Current usage and future trends in gross digital photography in Canada

The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective

PURPOSE

Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen.

DESIGN/METHODOLOGY/APPROACH

The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis.

FINDINGS

The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad.

PRACTICAL IMPLICATIONS

Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages.

ORIGINALITY/VALUE

This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.

Visual-spatial dimension integration in digital pathology education enhances anatomical pathology learning

Literature review demonstrated a surprising lack of publications on digital e-learning pathology resources for senior medical undergraduates and interns. An interactive Digital Pathology Repository (iDPR) integrating two- and three-dimensional (2D, 3D) high-resolution anatomical pathology images with correlated digital histopathology was developed. The novel iDPR was rigorously evaluated using mixed methods to assess pathology knowledge gains (pre- and post-tests), quality impact analysis (questionnaire), user feedback (focus group discussions) and user visual behaviour (eye gaze tracking analysis of 2D/ 3D images).Exposure to iDPR appeared to improve user pathology knowledge, as observed by significantly increased test scores on topic-related quizzes (n = 69, p < 0.001). In addition, most users were highly satisfied with the key design elements of the iDPR tool. Focus group discussion revealed the iDPR was regarded as a relevant online learning resource, although some minor technical issues were also noted. Interestingly, visual behaviour trends indicated that specific diagnostic pathological lesions could be correctly identified faster in 3D images, when compared to 2D images.The iDPR offers promise and potential in pathology education for senior clinical students and interns, gauging from both qualitative and quantitative positive user feedback. With incorporation of image annotations and interactive functionality, and with further technology development, this would prove a useful tool for diagnostic pathology and telepathology. As images with added visual-spatial dimension can provide enhanced detail and aid more rapid diagnosis, future applications of the iDPR could include virtual reality or holographic images of anatomical pathology specimens.

Digital media archive for gross pathology images based on open-source tools and Fast Healthcare Interoperability Resources (FHIR)

Macroscopic examination of surgical pathology and autopsy cases is a fundamental component of anatomic pathology. The photographic documentation of such clinical specimens is essential, and it may be required in certain instances. Our department began using consumer-grade digital cameras in 2005 to improve the practice of gross photography. However, the lack of an application to correctly catalog the photographs resulted in thousands of digital image files scattered across shared network drives, with limited case and patient metadata, making image retrieval a cumbersome and sometimes impossible task. Thirteen years later, we examined the legacy method of acquiring and accessing gross photographs in our department and determined the need for a web-based digital media archive to capture images with structured metadata. Using several open-source tools, including MediaWiki, we developed a flexible platform for building our digital media archive with a data schema based on the Fast Healthcare Interoperability Resources standard. Following a short pilot, we replaced the legacy method of handling gross pathology images with a new acquisition workflow and digital media archive. Through March 2021, 233 distinct users have accessed the system, 58 of which have uploaded 21,024 images. Of those images, 13,684 (65.1%) correspond to surgical pathology images, 4045 (19.2%) belong to neuropathology cases, and 3295 (15.7%) originate from autopsies. We demonstrate the design and implementation of a customizable anatomic pathology digital media archive solution in an academic pathology department setting using a modern standard for exchanging healthcare information electronically. The system's efficiency and scalability for our current operation will enable us to integrate with other applications and pathology informatics initiatives in the future.

UniTwain: A Cost-Effective Solution for Lean Gross Imaging

Background:

Gross imaging of surgical specimens is paramount for the accurate gross examination and diagnosis of disease. Optimized imaging workflow can facilitate consistently high-quality gross photographs, especially in high-volume, metropolitan hospitals such as ours. Most commercial medical gross imaging technology provides ergonomically well-designed hardware, remotely operated cameras, intuitive software interfaces, and automation of workflow. However, these solutions are usually cost-prohibitive and require a large sum of capital budget.

Materials and Methods:

We applied lean techniques such as value stream mapping (VSM) to design a streamlined and error-free workflow for gross imaging process. We implemented a cost-effective technology, UniTwain, combined with high-resolution webcam to achieve the ideal results.

Results:

We reduced the mean process time from 600 min to 4.0 min (99.3% decrease in duration); the median process time was reduced from 580 min to 3.0 min. The process efficiency increased from 20% to 100%. The implemented solution has a comparable durability, scalability, and archiving feasibility to commercial medical imaging systems and costs four times less. The only limitations are manual operation of the webcam and lower resolution. The webcam sensors have 8.2 megapixel (MP) resolution, approximately 12 MP less than medical imaging devices. However, we believe that this difference is not visually significant and the effect on gross diagnosis with the naked eye is minimal.

Conclusions:

To our knowledge, this is the first study that utilized UniTwain as a viable, low-cost solution to streamline the gross imaging workflow. The UniTwain combined with high-resolution webcam could be a suitable alternative for our institution that does not plan to heavily invest in medical imaging.

