MacroPATH

The underutilized practice of photographing anatomic pathology specimens from surgical pathology and autopsies is an invaluable benefit to patients, clinicians, pathologists, and students. Photographic documentation of clinical specimens is essential for the effective practice of pathology. When considering what specimens to photograph, all grossly evident pathology, absent yet expected pathologic features, and gross-only specimens should be thoroughly documented. Specimen preparation prior to photography includes proper lighting and background, wiping surfaces of blood, removing material such as tubes or bandages, orienting the specimen in a logical fashion, framing the specimen to fill the screen, positioning of probes, and using the right-sized scale. Gross pathology refers to macroscopic manifestations of disease in organs, tissues, and body cavities. The term is commonly used by anatomical pathologists to refer to diagnostically useful findings made during the gross examination portion of surgical specimen processing or an autopsy. It is vital to systematically explain the gross appearance of a pathological state, for example, a malignant tumor. One should note the site, size, shape, consistency, presence of a capsule and appearance on cut section whether well circumscribed or diffusely infiltrating, homogeneous or variegated, cystic, necrotic, hemorrhagic areas, as well as papillary projections. Currently, progress is being made to extend the roles in biomedical sciences, and gross room protocols in histopathology are of particular interest in this respect. Innovative digital gross pathology imaging technology can be of great assistance in meeting the challenges presented by the extended roles and, in more general terms, can greatly assist in the preparation of reports and also save a considerable amount of time. Histopathology is a very visual science and, while diagnosis can be influenced by an assortment of data, it is ultimately based on the gross and microscopic appearances of biopsy material and excised gross specimens. Presently, a significant part of routine histopathology report is dedicated to the macroscopic description of the specimen and the documentation of those appearances that substantiate a histologic diagnosis. Much of a report’s accuracy depends on the vocabulary used and the descriptive expertise of the pathologist or biomedical scientist. In addition, there is a requirement to document and record the location on the specimen from which each tissue samples is taken. In the interest of clarity and in recognition of the wide variation in descriptive skills, reports on complex specimens are occasionally supplemented with photographs of the gross specimen. The notation of this data occupies a considerable amount of time required to produce a histopathology report. Furthermore, filing hard copies of photographs becomes a problem as the database expands. MacroPath is a gross pathology digital imaging system that was designed specifically for use in the gross room to help eliminate the vagaries of the purely descriptive report and to save time during the grossing process. The system allows the immediate capture and storage of digital images of gross specimens and provides a means to indicate the location of sample excision and a convenient method of on-screen specimen measurement. The system also stores the gross pathology macroscopic images of all specimens examined and provides an indispensable diagnostic database for teaching, research and quality assurance. Currently, specimen measurement can be a messy and time-consuming process, as can marking sites of excision with dyes, while diagrams of specimens with block keys can be crude and difficult to interpret. The MacroPATH gross pathology digital imaging system makes these crucial steps easier and cleaner, and the user-friendly software means the computer knowledge is not essential. As the system is designed for use in a “wet” area, a waterproof and dust proof keyboard and mouse are available, and is uses a space-saving all-in-one controller with an integrated 17-inch touch screen housed in a translucent splash-proof enclosure. To start the process, the patient identifier code (case number) is entered via keyboard or barcode and a subsequent gross image capture, measurement, annotation and sample site identification are inserted using the touch-screen technology, foot pedal controls or mouse. Images are captured within two seconds and a thumbnail sequence of all images saved is generated to facilitate subsequent image manipulation. The system uses an enclosed industrial video camera with optical zoom which can be installed either at the grossing workbench or on a photographic stand. Therefore, the operator can examine the whole specimen or zoom in to the smallest detail. Digital cameras are already in use in some gross rooms to capture images but MacroPATH uses a video camera (a frame grabber card transforms the camera signal into a digital image) in preference to a digital camera because as yet the latter does not provide optical zoom-for digital cameras to achieve optical zoom above x5 a digital zoom is required, which implies a lower definition. In addition, digital cameras are less suitable for low-light conditions and specimen sizing is not possible with them because software (and therefore calibrated) control of the zoom position is not yet unavailable. Captured gross pathology digital images can be saved in a variety of formats (jpeg, tiff or bmp) and thus can be opened with a range of software and easily attached for email transmission. When stored on a central data server, any PC connected to the intranet can download the images. With MacroPATH, images of the gross specimen are available to the pathologist at the time of microscopic examination, as too are the fully embedded annotations and measurements, which can be included in the final pathology report. MacroPATH gross pathology images are identified by a unique file name and built-in enhancers can be used to improve color, brightness and contrast. Furthermore, new measurements can be taken, new lines and annotations added and the images can be printed. Introduction of the MacroPATH is particularly timely. Currently, the role of biomedical scientist in being extended to grossing, and work on suitable training programs is underway. This exciting opportunity is intended to unlock a pathologist’s time and to add value to the role of the biomedical scientist. MacroPATH can be used to complement this process. In addition, MacroPATH’s comprehensive database can facilitate the teaching and supervision required for this extended role and allows the biomedical scientist to build up a portfolio of case histories. It will also provide peace of mind for all concerned as gross pathology images can be retrieved easily for retrospective manipulation and examination. All in all, MacroPATH represents a versatile tool in an environment that has changed little over the years. Also, a version of MacroPATH is available for the mortuary call MacroVIEW. The description of macroscopic appearances of surgically excised specimens together with the sites of specimen sampling form an important component in the documentation of a histopathology specimen. Unfortunately, accuracy of description depends on the vocabulary and descriptive prowess of the pathologist which means that the result can be variable. Transcription of the dictated word also takes time and involves typists. We developed a user-friendly, high-resolution image capture system that will supplement word description of macroscopic specimens and has the potential to replace it completely. It also provides the opportunity of revisiting traditional methods of documenting specimens with words, allowing the production of more relevant and user-friendly reports containing information relevant to clinical management and supplemented by high-resolution digital images. The accompanying Windows-based software has capabilities of generating the entire histopathology report and allows rapid retrospective searches through any one of several common search parameters. The stored images form a powerful database for teaching and research. Connection to remote transmission facilities allows teleconferencing and telepathology consultations. A picture is worth a thousand words Milestone world market leadership First company to develop and market a grossing pathology camera system. Largest installed base of macro gross pathology digital imaging systems. Since 1999 over 1,000 units in operation worldwide. The de facto standard in macro gross pathology digital imaging for grossing. The highest quality of application and service support. The use of the MacroPATH gross pathology digital imaging system is a valuable tool when documenting surgical pathology specimens for gross examination only and exempt from submission for microscopic examination such as appliances, hardware, implants and foreign bodies removed at surgery or at endoscopy and were medicolegal evidence and given directly to law enforcement personnel. The common tissue specimens for gross-only examination include calculi (renal, ureteral, bladder), teeth, lens cataracts, cartilage and bone from septorhinoplasty and toenails and fingernails. MACRO DIGITAL IMAGING SYSTEM FOR THE GROSSING ROOM MACRO DIGITAL IMAGING SYSTEM The visual description of surgically excised specimens together with the sampling site forms an important component in the documentation of a patient’s case. The accuracy of the description depends on the vocabulary and on the descriptive process of the Pathologist or Pathologists’ Assistant The transcription of dictation also takes time and can involve additional services external to the pathology group. Since 1999*, Milestone has pioneered the use of macro gross pathology digital imaging systems to document the grossing procedures. Our technology has enabled laboratories to implement better quality assurance oversight, reduce specimen description time, and provide greater accuracy. The new MacroPATH pro-x gross pathology digital imaging system is a user-friendly, high-resolution gross image capture system that can either be mounted to fit any existing grossing workstation or used as a shared stand-alone resource. Selected high-resolution images can be used to supplement synoptic or preformatted reports that provide essential data of clinical relevance. The stored images form a powerful database for QA, teaching and research. Connection to remote transmission facilities allows teleconferencing and telepathology consultations. The MacroPATH pro-x gross pathology imaging system assures and improved productivity and work flow for the grossing room. * An advanced digital image-capture computer system for gross specimens: a substitute for gross description. Antony S.Y. Leong – Pathology (2000) 32, pp. 131-138 IMPROVED PRODUCTIVITY AND WORKFLOW… … For the grossing room. Quality is assured and images are optimized. The software is user friendly and icon-driven for very easy operations. In addition to stand-alone operations, MacroPATH pro-x gross pathology digital imaging system can interface with a PACS or LIS through a coded solution or TWAIN mode and can be installed in any existing workstations. No more hand drawing and long descriptions. THE MACROPATH PRO-X INSTALLED IN AN EXISTING GROSSING WORKSTATION 1. State-of-the-art digital camera with 16 MPixels resolution (Image size: 4608×3456 px) Lens 10x. Autofocus, Auto-light adjusting, Auto WB. Built-in LED illumination and USB extender. 2. Point-of-care control terminal, 17” touch screen 3. Waterproof IP68 keyboard 4. Foot control module (ZOOM IN/OUT, SAVE, RECORD) NO MORE HAND DRAWING AND LONG DESCRIPTIONS… JUST MACROPATH PRO-X

