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Including a digital photo in your pathology report


Dr. Mona Abdel-Halim

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For any dermatopathologist, it is of utmost importance to document cases and maintain a slide copy of them. This slide archive represents a valuable asset. However, with the advances in digital technology systems, keeping slide copies of your cases is no more the only way of documentation. Many dermatopathologists have digital camera systems which allow them to capture shots of their cases and keep them stored on computers. This provides a more useful resource. Images can be used in lectures, courses and workshops as well as in creating educational websites. Moreover, images can be sent instantly to colleagues for second opinions. They may represent a source for future publication of atlases or textbooks. Needless to mention is the value of digital imaging in research.

I have recently bought a camera system for my microscope and I started gradually to develop my microphotography skills. Together with my colleague, we started to document all our cases digitally. We thought of an additional use of these images; to include a digital image(s) emphasizing the key diagnostic feature (s) in our report. We tried it and we got positive and impressive feedback from the referring dermatologists. The inclusion of a digital image added quality to our reports. As many clinicians like to revise radiological images by themselves, we believe that pathology images included in a pathology report will provide the same to dermatologists. Moreover, they can help the clinician explain to the patients some things that will affect the management like the presence of residual tumor in resection margins for example.

I would like to know your opinion about this and whether this service is given in your labs or not and what do you think the advantages and disadvantages of it are.
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Dr. Phillip McKee

Posted

I have photographed my signout interesting cases for about 2 decades and they have proven an invaluable resource for me and colleagues. I am not so sure about photographing images for clinicians. The size of the signout in the US is so huge that if you were to photograph cases for the clinician you would never get finished. I suppose if one was very selective, it might be a good idea.
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Robledo F. Rocha

Posted

I’m about to begin including digital photos in my reports. I recently invite some clinicians to see the prototypical models, just to assess what kinds of cases and what kinds of images are interesting to include. I noticed that clinicians are not able to correctly interpret the microscopic features without the aid of arrows and legends. And the images they want to find in the report basically cover the three following:[list]
[*]key microscopic features that are critical to exclude clinical differential diagnosis, like epidermotropism, parakeratosis, eosinophils, fungal hyphae, and so forth;
[*]status of the ressection margins or presence of residual tumor; and
[*]microscopic features that were used to grade or classify a given disease, flanked by a table with the employed scheme.
[/list]
In my opinion, there are two main disadvantages: include digital photos in reports is a time-consuming task and save such heavy digital files require investment.
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Mark A. Hurt MD

Posted

I don't provide photographs, and I have a real concern about doing so. First, it is time consuming to photograph each case, making it impractical; second, it's very expensive to invest in the technology that offers marginal value to a busy clinicians who rely on your integrity to stand by the diagnosis; third, no photograph you provide is equivalent to the examination of the glass; and fourth, one adds medical liability by providing images that might not be interpreted properly by others if they ignore your diagnosis.
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