How to turn your Smartphone into a pathology practice aid
March 2021—For many pathologists, smartphones are an untapped resource. Although the screen is significantly smaller than a computer display, the device offers much of the same functionality to enhance the practice of pathology as its larger cousin but with the benefit of pocket portability.
With a smartphone, you “have in your pocket the tools to do a lot of the things that you need to do with pathology images,” says Xiaoyin “Sara” Jiang, MD, associate professor of pathology at Duke University. “At least for those of us in anatomic pathology, it’s all about visuals and using pictures to either educate, tell a story, learn, and, importantly, make the diagnosis for the patient.”
Dr. Jiang and Jerad Gardner, MD, of Geisinger Medical Center, shared their experiences with using iPhones for laboratory practice, medical publishing, and educational purposes in a CAP20 session last October and in a recent interview with CAP TODAY. (Much of the functionality discussed is also available via Android smartphones.)
[dropcap]A[/dropcap] few years ago, “I was really pushing out a lot of pictures and tweets,” says Dr. Gardner, dermatopathologist and section head of bone/soft tissue pathology at Geisinger Medical Center, Danville, Pa. “Now I’ve shifted to making lots more videos. I use my Twitter, Facebook, and Instagram to share those. I make videos for the purpose of teaching and education, but I also make videos because it makes me more efficient.”
Pathologists can enhance their efficiency by creating videos on smartphones or computers for topics they explain repeatedly, Dr. Gardner says. They should consider making videos that can be used to teach, introduce a hospital’s residency program, or orient new personnel. They can name the videos with keywords and store them in the cloud so they can be accessed easily by anyone interested in their content or post the videos publicly or privately on YouTube or another platform.
“To take video of what’s going on underneath your ‘scope,’” adds Dr. Jiang, use a low-cost, smartphone-to-microscope adapter because “it’s really hard to hold your phone freehand steadily enough to take a video.”
For photomicrographs, however, freehand is “much easier than taking the adapter, attaching it to a microscope, and attaching your phone,” she says. “It just takes a little practice.” Dr. Jiang suggests watching the short video of the Morrison freehand technique on YouTube.
[dropcap]W[/dropcap]hile there are practical external devices to turn smartphones into pathology practice aids, Dr. Jiang also touts the smartphone’s internal toolbox, which contains, among other functionality, scanning and editing tools, magnifier tools, and text shortcuts. You can use what’s built into the phone or download apps to add pointers, labels, description, bubbles, signatures, and commentary, she says.
IPhone users can scan documents using the phone’s camera via scanner functionality in iPhone Notes and clean up photos, such as pictures of slides snapped at meeting presentations, by cropping, straightening, and brightening images, and then create a PDF. Apps such as PDFCreator or Microsoft Office Lens provide such functionality and allow users to share images, save them for reference, and tweet them, with attribution.
Some image-editing tasks—white balancing and watermarking, for example—may be better accomplished with apps users can install on the phone versus those that come with the device, Dr. Jiang says. Sometimes, she adds, the free version of the app is all you need.
One reason it may be necessary to use an external app to achieve white balance is that smartphone cameras skew toward yellow tones, Dr. Gardner explains. Therefore, the color may need to be adjusted to get the white balance needed for pathology images. IPhone users should try the auto-adjust feature in the phone’s built-in image editor, he says, and familiarize themselves with the color adjustments they can make with the track bar. If the color is still not right, try an app such as Enlight, he suggests.
Collage-making apps, including Photo Collage, also boost phone functionality, particularly for tweeting, pathology publishing, and educational purposes. The apps are ideal for creating side-by-side comparisons of images, Dr. Jiang says. “Something I like to do for Twitter is the cyto-histo correlation [to show similarities and differences],” she explains. “I usually use the collage-making app just for tweets.” However, she points out that “depending on the resolution of your phone, a lot of these phone images are high enough resolution even for publication. . . . It’s a useful tool, for instance, if you wanted to put together a composite photo for publication.”
[dropcap]S[/dropcap]haring images, particularly via the Internet, raises the issue of proper attribution, another task suited to the smartphone. “People can share your image, and they may not intend to share it without properly attributing,” says Dr. Jiang, but it happens. Therefore, she recommends that laboratorians watermark all images they create as a reminder to others to ask permission to use them.
Dr. Jiang uses an app called eZy Watermark Photos Lite, a free tool that not only saves the watermarks users create but allows users to perform batch watermarking. The iPhone’s text tool lets you watermark too, but “if you’re going to watermark a lot of different images—like I watermark all of mine—it’s easier with an app that has that ability,” she says.
