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Hortsch M, Koney NKK, Oommen AM, Yohannan DG, Li Y, de Melo Leite ACR, Girão-Carmona VCC. Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1421:79-124. [PMID: 37524985 DOI: 10.1007/978-3-031-30379-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.
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Affiliation(s)
- Michael Hortsch
- Departments of Cell and Developmental Biology and of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Nii Koney-Kwaku Koney
- Department of Anatomy, University of Ghana Medical School, University of Ghana, Korle Bu, Accra, Ghana
| | - Aswathy Maria Oommen
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Doris George Yohannan
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Yan Li
- Department of Anatomy, Histology and Embryology, Fudan University, Shanghai, China
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Eccher A, Girolami I. Current state of whole slide imaging use in cytopathology: Pros and pitfalls. Cytopathology 2020; 31:372-378. [PMID: 32020667 DOI: 10.1111/cyt.12806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/17/2023]
Abstract
Whole slide imaging (WSI) allows generation of large whole slide images and their navigation with zoom in and out like a true virtual microscope. It has become widely used in surgical pathology for many purposes, such as education and training, research activity, teleconsultation, and primary diagnosis. However, in cytopathology, the use of WSI has been lagging behind histology, mainly due to the cytological specimen's characteristics, as groups of cells of different thickness are distributed throughout the slide. To allow the same focusing capability of light microscope, slides have to be scanned at multiple focal planes, at the cost of longer scan times and larger file size. These are the main technical pitfalls of WSI for cytopathology, partly overcome by solutions like liquid-based preparations. Validation studies for the use in primary diagnosis are less numerous and more heterogeneous than in surgical pathology. WSI has been proved effective for training students and successfully used in proficiency testing, allowing the creation of digital cytology atlases. Longer scan times are also a barrier for use in rapid on-site evaluation, but WSI retains its advantages of easy sharing of images for consultation, multiple simultaneous viewing in different locations, the possibility of unlimited annotations and easy integration with medical records. Moreover, digital slides set the laboratory free from reliance on a physical glass slide, with no more concern of fading of stain or slide breakage. Costs are still a problem for small institutions, but WSI can also represent the beginning of a more efficient way of working.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Kuo KH, Leo JM. Optical Versus Virtual Microscope for Medical Education: A Systematic Review. ANATOMICAL SCIENCES EDUCATION 2019; 12:678-685. [PMID: 30414261 DOI: 10.1002/ase.1844] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/21/2018] [Accepted: 10/26/2018] [Indexed: 06/08/2023]
Abstract
Many technological innovations have changed the traditional practice of medical education and clinical practice. Whole slide imaging (WSI) technology provided an unique way of viewing conventional glass slides in histology and pathology laboratories. The WSI technology digitalized glass slide images and made them readily accessible via the Internet using tablets or computers. Users utilized the pan-and-zoom function to view digital images of slides, also referred to as the virtual microscope (VM), simulating use of an optical microscope (OM). Several articles have reported various outcomes on the utility of VM in teaching laboratories. Recently, the Royal College of Physicians and Surgeons of Canada certification examinations for anatomical pathologists ha completely adopted VM for the national licensing examination. To better inform medical educators, there is an urgent need for more structured reviews to draw evidence-based conclusions on the effectiveness of VM and learner's perceptions, in comparison to OM. The current study provides a descriptive summary of published outcomes using the systematic review approach. In conclusion, medical students' performance was improved with adoption of VM into the curriculum and recognized as a preferred learning modality, compared to OM. On the contrary, resident learners' performance was comparable between using OM and VM, with OM being the favored slide-viewing modality.
