3D Scanning: An Important Innovation in Pathology

This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Krueter, the Bow Tie Bandit of Blood, a Transfusion Medicine pathologist at Mayo Clinic. Today we are rounding with Shane Ferraro, a Pathologists' Assistant, Assistant Supervisor in the Division of Anatomic Pathology at Mayo Clinic in Rochester, Minnesota, to talk about the important innovation of 3D scanning. Thanks for joining us today, Shane. Yeah, my pleasure.

Thanks for having me. Very exciting. Yeah. So 3D scanning is something that I think a lot of us are starting to kind of hear about. Some of us are probably getting a chance to see about this innovation. I'm curious, from your perspective why is 3D scanning an an important innovation in pathology?

Yeah, it's a, it's a very exciting question and a very exciting topic. So from all of my experiences with our 3D scanning system so far I think the most important impact is on education. And for instance, so with our pathologist assistant team, we're heavily invested in resident and PA student education. So the applications of this technology really allow for like a versatile and kind of conducive approach to how people in anatomic pathology learn.

So we're very visual learners, we're very hands-on, and that's an extension from our experience in like cadaver labs. And, you know, as we were to the frozen section lab here, surgical pathology labs in general. So the the applications of the technologies here, can really be fostered in a way to, create environments that are more conducive to learning.

So for instance, with this technology, we can create things like QR codes, which you can bring to a presentation and you can have the audience kind of scan that with your phone, and then they could look at a 3D model that you created on their phone. So they get a really interactive experience with that. In addition to that we also have the ability to create actual tangible 3D models from the specimens that we have scanned.

So when we do that we can actually have those models shared in an environment that's, that's not a an actual like pathology lab. So you don't have to worry about safety precautions. You don't have to worry about balancing clinical care with resident education. So you can really hone in on some of those skills and really foster a good environment for them to learn in. So, very exciting from that angle for us. Yeah, I mean, it sounds really almost transformative, right?

I think you mentioned a couple of things that you can do

that we haven't really been able to do before. You mentioned, so with a 3D scan that we're able to really take anatomic models and we can kind of, the audience can play with them on their phone. And I'm curious, like when you talk about, you know educational change that's happening because you can get the audience do that are there certain activities that you can do with the audience that you weren't able to do before?

Are there certain insights that you're hearing from the learners when you're doing that kind of approach? It's hard to really know because this is something that we just received and as I mentioned, like, so all all of our PA educators are, are really excited. I've had several of them already asking

about the opportunities to actually get their own specimens and their QR codes to share. So the enthusiasm is there. I can't quite comment on how it might transfer into an audience kind of engagement, but just the fact that somebody could get their phone, scan the QR code and then just you can hear all the audible ooh's and ah's as they go through a specimen. It sounds like a very exciting thing. And I look forward to having those opportunities with people. So Yeah. Absolutely.

So what do you think is important for our audience to understand about 3D scanning? So two, two things come to mind. You know, we talk about 3D scanning as if it's like some kind of really like futuristic abstract technology when in reality it's, it's more simple than that.

So the machine is, you know, it's this big cube and we would put the specimen inside this chamber and it would have, it's mounted on a rotating platform and we could kind of choose like what kind of, you know mount it's on, it could be a glass surface, it could be like a pin mounted method, or we can do like, it's a resting kind of mesh kind of screen. So it's on this, this, this mount and then it's in the chamber and there's several cameras kind of lined along the edge.

So the specimen will rotate and the cameras are just taking multiple photos of it as it rotates. So it's just a really fancy kind of camera setup. So those photos actually act as the the data for the 3D model to be rendered. And these models are really like crisp and clean and this is like, it's very simple and very scalable. So it's something that I think will be much more prevalent going forward.

The other the other thing that I think is really interesting about this is, I talk about the education side a lot and that actually transfers over towards patients too. So for instance, here with our PA service and our pathology service, we see a lot of heart and lung transplants. So we actually have a service where patients can request this upfront. They can, they can request to see a scan of their specimen. So the, the patient could come in after they've had their lungs, you know, removed.

