What’s Driving Digital Pathology Forward? | Insights from PathVisions 2024

Aleks: Reporting straight from Pathology Visions. I’m with Imogen Fitt from SIGNIFY Research. Hi Imogen. 

Imogen: Hi! 

Aleks: And Nick Best from Pathology News. 

Nick: Hello. 

Aleks: We have been crossing paths online and offline at this conference and at other conferences. You might have seen some content from our previous conferences with Nick.

For the past two days, we’ve been attending lectures and talking to vendors and basically networking at Path Visions. And we wanted to share our insights with you, what we think is happening in the digital pathology space. We’re gonna start with you, Imogen, give us your Signify research perspective and basically like the industry perspective, what’s going on, and we’re gonna start building on that.

Imogen: So in terms of market trends, I. Definitely noticed. If you look at like the speaking agenda and the topics that they’re talking about, radiology has a massive influence at this year’s event. So SIMS here, the Society of Imaging Informatics, there’s talks about DICOM as a standard where a couple of years [00:02:00] ago that was something that the industry was a little bit resistant to arguably.

And also enterprise imaging, how to incorporate digital pathology into the wider imaging strategy at these kind of healthcare institutions. So that’s really exciting because there’s an opportunity to learn from other imaging departments. And like leapfrog ahead of challenges that they may have encountered already.

And I’m really encouraged, there’s obviously been a lot of radiology partnerships in the industry over the last couple of years, so this is obviously a, organic next step to that. But did you guys see that as well, or,

Aleks: Yes. I’m actually surprised that it’s happening so late. 

Imogen: Yeah. 

Aleks: Because like digital pathology, radiology went digital long time ago, but it’s happening, so I’m happy about that.

Nick: Yeah, I’ve noticed the same things. It’s time, isn’t it? It’s time that we bring that radiology story in and go, okay. Or what are the lessons learned and how can we move forward? But I do think, yeah, you’re right, definitely here. Look at how many people here. What is it?

850 people? 

Aleks: Yes. 

Nick: So people are looking to learn, figure out, okay, how can I get on this journey?

Aleks: And I like the Society of Imaging, informatics in [00:03:00] Medicine is. Not accepting, but like getting as members more and more pathologists. I was in touch with them with the radiologists being active there and they say, no, it’s imaging.

It’s not just radiology, obviously, it’s still radiology-heavy because this is the biggest imaging specialty, but still Nick, any thoughts on AI and foundation models?

Aleks: Obviously foundation models is the buzzword in digital pathology right now. Let me give you one sentence. What I’m seeing. I’m seeing this.

Being actually incorporated into the places where pathologists work with images. But I see it as early stage still.

Nick: Yeah, it is. Do you know what, actually, when I, when you talk about AI, the things that excited me about this is the Modella from Paige I found fascinating. Have you had a demo from those?

Aleks: Yeah, I went to the, they started collaborating with PathPresenter. They have, and I went to that presentation.

Nick: Yeah. So they’re using their viewer now, aren’t they? And that’s going straight to their viewer, which is really good. [00:04:00] Do you know what, I haven’t spoken to a lot of the AR companies because I’ve spoken with Modella, I’ve spoken with Paige, find out what’s going on, and how are they driving their business forward?

But yeah, I haven’t spoken with IBEX yet, so I’m really interested to get an idea from them about how they’re feeling about the industry, because I think things are picking up for all of them. They’ve got their kind of foot in the right doors. I know there’s. I’ve heard talk of maybe still two, three years off.

But yeah, it’s it’s interesting to see how that market’s moved that way. What I don’t wanna happen is for it to, we have burnout on AI, so we, I don’t want, I don’t want it to be a case where, so in the US, the way I saw it, digital pathology conferences were massive. Everyone was going, everyone was really interested.

It was a real burning thing to understand what these scanners, and the scanners were so important to everyone. And then it king of okay, yeah, we can’t go now. FDA approval’s not there. Or what we’ve gotta make sure what happens with AR is it doesn’t, we don’t get to that peak and then everyone’s a bit sort of giant.

