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Dr Roy Ruddle (from the School of Computing, University of Leeds), recently gave a presentation at Bradford University about a research project developing a Virtual Reality (VR) microscope. As the video clip (above) shows, the VR microscope is a new technology that seeks to digitise the process of diagnosis in histopathology. Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease, which is used extensively in the diagnosis of cancer. In clinical medicine, a biopsy or surgical specimen of skin tissue (or histological sections) are prepared on glass slides. A doctor will work with a desk-based microscope to view each slide to make a diagnosis. On any given day a case load will involve looking though anything from 20 to 100 slides, if not more. On average each slide will be viewed for up to just 3 minutes.
The development of the VR microscope seeks to allow diagnoses to be made quicker, but as accurately as, a conventional microscope; an essential step in making digital pathology suitable for routine use. The research team have sought to achieve this by combining ‘giga-pixel’ displays with VR technology and ‘intelligent navigation’ techniques. They have developed both a single-user workstation for clinical work and a multi-user ‘Powerwall’ for teaching (see video clip). The digital process first requires the glass slides to be scanned. However, in order to create digital images that are of comparable quality to that which a doctor can view down the lens of a conventional microscope, the resolution of the image is such that if you printed out a picture of a single slide it would be the size of a squash court. The technologies required for this project are not new as such. We already possess the means to scan slides and to view them on a computer. However, the key aspect of the project is to create a system for viewing the image that is sufficiently large to allow a doctor to examine the same area of a slide at a comparable resolution. This involves bringing together multiple screens to create a single, large viewing area.
Technological innovations aside, the research project centres around an analysis of user interface. The findings to date are not necessarily conclusive, but nonetheless appear to show that the VR microscope can match the use of a conventional microscope in terms of both efficiency and quality of the diagnostic process. The crucial issue however is less about the single use of the microscope, but rather the organisational implementation of the system. One selling point of the VR microscope is the speed and simplicity to send the digital slides anywhere around the country to gain an immediate second opinion. Rather than needing to place a physical slide in transit, it is possible to digitally transfer the file across the internet. However, while currently we can rely on another hospital to have a conventional microscope for viewing a slide, we cannot yet assume availability of the necessary viewing equipment to handle a digital slide. The issue becomes acute when a diagnosis is required in the middle of an operation. What was most interesting about the talk given by Dr Ruddle, was not so much the ins and outs of the project itself, but rather the audience in the room. During a Q&A session it was apparent most people in the room were medical practitioners (not computer scientists). While there was genuine interest in the technological achievements of the project there was equally scepticism – if not anxiety – about organisational implementation.
In effect the VR microscope project is seeking to achieve something akin to the ‘revolution’ of digital radiography, which is now generally regarded a significant achievement in the medical field. However it has taken decades to be realised as the standard, embedded system within the NHS. Geoffrey Rivett gives some of the history, as follows:
“In 1985 the Hammersmith Hospital expressed a wish to develop a filmless radiography department, and over the next ten years the first such system in the UK was created, partly from central funding but mainly from charitable donations. All forms of imaging equipment were interfaced to the computer system. Straight X-ray images were recorded on special screens and read digitally by laser. The data created were vast, as each chest X-ray required more storage space than the Bible. Images were fed to immense computing facilities, for distribution by fibre optic cable to workstations throughout the hospital. The high definition of the images and the ability to magnify areas of interest and change their density and contrast were found by clinicians to be a substantial advance. More complex images, such as those produced by scanning, could be displayed, rotated and examined in three-dimensional form.” (Geoffrey Rivett, National Health Service History)
The implementation of a new system such as the VR microscope brings to light various aspects of going digital. While there are obvious advantages in terms of integrated, networked storage and viewing systems, digital technologies can quickly reveal limitations or at least clumsiness when working at high resolutions and dealing with subtle forms of image analysis. It is also apparent, that while it is perfectly possible to digitise a process, such as in this case diagnosis in histopathology, it is never a matter of simply bringing the technology together, but rather involves a great deal of consultation and human testing in order to get over the real hurdle of implementing something at a organisational level. The VR microscope project provides one very good example of the complexities and possibilities when bringing together of the separate fields of computing science and medicine.
For more on scientific imaging see Chapter 7 of Image Studies: Theory & Practice (Routledge, 2013).
For more information on the VR microscope, see:
Randell, R., Ruddle, R. A., Thomas, R., & Treanor, D. (in press). Virtual reality microscope versus conventional microscope on time to diagnosis: An experimental study.Histopathology.
Randell, R., Ruddle, R. A., Quirke, P., Thomas, R., & Treanor, D. (2012). Working at the microscope: analysis of the activities involved in diagnostic pathology.Histopathology, 60, 504-510.
Randell, R., Ruddle, R. A., Thomas, R., & Treanor, D. (2011). Diagnosis at the microscope: A workplace study of histopathology. Cognition Technology & Work, 1-17. DOI: 10.1007/s10111-011-0182-7
Treanor, D., Jordan Owers, N, Hodrien, J., Quirke, P., & Ruddle, R. A. (2009). Virtual reality Powerwall versus conventional microscope for viewing pathology slides: an experimental comparison. Histopathology, 5, 294-300.