Section 3 -

"Perfect Sight without Glasses" - Virtual Slides in Pathology Education and Training Henrik Helin, Jorma Isola Institute of Medical Technology University of Tampere, Tampere Jouko Lohi, Johanna Arola, Veli-Pekka Lehto Department of Pathology, University of Helsinki Helsinki , Finland Mikael E. Lundin, Johan Lundin, Heikki Helin HUSLAB, Helsinki University Central Hospital Helsinki , Finland

Virtual microscopy denotes a digital imaging technology in which the entire microscopic slide is scanned and digitized, stored as a "virtual slide" on CD-ROM, DVD or a computer hard disk and viewed on a computer screen. Web-based virtual microscopy utilizes internet in the image transfer and thus provides a platform which is reachable globally, instantly and at a will of the user and - given the current technology - at a low cost. The benefits of virtual microscopy in pathology education and training, when compared with the conventional glass slides provided as multiple sets or displayed during a session/seminar and with the still micrographs in text books and CD-ROMs, are obvious: large number of simultaneous users/viewers is allowed without a need of multiple sectioning, individual control of the slide is possible, dynamic viewing of the entire slide at any magnification is possible, annotations and instructions as well as links to further educational material can be added for didactic purposes. Virtual microscopy serves especially well in occasions in which multiple sets of slides are required and/or users in different locations are to be reached. Thus, it has wide applications in quality control, board certification and consensus programs. Virtual microscopy could also serve as platform for a global distribution of commonly accepted/accredited (by professional bodies) virtual slide collections to be used in basic training, residency programs and CME, in essence, for global harmonization of the education and training programs and the diagnostic criteria applied. In this presentation a web based virtual microscope system currently in use in Finland and some of its applications in pathology teaching and training are described. In the system, the slides are scanned and the images captured and digitized by using a robotic microscope equipped with a CCD camera and a software based on and utilizing advances in aerial and satellite imaging. The images are uploaded on a web server which is connected to the Finnish University and Research Network enabling high capacity connections to the global internet. All the steps are automatized and invisible to the user. Internet domain (www.webmicroscope.net) and a special website allows the viewing of the images with standard browsers on any Windows platform. The website is publicly available and currently features for instance a comprehensive virtual slide atlas of breast histopathology (WHO 2003 classification) (J Clin Pathol 2004, 57:1288-1291) and a set of prostatic needle biopsies that can be used for self-testing and learning of Gleason grading (Hum Pathol 2005, 36: 381-386). Image quality and viewing speed has been tested and evaluated by practicing pathologists and found to be largely compatible with that provided by conventional microscopy. During the autumn term of 2005 one study group of 32 students took part in a virtual microscopic teaching research project during their pathology course in the third term of their graduate studies. The study material for microscopic pathology consisted of seventeen multi-tissue slides (containing in all 64 tissue sections) which comprise eleven entities (such as "From dysplasia to invasive carcinoma"). Students study the slides using conventional light microscopes in study groups of about 30 students together with a pathology teacher in a microscopy classroom. The study group of 32 students studied nine of the eleven microscopic pathology teaching entities using traditional glass slides and the remaining two ("Chronic inflammation and healing" and "From dysplasia to invasive carcinoma") using a novel virtual microscopic method. The method consisted of two virtual slides (of which one was annotated) on a freely accessible Internet website together with additional text as computer text files and computer spread sheet presentations (which students normally view as paper copies) and links to microscopic still images elsewhere on the Internet serving as extra self study material. The teaching was conducted by a pathology teacher in a computer classroom instead of a microscopy classroom. After the latter of the two virtual teaching sessions the students received and filled a questionnaire about how they thought the virtual teaching was compared to the conventional teaching method. The results that will be discussed in detail show a clear preference of the virtual microscopy over traditional light microscopy when it comes to which method is more convenient or enjoyable to the student. The students' main concern with implementing all of the microscopic pathology teaching with virtual microscopy was the possible lack of learning to operate a conventional light microscope.