Get a Microscope!
What we can learn about hesitancy from the fight between horses and cars
What fuels reluctance to digital pathology? We only need to look back to the emergence of the automobile to understand – welcome to part four of our six-part "Barriers to Adopting Digital Pathology" series.
In 1930, Alexander Winton – a pioneer of the automobile industry – penned an article titled, “Get A Horse! America’s Skepticism Toward the First Automobiles.” It’s a fascinating account of the earliest days of cars in this country, in which he details not only the engineering and logistical difficulties the first car innovators faced, but also the skepticism they endured from the public. He wrote: “to advocate replacing the horse, which had served man through centuries, marked one as an imbecile.”
Digital pathology – a technology attempting to displace the tried-and-true microscope – faces a similar battle. After two decades, many pathologists still remain dubious. Concerns about image quality and cost always come up. But there is an even simpler question that, in some ways, underlies the others: Why bother? After all, the microscope works perfectly well.
In order to answer this question, digital pathology can perhaps learn something from the automobile industry. Those early cars – once they finally did get going – not only matched their four-legged competitors, but surpassed them. In the same way, digital pathology can win the day by not only providing a streamlined experience equal to the microscope, but also by doing things unimaginable with a glass slide.
Until recently, reviewing slides digitally was a frustrating, physical exercise, requiring furious wheel scrolling and mouse clicking. Today, companies are taking a hard look at the ergonomics of slide review, optimizing their software and even creating simulators to perfectly emulate the experience of looking at a glass slide. Similarly, teams are innovating to allow for fine focus in the z-plane, oil immersion, and polarization.
These efforts, while critical, only get digital pathology to match a microscope. The exciting part of digital pathology is where it can transcend the microscope. This idea invariably evokes the promise of artificial intelligence (AI). Though the revolution is certainly coming, focusing exclusively on AI actually sells digital pathology short. What if digitized slides arranged tissue fragments in rows so they could be reviewed systematically without any piece being missed? What if digital viewers kept track of suspicious foci across deepers and immunohistochemical slides regardless of orientation, sparing the pathologist from doing it manually? What if software tracked high-power fields during a mitotic count and allowed the pathologist to quickly mark mitoses, ensuring that an accurate count was documented for future reference?
These saved seconds and minutes would quickly turn into hours. At that point, digital pathology wouldn’t just be providing an easier experience, but a safer one. All the energy once expended on peripheral activities would be devoted to looking at slides, meaning less fatigue, fewer mistakes, and faster turnaround times.
The day will come when digital pathology not only meets but exceeds the high bar set by the microscope, leaving the microscope looking like a horse and buggy. Perhaps then, a historian will write a book about the early years of digital pathology. With any luck, they’ll call it, “Get a Microscope!”
Check out the other parts of our "Barriers to Adopting Digital Pathology" series below:
Medical Director at Pramana, Cambridge, Massachusetts, USA.
