Our guests are Dr. Garth Bryson Consultant Pathologist and Clinical Director for Laboratory Medicine at the NHS Greater Glasgow and Clyde and Dr. David Harrison, Professor of Pathology from the University of Saint Andrews, and both from ICAIRD - the Industrial Center for Artificial Intelligence Research and Digital Diagnostics a program matching AI solutions and research with health and social care priorities across Scotland.

We talk about the long journey of implementing digital pathology in a large health care system, barriers to adoption of digital pathology, the promise of artificial intelligence, the business case for digital pathology – have we finally been able to articulate one? And finally, we discuss our guests’ experience so far in creating a digital slide sharing network throughout Scotland.

Our guest is one of the giants in the field of digital pathology and image analysis. And if he has seen further than others, he will tell you, it is because he was able to stand on the shoulders of giants as well. His unique multidisciplinary approach has allowed him to breakdown silos and see across the often-artificial barriers and distinctions imposed by academic disciplines and patient treatment paradigms.

We're talking with Professor Anant Madabhushi, Director of the Center for Computational Imaging and Personalized Diagnostics and Professor of Biomedical Engineering, Radiology, Pathology Urology and Radiation Oncology at Case Western Reserve University.

We discuss silos in academic departments and disease states and how looking beyond these limitations can propel progress. What exactly is image analysis, what if we've been able to do with it so far and what predictive and prognostic information can we unlock from histologic features. And finally, how can an image analysis and non-tissue destructive computational and AI powered methods help to democratize access to care and lead to better outcomes for patients across the world.

What have we been waiting for? What's taking so long? Much of the technology surrounding digital pathology has been with us for over 20 years. After fits and starts and initial excitement we've been left with disappointment in the past ten years. But now, it seems like the tide is turning and the digital transformation is here.

Our guest is Richard Lash, MD, Chief Medical Officer from Lumea, a company re-imagining pathology by developing a comprehensive end to end workflow. Dr. Lash has had a long career as a pathologist as well as holding leadership positions in addition to Lumea at several prominent organizations including Inform Diagnostics, Ameripath and Mount Sinai Medical Center.

We're going to be talking about how the lack of a cohesive business for digital pathology, lack of a vision to integrate exciting new technologies into everyday workflows has hindered the adoption of digital pathology; what has changed and why now with compelling new technologies including artificial intelligence, we can finally begin to develop and incorporate end to end solutions that can enhance pathologist performance and improve outcomes for doctors and patients.

We've all seen it in science fiction movies and maybe somewhat in consumer tech culture with things like Google glasses, or Pokémon GO. Augmented reality – an enhanced version of the physical world through the use of digital visual elements - does it have a role in digital pathology?

Gabe Siegel is the CEO and co-founder of Augmentiqs, a company that develops augmented reality and digital pathology capabilities for the existing microscope. Prior to starting Augmentiqs, Gabe worked for multiple medical device and digital pathology companies, focusing on marketing strategy and communications. Gabe developed the concept for augmented reality microscopy & microscope-based digital pathology.

We discuss what exactly is augmented reality? What are the benefits - can it really save time and money?

In this digital transformation of pathology, much of the focus is, of course, on the imaging of histologic sections or glass slides, which were once viewed under the microscope. It's often easy to forget that the examination of the specimen begins much earlier in the process - in the gross room or even in the operating room.

Our guest is Vikram Butani, CEO and founder of Kubtec, whose passion is developing transformative specimen imaging, and specimen radiography systems that enable medical professionals to provide the best quality of care for their patients.

Kubtec has developed range of advanced specimen radiography systems provide high resolution specimen X-ray for the biopsy suite, the operating room, the pathology gross room and the morgue. In addition, KUBTEC Specimen Radiography Systems include proprietary workflow management tools to help reduce turnaround time and labor costs.