Aleks: Yeah. Because we are like so accustomed and used to consumer AI and consumer technology that the moment they talk about the. Like the moment you hear about it, it’s right there [00:05:00] for you. You can buy it. It’s not the same in the medical space. And then people just, like you say, get tired. The burnout is I see it like they get tired of waiting, and they think it’s okay.

It’s never gonna happen. There is no point in driving or requesting it because it’s not out there. What are your thoughts on that Imogen?

Imogen: See now I’d offer a. Sort of a contrasting view in the sense that yes, we should still be very excited for AI and it is coming, but in order not to burn out about it, we need to focus on the day-to-day early adopters and their journey, because that’s the kind of push that the market needs for now to drive adoption.

’cause adoption’s, incremental, isn’t it? Often you have budget, you buy a scanner, then you decide to invest in investor breed workflow software. And then not only then are you ready really to start really investing in AI and incorporating it at higher volumes, but. You need to, at the end of the day, you need to walk before you can run.

So I would want there to still be this focus on those, the majority of the market itself. ’cause obviously we’ve been talking about this for like decades [00:06:00] and I’ve not personally. Then… 

Aleks: The anniversary of the Digital Pathology Association. Yes. They had the, yesterday they had 15 anniversary cookies, made a video about.

Imogen: That’s lovely. I’ll check it out.

Nick: Do you still see AI as the business case?

Imogen: As the business? There’s not, it’s not just that as a business case, because there’s also like telepathology for consulting. There’s this entire trend that there’s this new generation of pathologists coming in and they want the flexibility to work remotely.

So you want to use it to attract talent and new talent and retain it as well to offer your employees the chance not to just be in a lab.

Aleks: I have a story about that. So I was talking to a lab manager, no, an IT person from the lab, and they shared with me, Hey, we have two pathologists who wanna leave one person who is retiring.

And basically I’m here at this conference to figure out how to bring in digital pathology because they said if we have digital, they’re gonna stay part-time. So that was like, I thought until that story, I heard that story, I thought, okay, like it’s a nice to have that fancy people [00:07:00] maybe can request. But no, this is actually a story.

The three people, three pathologists is. Enough to make or break the diagnostic workflow and the continuity of care for an institution. And basically, the only institution decided they cannot afford that. They cannot afford to lose those people. They cannot afford not to be able to take care of the patients and they’re doing digital pathology.

’cause two people requested that they wanna do part-time remotely. So I thought this was great.

Imogen: Yeah, it’s really real. And flexibility’s important. You also have like others there’s indirect. Things as well. If you are an academic institution and you want to be publishing these top-level papers and finding these new insights and getting those grants.

Digital pathology offers a way to engage in some really exciting new front-level work. So AI foundation models, that’s where the excitement can stay and sustain essentially. ’cause you’ve got things like multiplex imaging and spatial biology. There’s a few vendors who are here today and they weren’t here a couple of years ago, [00:08:00] so that’s still very exciting.

There’s virtual staining as well. Virtual staining companies that. Were in stealth mode a year ago, and that’s obviously novel and new and something that can keep the people that are more accustomed to digital pathology engaged with market whilst also providing some more sort of value on that from that digital workflow itself.

’cause obviously if you do virtual staining, do you have to spend money on other types of, those more expensive or maybe dangerous things that are used commonly today? I

Nick: think I’ve noticed from this event. The skepticism kind of relaxed a bit. I think there was a, there was, even up until this point, there’s been that skepticism, especially around AI.

Yeah. If this is really gonna be all that different for me and that’s going because I think we are getting educated, we’re getting more pathologists who are understanding the benefits and seeing, because we’ve got fantastic people who are just speaking at events like this, Giovanni needs like that, who are giving their stories.

Yeah. And all of us, we need those stories so much for everyone to understand exactly how. Or they can benefit from this.

Imogen: Yeah, and I wax [00:09:00] lyrical about it all the time. There needs to be more sort of case studies out there and more transparency in the market in terms of what kind of products are available and how do I easily compare them.

Because if you are stepping out and taking those first steps on that journey, you’re going through typically two years of demos and it’s really hard to differentiate between what’s out there and to select the right solution. For you. Yeah. And that’s before you even worry about storage, what you’re actually gonna do with the images once they’re there.

