Embracing Technology in Cytopathology

by Christina Zioga, MD; Aristotle University of Thessaloniki, Greece

It’s one thing, wanting to convert a conventional Cytopathology department to a more digitized diagnostics workflow, and another thing to have the resources to do so. In our lab, we are more than eager to digitize our practice but at the same time, a general lack of funding for our National Health System translates into having to make do with what funds the department is allocated.

When I first started working at the Cytopathology Laboratory of the George Papanikolaou General Hospital, Thessaloniki, Greece, as a medical consultant, the lab was being run by doctors employed under temporary one-year contracts. Working with temporary staff with such short tenures is not the proper way to instill new ideas.

The lab equipment was sorely deficient in all manner of ways, especially the electronic equipment. For example, only one PC is available for all staff members. Cytopathologists would write their diagnoses on the back of  request forms and Cytotechnologists would then type the reports into the LIS and print them directly. If a mistake was made or if something needed to be changed, we would send back the printed document to have it rewritten and printed again.

Within a few months’ time, we managed to have a brand-new PC for each Cytopathologist (three devices) as well as one for every member of the Cytotechnologists team (three devices). This was not an easy task, due to the fact that the lab’s electrical and network facilities required extensive rewiring. Every Cytopathologist now has one of at least two monitors that are required for going digital. We chose to equip our lab with 27-inch screens. The decision was made based on the fact that 24-30 inch monitors are generally accepted as the optimal digital pathology solution, with 27 inches considered to be neither too small (one can still see all the details) nor too big (so as one doesn’t have to move his/her head too much).

As far as the login credentials of each employee using the LIS are concerned, in the beginning, all staff members used the same username and password for all levels of security. Now, each one of us has our own login information and credentials. This allows us to better define access privileges. The end result is that Cytopathologists can now view, edit and approve, while Cytotechs can input, view and edit.

A printer has been purchased for the doctors’ office, in order to localize document output. Once the report has been corrected and approved by a Cytopathologist, it is then printed in its final form. In order to transition to a paperless office environment, we are currently exploring the possibility of digitally signing our reports.

Since our lab currently lacks any appropriate camera equipment, I’m considering buying an “add-on” tool for my microscope, in consideration of Dr Glassy’s (my DPA mentor) suggestion.

There are several steps that need to be taken in order to go digital such as understanding the benefits that digital pathology has to offer, defining needs and goals, specification of necessary infrastructure and LIS needs, defining the workflow, configuration and training, and lastly the system rollout, application analysis, and expansion. We are still at the very beginning of this process. Our vision is to convert our lab from optical to digital microscopy, which of course involves more than just the purchase of whole slide scanners. We want to prepare our laboratory for the future with digital pathology solutions including software systems that will help us provide fast, efficient Cytopathology service of the highest quality.

We are really eager to embrace technology in Cytopathology. We believe that we are witnessing a turning point, and those apprehensive about going digital are holding themselves back from reaping significant benefits. 

Disclaimer: In seeking to foster discourse on a wide array of ideas, the Digital Pathology Association believes that it is important to share a range of prominent industry viewpoints. This article does not necessarily express the viewpoints of the DPA, however we view this as a valuable point with which to facilitate discussion.

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