They have a new set of lungs they can come in with their family and they could, they can talk to the actual pathologist who reviewed the actual specimen, the, the patient's lungs. They took sections to look at microscopically and they could get a one-on-one interactive session to

kind of go over the specimen and kind of really see the cycle of care. And then they can also go home with that specimen so they can have a, a memento and a reminder of the service and the care that they experience here at the clinic. So there's some really cool things, you know that are happening in addition to like just the education that goes along with this.

So You know, another thing that comes up in my mind is, I I mean, you're a pathologist assistant, you know are you taking this home to show your family members what kind of stuff you deal with? I'm excited to, I have to be careful. I mean, I could tell my wife about some of these things but she doesn't wanna hear it as much. So I gotta, I have to make sure I pick the right kind of specimen to bring home that might not hit those kinds of buttons for some people. Oh, I,

I understand that. That kind of gets us into, you know what are some of the practicalities for implementing 3D scanning and a pathology practice? Right. You mentioned that you're seeing this as really a a very scalable technology. Yes. So going back to kind of how I mentioned how it's, yeah, it is scalable and it's a really simplified kind of setup. So right now we're launching this system in our frozen section lab which is a rapid intraoperative diagnosis lab.

So it's a very clinical heavy setting. We, provide intraoperative results to surgeons so that they can know how to advance with their procedures. So balancing that kind of aspect of our work with getting some of these educational requests, is a hurdle. You know, so as we kind of learn how to, how to balance our work and really accommodate these requests because for the most part this is primarily an educational kind of setup.

There are, you know, ideas to kind of expand this into a more clinical kind of aspect, but right now it's it's really finding that, that that sweet spot to get the get our pathologist and the surgeons the answers they need and really make sure that we can streamline our processes. And, you know, that, that might be something as simple as,

as I mentioned earlier there's different mounting techniques. So for instance if you have something that might be more soft, like a like a fatty kind of tumor that's really squishy and just kind of sits, you're you're not going to be able to put that on like a a pin mounted method. You're going to have to put it on the glass surface. If you have something like a bone, which might look weird or it might stand at an awkward angle using that glass might not work.

So kind of making sure that we can rapidly kind of put together the mounting technique, get a good scan, get the surgeon what they need, get the consultant what they need, and make sure all kind of parties are involved, is probably the biggest hurdle in, in my mind. And are there different teams that you are interacting with like outside of pathology that is helping to kind of bridge to make some bridges between pathology and other clinical departments?

So, right, so the system that we use the actual scanning system is called Med Creator. We're supported by a thing, which is the company named they're based out of Chicago and they have other departments here that they they collaborate with. So we haven't really worked too much outside of our department. We work closely with the autopsy lab who really pioneered a lot of this, these techniques and kind of helping support this growth of the technology.

So we work closely with them but otherwise outside of like surgical pathology and you know, anatomic pathology we haven't worked with too many other departments. I'm excited for those opportunities. I know in the past as this kind of technology was more experimental there were different opportunities we had with I think it was radiology who did want to like

coordinate with certain specimens. So we did have those opportunities in the past which was a lot of fun. I had a lot of fun with that. So Yeah. And you mentioned, you know, in pathology it sounds like it kind of got its route started with forensic pathologists and then you're saying now it's kind of being brought out to the surgical practice? Yeah, so our, our autopsy lab, it, it functions as a a medical or an in-house autopsy lab in addition to the, the forensics pathology service.

So those, it was more or less those medical, those kinds of autopsies, those educationally approved for cases where we were kind of expanding on some of this technology.

Their interfaces are a little bit more complex and as I mentioned before thing has been able to really condense and simplify all the applications and, you know for instance, the software that controls how the the mounting station kind of rotates, stops the cameras engage, all of all that stuff was kind of worked together in autopsy and they really like consolidated those applications. Hmm. And, and how long does it take to scan some tissue?

Is this something that is relatively quick or is this like a day long process? It's actually, yeah, I didn't even think about how I'm commenting on how interesting this is. So it's really simple.

It's really quick actually. So we would just need to go into the software the software that they've made, this kiosk application we would just need to basically adjust the the camera settings and you could adjust like the model quality, but it's not necessary. So you would just put in your settings, name your file hit the button, and it takes about five minutes for these pictures to be taken. So once the pictures are taken, you can open up the chamber and retrieve your specimen.

