Digital-Pathology-Today

Imagine a world without staining… in the excitement of digital pathology we often forget that we're using with a legacy system of staining tissue pink and purple, which is time-consuming and tissue-destructive. There's got to be a better way. Our guest is Dr. Gideon Ho, who co-founded HistoIndex to develop and commercialize the world’s first fully automated, quantitative, stain-free imaging system. Under his direction as the CEO, the laser-based stain-free imaging system has been successfully implemented in academic, clinical and commercial research centers in major universities, hospitals and research facilities around the world. Dr. Ho has multiple patents and journal publications in medical imaging, lasers and optics to his credit. We’re going to discuss the promise of Stain-free digital pathology and the technologies developed at Histoindex. What is multiphoton technology? What is second harmonic generation (SHG)? The clinical applications Histoindex is focusing on first is NASH – nonalcoholic steatohepatitis. What is NASH? what is the unmet need? How does it affect society. What are the diagnostic challenges?

What is The State of the Practice of digital pathology as we enter 2022? Where are we in terms of integrated workflows, predictive and prognostic algorithms based on H&E morphology, and incorporating AI into workflows or diagnostic assistance? Perhaps most pressingly, have we finally made the business case for wide scale adoption of digital pathology? Our guest is Michael Feldman, MD, PhD, Professor of Pathology and Laboratory Medicine at the University of Pennsylvania as well as Vice Chair for Clinical Services and Director of the office of Pathology Informatics. We're going to be talking about all these things and in addition perhaps a perspective on digital pathology in an academic setting. Will digital fellows become a reality - artificial intelligence enabled machines that will organize, prepare, preview, maybe even diagnose cases and prepare the report for sign out? We’ll discuss what image analysis and computational algorithms mean for the diagnostic acumen of trainees in the next generation of pathologists.

In addition to interpreting patient biopsies and signing out cases, pathologists perform a wide variety of functions - including intraoperative consultation or frozen section, presenting cases at tumor boards or other conferences, doing procedures, or assessing the adequacy from image guided biopsies. This is done in a wide variety of practice settings. Many times, it's done over a very large geographical area where the physical presence of a pathologist may be impractical or highly inconvenient. Our guest is Hannah Gilmore, MD, Chief of the Division of Anatomic Pathology at University Hospitals Case Medical Center in Cleveland. We’re talking about the unique challenges and pain points pathologists face in the large hospital system covering a large geography. How can digital pathology help alleviate some of these challenges? What are specific applications that, if implemented, would give us immediate benefit? How can digital pathology make pathologists more productive - particularly in areas not strictly related to primary diagnostic activity?

We welcome back Professor Hamid Tizhoosh from KIMIA Lab and now of the Mayo Clinic. Dr. Tizhoosh was one of our most popular guests from last season. We talked about artificial intelligence, but it seems like we barely scratched the surface. AI is such a hot topic - so before we go any further, we’ll go back to a rough definition of Artificial Intelligence. In Machine learning a theme we keep hearing about is supervised vs. unsupervised learning. What does that mean and why is it important? The concept of validation is critically important in pathology and laboratory medicine. What does this mean in the context of Artificial intelligence? What is image archiving? And how does image search work? We discuss the difference between tissue representation and patient representation and why this distinction will be critical for the future of digital pathology and moving precision medicine forward.

We all want to do the right thing - but how do we know what that is? What is ethics and what is the difference between ethics and the law? Our guest is Brian Jackson, MD, medical director of IT, business development and support services at ARUP, as well as associate professor of Pathology and adjunct associate professor of biomedical informatics at the University of Utah. We're talking about the foundational principles of ethics in science and medicine. What are the limits of informed consent as it applies to developing new products utilizing patient data? Is technology evolving faster than our ability to regulate it? How do we get comfortable with and regulate algorithms and devices that appear opaque or black box? And what will the future hold as we increasingly have the ability and responsibility to develop these great new tools to help patients?

