By: Valerie Hofstetter
There are many associations for Pathologists on an International (USCAP, IAP), National (CAP) and State level (State Pathology Societies). There are subspecialized societies for Vet Pathologists, Toxicology Pathologists, Forensic Pathologists, Surgical Pathologists, Research Pathologist, Professors of Pathology, Clinical Pathologist, Cytopathologists and Dermatopathologists… So, why was there a need for another association?
Digital pathology is not limited to a specific pathology specialty or subspecialty, there are many digital pathology applications that can be applied to achieve greater efficiencies, improve turnaround time and affect outcomes. There was a need to create an association where academia, pharma, hospitals, labs and industries from across the globe could share best practices and engage in peer-to-peer learning and exchange of information. The realization of this need was shared by some of the more vocal early adopters, including Dr. Sylvia Asa and her eye-opening Pathology Visions presentation in 2010; Juan Rosai’s contribution of the ‘digital’ Collection of Surgical Pathology Seminars to promote the use digital pathology; Marcial Garcia Rojo and his international telepathology zeal; Stephen Hewitt and NIH’s continued support for this emerging technology; Dirk Soenkson and his vision; Jared Schwartz and his constant championing; Richard Friedburg and his radiology-pathology parallel; and Keith Kaplan , who kept us all informed on the latest in digital pathology news.
We focused on digital pathology – not just pathology, because there was a great need at that time to educate pathologists on its benefits. In the early 2000s, there were a number of thought leaders and early adopters that were using and championing the technology, but digital pathology was far from mainstream. Many thought digital pathology was synonymous with ‘camera-on-a-stick’, or robotic microscopy, a technology that had been in use for decades to take pictures of regions of interest on a slide. The drawback was that these still photos were ‘still’ – the pathologist could only see the region that was captured, could not review the rest of the tissue sample and could not change magnification or do any fine focusing. The introduction of digital pathology was game-changing.
By creating a dynamic whole slide image (WSI), the pathologist had the ability to quickly review the whole slide and to easily change magnification, as well as make annotations on the slide, create reports and archive the slide for retrieval. The true benefit of its application comes through in the fact that digital pathology knows no borders or boundaries. When many countries, like China, will not allow glass pathology slides to leave the country, digital pathology becomes a lifeline when there are challenging cases, a large scale research project or no immediate access to pathology subspecialists. Digital pathology was a new and disruptive technology, and while there is no doubt this technology will eventually change the way pathology patient care standards are met, that change will take time, attention, leadership, money and focus.
The Naming Game
Digital pathology versus virtual microscopy – that was the big question 10 years ago. You had two camps, one camp saying virtual microscopy and the other saying digital pathology. In the end, Dirk Soenkson, founder and CEO of Aperio, convinced the industry that digital pathology was the correct future term because digital pathology encompassed so much more than a virtual slide. He said, “We think of digital pathology as a digital environment for managing and interpreting pathology information, specifically information that is enabled by the digital slide, which is a whole-slide image. It’s what you do with the information that matters.”
The year 2007 signified an important inflection point in the history of digital pathology and the continuation of this new and disruptive technology. Aperio, the undisputed leader in digital pathology at that time, had been holding annual Pathology Visions User Group meetings in San Diego. These meetings brought together digital pathology thought-leaders and early adopters for peer-to-peer interaction and sharing of best practices. In 2007, Aperio opened Pathology Visions to anyone working with or interested in digital pathology, even welcoming industry competitors. This decision was prompted by several factors, but none were greater than the desire to promote the evolution and adoption of digital pathology. We were still seeing low awareness of digital pathology among pathologists, but important clinical pathology applications were emerging, like reference labs using this technology to gain competitive advantages and improving turnaround time.
I’ll admit in the first few years it was hard to get speakers that weren’t pro-Aperio because there just weren’t that many competitors in the industry – this was years before GE and Philips entered the arena. But even securing government and academia speakers became challenging, because their institutions would not allow them to be paid to attend a conference if the check was from a vendor (Aperio). Headwinds like these continued to mount up and reinforce the need for a formal association or society to take over the reins.
Pathology Visions partnered with the California Society of Pathologists in the first of many steps on the road to the Digital Pathology Association. That year, Dr. Elizabeth Hammond from Intermountain Health was the keynote speaker presenting Digital Imaging: Role in Distributed Pathology Practice and Education and Dr. Jared Schwartz (past president of the College of American Pathologists) presented the Future of Pathology: Vision 20/20 . Both continue to be strong advocates of digital pathology today.