And then the, the actual rendering of the model will take 20 minutes. So you can, you can have a really quick turnaround, but in the grand scheme of things, those five minutes are really important for a patient who's on the operating table. So you have to still balance making, you know making sure you're getting those results back

to your surgeon and the consultant. But it, it is very quick, relatively speaking, so Oh wow. It's interesting. Yeah. You know, so quick to scan. And then also it sounds like if everybody's able to get on their cell phone and manipulate it, it's not like the old kinda lag time of, you know you have to make sure you're on good internet. Correct. And yeah, so we can look at the model real time on the system.

Once it's, we can we can look at it on our screen as, as it's rendered and we can kind of look at it and say, you know what maybe maybe we should try to get a better angle or, no this is great. You know, we can we can know real time if what we have is good. Is the thought is this going to replace? I know there's always been kind of surgical photography or surgical pathology photography. Is, is this thought to replace this in the next five, 10 years? In my mind, no. I don't.

I think that there's too much value in photography itself. 3D models have their place and you know, they really they really can fit into the picture. Sorry for the pun, but I don't think that photography is gonna go away. There's just you, there's too much pop, there's too much pop to photographs that you kind of lose in a 3D model. And I, I enjoy taking photos of our specimens and I take a lot of pride in it so I don't want to see that go away anytime soon.

Yeah, no, I, I really appreciate your kind of nuance too. You know, it's not like the panacea that's gonna replace everything. There's a time and a place these certain things. So I guess that kind of brings me to my final question of where do you see, you know this innovation going over these next five, 10 years? Yeah, it's, it's fun. It's really fun to think about that. And it's, I get a lot of like insights from our PA team and they have some plans, they have some concepts.

One of the really interesting things is as I mentioned before, you know, we could you can print 3D models, but what you you can also do is you could change colors of certain anatomic sites or structures on these models. So we can create like unique really unique models to show the relationships of adjacent structures. And that's, that's a significant it's a really important skill to have

in anatomic pathology and gross anatomy. So we can do that. And I think another kind of step I would like to see which really kind of takes that to like the enth degree would potentially be the applications for augmented or virtual reality options.

So what I'm thinking is, like, you could take a specimen, so you could take a kidney specimen, so you could take an overall scan of the specimen, and then you could do like a step-by-step scan as you would grossly examine the specimen and grossly examine like if there's a tumor present, how it relates to adjacent structures. And you can provide a step-by-step gross examination of that for a learner.

And they could have, they could pop on a VR set and kind of go through the whole, you know the whole steps and the the maneuvers of grossing in a, like a surgical specimen. Or they can have some kind of a some other kind of like goggle system that provides like an augmented reality system so that they can see out of their periphery of the side of their vision like the actual step-by-step process of it while they're going through an actual surgical specimen.

It's, it's a lot of fun to kind of think of these things. I have no idea if they're 100% applicable but it's a lot of fun to kind of get these ideas and see if they're, they're possible. Yeah, I'm really excited by that. I think something that young learners in the field of pathology struggle with is sometimes looking at something that's 2D and having to kind of construct this as a 3D and it, it sounds like there's some wonderful that may not always be the case going forward.

Yeah, it's, I get, I'm excited. I think this provides a unique opportunity for people to learn because maybe maybe they're really intimidated by an actual like specimen when they first see it so can provide a more controlled environment for them to get that hands-on experience and the visual kind of correlation between what they read in the book, versus what it actually is. So, very cool opportunities. Brilliant. Hey, we've been rounding with Shane Ferraro.

Thank you for taking the time to talk about 3D scanning with us today. Yeah, my pleasure. Thanks so much. And if you'd like to hear more on this topic, Shane will be presenting at the 2023 Pathologist's Assistant Symposium in June. Please visit mayocliniclabs.com/2023PAsymposium for more information. To all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email.

Please direct any suggestions to mcleducation@mayo.edu and reference this podcast. If you've enjoyed Lab Medicine Rounds podcast please subscribe, and until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations.