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Virtual 3D microscopy in pathology education
Human Pathology (2010) 41, 457–459
www.elsevier.com/locate/humpath
Correspondence
Virtual 3D microscopy in pathology education
the original kdu_server v6.0 (Kakadu Software), (2) JVSServ v1.0 from Jorma Isola [3], and (3) JPView v1.8 (Imassense, Berlin, Germany) running on the same hardware (HP Proliant 12 Core, 2.8 GHz, 32-GB RAM, W2K3-64Bit with HP storage EVA4400; Hewlett-Packard, Böblingen, Germany). The client (Intel Core Duo, 3 GHz, 1-GB RAM, WXP-32Bit SP3) was connected to the Hospital network with 100 Mbit/s. The viewer software kdu_show v5.2 (Kakadu Software) was required for viewing virtual 3D slides using server 1 and 2, whereas server 3 provides a Web application using asynchronous JavaScript and XML (AJAX), which enables the presentation of virtual slides directly within the browser window (Mozilla Firefox v3.5.2). Three virtual 3D slides (lossy compression ratio: 20:1; waveletfilter: 5 × 7; wavelet levels: 8; tiles per image: 1; images per multidocument: 9; code block size 64 × 64; progression: RPCL; quality level: 4) as used in our previous study [4] with file sizes of 0.9, 1.1, and 1.4 GB, were used for repeated measurements of times (in seconds) needed for (a) presentation of the image overview, (b) presentation of a detail at maximum resolution (100%-zoom), and (c) switching between 2 focus planes (z-stack) on a display with 1600 × 1200 pixels. In addition, the times for image reloading from the cache were measured in each case. The results are shown in Table 1. Most significant differences between the softwares were detected in time
To the Editor, In the August issue of HUMAN PATHOLOGY, Fred R. Dee provided a detailed overview of virtual microscopy in pathology education [1]. As requested by the author, we would like to supplement his contribution by findings on the current speed and efficiency of virtual 3-dimensional (3D) microscopy, and by further trends in image distribution using common standards. Apart from sufficient image quality, reliable and rapid presentation of virtual slides certainly is a major criterion for the successful application of virtual microscopy in education and, particularly, in upcoming diagnostic virtual microscopy. In this regard, we and others have identified JPEG2000 using JPEG2000 interactive protocol as the most appropriate format for virtual 2-dimensional (2D) and 3D microscopy [2-5]. The speed and efficiency of virtual microscopy may be influenced by several factors including the hardware of the server and clients, the network, and the software, particularly with the latter being the most promising target for further improvements. To give the readers a notion of the speed and efficiency of virtual 3D microscopy, we tested 3 currently available JPEG2000 server softwares based on the Kakadu library of David Traubman (Kakadu Software, Sydney, Australia): (1)
Table 1 Speed and efficiency of virtual 3D microscopy using three currently available JPEG2000 softwares (1, kdu_server v6.0; 2, JVSServ v1.0; 3, JPView v1.8) Time (s)
a. b.
c.
Presentation of the image overview Reload from cache Presentation of a detail at maximum resolution (100%) Reload from cache Switching between two focus planes Reload from cache
Slide 1 (24 576 × 26 368 pixels; 0.9 GB)
Slide 2 (28 672 × 35 584 pixels; 1.4 GB)
Slide 3 (28 672 × 29 440 pixels; 1.1 GB)
1
2
3
1
2
3
1
2
3
12.2 0.75 43.6
3.6 0.75 7.45
3.0 1.0 1.45
6.15 0.6 52.7
1.95 0.55 12.05
2.5 0.85 1.5
19.75 0.7 48.2
5.25 0.8 8.75
3.95 0.75 1.45
0.55 0.55 0.35
0.55 0.75 0.35
0.6 1.9 0.7
0.65 0.65 0.3
0.65 0.7 0.3
0.6 1.95 0.55
0.5 0.55 0.4
0.5 0.7 0.35
0.6 2.3 0.6
0046-8177/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
458
Correspondence
needed for presentation of a detail at maximum resolution (b), whereas cached data was rapidly presented in all applications (≤1.0 s). Speedy switching between the focus planes (virtual focusing) was possible, especially if the data were cached (≤0.7 s). We conclude that the currently available maximum speed in virtual 3D microscopy, which depends on the software, is acceptable for education, if not also for diagnosis, as zooming and panning (which equates to zooming speed) are the most frequent actions in routine. Actually, we use JPView (Imassense) for education in large group teaching with 120 workstations and Web presentation of 2D and 3D slides, and 3D specimens [6] with great success (http://patho. med.uni-magdeburg.de). Moreover, we intend to use the same hardware and JPEG2000 application also for all other types of medical images such as macroscopic photos, scanned documents, and others, incorporated in the DICOM standard [2]. AJAX based applications do not require the installation of a local viewer software, and are therefore fail-safe. Moreover, AJAX provides more speed in initial zooming and panning, as it uses the processing power of the server hardware. We suppose that non-proprietary DICOM-JPEG2000 format will become the gold standard in virtual 2D and 3D microscopy in education and upcoming diagnostic virtual microscopy. The function of labeling virtual slides, which is important not only for education, and which is actually not provided by the current JPEG2000 software versions, is already included in DICOM as structured reports. Ralf Zwönitzer Department of Pathology Otto-von-Guericke-University Magdeburg, Germany Imassense Deuthschland GmbH Berlin, Germany Harald Hofmann Medical Computer Center Otto-von-Guericke-University Magdeburg, Germany Albert Roessner MD Thomas Kalinski MD Department of Pathology Otto-von-Guericke-University Magdeburg, Germany doi:10.1016/j.humpath.2009.10.012
References [1] Dee FR. Virtual microscopy in pathology education. HUM PATHOL 2009: 1112-21. [2] Zwönitzer R, Kalinski T, Hofmann H, et al. Digital pathology: DICOMconform draft, testbed, and first results. Comput Methods Programs Biomed 2007;87:181-8.