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Affiliation(s)
- Kuo-Hsing Kuo
- Northern Medial Program, University of Northern British Columbia, Prince George, Canada
| | - Joyce M Leo
- Department of Laboratory Medicine, Royal Jubilee Hospital, Victoria, Canada
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Mukherjee M, Donnelly A, Rose B, Warren DE, Lyden E, Chantziantoniou N, Dimmitt B, Varley K, Pantanowitz L. Eye tracking in cytotechnology education: "visualizing" students becoming experts. J Am Soc Cytopathol 2019; 9:76-83. [PMID: 31401035 DOI: 10.1016/j.jasc.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/03/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study reports the potential of eye-tracking technology in determining screening skills of cytotechnology (CT) students while examining digital images (DI). MATERIALS AND METHODS Twenty-five static DI of gynecologic cytology specimens were serially displayed on a computer monitor for evaluation by 16 CT students and 3 cytotechnologists at 3 locations. During evaluation, participant's eye movements were monitored with a Mirametrix S2 eye tracker (iMotions, Boston, MA) and EyeWorks software (Eyetracking, Solana Beach, CA). Students completed the protocol at: Period1 (P1)-4 months, Period2 (P2)-7 months, Period3 (P3)-11 months during their 1-year training; and the cytotechnologists only once. A general linear mixed model was used to analyze the results. RESULTS The proportion of agreement on interpretations for cytotechnologists, students during P1, and students during P3 were 0.83, 0.62, and 0.70 respectively. The mean task duration in seconds for cytotechnologists, students during P1, and students during P3 were 21.1, 34.6, and 24.9 respectively. The mean number of fixation points for cytotechnologists, students during P1, and students during P3 were 14.5, 52.2, and 35.3, respectively. The mean number of gaze observations of cytotechnologists, students during P1, and students during P3 on region of interest (ROI) 1 were 77.93, 181.12, and 123.83, respectively; and, ROI 2 were 38.90, 142.79, and 92.46, respectively. CONCLUSIONS This study demonstrated that students had decreased time, number of fixation points, gaze observations on ROI, and increased agreement with the reference interpretations at the end of the training program, indicating that their screening skills were progressing towards the level of practicing cytotechnologists.
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Affiliation(s)
- Maheswari Mukherjee
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Amber Donnelly
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Blake Rose
- Department of Pathology and Microbiology, Nebraska Medicine, Omaha, Nebraska
| | - David E Warren
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, Omaha, Nebraska
| | | | - Brian Dimmitt
- Department of Anatomic Pathology, Carle Foundation Hospital, Urbana, Illinois
| | - Karyn Varley
- Department of Pathology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Donnelly A. CytoTECHnology: The benefits of technology in teaching. Cancer Cytopathol 2018; 126:511-512. [PMID: 29975463 DOI: 10.1002/cncy.22022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Amber Donnelly
- Cytotechnology Education Program, University of Nebraska Medical Center, Omaha, Nebraska
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Liikanen E. Finnish cytotechnologists' views on the competencies of newly graduated biomedical scientists in clinical cytology. Cytopathology 2017; 29:80-83. [PMID: 29193452 DOI: 10.1111/cyt.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study asked 40 cytotechnologists for their views on the competencies of newly graduated biomedical scientists in clinical cytology during the national conference of the Finnish Association of Cytotechnologists in November 2015. METHODS The questionnaire mainly consisted of statements that were scored on a five-point Likert-scale, where 1 was not important and 5 was very important. It covered five sections of clinical cytology: sampling and techniques, gynaecological screening, non-gynaecological screening, safety and quality management, and miscellaneous. RESULTS Of the 40 delegates approached to complete the questionnaire, 37 (92.5%) agreed. Respondents felt that important sampling and technique competencies were specimen fixation, with a mean score of 4.9 out of 5.0, types of specimens (4.7), Papanicolaou smear collection (4.7), Papanicolaou smear request information (4.7) and evaluation of specimen sufficiency (4.6). Less important competencies were examining FNAs (2.0) and nasopharyngeal specimens (2.2). The respondents had many expectations about how education in cytology could be developed, for example more theoretical lessons, more practice in microscope use, and consistent criteria for training and cooperation between cytology laboratories and universities of applied sciences. CONCLUSIONS The cytotechnologists who took part in our survey expected newly graduated biomedical scientists to have basic competencies in cytology. These were sampling and techniques, laboratory safety and quality management, specimen adequacy and identifying normal cells taken during gynaecological screening. They were also keen to develop education in cytology.
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Affiliation(s)
- E Liikanen
- Biomedical Laboratory Science, Tampere University of Applied Sciences, Tampere, Finland
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Chantziantoniou N, Mukherjee M, Donnelly AD, Pantanowitz L, Austin RM. Digital Applications in Cytopathology: Problems, Rationalizations, and Alternative Approaches. Acta Cytol 2017; 62:68-76. [PMID: 29183021 DOI: 10.1159/000484434] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to raise awareness of problems using digital applications for examining, teaching, and applying telecytology at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; University of Nebraska Medical Center (UNMC), Omaha, NE, USA; and University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. The objective was to rationalize problems and propose alternative digital approaches. STUDY DESIGN We sought to identify solutions to improve the following: (a) interpretive examination scores at KAMC for complex cytological templates (i.e., high-grade squamous intraepithelial lesions [HSIL]) when using static digital images (SDI) of cells in regions of interest (ROI); (b) visualization of cells in 3D clusters when teaching at UNMC using 2D and 3D whole-slide imaging (WSI); and (c) visualization of cells through streaming telecytology at UPMC. RESULTS Composite SDI (CSDI) improved test scores for complex interpretations (i.e., HSIL) by converging diagnostic criteria from multiple ROI. Multiplane focusing through z-stacked WSI facilitated the teaching of cytological entities characterized by 3D cell clusters and consultative telecytology through robotic cell analysis. CONCLUSIONS Adequately visualized cytomorphology and multiplane focusing are essential for virtual cytopathology examinations, teaching, or consultative telecytology. Visualization of diagnostic criteria through 2D or 3D imaging is critical. Panoptiq panoramic WSI with integrated z-stacked video clips enables optimal applied telecytology.
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Donnelly AD, Mukherjee MS, Lyden ER, Radio SJ. Online education in cytotechnology programs: a pilot study. J Am Soc Cytopathol 2016; 5:235-243. [PMID: 31042514 DOI: 10.1016/j.jasc.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The University of Nebraska Medical Center's cytotechnology program has received requests for an on-line program. The purpose of this study is to demonstrate that on-line education with virtual microscopy (VM) achieves similar screening and interpretation skills as traditional teaching methods using light microscopy (LM). MATERIALS AND METHODS The pilot phase was conducted using the first two courses in the program. The students were divided into two groups; traditional and virtual. The virtual group replaced LM with VM, while the traditional group utilized traditional teaching methods. At the end of the two courses, the virtual group was shown how to use LM and was given glass slide examinations. RESULTS The mean of the female genital tract (FGT) screening quizzes and exams of the traditional group was 92.5; the mean for the virtual group was 86.8. For the respiratory tract (RT) course, the traditional group had a mean of 96 for their screening exams while the virtual group's was 85.3. The glass slide examinations (FGT Mean = 98, RT Mean = 95.3) given to the virtual group at the end of the pilot study demonstrated their ability to apply screening and interpretation skill learned from VM to LM. CONCLUSION The study concludes that screening and interpretation skills of the traditional and virtual groups were similar. It appears possible to train students using VM as the sole method of teaching. The study will be extended to another cohort of students using the entire curriculum to further demonstrate the soundness of these results.
