Blazing another path through digital wilderness
Adding images to reports easily and economically has been the
aim of Eric F. Glassy, MD, for the past five years. His solution,
dubbed ImagedPath, shows early signs of meeting that need simply and
"I started working on the program in 1996," says Dr. Glassy, who
is a partner with Affiliated Pathologists Medical Group, Torrance,
Calif. "At that time, I was just interested in putting four pictures
on a report." Like many of his colleagues, Dr. Glassy found that
most off-the-shelf software applications didn’t quite do the job.
"Photoshop makes a poor word processor, and Word makes a poor image-manipulation
program," he says.
After experimenting with traditional page-layout packages, such
as PageMaker, Quark, Freehand, and Illustrator, Dr. Glassy settled
on FileMaker, a popular desktop database program. "I like the ease
of using a relational database, and it met our group’s requirements
for a cross-platform solution that was also easy to use," he says.
Modules of the ImagedPath program, which is still in development,
are being beta-tested at several sites in southern California, including
Cedars Sinai Medical Center and Dr. Glassy’s hospital, Little Company
Not a full-blown anatomic pathology system and "not a panacea,"
as Dr. Glassy puts it, ImagedPath is designed solely to create image-rich
anatomic pathology reports-and to do that as well and as simply
as possible. The program can be used on a Mac or PC, standalone
or in a networked environment. It is designed to store and retrieve
digital images and to facilitate the process of including them in
reports, along with text annotations, other text elements, patient
demographic data, branding elements such as provider logos, and
patient education information.
ImagedPath is made up of several modules. The general pathology
function and prostate and breast modules are operational. Other
modules—skin, liver, and gastrointestinal—are still
in development. When it is complete, the product will also include
an online help function, search capabilities, and features that
help users create customized graphics and reports.
One of Dr. Glassy’s goals was to make ImagedPath user-friendly,
so support personnel can use it and pathologists can concentrate
on interpreting specimens and capturing digital images. "I’ve tried
to make it as simple as possible to minimize workflow disruption,"
he says. "I built the product so that it would support a workflow
process in which the pathologist takes the photo, stores it on a
central database, or inputs it directly on a support person’s PC
or Mac." The support person then imports the image or images directly
into ImagedPath using basic point-and-click functions, works through
the other straightforward steps in creating the report, and prints
Like many pathologists, Dr. Glassy finds the image-handling capabilities
of commercial anatomic pathology packages less than adequate. The
effort he and other pathologists have exerted creating homegrown
solutions, he says, is a tacit judgment of the limitations of these
alternatives. "Not only does it underscore the lengths we are willing
to go to generate a great report, it is also a commentary on the
weakness of the current commercial anatomic pathology systems in
this particular respect," he says.
Part of the problem, Dr. Glassy suggests, is that many commercial
AP package-based imaging solutions are wedded to MS Word. "Word
is a fine word-processing package, but it’s not designed to handle
images well," he says. Using Word to handle images requires a fair
amount of manipulation of Word’s templates and, even then, the adjustments
don’t always deliver acceptable results. "Word templates don’t always
manage placement of the images on the page well," he adds, "nor
does this solution offer the advantage of a database solution,"
which lets you easily add canned text, annotation, and other elements,
such as help screens.
But growing competition from large commercial labs that have,
in recent years, been supplying image-rich reports to their clients
has intensified the need for imaging. "Large labs like Dianon/Urocor
and, more recently, LabCorp are providing reports with images, and
it is difficult for pathologists in small groups to compete," Dr.
Glassy says. "I wanted to create a report tool that was better than
anything that the ’big boys’ were doing and put that tool into the
hands of the average pathologist."
The completed prostate and breast ImagedPath modules are relatively
robust and detailed. The breast module includes graphical representations
for Scarff-Bloom-Richardson scores for gland formation, nuclear
atypia, and mitotic activity. The prostate module includes Gleason
scores and areas for adding information about the site, length of
core, percent of carcinoma, and presence of high-grade prostatic
intraepithelial neoplasia. It also supports ways to create biopsy
images that show cancerous areas in red. "Urologists are very interested
in showing what percentage of carcinoma is involved in that core
biopsy, so we wanted to create a graphical representation for how
much of the core is involved," Dr. Glassy says.
Dr. Glassy is particularly proud of the prostate module. "It has
taken a lot of work to complete and is designed to help create a
’teaching moment’ between the urologist and the patient," he says.
The format of the prostate report is based on input from urologists, including
several at the Cedars Sinai Medical Center Prostate Cancer Center. A typical
ImagedPath prostate report might contain half a dozen pages:
The first, a standard cover sheet, includes the patient’s name,
number, demographics, who performed the
procedure, and provider logo.
The second page contains a summary of findings, including biopsy
findings with cancerous areas shown in red,
Gleason score patterns, and
several images with captions and annotations
neoplasia, core biopsy, and carcinoma (high
The third page shows a prostate core biopsy report, with Gleason
and cancerous areas.
The fourth page includes a Partin table prognostic summary report
indicates probabilities that carcinoma has
spread outside the prostate,
penetrated the capsule of the prostate,
or spread to seminal vesicles or
The last pages conclude with educational material describing Gleason
scores, tumor staging, and PIN precursors
to cancer, as well as
prostate-specific antigen data and a list
of related Web sites.
For a demonstration disk (Mac or PC) and more information, contact
Dr. Glassy at firstname.lastname@example.org
or visit the Web site www.evirchow.com.
Eric Skjei is a writer in Stinson Beach, Calif.