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Pathology - Global Challenges in Education |
Correspondence: www.vet.utk.edu/faculty/mendis.shtml
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ABSTRACT |
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The digital slide offers equivalent quality and resolution to the original glass slide viewed on a microscope and has several additional advantages over microscopes. Students can choose to examine the entire slide at any of several objectives; they are able to access the slides (called WebSlides) from the college's server, using either Internet Explorer or a special browser developed by Bacus Laboratories, Inc.,a called the WebSlide browser, which lets the student simultaneously view a low-objective image and one or two high-objective images of the same slide. The student can "move the slide" by clicking and dragging the image to a new location. Easy archiving, annotation of images, and Web conferencing are additional features of the system.
Key Words: virtual microscopy • teaching technology • veterinary curriculum • digital microscopy • student evaluations
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INTRODUCTION |
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WHAT IS VIRTUAL MICROSCOPY? |
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PREVIOUS USE OF VIRTUAL MICROSCOPY |
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Many of the same faculty at the UICM undertook several initiatives to increase efficiency while still teaching mastery of traditional histology glass slides.2 All the slides in the student histology collection were scanned and placed on a Web site. Virtual microscope images and 35-mm slides were catalogued in a Histology Image Index, which was accessible on the Web. A photographic atlas was also available on videodisc. For the virtual microscope, students rated the resolution and quality of the image at 3.73 and ease of use at 4.28 on a five-point scale (5 = excellent).
Following a reduction in course hours for medical histology, faculty at the University of South Carolina instituted an initiative called the Technology-Enhanced Curriculum.3 In 2001, students entering the program were required to purchase laptop computers with additional software and hardware to enable them to connect to the campus wireless network. The Web was used to deliver histology laboratory manuals, digital images, and PowerPointc presentations. Very soon after that, virtual histologic slides were made available to students on CD-ROM. An advanced tiling algorithm was used to merge hundreds of individually scanned fields into single, seamless composites. Both static and virtual images could be viewed on computers without having to access the Web. The study reports that microscope glass slides and light microscopes were used very little in 2001 because students preferred the virtual slides and virtual microscopes. Some faculty continued to use projected images for practical exams, but others began using the virtual microscope to obtain pre-labeled images and delivering them in PowerPoint. Approximately 25% of the students surveyed found it necessary or helpful to use both the light microscope and computer to study. However, more than two-thirds of them found that ease of navigation with the computer and image viewer resulted in a more efficient use of their time. Only eight students advised against getting rid of the microscopes. The students in 2002 were asked about getting rid of light microscopes, and 87% of 57 students advocated getting rid of light microscopes in favor of the virtual microscope. However, these students used the departmental light microscopes only for a limited number of labs.
In another study at UICM, students had no formal lab sessions but were given the responsibility of independently examining microscopic slides in preparation for small-group cases analyses and student presentations.4 In preparation for this approach, all glass slides used in the course were digitized and placed in the virtual laboratory, along with other materials previously delivered on the Web. Attendance at the traditional lab decreased to 25% of previous years’ attendance, indicating that the majority of students were choosing the virtual lab over the traditional lab, and this conclusion was confirmed by server statistics. Based on student evaluations, as confirmed by server statistics, students found the image quality almost equal to traditional slides and learned better with the virtual microscope. The greatest advantages of the virtual lab were judged to be its efficiency and availability. Evaluations indicated that students lacking prior experience with traditional microscopes were not disadvantaged. Two major advantages of the virtual microscope were efficiency of learning and accessibility. Faculty benefited from better interaction with the students, and the institution benefited from lower costs associated with the virtual lab. The authors are hopeful that the technology will be well received nationwide, and they are planning on incorporating it into their dental-school curriculum.
In a 2002 article, Demichelis et al. describe a method for digitizing entire histological and cytological slides using robotic microscopes.5 These digital images were used to construct what the authors call virtual cases (VC), consisting of the images at all magnification levels together with all relevant clinical data. The computer-viewed VCs allow students to select the appropriate fields and examine the fields at different magnifications and facilitate rapid transition between panoramic and high-resolution views. The VCs are recommended for training medical students and for use by pathologists during residency and in continuing education.
Romer and Suster review the history of frustrations when faculty are faced with communicating the contents of a glass slide to a large audience.6 The previous use of photographs and 35-mm slides did not reproduce the intellectual process involved in information gathering and diagnosis. Later, still images gave way to larger digital images captured by robotic photomicroscopes and the resulting "virtual slides." A microscope, capture kit, and software provided images that were tiled to recreate the tissue section. This proved to be an effective alternative to the use of multi-headed microscopes or closed-circuit video-microscopy images projected on multiple monitors connected via a camera to a single microscope. The authors suggest that virtual-slide technology could be used for prospective or retrospective analysis of cases in a multi-institutional setting or for cooperative study groups. Additionally, the technology would allow multiple investigators to evaluate slides simultaneously via the Internet. The authors suggest that with continuing refinement of the technology and increased availability to the general public, this type of technology would be the preferred method for reviewing histologic slides with large audiences.
