International university of Health and Welfare School of Medicine

In International university of Health and Welfare School of Medicine, most of the first- and second-year courses are taught in English and an overseas clinical internship for more than four weeks is required for six-year students in order to foster international professionals. They installed our color LCD monitor for digital pathology in School of medicine in 2019.

Despite that pathologists play a great role in medical diagnoses, there are problems with the chronic lack of pathologists and aging population. It is expected to overcome the lack of pathologists and improve the efficiency and accuracy of diagnoses using digital pathology and WSI (※) system.

When it comes to the digital pathology diagnosis, specifications of monitors have a great influence on the quality of digital files of specimens. Since histological sections will be shown in pastel colors which is very indiscernible after stained with H&E, accurate color reproduction is required. But conventional IT monitors or televisions have variations in the image quality and may enhance the sharpness, hue, contrast etc. intentionally to provide a better visual perception. Therefore, there seems to be a problem for pathology diagnosis in consideration of the image quality and stability.

In addition, as monitors are desired to reduce eye strain while working for long hours, a screen size able to keep an optimized viewing angle from a moderate distance is required. And an appropriate resolution of the monitor is necessary because whether it fits the image processing speed of PC will influence on the operability of zooming in/out or moving images. Therefore, setting performance standards and use a monitor with quality assurance is extremely important.

Furthermore, the colors, brightness, and gradation of the same image may look different when viewed on multiple IT monitors even with exactly the same model. Thus, using those monitors will be high risk for remote image sharing. As for medical scene, it is crucial that a pathology monitor can always display images in the same way regardless of location, time and connected devices which is also compatible for medical use.

(※) WSI (Whole Slide Imaging): refers to scanning a complete microscope slide and creating a single high-resolution digital file.

• Construction of multi-monitor system in combination with IT monitor
• Utilization of medical monitor JD-C240 with quality assurance for digital pathology

We interviewed professor Ichiro Mori, Department of Pathology, School of Medicine about the effectiveness of installation.

Professor Mori has been devoting himself to digitizing pathology diagnosis as the president of the Japanese Society of Digital Pathology, which aims to research, apply, and generalize digital pathology in Japan.

Q: May I ask your impression about the image quality of pathology monitor JD-C240?

A: JD-C240 comes with nearly 2K resolution, but it is comparable to the 27inch 4K monitor installed next to it. What’s more, the capability of quality assurance and little change over time is so marvelous, making me decide it for viewing virtual slide images.

Q: What is required of the monitor when digitalizing pathological images?

A:The guarantee of long-term stability by quality assurance is the most important for imaging monitors. Because it is hard to remember whether the image is displayed in the same color as previous due to monitors are aging over time. For example, radiographic images are basically viewed on two monitors side by side, the difference between two monitors can be recognized immediately, so monitors without quality assurance can be hardly used for long time.

Q: You have devoted yourself to creating a foundation for digitalization as the president of the Japanese Society of Digital Pathology. Could you tell me some examples about your efforts?

A:The Japanese Society of Digital Pathology proposed a new digital pathology guideline and a revised version of Technical Standards for Digital Pathology Systems for Pathology Diagnosis. They will be officially released in 2018. The guidelines recommend to comparing WSI diagnosis with microscopic diagnosis by using at least 60 specimens at each facility to verify and ensure there is no significant difference between two diagnostic methods and in order to let physicians get used to diagnosis by monitor. If they had been used to WSI diagnosis, but the color of the conventional IT monitors changes over time, diagnosis would be difficult. This is a critical issue for physicians who have made microscopic diagnosis for long time.

Q: What are the advantages of diagnosis by monitors in digital pathology?

A: Pathologists have to remember what they see through a microscope and then typing the diagnostic report on the word processing program in the case of no monitors to display pathology images, but diagnosis by monitors can make it very easy because of pathological images displayed right next to the word processing program. Observing multiple specially stained specimens at once is also an advantage of diagnosis by monitors. Furthermore, if digital files of specimens had been archived, previous data can be quickly referred to. Nowadays, medical data is almost digitalized, and the digitalization of pathology will also be inevitable. If pathological specimens can be viewed anywhere as same as electronic medical records and CT/MRI images, physicians can describe the disease to patients while displaying pathological images.

Q: What is the standard observation environment for digital files of specimens?

A: Since specimen observation requires more than one monitor, three units in the combination are most ideal. First one is for imaging reading; second one is for report reading and third one is for electronic medical records. The diagnosis may change if clinical information including radiological or other medical images can be viewed or not. Since viewing various medical images has come true in recent years, as long as those images are viewable, we should see them during making pathology diagnosis.

Q: How did you spread remote diagnoses by the digitalization?

A:International university of Health and Welfare has collaborated with Cho Ray Hospital, a general hospital locating in Ho Chi Minh City, Vietnam. The first professional health examination facility in Vietnam, Health Evaluation & Promotion Center (HEPC) was established near to Cho Ray Hospital, aiming to build a concept of preventive medicine in Vietnam and contribute to maintaining Vietnamese heath. We constructed a double check system. The first diagnosis in local departments of pathology and radiology will be sent to International Remote Diagnostic Center in Japan to be reconfirmed.

Q: Are there any requests of pathology monitors in the future?

A: The invariance of medical monitors is the selling point, so it is of great importance to be able to avoid aging properly and easily. The color of the monitor changes over time, but it is difficult to recognize if watching every day. Because quality assurance is time consuming for physicians, I hope that necessary maintenance could be easier by ourselves.

Thank you so much for your time.

(Interviewed in January 2019)