This signaled the beginning of the transition from an “Aperio-run” conference to a conference managed by the Digital Pathology Association (who knew a major recession was brewing that would add 2 years to the transition?!). Aperio continued to finance/sponsor and produce Pathology Visions until 2011, when The Ward Management Group was hired to manage the fledging association.
Things changed rapidly once the conference was open to the industry and we had established an arms-length distance between Aperio and Pathology Visions with the creation of the Digital Pathology Association. Forming the not-for-profit, Digital Pathology Association, would enable us to seek out speakers without the risk of a conflict of interest and would provide a path towards achieving one of our long-term goals – offering CME credit. Pathologists were required to maintain a certain number of credits each year so we felt that offering CME credit was an important driver in the decision to attend a conference. For years, we had chased down PACE, RACE, CE and CME accreditation without success, but the DPA provided new means and opportunities.
Digital Pathology vendor support was a milestone that was integral to the success of the DPA, so a campaign, led by Dirk Soenkson, was launched to enlist the top players in digital pathology. The industry was very young, there was a lot of promise and excitement about the technology, but the industry needed to unite to create standards and alignment that would be key in advancing digital pathology from niche applications to mainstream adoption. The work that has been done by the DPA joint task forces has been impressive from the first Interoperability of LIS and Digital Pathology to the ongoing efforts with the FDA. I remember being on some of those first calls and the wariness that first existed between members that were competitors. Benefactor members had a seat on the board and a voice in the industry. The first Benefactor members were Aperio, Leica, Premier Labs, Olympus, Omnyx and Sunquest.
My Personal Involvement
I was involved in inception and start up of the DPA, including name and domain searches, mission statements, marketing efforts and creating membership tiers and benefits, as well as sponsorship sales. My #1 goal was to promote the adoption of digital pathology and unite in a joint FDA approval effort. But who knew that it would take this long?!
I was involved in all aspects of the planning and production of Pathology Visions from an operations and conference management perspective from 2007 until we transitioned over to the DPA and The Ward Management Group in 2011. After that, I remained on the planning committee until 2016. I worked closely with the industry, securing sponsorships, exhibitors and advertisers and I learned a great deal about setting up a nonprofit.
Here’s a glimpse at the mission and goals of the DPA in the early days. You can see a recurring theme of digital pathology users coming together and using their combined expertise to move the digital pathology through the adoption curve. We’ve come a long way and I am so very proud to be connected with such a diverse, passionate and dedicated team of global digital pathology experts working together to improve patient care.
Organizations, institutions and individuals with interest in developing common technical DP specifications, collaborating in task forces and building digital pathology adoption.
The DPA’s mission was to facilitate education and awareness of digital pathology applications within healthcare.
- A wide range of perspectives from a diverse member base will help build a firm and flexible foundation for a future digital pathology growth.
- Members working together to create the digital pathology standards that are the foundation for digital pathology product and service interoperability.
- Members will design and introduce 100’s of opportunities leveraging digital pathology in healthcare and life sciences. (new algorithms, new integrations, secure access, applications for device communications and delivering digital content anytime, anywhere.
Today, the focus of digital pathology continues to be about what you can do with the slide after it is digitized, whether it’s telepathology, image analysis, education, second opinions, enhanced accuracy, quality, safety or overall patient care. As we move toward a future driven by technology and legislation, this focus will no doubt shift again. In short, we have come a long way, but we still have a long way to go.
When I first became involved in this field I had no idea what a pathologist did, how important a role they played in diagnosing disease, and how their decisions influenced a patient’s treatment plan including surgery and chemotherapy. I also didn’t realize how subjective the diagnosis could be, varying from one pathologist to another and dependent on specialization and sub-specialization.
Today, the DPA is a non-profit association comprised of pathologists, scientists, technologists, and industry representatives dedicated to the advancement of the field of digital pathology. The mission, changed slightly from its inception, is: to facilitate education and awareness of digital pathology applications in healthcare and life sciences.
Members are encouraged to share best practices and promote the use of this technology among colleagues in order to demonstrate efficiencies, share knowledge and its ultimate benefits to patient care.
Digital pathology takes the subjectivity out of the equation; a research pathologist can produce quantifiable, consistent, reproducible results. A surgical pathologist can visually share and review the tissue sample with the patient and when he or she comes across a challenging case, they can easily consult with other pathologists next door or across the globe. When I learned all of these benefits, I quickly joined the digital pathology movement, and I continue to be a vocal champion and strong advocate for the technology.