Surgeon-Pathologist: Digital Pathology Is ‘Day to Analog Pathology’s Night’
Thanks in no small part to a former surgeon who traded her scalpel for a microscope more than a decade ago, digital pathology is today finding a sure foothold in the largest region of Spain.
The region is Castile and León, which comprises nine provinces and borders Portugal in the northwest of the Iberian Peninsula. The foothold is a group of 14 hospital-based pathology departments, 13 of which have been fully digitized so far.
That surgeon-turned-pathologist is Johanna Palacios Ball, MD, of Hospital Universitario de Burgos.
The upshot of the move from analog glass slides to digital whole-slide imaging? For Dr. Palacios Ball, the proof of concept has been arriving at definitive diagnoses about 20% to 30% faster, she reports.
“Overall, we’ve found the difference between digital and analog is like day and night.”
—Johanna Palacios Ball, MD
“Beyond speed, the digital tools themselves elevate how we pathologists work on a daily basis,” Dr. Palacios Ball says. “Measurements, annotations, zooming, panning—these tools are all incorporated into the viewer. Sharing cases for consultations, second opinions and remote diagnoses is much easier, both across hospitals and within our own department.”
She further offers that digital diagnosis is 20% faster than it was with glass slides, tumor-board case reviews have become “a breeze”—no cumbersome PowerPoints or PDFs to prepare—and training of residents and fellows is both smoother and more impactful.
All of this has come together, Dr. Palacios Ball is quick to add, with the Sectra Digital Pathology Solution serving as the IT superstructure for the modernization project.
“Everything runs on DICOM with Sectra’s IDS7 application for unifying workspaces,” she says, noting the combination lets physicians readily share subspecialty expertise among and between hospitals.
“Overall,” she says, “we’ve found the difference between digital and analog is like day and night.”
The evolutionary leap forward in Castile and León is a story worth considering by pathology leaders and decision-makers who are mulling digitization in the U.S. and around the world.
‘A lot to learn’
It’s fortuitous that Dr. Palacios Ball is upbeat and forward-looking by nature, because she has emerged as an unofficial physician champion for digital pathology across those 14 hospitals in Castile and León.
The personal overlapped with the professional
Dr. Palacios Ball’s intertwined professional and personal history is a noteworthy story within the chronicle of pathology digitization in her part of Spain.
While in the final year of her three-year general surgery residency, she was diagnosed with breast cancer. She was 26 years old and finishing her last year of surgical residency. She beat the cancer and went on to serve as a general surgeon at Caracas University Hospital in the country of her birth and upbringing, Venezuela, until 2014.
That was the year various circumstances began pushing her away from surgery and toward pathology. One of the nudges came from the stress of being on call almost constantly in a city besieged by gang violence. “We had many gunshot wounds,” she recalls. “I wanted a quieter life and I wanted to have a family.” (She has happily made good on the latter goal.)
On top of surviving cancer, Dr. Palacios Ball had greatly enjoyed a yearlong rotation in anatomic pathology during med school and a one-month pathology rotation during surgical residency. While thinking back on those experiences, the proverbial lightbulb came on over her head. She took aim at pathology and moved to Spain, where she completed her pathology residency at Hospital Universitario de Burgos.
She has been a practicing pathologist since 2020. In the years since, she says, “I have never looked back.”
She has embraced the role even though she thought herself unqualified when she was initially tapped for it.
“When we started this project in 2022, I didn’t know anything about whole slide imaging or DICOM—or any other part of digital pathology,” she says. “I had a lot to learn.”
Learn she did, avidly studying the subject largely on her own time. In the process, she gained knowledge that regional project leaders recognized as an obvious asset to the entire effort.
They also got a taste of Dr. Palacios Ball’s outstanding communications skills. The combination made her a clear choice to serve as a bridge between industry players seeking the work and pathologists who would be using the new-to-them technologies.