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Affiliation(s)
- Amber D Donnelly
- Cytotechnology Program, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Maheswari S Mukherjee
- Cytotechnology Program, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth R Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Stanley J Radio
- Cytotechnology Program, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska; College of Medicine, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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Saco A, Bombi JA, Garcia A, Ramírez J, Ordi J. Current Status of Whole-Slide Imaging in Education. Pathobiology 2016; 83:79-88. [DOI: 10.1159/000442391] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mukherjee MS, Donnelly AD, DeAgano VJ, Lyden ER, Radio SJ. Utilization of virtual microscopy in cytotechnology educational programs in the United States. J Pathol Inform 2016; 7:8. [PMID: 27076986 PMCID: PMC4809110 DOI: 10.4103/2153-3539.177682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
Background: Our cytotechnology (CT) program has been utilizing virtual microscopy (VM) as an adjunct educational resource since 2011. Aims: The aim of this study was to identify the utilization of VM in other CT programs across the United States (US). Subjects and Methods: A cover letter was sent to the program directors of all accredited CT programs in the US (excluding our program), requesting their participation in an online survey. After 2 days, the participants were sent an online link to the survey. The survey results were analyzed using descriptive statistics. Results: There were a total of 25 respondents to the survey. Among the 25, three CT programs use VM. Two of the three programs have been using VM for <2 years while another program for “2–4” years. The respondents found that VM's side-by-side comparison feature helped to demonstrate differences between diagnoses and preparation methods, and VM helped to preserve the important slides by digitizing them. Respondents believed that teaching with glass slides was very important. The reasons for not using VM were that VM is expensive and time-consuming to incorporate into the program, and lack of manpower resources to create digitized teaching files. Conclusions: The CT programs that use VM found it to be a valuable educational tool. Even though many were not using VM, responses from the survey indicated they will likely use it in the future.
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Affiliation(s)
- Maheswari S Mukherjee
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amber D Donnelly
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Elizabeth R Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Stanley J Radio
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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El-Gabry EA, Parwani AV, Pantanowitz L. Whole-slide imaging: widening the scope of cytopathology. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Shidham VB, DeMay RM. Thank you CytoJournal reviewers for your 2012 and 2013 services! Cytojournal 2014. [PMCID: PMC4007383 DOI: 10.4103/1742-6413.129186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Detroit, MI 48201, USA
| | - Richard M. DeMay
- Department of Pathology, University of Chicago, Chicago, IL, USA
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Shidham VB, Demay RM. Announcement of first time Cytojournal impact factor for 2012 coincides with Cytojournal decade celebration (2004-2013). Cytojournal 2013; 10:18. [PMID: 24082914 PMCID: PMC3779425 DOI: 10.4103/1742-6413.117359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vinod B Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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Pantanowitz L, Szymas J, Yagi Y, Wilbur D. Whole slide imaging for educational purposes. J Pathol Inform 2012; 3:46. [PMID: 23372987 PMCID: PMC3551531 DOI: 10.4103/2153-3539.104908] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022] Open
Abstract
Digitized slides produced by whole slide image scanners can be easily shared over a network or by transferring image files to optical or other data storage devices. Navigation of digitized slides is interactive and intended to simulate viewing glass slides with a microscope (virtual microscopy). Image viewing software permits users to edit, annotate, analyze, and easily share whole slide images (WSI). As a result, WSI have begun to replace the traditional light microscope, offering a myriad of opportunities for education. This article focuses on current applications of WSI in education and proficiency testing. WSI has been successfully explored for graduate education (medical, dental, and veterinary schools), training of pathology residents, as an educational tool in allied pathology schools (e.g., cytotechnology), for virtual tracking and tutoring, tele-education (tele-conferencing), e-learning, virtual workshops, at tumor boards, with interactive publications, and on examinations. WSI supports flexible and cost-effective distant learning and augments problem-oriented teaching, competency evaluation, and proficiency testing. WSI viewed on touchscreen displays and with tablet technology are especially beneficial for education. Further investigation is necessary to develop superior WSI applications that better support education and to design viewing stations with ergonomic tools that improve the WSI-human interface and navigation of virtual slides. Studies to determine the impact of training pathologists without exposure to actual glass slides are also needed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA
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