Pioneering the Future

What led you to pathology – and, from there, to digital pathology?
 

During my medical studies at the Vrije Universiteit in Amsterdam, I found a side job as a researcher in the pathology department. That allowed me to learn about the pathology department and realize that and a specialization in pathology would suit me well.

My research required me to work with a type of early artificial intelligence (AI) software that could recognize certain structures on photos of glass slides. I found this research very interesting because, alongside my medical studies, computers were a hobby of mine – one that later led to my fascination with digital pathology. After finalizing my training as a pathologist, I was given the opportunity to work for LabPON (Hengelo, The Netherlands), which was looking for a pathologist with an interest in digital technologies. I began digitizing the entire laboratory – a difficult, but instructive and innovative project – and, in 2015, we completed the switch to fully digital diagnostics.

How did you do it?
 

When we began, nobody had any experience with digital pathology. We visited various laboratories in different countries that used scanners mainly for research and education – but we wanted a suitable scanner and IMS (image management system) software for diagnostic purposes. Unfortunately, there was nothing at the time that met our requirements – so we decided to collaborate with an industry partner to improve scanner technology and develop a diagnostic IMS. Since then, we’ve worked together on not only an IMS and a scanner, but also diagnostic-quality monitors, an optimal server, and other necessary equipment and software. We tested and validated each new piece of equipment and software and then put it to use in our lab.

Many people at LabPON put huge amounts of effort into this project, which is why it was so successful. After we became the first fully digital lab, there was enormous worldwide interest in our work; visitors came from various countries every week to see our equipment and workflows. Our group – and I personally – learned a lot during not only the digital pathology development process (which has taken many years and inspired products that did not previously exist), but also from our many international visitors.

LabPON has been fully digital for over five years now. What’s next?
 

Our next step is to implement a new IMS – which we’re currently working on. Our scanner is also due for replacement; because we want to digitize cytology and solve other challenges in digital diagnostics, we have set higher requirements for a new scanner. And, finally, we are looking for affordable long-term WSI storage so that we can keep our slide images for longer.

One of our most important goals is to integrate AI into diagnostics. We are currently working on determining our vision for the future in connection with AI to plan the next steps properly.

Now that digital pathology has advanced a few years, what are the biggest challenges facing those who want to make the transition?
 

Not only are there many more scanner choices than when we began, today’s scanners can also do much more and the quality of the WSI is much better. It is very important to select the correct scanner when planning a digital transition, because each scanner has its own limitations and the laboratory’s needs should guide the choice of equipment. 

There are also multiple IMS options. It is important to choose an IMS that can work with the WSIs from different devices so that you are never limited in terms of scanner choice. The IMS must also be easy to use and integrable with not only the laboratory information management system, but also the various image analysis apps used by different companies.

My most important advice is to investigate the laboratory’s workflow well before switching to digital diagnostics and to use that information to draw up a phased plan that includes selecting the right scanner and IMS for the laboratory.

Has going digital changed your work-life balance?
 

Digitization has indeed changed the way we work. Pathologists are no longer dependent on microscopes and therefore on their offices. Thanks to digitization, we now have the liberty to choose our workplaces. We can now work at home, at different locations in hospitals or laboratories, and anywhere else suitable. Of course, it is important to ensure that this advantage is used responsibly on both sides. Don’t allow this new freedom of movement to increase pathologists’ working hours or tolerance for work in irresponsible circumstances. At LabPON, we have worked remotely for a long time – and we have developed agreements that ensure it’s a good situation for everyone.

What is your best career advice for aspiring pathologists and laboratory medicine professionals?
 

Digitization is the future. Over the next few years, digital diagnostics will replace microscopes and AI will come into its own as a diagnostic methodology. It is important for pathologists to maximize use of new technologies during their studies to gain familiarity. Digitization will lead to changes in tumor grading, immunohistochemical staining assessment, quantitative pathology, and many other areas. Pay good attention to digital pathology while studying and you will be well-prepared for the future of the field.