Nick: That’s exactly why we created the Technology Buyer’s guide was to, because we understood, yeah, we understood that there was this kind of, it is almost an educational standpoint of, what does a digital workflow look like from start to finish? And okay, yes, it’s really difficult to every one of those is gonna be different.

Aleks: Let me tell you, what’s the buyer’s guide official name?

Nick: It’s the Technology Buyer’s Guide.

Aleks: Technology Buyer’s Guide is a space at Pathology News website where you can compare whatever solution you’re looking at. 

Nick: Yeah, and I think… 

Aleks: So they can have the context… 

Nick: …because there’s so many solutions out there, what’s, what we’ve done with the Technology Buyers Guide is give users criteria that they can choose.

Whether it’s a [00:10:00] scanner and they know that they need to be doing 200 slides a day, or they need this magnification so they can put in these criteria. And then all of the solutions that fit those criteria come up. And it means that you are automatically not looking at 50 products. You might be looking at three products that fit what you need in your lab.

And then you can compare those side by side, which…

Imogen: And I think pathologists are generally really engaged in the market as well, in its development and where it’s going. My, my news roundup piece that’s on LinkedIn, but there’s a lot of like engagement in terms of, oh, I saw a vendor did this. What does it mean?

And that’s really exciting, and I want to get involved. How do I start digital pathology in my lab, in my country? I don’t think you necessarily find that as much in other markets where there may be a bit more used to the technology that’s going on, and yeah. I think that’s something that needs to be embraced and utilized a little bit more.

And in terms of all these new adopters connecting them with, mentors from the community who are a bit more advanced in it and a bit more knowledgeable and able to share the information that they need to do.

Nick: That’s why I like working with you both as well actually, because I think our job, realistically, we come from three different angles, [00:11:00] but actually if you were to pin pinpoint what we do, it’s trying to empower users to have the right information on hand in different format.

But each of us giving users the ability to understand exactly what they’re getting into or what they might want to get into. Yeah. And helping ’em on that.

Imogen: Yeah. Absolutely.

Nick: But, we can reiterate the stories that need to come from the pathologists who have done it, who have worked from home during COVID and been signing out cases on a plane or whatever that may be, and show those benefits to them.

Aleks: Something that I, it’s nothing groundbreaking, but I went to the lecture given by Dr. Anil Parwani, and he basically had the lecture talking about all the different steps. That he went through on his digital pathology journey, starting with scanner, everything to AI. Now his main hurdle is like how to integrate different AI.

So he’s actually using it, but that was his story. But he also depicted it as everybody’s digital pathology journey, like as a train with different stations. And everybody is at a different station, needs to get to the next station [00:12:00] and then you guys are gonna be looking for information. That’s what we wanna do for you.

From different angles.

Nick: Yeah. Because there are different ways of going about it, isn’t there? You could go the all-in approach or you can go the staggered approach. And actually, I’ve heard stories from different pathologists who have done different approaches or have done one approach and wish they’d gone the other approach.

And these are the stories Yeah. That we have to share. So people go, okay, I can see the benefits of that. Now I can see why I would use that approach moving. Towards digital, or I might use that approach, and yeah, that’s something that’s really important as well.

Aleks: Do you have any favorite moments of the conference or like best insights?

I already said my favorite moment. My favorite moment was when I learned that two pathologists requesting working from home drove digital pathology adoption. That was my yes. And I, of course, resonate because I work from home on digital images, so I’m like, yes. Let’s push from that angle, but everybody has their own angle insights and gold nuggets that they gathered at this conference.

Imogen, what is your favorite thing? 

Imogen: Oh, I didn’t wanna go first ’cause… 

Aleks: Okay, Nick. [00:13:00]

Nick:  See my, my i my diff… my, I’m a bit different. My favorite thing is actually been, so I’ve got… 

Aleks: The food, right? 

Nick: No, I’ve got meta glasses on, right?

Aleks: Uhhuh. Yeah, I was wondering if these are meta glasses.

Nick: Yeah. So they’re meta glasses, and what I think is gonna be amazing, so this is how this has AI built in.

Really?

Aleks: Do you see AI in it?

Nick: No, I don’t. No, I don’t. But the thing is, so at the moment, it’s just a camera. So I could look at in the future, these glasses, I could be looking at a slide and I could say, Hey, whichever is gonna be integrated, whichever AI will be integrated, what am I looking at?

