Image Processing

The workstation includes:

• hardware and software components used for managing, retrieving and viewing WSI and associated metadata for a given case.
• connection via a network to the storage and archive devices and LIS.
• connection which allows pathologists to report and provide comments.

Workstation configuration and issues such as visual strain associated with prolonged engagement with a computer screen are important considerations. Voice recognition may assist with dictation during reporting.
Information regarding pathologist workstation can be reviewed in more detail in Module 2: Technical Requirements.

A secure web-browser or desktop image review application should allow local and remote network access to view the stored image file. The laboratory must ensure thorough testing on all intended devices before using the device for diagnostic purposes.
The software application should seamlessly connect to the storage system anywhere on the network including remote access using VPN where a web-interface is not used.
The local and remote software application must provide security access and be able to verify a valid user login.  Please refer to Module 5: Privacy, Confidentiality and Security for more details.

The pathologist should have access to an ergonomic navigation control device. The navigation control device must provide adequate speed, panning and zooming capabilities, with no pixilation of the image. Common navigation control devices should be supported and other ergonomical navigation control devices are important considerations to minimise constant large repetitive movements of the wrists, thumb and index finger. Navigation devices include the mouse, trackball, touch screen, light pen, graphic tablet, joystick, eye-controlled input, and foot mouse. RCPA Guidelines for Digital Microscopy in Anatomical Pathology and Cytology October 2015.

Efficiency and effectiveness of the reporting pathologist in part depends on the performance and usability of the application used for viewing the slides. There are many design features which should be considered when purchasing an image review system for diagnostic use. These are discussed below.

In 2016, the RCPAQAP changed the platform for viewing online WSI to Collibio web image viewer. This change was primarily to support viewing and management of slides from different slide scanners, which each have their own proprietary image formats.

To assist with the transition, participants were provided with access to a number of test images. Participants have been encouraged to test drive the application thoroughly and report any issues to the RCPAQAP. To operate Collibio, it is recommended that a normal wheel mouse is used, a minimum of 2Mbps internet connection, and one of the following web browsers used:

1. Google Chrome

2. Internet Explorer

3. Mozilla Firefox

4. Apple Safari

Refer to User’s Guide for Collibio by Pixcelldata and Quick Guide to Collibio outlines the functions and navigation tools of Collibio.
The sample digital slide image with the new Collibio viewer can be accessed on the RCPAQAP website: http://www.rcpaqap.com.au/rcpaqap-collibio
 
These guides should help further explain some of the design features listed below:

• routine diagnostic workflow and fast response time to retrieve images and metadata from storage
• user-friendly functionality for the diagnostic viewing and reporting of a case:
  • annotation tools such as the ability to circle, highlight and add free text comments,
  • image manipulation functions such as colour alterations (adjust colour, white balance) and image sharpening functions (if z- stacking is available),
  • calibrated ruler,
  • calibrated standard area such as circular 1 square mm to drag out to enable counting of mitoses,
  • ability to compare multiple slides for a case,
  • facility for simultaneous viewing of a slide by multiple pathologists, and
  • facility for live sharing of annotations on a slide between remotely located users.

Figure: The visualisation of virtual slides by the user is performed using the virtual microscope. Virtual slide is viewed here with Collibio web-based viewer in  X and Y axes. Several functions like measuring and annotations are offered. Basic annotation functions (pointers) demonstrated  in this screenshot.
Source: Courtesy RCPAQAP, 2017
 

• software interaction:
  • data entry (spell check, ways to prevent data entry errors),
  • steps required to perform a diagnosis,
  • dictation facility via speech recognition, and
  • report integration with LIS including ability to capture data for structured reporting templates.
• screen display:
  • screen layout,
  • field of view of displayed slide,
  • icon and font size configurable by the use, to suit individual user preferences, and
  • use of thumbnails, menu options, and keyboard shortcuts.
• software functions (ease of use and speed):
  • moving between cases,
  • selecting fields of interest equivalent to dot,
  • easy selection of magnification level for panning and zooming of an image,
  • display for any randomly accessed field of view within the digital slide image, at any level of magnification, and associated information for a case should be within:
    - 0-2 seconds (local area network)
    - 0-5 seconds (WAN, internet, VPN).
• navigation controls (ease of use and speed):
  • provision of different types of navigation such as keyboard (including shortcuts, arrows, etc.), mouse, joystick, touch screens, etc, and
  • ergonomics consider repetitive use of the navigation tool and fatigue.

Refer watch this Video demonstration of the Aperio ImageScope software.

For MAC computers, please note that Aperio® ImageScopeTM is a Windows-based application that requires Parallels™ Desktop or VMware Fusion. 4 ObjectiveViewTM image viewer runs natively on a Mac computer. No virtual Windows is required. It can be downloaded on:
http://www.objectivepathology.com/#!objectiveview/c3zr

An un-annotated version of the image should be stored.
The web-browser or desktop image review application should provide the ability to copy, de-identify and share a digital slide image and related case data, for use in teaching, quality assurance, presentations or research. Please refer to Module 5: Privacy, Confidentiality and Security  for more details.

1. Objective
   To understand best practice guidelines to consider when implementing digital microscopy in the workplace for diagnostic use in histopathology and cytology.

2. Knowledge
   Section 1: Pathologist Workstation
   Outcomes:

   1. Understand the physical characteristics of the pathologist workstation;

   2. Understands the importance of safety and ergonomics of the pathologist workstation.

   Section 2: Software Connections
   Outcomes: Understand the principles of software connections to consider when implementing digital microscopy for diagnostic use, including:

   1. Local and remote network access;

   2. Thorough testing on all intended devices;

   3. Seamless connections to the storage system anywhere on the network;

   4. Security access.

   Section 3: Image Annotation
   Outcomes: Understand the principles of image annotation using:

   1. High quality display monitor;

   2. Ergonomic navigation control device.

   Section 4: Image Review Application and Reporting
   Outcomes: Understand the principles of image review applications including:

   1. Uninterrupted routine diagnostic workflow;

   2. Basic software interaction and function;

   3. Clear screen display and layout;

   4. Navigation controls;

   5. High quality image which is maintained;

   6. Secure local and remote network access;

   7. Un-annotated version stored;

   8. Speedy performance and fast response times;

   9. Copying and de-identifying image.

   Section 5: Image Storage
   Outcomes: Understand the principles of storing images, including:

   1. An un-annotated version of the image should be stored;

   2. The web-browser or desktop image review application that should provide the ability to copy, de-identify and share a digital slide image and related case data.

3. Behaviours
   Practices the fundamental principles of digital microscopy.