We keep hearing that one of the promises of digital pathology is the ability to develop AI based algorithms and tools that will allow us to do things that we never have before. This gets many people excited in the industry - particularly computer scientists, programmers and machine learning specialists - but what about the role of the pathologist? How can we the keep pathologist engaged in the development of AI algorithms and digital pathology workflows? One of the things that has hindered surgical pathology (maybe just in perception) is lack of standardization and reproducibility both in terms of molecular and IHC testing as well as interpretation of H&E images. Part of the promise of digital pathology is that we could eliminate this variability or subjectivity. But wouldn't pathologist developing their own algorithms recreate similar problems? Rish Pai, MD, PhD is Professor of Laboratory Medicine & Pathology and serves as a Consultant Pathologist at the Mayo Clinic, Arizona and Associate Chair of Research. Dr. Pai has lectured nationally and internationally on many aspects of gastrointestinal and hepatic pathology and has directed multiple GI and Liver CME courses. He is Past-President of the Rodger C. Haggitt Gastrointestinal Pathology Society. Dr. Pai is a regular reviewer for numerous pathology and gastroenterology journals and serves on the Editorial Board of the American Journal of Surgical Pathology. He has published 130 articles and written multiple book chapters in the fields of gastrointestinal and hepatic pathology. Pathology is a unique specialty. Much of what we do becomes a “permanent record,” and yet there remains an inherent subjectivity and imperfection. Do we have a special obligation to get it right?

Our guest is Michael Valante, Global Business Leader for Dell Technology’s Healthcare Division and Dell’s Chief Technology Officer for Digital Pathology, where he is a subject matter expert in the areas of enterprise imaging and pathology informatics. Mike is deeply focused on the healthcare industry and the intersection of medical imaging and information technology. We’re going to discuss lessons learned from Dell’s involvement in IT infrastructure throughout healthcare and disciplines outside of pathology. Digital Pathology, as a field is, moving incredibly fast. It seems like we’ve hit an inflection point in the past year. We’ll discuss the trajectory and the velocity of the digital transformation. Pathology certainly has different stakeholders – lab managers, hospital administrators, IT staff, the pathologists, other physicians. Roughly what are the concerns of each of these varied groups of stakeholders? And what is Dell’s approach to balancing both the technical and clinical aspects of digital pathology?

Immunotherapy and immune-oncology have become such hot areas of exploration in the past few years. We're going to explore the forces which have coalesced to make this a reality. Our guest is doctor Katir Patel, PhD a scientist with a keen interest in immunotherapy and diagnostics. We're going to be exploring the role of digital pathology in immune-oncology. How will we use the tools in our arsenal, such as image analysis, multiplexing, artificial intelligence and even good old-fashioned H&E sections to bring pathology to the forefront of immune-oncology.

There's so much excitement and hype around AI, but what does it mean for the practicing pathologist? Workflows seem very fragmented and antiquated, particularly in this new era of digital pathology. Can we add value in the pre-analytic or specimen handling phase and also in the post-analytic or reporting phase? Our guest is Hillel Kahane, MD, founder of Starpath diagnostics, a renowned and well-respected board certified uropathologist with over 28 years of experience in the commercial USA laboratory industry. He has personally signed out over 1,000,000 prostate needle biopsies throughout the USA serving well over 6,000 urologists and radiation oncologists nationwide. Dr. Kahane has served as the Chief Medical Officer & Director of Uropathology at Acupath Laboratories, Medical Director of Bostwick Laboratories, and Executive Medical Director, Uropathology DIANON Systems- LabCorp. There seem to be many different use cases for AI. We’re going to discuss potential to enhance workflows, quality assurance application and primary diagnosis. Pathologists have long been changed to their desks and microscopes. What is the future of remote sign-out? Pathologists are very good at what they do, but how can we improve upon conventional light microscopy? And can come up more innovative ways of capturing the value we have created?

There is so much rich information imbedded in the histologic and molecular features of tissue sections which can be extracted through digital pathology. We seem to be at the convergence of AI-powered image analysis and precision medicine. Our guests are Jonathan Daniels and Ori Zelikov, MD from Nucleai, who are committed to bringing the power of spatial biology to reality by providing pharmaceutical companies and clinicians with AI- powered image analysis applications. We're going to be talking about the promise of digital pathology and image analysis and how these technologies can be leveraged in drug discovery and ultimately patient care. What does the future hold and how a higher throughput of patient biopsies through a digital pathology system will result in a new age of information and discovery analogous to the revolution we have seen in sequencing the human genome. We will also talk about the rich ecosystem in med-tech in Israel and what makes Nucleai unique in its makeup and approach.