And automatically it will tell me, ’cause I’ve got speakers in the ears.

Aleks: No kidding. Yeah, I see. That’s what I said. The consumer AI, I saw it on the billboard like a month ago and he’s wearing this and I’m like, it’s not, ’cause I was looking at these. Yeah. The thing is, and I’m like, it’s not possible that he already has the glasses from the billboard.

Nick: I like to try, I try to stay ahead of the curve. But they’re fantastic. They are also glasses I can’t see without them but…

Aleks: What do you see from those cameras?

Nick: I take for instance, I take a… [00:14:00]

Aleks: You would need to watch a Meta glasses commercial because I don’t know, obviously.

Imogen: Yeah, you’re not stealthily.

Nick: No. I would never obviously take, but actually, these would be great for you. ’cause literally you can have your camera, you can record and if so, yeah. So you need to think about that. 

Aleks: I see. I need to think about that. 

Nick: But yeah. But I think things like this commercial thing can be used within Apple Vision Pro.

For example, I saw that the booth had Apple Vision Pro. 

Aleks: Yeah. They had… 

Nick: Imagine, are we gonna see like a minority report type screen system where pathologists are able to have the image? 

Aleks: Did you see their demo? Did you… 

Nick: No, I didn’t. 

Aleks: Do you know their system? So I saw their demo and I did a little, part of a vlog that it’s gonna be there. But yeah, he basically sits with this with this mask on his head and he’s zooming in, zooming out. And I see everything he’s doing on the screen and I’m like, show me on the screen. He looks at me and I see myself on the screen from the angle he’s looking at me.

Nick: Wow. 

Aleks: This is, that’s freak. But it’s also super cool.

Nick: Yeah, it is cool. I love tech. So that’s really cool for me. So that, [00:15:00] for me, that’s the interesting bit. And seeing, the likes of Jude from Paige and Modella AI’s, chatbot and, sorry, Jude from Modella AI. And I find it really interesting to know how that’s gonna be integrated into tech like this.

I think that’d be… 

Aleks: Yeah, with voice command and… 

Nick: Voice command. Yeah. And, and having an assistant, having a pathology assistant. I think we’re gonna really get to that point.

Aleks: Imogen, what do you think about this assistant? From the industry perspective. And by assistance, the chatbots integrated into the electronic health records, and also the technology that can search for similar images.

Imogen: So when you look at sort of any AI and any technology, Gen AI in particular, it can be really hard to regulate. And this is an indirect way of providing benefit to health systems without having to. Worry too much about that kind of impact. I would say I’m a bit, it’s probably not gonna have the widest impact over the next couple of years.

For the majority of the market. Because like I said, I think they’re still focused on which slide scanner do I choose? [00:16:00] Yeah. And how do I best go ahead? Before, again, walking before you can run. In terms of generative AI, I think that’s set to really have a massive impact on the market in the future.

Both direct and indirect ways. So there are vendors out there that are trying to use it. To scale up portfolios more quickly than usual. So instead of having to buy and acquire and train these algorithms on massive data sets, they’ve almost got a foot in the door already to quick speed up that process and get more products out there.

’cause I think part of the challenge with AI as well is that it doesn’t cover enough of the workflow itself. There’s, it’s all right to have a cell counter, for example, but how much are you really gonna pay for that? ’cause how much does it actually.

Aleks: Yeah. And how many different cell counters do you need to count?

All the cells of different stains? 

Imogen: Exactly. But then if you have a comprehensive solution that basically does most of the reporting for you on breast cases, for example, it doesn’t, take the ownership of the case out. You still have to review it, sign it out, but it supports you in that diagnosis and truly makes everything a lot quicker.

That requires [00:17:00] a lot of different feature analysis and different types of algorithms combined to help truly provide that support. But those are really gonna be the type. Of solutions that actually impact users and actually allow them to see the benefits of AI at the end of the day. So we saw that in radiology as well.

So I talk about the influence radiology has and you know it’s gonna happen. It’s one of those things that we learned.

Nick: Yeah. With radiology, was it all groups that were able to like that, bought into it really quickly? Or did you see a younger radiologist take to it quicker than perhaps someone who was in a different generation?