In order to deliver high-quality histologic images to biomedical students in developing countries, Silva-Lopes and Monteiro-Leal recommend the use of high-quality digital image montages via the Internet or an intranet.7 These images allow the visualization of high-resolution, wide-field frames. The production of a free, Web-based digital histology atlas allows students to acquire greater amounts of visual information, thus reducing the IT educational gap between developed and less developed regions.
Second-year medical students at the University of California—Los Angeles (UCLA) were traditionally taught pulmonary pathophysiology through lectures and histopathology labs using histologic slides and a multi-headed microscope. Because the multi-headed microscopes could accommodate only 12 students, multiple senior residents were required to teach the course.8 Since 1998, however, these lab sessions have been replaced by interactive, self-instructional sessions using Web-based technology. Part of the course restructuring involved digitizing the glass slides to produce high-resolution images. The case presentations and the images are presented in two separate frames on a computer screen: the left frame provides navigation, and the right frame provides digital images with microscopic descriptions. Students rated all aspects of the Web-based case studies as highly successful. The authors envision that a more advanced method of virtual microscopy would enable students to study digital images from an entire slide as if examining a glass slide under a microscope.
Because of their successful experiences in incorporating the virtual microscope into histology and pathology courses at the University of Iowa, Dee et al. developed a plan to use virtual slides in the American Association for Cancer Research's annual Pathobiology of Cancer Workshop.9 The virtual slides were intended to augment microscope labs in which workshop participants examined more than 100 slides. Because many of the trainees had minimal training in microscopic morphology, session leaders had to demonstrate important features on projected images. Visual slides were created using Virtual Sliced and ScanScope.e Participant evaluations indicated strong agreement that the images were of high quality and resolution, that they enhanced the instructor's ability to point out the cells and lesions that participants were expected to see on the glass slides, and that this technique enhanced participants’ overall ability to learn from the glass slides at the actual microscopes.
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USE OF VIRTUAL MICROSCOPY AT UTCVM |
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In microanatomy, the manual for the spring course in organology was converted into an online interactive manual by a veterinary student supervised by the course instructor. The textual portion of the manual appears on the left side of a two-frame window, while the right side contains the virtual microscope (see Figure 4). Any text that refers to a slide is used as a link to that WebSlide in the Virtual Microscope. When the text is clicked, the image appears in the right-hand frame at a predetermined objective and place on the slide. The features of the Virtual Microscope are then available to the student as he or she reads the manual.
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ADVANTAGES OF VIRTUAL MICROSCOPY |
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Certainly one of the most important features of the Virtual Microscope is that the student uses it the same way that he or she would use a conventional microscope; that is, the low-power objective is used first, and then higher-power objectives are used as needed. The low-power objective permits the student to observe patterns or specific loci that should be viewed for cellular detail via a higher objective. It is important to stress that the Virtual Microscope is not a collection of large still images but, rather, a collection in which many small images are tiled to reconstruct any given field. This interactive use discourages students from memorizing the still images often used in teaching programs.
In the past, interactive slide examination relied on a videocamera mounted on a microscope and projected onto a screen. Such systems require cumbersome manipulation of the microscope; it is not possible to return quickly to areas of interest, and resolution is limited to the output of the video camera. Thus, an additional advantage of the Virtual Microscope is its use in a lecture environment. With the assistance of a digital projector, instructors can incorporate the interactive images into electronic presentations to show students how best to identify and analyze specimens. A window can be created in PowerPoint slides and the Virtual Microscope inserted as an interactive field; this eliminates the use of still images, and the window allows the instructor to make use of all the capabilities of the Virtual Microscope without exiting PowerPoint.
The WebSlide program established by Bacus Labs encourages colleges to share digitized slides and thus increase the size of their teaching sets. The digitized slide sets from any participating college or university are available to all those licensed use the Virtual Microscope. WebSlide sharing is particularly advantageous in those courses that are building a set of slides relating to disease processes. This unlimited access to a continually growing Virtual Microscopy Slide Library of more than 1,800 specimens is an excellent resource for all colleges.
Some colleges of medicine and veterinary medicine are interested in virtual microscopy because of the reduced expense for purchasing and maintaining microscopes and teaching slide sets. In fact, some medical colleges no longer use microscopes at all in basic sciences courses but have opted for the virtual microscope because of cost savings.3 The absence of microscopes in laboratories is consistent with the fact that many physicians and veterinarians do not examine tissue microscopically in practice. However, microscopes are used by veterinarians and veterinary assistants for tasks such as examining fecal flotations and other parasite diagnostic procedures, urine sediments, blood smears, and some cytologies; therefore, basic knowledge of the microscope is important, and most veterinary colleges continue to provide opportunities for learning these skills.
The Virtual Microscope can provide access to slides at any time and in a variety of locations that students use for study. A wireless network allows students to access the Virtual Microscope from anywhere in a particular building. By downloading the free browsers from Bacus Laboratories, they can also download the slides to a home computer.