Indeed, one of Dr. Palacios Ball’s first major moves in the leadership role was helping to drive the search for the right industry partner. This was no simple exercise, since the 14 hospitals are all publicly funded. Bureaucracy and red tape were a given.
Besides that, “COVID was still affecting everything, so early on all vendor meetings had to be held online,” she remembers. “Once we were allowed to visit hospitals that already had digital pathology, it was two years of working together as a group of six pathologists. We made many trips across the country to see these technologies in real-world use.”
Interoperability a ‘scary’ sticking point
Suffice it to say that, despite the demanding groundwork, due diligence got done in a relatively timely manner.
“We had to publish one tender for pathology PACS and 13 separate tenders for scanners,” Dr. Palacios Ball explains. (A tender is a structured RFP inviting companies to bid on a precisely defined project; it emphasizes that finalists will compete mainly on compliance and cost.)
“We were facing some potentially serious interoperability issues,” Dr. Palacios Ball says. “That was scary for us. And that’s why we made sure the PACS we chose by in-depth market research would be capable of adapting to any situation we might encounter.”
Five potential vendor partners made it to the final cut. When those results were tallied, Sectra topped the scoreboard.
This pleased Dr. Palacios Ball.
“Due to the rules around public tenders, we couldn’t have favorites during the product evaluation phase,” she says. “But now that the dust has settled, I can say that Sectra struck me as having the best product and the best people. It was my personal favorite.”
She had to hold her tongue then but can speak freely now. On interoperability as well as other concerns, she says, “I was right about Sectra.”
5 performance notations
To be sure, each of the hospitals involved in the project had its own physician champion for digital pathology. Some had more than one.
Still, Dr. Palacios Ball’s enthusiasm for the technology has made her a sought-after guide among her pathology peers.
“We made sure the PACS we chose by in-depth market research would be capable of adapting to any situation we might encounter.”
—Johanna Palacios Ball, MD
For this reason, pathology leaders around the globe would do well to give consideration to Dr. Palacios Ball’s comments about the Sectra Digital Pathology Solution—especially now that she and colleagues have been working with the software for more than a year.
Among Dr. Palacios Ball’s most salient observations are these five.
- “The biggest improvement is having the patient’s complete picture within my own workflow. I can open earlier biopsies from other hospitals in our region alongside the current case without requesting or waiting for physical slides. Recently, that let me reach a diagnosis on a very limited small biopsy by combining it with the patient’s biopsy from a month earlier at another hospital.”
- “The DICOM-based approach is what made our project possible. Each hospital chose its own scanner, and now we have four different scanner suppliers working under the same roof for every pathologist. This keeps the door open for future growth and new technologies.”
- “We were able to keep the laboratory information system (LIS) that we’ve had since 2016 and connect it through a simple HL7 integration—the minimum we needed to go live. Our goal now is a more PACS-driven workflow, which will let us take even fuller advantage of the platform.”
- “From the start of the project, I made sure my colleagues at my hospital had a lot of information. I shared everything with them. I walked them through every step. Sectra has an excellent training course on its website, so I even walked each one of them through that course. By the time we were up and running, everyone felt comfortable with the new and improved way of working.”
- “The Sectra platform was, in my opinion, the most complete digital pathology platform that I personally tested. But just as importantly, I have found that Sectra’s people would be hard for any others to match in day-to-day work life. Simply put, Sectra provides outstanding support. They walk next to me, working through questions and issues. They are flexible too, accommodating all our pathologists according to each one’s preferences around assistance and communication.”
Patients always top of mind
Dr. Palacios Ball closes with a word of advice directed at pathology peers down the road and across the globe.
“When you choose a tech vendor to equip and assist you with digitizing pathology, you have to be able to see them as a true partner, not just as a supplier of products and services,” she says. “They have to appreciate that the people we ultimately serve are patients.”
“By extension,” Dr. Palacios Ball adds, “the tech partner is ultimately serving patients too.”
For a detailed overview of the Sectra Digital Pathology Solution, click here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.