STEP 1 – START A NEW FILE Enter specimen/patient data by keyboard or scanned barcode. The program automatically opens.

STEP 2 – DIGITIZING THE REQUISITION FORM Capture a digital image of the requisition form to exclude potential mismatch errors when manually entering data.

STEP 3 – CREATE A LIBRARY OF IMAGES Capture real size, close up images of excised specimens in rapid sequence. Saved images appear as thumbnails.

STEP 4 – AUTOMATIC SIZING/AREA Select the image of interest. Choose the appropriate sizing tool (linear, area, perimeter) and select area of interest.

STEP 5 – AUTOMATIC BLOCK KEY INDICATION Pick the image of interest. Select the “Sections” icon. Draw on the specimen to indicate sampled areas. The tool will label sequentially.

STEP 6 – CORRELATION Eliminates the potential mismatching of labeled cassettes, number of blocks, sampled tissues by correlating labeled cassettes and sampled tissues. Valuable documentation in educational/training environment is provided.

STEP 7 – ENHANCED DIAGNOSTIC REPORTING Macro images and MP3 files of the description text are available to all pathologists at sign-off time. MACROPATH PROX QUALITY IN THE GROSSING ROOM • A major visual complement to standard descriptions • Elimination of vagueness in the description of shape, size and color • Eliminates hand drawings or long descriptions • Detailed observation and/or documentation through 10x optical magnification Rapid and accurate sizing/area of specimens Easy and precise labeling of tissue block sample locations Full documentation of the specimen “as received” IN THE MICROSCOPY ROOM Macro images are available to all pathologists at sign-off time. More informative reports by adding context with macro images Image is everything as the MacroPATH arrives in the pathology gross room.