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Imagine a pathologist in a lab coat, hunched over a microscope looking at a slide, trying to figure out if a patient is infected with a new strain of influenza or the common virus making the rounds this season. Sounds like something out of the 1950s, right?
A few years ago, that could have been the situation at the American Society for Clinical Pathology. But after running out of physical storage space and running into typical glass-slide issues, such as loss, breakage and degradation over time, these medical professionals crucial to U.S. public health decided to digitize the glass slides and implement archive management software. The result was a more usable, accessible and quickly searchable archive of the thousands of samples ASCP has built up.
The problems with storing glass slides are both obvious and unique -- they are prone to being lost or damaged, and the iodine dye that is used can fade over time, compromising the educational value of the slide.
Digitizing eases cumbersome process
"It was an inventory and logistic nightmare," said Ron Swan, CTO at ASCP, based in Chicago, referring to the cumbersome process of mailing out binders of slides and paperwork that corresponded to them. "Some products would be mailed to keep, but others were part of an assessment process where we'd see if a lab could accurately diagnose diseases. They would get a box of slides with a check sheet and be expected to ship them back to us. In a lot of cases, the slides got lost or broken."
In 2012, ASCP started digitizing its existing slides and storing them on Alfresco's enterprise content management (ECM) platform. ASCP uses the cloud-based platform to store most of the high-resolution images, because the digitized slides can be as large as 3 GB per image. The move toward digital storage was also due to ASCP moving to a new location, and the cost and resources dedicated to storing and maintaining the glass slides was no longer efficient.
"We have to pay to store the slides in a controlled condition," Swan said. "Over time, the stain will fade and the integrity will be compromised. A lot of this educational inventory was at risk of fading and not being viable as an educational product."
More recently, ASCP established an online tool through Alfresco, called ASCPedia, which allows pathologists to network and contribute slides and lab material -- all of which goes through a thorough vetting process, according to Swan. The archive management software allows for easy searching among the vast amount of slides.
Digital library serves to educate
"A lot of our new contributions have been digitized images," Swan said. "We have a lot of volunteers and members that are certified pathologists and will work with whole slide images that have been digitized. Surgical pathologists will wait for a biopsy, freeze it, slice it, stain it and immediately digitize it."
And while the library of slides isn't used for diagnosing patients a pathologist is currently seeing, it acts as a useful resource for the pathologist or other laboratory professionals to view similar cases that are digitally stored.
Ron SwanCTO, American Society for Clinical Pathology
"The FDA [Food and Drug Administration] doesn't approve primary diagnosis through digital pathology yet; they still use a microscope for that," Swan said. "But if I'm a pathologist and choose to brush up on kidney abnormalities, for example, I could go to ASCPedia and search by discipline or by organ."
While many ECM and archive management software companies exist, including Laserfiche, Dell EMC, Oracle and IBM, Swan and ASCP were drawn to Alfresco due to its open source capabilities and Swan's familiarity with its script.
Hybrid cloud stores large images
"We give enterprises the ability to control their own destiny and not be beholden to a technical vendor," said Thomas DeMeo, vice president of product management for Alfresco.
While digitizing the lab slides solved the problems surrounding lost or broken slides, Alfresco was paramount in helping ASCP with storing and transferring the digitized lab material, which often took up substantial digital real estate. ASCP uses a hybrid cloud to store larger files, while keeping on-premises storage space clear.
"Alfresco could act as a single platform and is a repository for not only regular documents, but high-end resolution images," DeMeo said.
There are some areas where Swan and those at ASCP see room for improvement, specifically when it comes to natural language processing -- although, that can be difficult in a jargon-filled field like pathology.
"Some of the medical taxonomy -- your normal spell-checker won't work," Swan said, adding that mobile capabilities could be improved as well, but primarily for tablets due to resolution restrictions. "We're not looking at taking this down to the level of a phone -- it's not practical. Due to the size of the image, pathology is visual, and no one is pulling out their five-inch-screen iPhones."
Alfresco declined to comment regarding pricing, other than directing those interested to its pricing page on the Alfresco website.
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