Among the other text-related functions that benefit the practice of pathology is text replacement, a smartphone feature Dr. Gardner calls “life changing.” Use it to create shortcuts using abbreviations that represent longer words or strings of words, he suggests, and for auto-correcting common typos and those in pathology terms that virtual assistants such as Siri may not recognize. It’s also useful for setting up standard replies. Users can insert sentences, paragraphs, and hashtag strings in an instant and easily share contact information, their publications in the literature, and Web links, Dr. Gardner explains.
[dropcap]A[/dropcap]ccomplishing tasks on the spot and on the go is an obvious advantage of upping your smartphone skills, Dr. Jiang says. However, users have to balance this against storage options and security capabilities. The limited amount of storage on most smartphones can be a drawback for laboratorians who want to save large numbers of images or documents, she explains. However, users can address this by transferring files to a secure computer or other device for storage.
For this reason, Drs. Jiang and Gardner use cloud storage. “The stored file is there as a backup, but the other benefit is it’s available from other devices,” Dr. Gardner says. Compare platforms, such as Dropbox, OneDrive, Google Drive, and WeTransfer, to find what suits you, he suggests.
Dr. Gardner has Dropbox on his iPhone, in which he stores his curriculum vitae, biographic profile, conflict of interest statement, and professional head shot, since he regularly gives lectures and talks. “Sometimes,” he says, “people say, ‘Oh, we need this stuff right now.’ I just go into my phone and copy/paste the Dropbox link into an email and send it off to the meeting organizer, and they’ve got all the information that they need from me.” Smartphone users can also access Dropbox to view and send photomicrographs, PowerPoint presentations, PDFs of their publications—“whatever you need,” Dr. Gardner says.
”If something’s not working to your liking,” Dr. Gardner continues, “try something different.” This may mean moving to a different platform or using Google and crowdsourcing to address issues. “Ask all the pathologists or other people out there on Twitter, ‘What do you guys do to work around this problem?’”
Keep in mind, adds Dr. Jiang, that “some things are easier on the desktop [and] some things are really easy to do on the go on your phone. As you learn how to use the tools and get comfortable, you figure out what’s easiest for you.”
“It sometimes takes a little bit of time on the front end to figure things out,” Dr. Jiang concludes, “but it really pays off in terms of efficiency.” —Nancy Williams
CDC releases tool to hasten COVID-19 test reporting
The Centers for Disease Control and Prevention, in partnership with the U.S. Digital Service, has released SimpleReport, a free tool that simplifies the process for COVID-19 testing sites to record patient results and report them to public health departments.
SimpleReport eliminates the need for users to re-enter the same data for rapid point-of-care tests every time they report. They need only pull up or enter patients’ names, enter their test results, and submit.
SimpleReport automatically converts data into the format required by the public health department to which it is being submitted via real-time reporting.
SimpleReport was available in Arizona and Florida at CAP TODAY press time, with access to more locations underway. To set up a SimpleReport account or be notified about availability, go to https://simplereport.gov.
Data Innovations offers pooled specimen testing on lab software
Data Innovations has introduced pooled specimen testing capability for its Instrument Manager laboratory management software.
The functionality, which is available in Instrument Manager version 8.14 and higher, provides automated convolution and deconvolution; integration with autoverification for automated release of test results; and full traceability of pool identification and pool result to individual specimen IDs.
“Our pooled specimen testing solution from Instrument Manager is a direct response to a critical lab need to help scale and manage high-volume testing for asymptomatic screening while confronting reagent shortages and other supply chain challenges,” said Data Innovations president Premila Peters, in a press release.
Data Innovations, 802-658-2850
BioDiscovery enhances genomics software for clinical research
BioDiscovery has released an upgraded version of its Nx Clinical cytogenetics and molecular genetics software for analyzing and interpreting genomic variants from microarray and next-generation sequencing data.
This latest upgrade of the platform-agnostic software, Nx Clinical 6.0, features a user interface that consolidates details about copy number and sequence variants from various sources and presents them in a single, structured view.
It also includes a knowledge base for copy number variant and absence of heterozygosity events. This allows laboratories to collect, organize, and use knowledge from their own constitutional or oncology case histories to create consistent interpretations and reports. Enhanced support for cancer cytogenetic testing allows users to create genomewide CNV and AOH profiles in the knowledge base and rank new cases based on similarity to these established cancer types.
The software is intended for use by clinical researchers and is not a tool for primary diagnosis.
BioDiscovery, 310-4114-8100
Dr. Aller practices clinical informatics in Southern California. He can be reached at raller@usc.edu. Dennis Winsten is founder of Dennis Winsten & Associates, Healthcare Systems Consultants. He can be reached at dwinsten.az@gmail.com.