We're going to be talking about the history of Kubtec from humble beginnings, what the digital transformation of radiology has meant for imaging in other parts of the hospital - specifically the pathology gross room and the OR. We discuss the critical role of the pathologist’s assistant in the diagnostic process, the value of specimen imaging and how it can impact cost, time and efficiency. And finally, what does the future hold? and how will 3D imaging enhance what we do and ultimately bring better care to patients?

The big trend in oncology over the past few years has been immunotherapy. this trend is converging with the digital transformation we are undergoing in pathology we seem to be at the crossroads of immune-oncology, digital pathology, image analysis, artificial intelligence, and the increasing ability to Multiplex.

Our guest is Keith Wharton Jr., MD, PhD from Ultivue, a company looking to reveal actional biology through multiplex immunofluorescence to make immunotherapy a reality for patients with cancer. Keith is a board-certified anatomic pathologist with diverse achievements in research, drug and diagnostic development, and clinical investigation. He leads Ultivue’s Pathology and Biomarker Analytics team.

We’ll be discussing what is the need for multiplexing. How much information can Multiplexing add above and beyond standard methods. When do we reach the point of diminishing returns? what are some challenges to implementation and risks of complexity and system failure? In addition, we'll talk about specific applications for immunofluorescence and multiplexing versus the current state of the practice including immunohistochemistry and quantifying tumor infiltrating lymphocytes on good old-fashioned H&E sections.

The Armed Forces Institute of Pathology (AFIP) was in existence from 1862 to 2011. Many of us in pathology know it as the publisher of the “tumor fascicles” or the Atlas of Tumor Pathology series, originating in 1947, as well as a center of consultation and tissue repository unparalleled in the world.

The AFIP was reborn as the Joint Pathology Center (JPC), whose mission is to deliver cost-effective, high-quality, multidisciplinary pathology consultation and education; and preserve, modernize, and grow the nation's oldest tissue repository to promote biomedical research. The JPC is home to the largest collection of human pathologic specimens in the world, unparalleled in size, age, and diversity. The challenge now is to digitize this collection.

In this episode of Digital Pathology Today, our guests are COL Joel Moncur, Director of the Joint Pathology Center and Katie Olson, Acting Director of the Defense Digital Service (DDS).

Dr. Moncur became the Director of the JPC in August of 2018. His priorities as Director include digitally transforming the JPC repository and ethically using the data to develop collaborative artificial intelligence algorithms that can lead to new insights into specific disease states or clinical scenarios.

At DDS, Katie Olson oversees products and operations for the 80-person rapid-response team working within the Office of the Secretary of Defense. As a Highly Qualified Expert (HQE), Olson brings both her government and private sector experiences to bear on these important initiatives.

We discuss the history of the AFIP through its disestablishment in the early 2000s and its rebirth as the JPC. What is DDS and what types of projects do they work on? The massive undertaking which many people are excited about is the project to digitize the JPC collection. We’ll learn about the size, scope and goals of the project. And, of course, artificial intelligence (AI) is a very hot topic - particularly in digital pathology. How will AI be incorporated in this project?

We hear that multiple file formats or perhaps, more importantly, lack of a uniform file format seems to be a big issue in digital pathology. Why is this? What do we even mean by a file format? And will we be able to overcome this barrier on the road to full scale adoption of digital pathology?

Yves Sucaet, a PhD in Bioinformatics, has a research background in systems and network biology. In 2012, he became intrigued with the idea of applying bioinformatics algorithms to virtualized microscopic material (whole slide images).

Back in Belgium, he went on to co-found Pathomation, together with Dr. Wim Waelput and Dr. Mark Kockx. The mission of Pathomation is to provide software (middleware) for digital pathology, allowing any organization to efficiently implement any digital pathology workflow imaginable.

We discuss why there are multiple file formats and the challenges this causes. Do different types of applications necessitate different file formats? (i.e. 2d vs. 3-d imaging, H&E staining vs. fluorescence?) How does evolving technology and new vendor specific applications create problems? And of course, DICOM seems to be the most talked about format. Why has it become the standard in radiology but not pathology?

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.