Quality Assurance and Quality Improvement Enabled by Whole Slide Imaging

Whole slide imaging (WSI) underpins a technological revolution which is transforming the practice of pathology. The microscope has been the primary method of histopathologic interpretation for hundreds of years, is the primary modality with which essentially all pathologists have received their training, and still is the primary diagnostic methodology for the vast majority of surgical pathology cases. However, WSI has matured technologically and can now be used for primary diagnosis in surgical pathology in many countries [1–4]. Since this modality is accepted for use in clinical practice and is being integrated into clinical workflows, robust quality assurance (QA) and quality improvement (QI) programs are necessary to ensure excellent clinical care. The defining feature of WSI is that digitization of glass slides obviates interpreting physical glass slides for pathologic evaluation. The “virtual” nature of a WSI workflow alleviates physical constraints and creates unique QA opportunities such as enabling the remote viewing of slides, enabling slide sorting functionalities, and creating disruptive approaches to objective analysis and computational approaches to quality efforts. The QA opportunities afforded by these unique characteristics of WSI are detailed below in the context of the three phases of testing.