Doug Tkachuk MD President, Objective Pathology Ltd. Staff Pathologist, Toronto General Hospital

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Doug Tkachuk MD President, Objective Pathology
Ltd. Staff Pathologist, Toronto General Hospital
Virtual Pathology Communities A model for
standardization and remote consultation
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The web as a resource for pathology consultation

• Remote undirected consultation
• Why?
• Equity in healthcare access, 2nd/3rd gtgtgt1st world
  consultation
• Remote directed consultation
• Ready-to-go dig pathology
• Eg blood films
• Marquee pathologists, unusual and/or rare tumors
• Difficult classific schemas
• WHO synoptic reporting
• Cohort analyses

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Web community for pathologic dxs
--Web community of image library allows for local
diagnosis --Taking advantage of world wide
opinion --Test reproducibility of diagnoses based
on not just pathologists capable of
research --lets do it!
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Web community
Automated image analysis, ie Gleeson grade this,
identify this infectious organismfield of view
or whole slide image Commoditize the cancer
diagnosis and grading Have scan will travel World
wide file sharing
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Remote directed consultation suitcase
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Web based dig path communitiesgtNew

• Web-based communities for consults and standards,
  lab proficiency, CME, institutional and personal
  consultation services

lab profic
lab profic fluids
CME
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The web as a resource for pathology consultation

• Remote directed consultation
• Boutique web portals for international
  consultation

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Repurposing shared educational contentthrough
promotional peer-review software filters
1.
2.
3.
Local content
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Web based dig path communitiesgtClassicalgtCentraliz
ed ihc services
Off site Diagnostic Lab
Offsite Web-based interpretation/reporting
Large centralized lab service Image
acquisition/processing
Lab info system
HL7
Pathologist
server/storage
Identifiers, codec, storage, conversion, streaming

Unstained tissue
DICOM HIPAA
Biomarker profiling
Referring hospitals, physician and local
reference labs
text report
Patient healthcare record
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Current (single, qualitative, costly)
Biomarker 1
Simultaneous, automated, quantitative multiple
biomarker profiling
Biomarker 1
Biomarker 2
Biomarker 3
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The cancer suitcase quality of assurance for
cancer diagnosis and care

• Diagnosis in a suitcase all data required to
  make a particular diagnosis new synoptic
  reporting
• Now with whole slide scanning, all data
  relevant to a particular cancer diagnosis is
  digitizable and therefore transferable, and
  amenable to 3rd party analysis
• Cohorts of related cancer cases can be
  archived, compared/contrasted for quality of
  cancer diagnosis and care.

Cancer board and biorepository workers With
cancer suitcases, diagnostic data will travel
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3rd party statistical analyses of cancer
suitcases(Cancer boards, drug trials, outcomes
research)
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Local content
New diagnostic entities based on image based
image retrieval (patho-centric)
Better drugs
Different drugs for different diseases
Completely digitized Cancer cases
Powerful analytic tools
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Creating web based dig path communities

• Classical
• Slide clubs, courses, lab proficiency, CME,
  tele-education, frozen-section service,
  centralized immunohist service

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Web based dig path communitiesgtClassicalgtDigital
slide box

• Digital slide box our 1st chance
• Robust, scaleable, sustainable, engaging
  interactive learning experience composed of
  peer-reviewed unannotated annotated digital
  slide cases reflecting local work experience.
• Preferably locally controlled, vendor
  independent, low cost collection readily shared
  by greater community

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• Digital slide box the self-evolving time bomb
• Engaging interactive learning experience composed
  of peer-reviewed unannotated annotated digital
  slide cases reflecting local work experience.
• Preferably locally controlled, vendor
  independent, low cost collection readily shared
  by greater community
• Meta raw data rich diagnosis suitcase
• Clinical hx, clinical/gross pics, diagnoses,
  radiology, flow cytometry, ihc, cc, molecular
• Features universal readers eg. web viewers for
  radiology, flow data, DNA sequencing

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Digital slide box the self-evolving time bomb
-immediate gratification provide annotated
answers, instructional videos and statistically
relevant peer-adjusted responses -text
boxes -central database to tabulate and analyze
responses
firewall
internet
Client manipulates and controls content using
simple web templates on own virtual machine
dig slide box demo
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• Web based community-alpha test