Gleason Grades
  • Potential
  • Pathology of Experimental Animals (web)
  • Web-based Continuing Medical Education (web)
  • Proficiency testing and certifying exams
  • Web based publishing of Atlases and Textbooks
  • Consortium of Pathology Departments -house staff
    training

20
Why create virtual slides for medical student
education?
  • Traditional microscopy is being replaced by the
    study of digitized microscopic slides on the
    computer.
  • Some course directors are voluntarily converting
    to computer digitized images.
  • Efficiency
  • No decrement in learning
  • Medical students dont need to know how to use
    a microscope
  • Integrated curricula leave no time for
    traditional microscope laboratories.
  • Deans and Chairs are unwilling to support both
    microscope labs and computer labs.
  • The total cost for slides, microscopes, and space
    for 100 students is approximately 100,000 per
    year.

21
Why create virtual slides for medical student
education (cont.)?
  • There is value to the study of selected,
    annotated images of glass slides in medical
    student education.
  • however
  • There is also an educational advantage to study
    with a microscope and glass slide.
  • Students become active rather than passive
    learners when they have to explore a microscopic
    section, independently find structures, and
    discover relationships and variations.

22
Why create virtual slides for medical student
education?
  • The goal of a virtual slide set is to
  • To maintain this educational advantage in a
    computerized format
  • Augment traditional microscopy with more
    efficient virtual microscopy.
  • Emulate traditional microscopy when traditional
    microscope teaching laboratories are no longer
    available...

23
Should we completely abandon traditional
microscope laboratories?
  • No!
  • Students need to develop a concept of where the
    histologic 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.

24
Should we completely abandon traditional
microscope labs? (cont.)
  • Therefore
  • Schedule use of the traditional microscope and
    glass slides at the beginning of medical student
    courses with microscopic content, but use
    virtual slides to facilitate study of a large
    number of slides.

25
Will we have to replace traditional microscope
teaching laboratories?
  • Probably, if it hasnt already happened

26
Acknowledgements
  • National Library of Medicine
  • Iowa Student Computing Fees
  • OCRME Educational Developmental Award
  • Universities Associated for Research and
    Education in Pathology (UAREP)
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