Imogen: I think people are still surprised when I tell them that radiology is still adopting AI and it’s still. Like I think they, 

Aleks: I was surprised we had as well,

Imogen: but there’s so many cha… It’s like the digital pathology. There is a very clear case, but there’s so many challenges as well, and some of them aren’t as obvious vendors.

Even vendors with reimbursement, they struggle with market education and getting their algorithms in into guidelines so that the actual users, they have the support behind them and they feel safe and comfortable [00:18:00] in adopting the algorithms. Essentially. It’s not just a case of, I think vendors say, okay, I’ve got funding.

This is a surefire success. A good, once you get funding, you need reimbursement or you need, some kind of evidence base to prove in both an economic way and also a patient care way that you’re having a natural impact compared to what was done before. And obviously from an analog perspective, we didn’t really measure, or it’s hard to put numbers to how efficient pathologists were before, because you don’t have that digital image format that you can quantify or compare.

And that’s why structured and sort of standardization is really important. I think, and it’s gonna really help improve the practice at a, I think vendors and pathologists are gonna be surprised at how much they’re able to benefit from that standardization in terms of reporting and that standardization in terms of being able to chop and change between solutions as well.

Nick: How far off are we from this standard evolution? There? There’s a, there’s a question for you ’cause you’ve got one person, we obviously, we know DICOM could be a standard, but. It’s still not, [00:19:00] and are we gonna find other, are there gonna be other solutions that come through?

Because actually, if there’s a company that comes up with that solution, 

Aleks:I think we have to to dicom.

Imogen: I think DICOM is the overwhelming front runner. 

Nick: Yes. 

Imogen: And it might be that in research environments, other standards persist, but there’s just too many reasons and too many influencing factors that means it’s much more convenient than any other standard.

Because first of all, most of the other common standards are proprietary for vendors. Not nobody wants. Nobody wants that. The industry has completely moved away from that. There’s almost this fear that there’ll be vendor lock in if they go with this particular vendor or solution, which is why most of them talk about interoperability.

What is actually for these vendors? What do they mean by interoperability? And I could talk for days about that, but I think the case for DICOM, a couple of years ago, I was talking in the industry and vendors were making very good points about the fact that it was made for radiology.

It wasn’t maybe technically the best requirement and these sorts of things, but the.They’re still making the standard, they’re still improving it year on year. And overwhelmingly across [00:20:00] those two years, it’s emerged as the favorite

Nick: In radiology?

Imogen: In pathology as well. Yeah. 

Nick: But the image are bigger, aren’t they? In pathology. And that’s the big thing.

Imogen: There’s lot of differences, but if you look at like a, for example, they’ve gone DICOM native with pathology. A lot of the other vendors are working on similar proposals. And that’s because you’re not gonna go with SSVS or tier four or any of those because it limits.

The scanners that you can have in place. And you want to be able, if you’re gonna spend that much money on a scanner you wanna be able to not be panicked about if later down the line you need to invest in another one. And combining those images together. I don’t see another case for anything that can compete as yet unless you

Nick: No, I, no, I agree.  It’s just that obviously I do hear, I hear the downsides and I was speaking with Merge. 

Imogen: Yes. 

Nick: Narrative. And and they use their toolkit, so they’re trying to get. These kind of companies to try and use their toolkit their DICOM toolkit. So yeah, no, I don’t think there is another, but it’s just interesting to know.

Aleks: No, it’s just not gonna be immediately It’s, it has already been a adjusted for pathology. [00:21:00] and the DICOM working group has been working. I was even part of the group at some point, but they’re very DICOM heavy, so I left the group, but but they have been working on this for years and yeah. Cool things happening.

Aleks: Are you guys coming back next year? 

Imogen: Yeah, I’ll be back next year. As soon What it. In San Diego. 

Nick: In San Diego, yeah. I think. I think I’ll be in San Diego. 

Aleks: So, I think we need to meet again and the same kind of chat and have a like Pathology Visions podcast series every year. And giving you some updates, what’s happening, what’s driving the digital pathology space, and how you can get involved as well and get informed.

Nick: Thank you. 

Aleks: Thank you so much guys.

Nick: Thanks very much.