Newsbytes

Volunteer organization focuses on digital pathology to advance training in developing countries

April 2023—At the medical center of the University of Medicine and Pharmacy at Ho Chi Minh City, patients are not screened for bladder cancer using urine cytology because the pathology department does not have the capability for such screening. But that may soon change, thanks to an organization focused on using digital pathology to increase the availability of pathology education resources in developing countries.

The Open Pathology Education Network, or OPEN, is a volunteer organization inspired in part by the upswing in online education during the pandemic, says Lewis Hassell, MD, professor of pathology at University of Oklahoma Health Science Center and president of the board of trustees for OPEN. Dr. Hassell is also co-chair of the education committee of the Digital Pathology Association.

“The COVID pandemic opened my eyes to the potential for using digital pathology as a remote-learning tool,” he says. This, in turn, led Dr. Hassell to conceive the concept of OPEN in 2021.

“It was not hard to find pathologist volunteers for OPEN,” says Matthew Leavitt, MD, an early member of the organization and executive director of the nonprofit DDx Foundation, which focuses on safe and ethical patient data exchange. Dr. Leavitt is also former CEO and founder of the digital pathology network PathNet and the digital pathology company Lumea. But Drs. Leavitt and Hassell and other early members of the organization realized that to become viable, OPEN would need to attract funding as well.

To launch the organization and garner support, they undertook small pilot projects that could be completed at a low cost and that could demonstrate OPEN’s value, Dr. Leavitt says. “We decided to find some early use cases for pathology education where we could show a measurable, real difference in health care in an area.”

The urine cytology project for bladder cancer screening at the Ho Chi Minh City medical center is one of two pilot projects underway, both in Vietnam. Ngoc Tran, MD, a hematopathology fellow at Oregon Health and Science University and an OPEN volunteer, who co-chairs OPEN’s informatics committee with Dr. Leavitt, helped arrange the project. Dr. Tran did her residency at the University of Medicine and Pharmacy at Ho Chi Minh City and was aware of the pathology department’s needs.

Three pathologists specializing in urine cytology volunteered to teach a class focused on this type of testing in the spring of 2022, but the project ran into its first challenge before it began. Pathologists at the Ho Chi Minh City facility did not have the training necessary to properly prepare urine cytology samples, nor did they have access to the commercially available kits that simplify the process. OPEN volunteers collaborated with those pathologists to find ways to make slides of acceptable quality for performing urine cytology, Dr. Leavitt says.

“We utilized the tools that they already had—the tools that we had in common—and developed protocols from scratch,” he explains. “By doing that, we created a standard that could be applied anywhere.”

Because the Vietnamese medical center does not have a digital scanner, the pathologists there attached a camera to a microscope to stream images of the slides they created during video conferences with OPEN members. It took several months of meetings for the OPEN cytopathologists leading the class to become comfortable with reading the slides prepared in the Vietnamese laboratory, Dr. Leavitt says.

Once they had established slide-preparation protocols, the OPEN volunteers conducted the class using a teaching set of anonymized urine cytology digital pathology images. About a dozen members of the pathology department in Ho Chi Minh City, including pathologists and lab technicians, are participating in the regular teaching sessions, Dr. Leavitt says. Lumea provided the participants with complementary access to its platform. The pathologists can log in to Lumea over the internet to access the urine cytology digital pathology images and then enlarge them, circle portions of them, and annotate them with questions and comments. OPEN instructors review the digital pathology images with the program participants through teaching sessions held by video conference.

OPEN’s other pilot project underway in Vietnam is a one-year class in gynecologic pathology at Da Nang Oncology Hospital, arranged in partnership with the International Gynecologic Cancer Society. IGCS provides mentored fellowship training, which includes holding virtual tumor boards at hospitals worldwide, Dr. Hassell says. The society agreed to partner with OPEN on pathology training at the hospital to enhance the quality of the support that local pathologists could provide in gynecology tumor boards, he adds. Five pathologists are participating in the program, and some of the hospital’s oncology fellows are following the curriculum as well.

Dr. Hassell, who specializes in gynecologic pathology, is one of three volunteers teaching the class, which began in April 2022. He and two other gynecologic pathology instructors send program participants reading material, videos, and images to study in advance of monthly mentoring sessions held via videoconferencing. But, at CAP TODAY press time, OPEN was in the process of rolling out a learning-management system called Open edX, created by the Center for Reimagining Learning, a nonprofit organization that is a collaboration between Harvard University and the Massachusetts Institute of Technology. For future OPEN courses, class participants will be able to access coursework contained in that system by clicking a “courses” link on the OPEN home page (open-pathology.org) to get to a webpage listing links to the various offerings or by going directly to courses.open-pathology.org.

Using the Open edX platform, which costs OPEN about $70 a month for 500 users, instructors can organize reading material, images, and videos into course frameworks that they can tailor to their teaching style, Dr. Tran says. For example, instructors can set up courses to be self paced or instructor paced. Furthermore, courses can be divided into sections or units, and instructors can use templates to create multiple-choice or fill-in-the-blank test questions that can be scored automatically. Instructors can also use Open edX’s test templates to create image-based test questions for which students can click on a location within an image to record an answer, a feature that is useful for identifying diseases, Dr. Tran says.

OPEN will use Open edX to structure course content into modules based on level of difficulty and organized by subspecialty, Dr. Hassell adds. “Our basic construct is centered around how you might organize a residency program,” he explains. “So you’ll have a first-year module on gyn pathology, a second-year module on gyn pathology, a third-year module on gyn pathology, and then you’ll have a fourth module that will be a kind of advanced practice.”

Dr. Hassell has loaded four gynecologic pathology modules onto Open edX and is refining them. By the end of the year, he aims to have courses in six to eight subspecialties on the site.

When the Da Nang Oncology Hospital project concludes this spring, OPEN instructors will administer final tests to assess how much participants have learned and, thereby, evaluate the effectiveness of the remote-teaching program and identify areas for improvement, Dr. Hassell says.

OPEN’s courses are free for participants, which Dr. Hassell hopes will always be the case. As a volunteer-run organization, OPEN’s costs are low, but additional funding will be needed to cover administrative and technical support in the future. Therefore, OPEN volunteers are focusing on fundraising, such as procuring educational grants, and have already been awarded a $10,000 grant from the CAP. They are also exploring whether various types of companies, including pharmaceutical firms and device manufacturers, may be interested in supporting the project since OPEN could potentially open new markets for them.