The ability to display images on workstation monitors encourages students to study individually in quiet study areas or in groups. With conventional binocular teaching microscopes, students would have to swap views of the tissue and attempt to explain what they were viewing independently. Except for multi-headed microscopes, which are not always available to every student, this study practice added unnecessary time to group study. With the Virtual Microscope, several students can gather around the computer monitor and all be assured that they are looking at the same images. The same rationale applies to instructors helping students in laboratories: the instructor can gather groups of students around the monitor and manipulate the image with ease while teaching.
Another advantage of the Virtual Microscope is the time saved when viewing several slides in succession. With the Virtual Microscope, to the user can move quickly from one slide to another with a few clicks of the mouse; with a conventional microscope, this operation takes considerably more time. This is particularly important when slides are used by an instructor during a lecture. Any one of hundreds of slides can be quickly accessed from a lectern computer and shown to the class via a data projector. Some of the newer digital projectors have zoom capabilities that provide further enhancement of small items.
A virtual multi-headed microscope interface allows multiple users to see a synchronized view of a particular WebSlide from a user who is selected to be the guide. There is also a built-in conferencing capability in the WebSlide Browser that enables two users at remote locations to synchronize a viewed image. A text area allows the users to communicate in a chat mode. This provides a method for collaboration between two individuals who have access to the Web collection.
One of the frequent requests by UTCVM students in courses that use microscopes is for plenty of microanatomical images to study. The Virtual Microscope has a feature that allows students to store as many images as they need for study. The VM can be displayed in a one-, two-, or three-panel window, and the student can save any image in any window as a single JPEG file. The WebSlide browser also allows students to annotate an image or transport it to any other program that provides annotation capabilities. This means that a student can store large numbers of annotated images for study purposes. Additionally, if students have color printers, they can print images and save them in a notebook for quick review then and in the future.
Other advantages include distributing WebSlide virtual slide collections for viewing on self-executing CDs or DVDs; Webslide's compatibility with e-learning software, including Angel, Blackboard, and WebCT; and its ability to provide excellent still images to use for practical exams. As an extension of this, the Virtual Microscope can be used in a more dynamic testing mode for one-on-one examinations.
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THE DISADVANTAGES OF VIRTUAL MICROSCOPY |
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STUDENT REACTION TO THE USE OF THE VIRTUAL MICROSCOPE AT UTCVM |
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In addition to the objective questions, we provided space for comments. Listed below are some of the comments made by students who had used the Virtual Microscope:
I think this was a good idea and should be used in other classes because we were able to study at home.It has been a great educational tool!! Thank you.
Interferes somewhat with my ability to use a microscope proficiently not quite as much practice, but I think it is sufficient with what we have in lab. This really helped my studying and it was so much more convenient! Thanks for your work!
I enjoyed it because I get a headache looking at slides for extended periods of time.
I did not use virtual microscope for the first microanatomy exam but used it extensively for the second exam and feel I was much more prepared. Thanks.
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Footnotes |
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Michael H. Sims, PhD, is a professor in the Department of Comparative Medicine and Director of Instructional Resources, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996 USA. E-mail: HYPERLINK "mailto:msims{at}utk.edu"msims{at}utk.edu. Instructional Resources includes the divisions of Medical Art and Graphics, photography, videography, Web production, and instructional support. Dr. Sims has a partial appointment in the Department of Small Animal Clinical Sciences in the area of electrodiagnostics.
Chamindrani Mendis-Handagama, DVM., PhD is a veterinary histologist and Professor of Comparative Medicine at the Department of Comparative Medicine, College of Veterinary Medicine, The University of Tennessee (UTCVM), Knoxville. Email: mendisc{at}utk.edu, , She is the course coordinator for VM826–Veterinary Microscopic Anatomy II and the chief of The Reproductive Research Group at UTCVM.
Robert Moore, B.S., is a fourth year veterinary student at the University of Tennessee College of Veterinary Medicine, River Drive, Knoxville, TN 37920. Email: rmoore19{at}utk.edu. He will earn a Doctorate of Veterinary Medicine in May 2007.
a Bacus Laboratories, Inc., Lombard, IL 60148 USA <http://www.bacuslabs.com/>. 
b Microsoft Corp., Redmond, WA 98052 USA <http://www.microsoft.com/>.
c Microsoft Corp., Redmond, WA 98052 USA <http://www.microsoft.com/>.
d MicroBrightField Inc., Colchester, VT 05446 USA <http://www.mbfbioscience.com/>.
e Aperio Technologies, Vista, CA 92081-8545 USA <http://www.aperio.com>.
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REFERENCES |
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This article has been cited by other articles:
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  F. R. Dee and D. K. Meyerholz Teaching Medical Pathology in the Twenty-First Century: Virtual Microscopy Applications J Vet Med Educ, January 1, 2007; 34(4): 431 - 436. [Abstract] [Full Text] [PDF]
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TOP
ABSTRACT
INTRODUCTION
