This online exhibition showed how digital innovations are helping pathologists diagnose disease.
Being able to diagnose an illness accurately and quickly is vital in healthcare, and pathologists play a crucial role in this. They also undertake research into how diseases develop and, in this way, help in the discovery of new treatments for conditions like cancer or Alzheimer’s disease.
As well as using microscopes to examine samples, pathologists are increasingly using digital tools to scan, save and share images to help with diagnosis. Artificial intelligence (AI) programmes are even being used to analyse images and help in the diagnosis of disease.
Gallery
Follow the journey of a biopsy sample to find out how the digital pathology process works.
Booking In: The specimen is delivered to the pathology laboratory by a porter from the surgical theatre or from patients’ GPs. It is checked and booked into the laboratory system ready to start its journey through the lab.
Cut-up: The specimen is described either by a pathologist or biomedical scientist. They examine the sample noting its appearance, size and weight. Small samples are all placed into a blue biopsy tissue bag and placed in cassettes. For larger samples, the parts that look more abnormal are sampled and placed into white cassettes.
Processing: The filled cassettes are then placed into different tissue processing machines depending on the type of sample. These machines are operated by the biomedical scientists and can be set to run over different times, from a few hours to overnight, to prepare the tissue for the next stage.
Embedding: The next stage is called embedding. The processed sample is now easier to handle and is orientated so it can be examined clearly. It is embedded in molten paraffin wax which is then cooled to solidify it so that the sample is held securely. This creates a tissue block.
Cutting Sections: The wax tissue block is held in a microtome machine which cuts the tissue sample into very thin, see through sections. This wax ribbon contains sections of tissue sample embedded in it. The wax ribbon is floated on a water bath, to be carefully picked up on a glass slide.
Staining the Tissue Section: The tissue sections on the slides are colourless until immersed in a variety of chemicals to stain different components of the cells in the samples. In the laboratory, machines are used to stain large numbers of slides at once.
Under the Microscope: This is a biopsy of a type of brain tumour magnified about 100 times. Looking down a microscope, the pathologist can accurately make a diagnosis. The pathologist discusses these results with surgeons, cancer specialists, nurses, physios and other medical staff, so that the correct treatment and care is provided for the patient.
Ready to View: Once the tissue section is stained it can be seen by eye and is ready to be examined under a microscope. The different colours let the pathologist identify changes in the cells and work out what type of condition the patient has.
Scanning: A slide scanner can scan individual glass slides at high resolution. Biomedical scientists and IT support are part of the team that operate the scanner and manage how the digital images are allocated to pathologists. The images are stored on a server, which means that pathologists can work away from the lab.
Digital Pathology: Digital pathology provides an effective service remotely. This is very important if you need a second opinion quickly from a pathologist in another town or even country. It also means important diagnostic work can carry on as normal during the current pandemic.
AI Diagnosis: Digital pathology is the first step to developing computing tools which will help automate some of the tasks pathologists currently do. This is called artificial intelligence or computational pathology. It is mostly a research tool at the moment, but an exciting development to advance pathology and support patient care.
© Panakeia Technologies
Cerebellum: The cerebellum is the part of the brain that controls movement and is involved in learning movements, such as playing a piano. It sits at the back of the brain, tucked underneath the cerebral hemispheres. The chemical stains help identify regions of the cerebellum as they stain differently.
Duodenum: This part of the gastrointestinal system is a c-shaped structure that sits alongside the stomach. The lining of the duodenum and its muscle layers (pink) around the central space (white) which is where chemical digestion of food takes place.
Myxopapillary Ependymoma: This type of slow-growing tumor is found in the spinal cord, usually near the base of the spine. It can be treated by surgery, radiotherapy or chemotherapy, or a combination of these methods.
Digital Pathology Explained
National Pathology Week took place on 2–8 November 2020. For more information, visit the Royal College of Pathologists’ National Pathology Week page.