A cross-sectional survey to evaluate acquaintance about dental photography among dental students in daily clinical practice

Background: In today's world of digital dentistry, dental photography plays an important role as multilevel significance and represents the synonym of contemporary dentistry. Thus, we aimed at evaluating the acquaintance of practice, opportunity and morals of dental photography in everyday practice among undergraduate dental students. Design and Methods: The current research was an observational cross-sectional study. Total 233 students participated; each was given questionnaire consisted of three parts covering the following aspects: questions 1 to 3 on the practice of dental photography, questions 4 to 7 on morals in dental photography and question 8 to 11 on opportunities of dental photography. The answers were tabulated and statistically analysed and association with the factors were tested for significance using Chi-square tests, and P<0.05 was considered statistically significant. Results: The total response rate was 86%. Among the 201 respondents, 100 were males and 101 females; 96% male students were taking photographs and 93% females were taking photographs, on regular basis. Phone cameras (41.3%) were the most commonly used device followed by DSLR cameras. Surveyed students mentioned patient education (53.2%) as most needed requirement for taking photographs, followed by treatment planning (49.8%) and monitoring of the treatment outcome (34.3%). Ninety-one percent of students feel that there is an opportunity for advancement in dental photography techniques. Conclusions: The participants aware of dental photography, but they require detail insight on proper capturing of photographs and morals, with regards to confidentiality of the patient and patient consent.

Three-Dimensional Pathology Specimen Modeling Using “Structure-From-Motion” Photogrammetry: A Powerful New Tool for Surgical Pathology

Context.—

Three-dimensional (3D) photogrammetry is a method of image-based modeling in which data points in digital images, taken from offset viewpoints, are analyzed to generate a 3D model. This modeling technique has been widely used in the context of geomorphology and artificial imagery, but has yet to be used within the realm of anatomic pathology.

Objective.—

To describe the application of a 3D photogrammetry system capable of producing high-quality 3D digital models and its uses in routine surgical pathology practice as well as medical education.

Design.—

We modeled specimens received in the 2 participating laboratories. The capture and photogrammetry process was automated using user control software, a digital single-lens reflex camera, and digital turntable, to generate a 3D model with the output in a PDF file.

Results.—

The entity demonstrated in each specimen was well demarcated and easily identified. Adjacent normal tissue could also be easily distinguished. Colors were preserved. The concave shapes of any cystic structures or normal convex rounded structures were discernable. Surgically important regions were identifiable.

Conclusions.—

Macroscopic 3D modeling of specimens can be achieved through Structure-From-Motion photogrammetry technology and can be applied quickly and easily in routine laboratory practice. There are numerous advantages to the use of 3D photogrammetry in pathology, including improved clinicopathologic correlation for the surgeon and enhanced medical education, revolutionizing the digital pathology museum with virtual reality environments and 3D-printing specimen models.

Performance of residents using digital images versus glass slides on certification examination in anatomical pathology: a mixed methods pilot study

BACKGROUND

It is anticipated that many licensing examination centres for pathology will begin fully digitizing the certification examinations. The objective of our study was to test the feasibility of a fully digital examination and to assess the needs, concerns and expectations of pathology residents in moving from a glass slide-based examination to a fully digital examination.

METHODS

We conducted a mixed methods study that compared, after randomization, the performance of senior residents (postgraduate years 4 and 5) in 7 accredited anatomical pathology training programs across Canada on a pathology examination using either glass slides or digital whole-slide scanned images of the slides. The pilot examination was followed by a post-test survey. In addition, pathology residents from all levels of training were invited to participate in an online survey.

RESULTS

A total of 100 residents participated in the pilot examination; 49 were given glass slides instead of digital images. We found no significant difference in examination results between the 2 groups of residents (estimated marginal mean 8.23/12, 95% confidence interval [CI] 7.72-8.87, for glass slides; 7.84/12, 95% CI 7.28-8.41, for digital slides). In the post-test survey, most of the respondents expressed concerns with the digital examination, including slowly functioning software, blurring and poor detail of images, particularly nuclear features. All of the respondents of the general survey (n = 179) agreed that additional training was required if the examination were to become fully digital.

INTERPRETATION

Although the performance of residents completing pathology examinations with glass slides was comparable to that of residents using digital images, our study showed that residents were not comfortable with the digital technology, especially given their current level of exposure to it. Additional training may be needed before implementing a fully digital examination, with consideration for a gradual transition.

Imaging and image management: A survey on current outlook and awareness in pathology practice

BACKGROUND

Flexibility of digital photography enables it to be an integral part of pathology practice. An assessment of guidelines of imaging is essential for proper usage of photographs.

OBJECTIVES

The purpose of the study was to assess awareness of oral pathologists about various aspects of medical photography.

METHODS

Questionnaire based on the availability of facilities, usage, technical details and ethical issues of medical photography was sent to postgraduate students and teaching faculties of Oral Pathology in various localities in India.

RESULTS

Photographs were taken mostly for the purposes of publication, medical documentation and education. Significant number of postgraduate students and faculties of Oral Pathology didn't receive any training or hadn't gone through any publications/books (P = 0.000) about medical photography. Consent for patient photography was taken by significant number of respondents (P = 0.000) but in a verbal form. Majority of people used image editing software, but 19.0% of faculties and 21.1% of postgraduate students were unaware of deleterious effect of image editing. Firm and sensible instructions concerning image storage, sharing and accessibility were not yet created.

CONCLUSION

This survey drew attention towards lack of proper understanding about the technical details, medical protocols and ethical issues related to medical photography. These findings recommend implementation of basic training for medical photography and policy for image management for students and faculties in every health care institution.