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More about virtual microscopy

By Roger P. Smith, Ph.D.

Virtual microscopy (VM)—the examination of digital images on a computer screen, rather than of glass slides through a microscope—is catching on quickly in the nation's medical schools. Dartmouth Medical School, an early adopter of the technology, began experimenting with VM in its second-year pathology course in 2005.

But the trend has created concern in some quarters that students may not acquire basic microscope skills, which they often need for other specialties as well as in pathology. "Not to worry," says Dr. Brent Harris, the co-coordinator of pathology in DMS's second-year Scientific Basis of Medicine curriculum. Of all the specialties, pathology is especially sensitive to the historically important role of the microscope in medicine. "It would certainly behoove us to do whatever we can to preserve that," says Harris.

At Dartmouth, he explains, first-year students use microscopes intensively in Anatomy, Microbiology, and Introductory Pathology. Although Anatomy has also embraced the use of virtual images—

using them for teaching a portion of the Cells, Tissues and Organs course—"none of us wants to give up microscope skills instruction and experience completely," Harris observes.

He believes that just as the stethoscope remains integral to the teaching of physical diagnosis, even as other sophisticated instruments have come on the scene, so, too, will the microscope remain essential for many purposes—not the least of which are those situations in which speed is of the essence. That's because it takes some time to digitize glass slides, although it has become faster as scanner technology has improved.

A further current drawback of VM is the fact that the digitized images are very large, so it takes a huge amount of hard-drive capacity to store the images, and it's also hard to transfer them by e-mail or over a network. But digital compression technologies are also improving. It is now possible to reduce a 1- to 2-gigabyte file—the size of an average slide—down to about 200 to 300 megabytes and still retain all the digital information from the scan.

Will there one day be a role for virtual microscopy in the practice of clinical pathology? Harris thinks so, but he notes that there are a number of technical issues that still need to be addressed.

He explains, by way of example, that although DMS's Department of Radiology is now totally digital, the transition from all-film to filmless took five to ten years. But now, x-rays and other scans are captured directly by digital equipment and are instantly available for online examination. So instead of the patient dragging unwieldy x-ray films around the hospital from one appointment to another, physicians can now view them on their laptops.

Harris believes that, likewise, digital microscopy will be used increasingly in clinical settings. That's another reason he believes it is important to prepare today's students for the virtual future. "When the compression technology gets full images down to 50 megabytes or lower, and the networking speeds are fast enough, we'll likely see a major shift to digital microscopy for much of the diagnostic work that anatomic pathologists do," predicts Harris.

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