[3] Tuominen VJ, Isola J. The application of JPEG2000 in virtual microscopy. J Digit Imaging 2009;22:250-8. [4] Kalinski T, Zwönitzer R, Sel S, et al. Virtual 3D microscopy using multiplane whole slide images in diagnostic pathology. Am J Clin Pathol 2008;130:259-64. [5] Kalinski T, Zwönitzer R, Grabellus F, et al. Lossy compression in diagnostic virtual 3-dimensional microscopy—where is the limit? HUM PATHOL 2009;40:998-1005. [6] Kalinski T, Zwönitzer R, Jonczyk-Weber T, Hofmann H, Bernarding J, Roessner A. Improvements in education in pathology: Virtual 3D specimens. Pathol Res Pract 2009;205:339-45.
Re-evaluation of IgG4 in systemic fibroinflammatory disease with intracardiac involvement To the Editor: We previously published a case report in HUMAN PATHOLOGY entitled “A case of multifocal fibrosclerosis with intracardiac solid masses” [1]. Briefly, a 70-year-old woman had fibrosclerotic intracardiac solid masses contiguous to thickened pericardium and fibrosclerosis in the pericardium, mediastinum, abdominal cavity, and retroperitoneum. Because the areas of fibrosis were observed in multiple lesions, her disease was diagnosed as multifocal fibrosclerosis accompanied with peculiar intracardiac masses. This systemic disease overlaps recently established clinicopathologic entity of IgG4-related systemic disease. However, the concept was not completely developed when the report was published, and we did not evaluate IgG4 expression in the plasma cells in this case. IgG4-related systemic disease was originally found in patients with autoimmune pancreatitis with elevated serum level of IgG4 [2]. Its histopathologic characteristics are diffuse lymphoplasmacytic infiltration with irregular fibrosis, occasional infiltration by eosinophils, obliterative phlebitis, and high ratio of IgG4-positive plasma cells/IgGpositive plasma cells. The spectrum of IgG4-related systemic disease has been expanding, but intracardiac lesion such as our case has not yet been reported. Accordingly, we have re-evaluated whether this peculiar case is IgG4-related systemic disease. Review of the slides revealed that our case had prominent fibrosclerotic lesions with infiltration of histiocytes and less number of plasma cells, compared with the histology of the recently reported cases of IgG4-related diseases [3]. Infiltration of eosinophils and obliterative phlebitis were not observed. The immunohistochemical analysis of IgG and IgG4 demonstrated that IgGpositive cells were scattered in fibrosclerotic lesions in the intracardiac masses and other fibrosclerotic lesions, but the ratio of IgG4-positive cells/IgG-positive cells was low. These results suggest that systemic fibroinflammatory disease accompanied with fibrosclerotic solid masses may not be specified as IgG4 related. Recently, Zen et al [4] reported that retroperitoneal fibrosis could be classified as IgG4 related or not. They raised an issue whether non–IgG4-related
www.elsevier.com/locate/humpath
Correspondence
Virtual 3D microscopy in pathology education
the original kdu_server v6.0 (Kakadu Software), (2) JVSServ v1.0 from Jorma Isola [3], and (3) JPView v1.8 (Imassense, Berlin, Germany) running on the same hardware (HP Proliant 12 Core, 2.8 GHz, 32-GB RAM, W2K3-64Bit with HP storage EVA4400; Hewlett-Packard, Böblingen, Germany). The client (Intel Core Duo, 3 GHz, 1-GB RAM, WXP-32Bit SP3) was connected to the Hospital network with 100 Mbit/s. The viewer software kdu_show v5.2 (Kakadu Software) was required for viewing virtual 3D slides using server 1 and 2, whereas server 3 provides a Web application using asynchronous JavaScript and XML (AJAX), which enables the presentation of virtual slides directly within the browser window (Mozilla Firefox v3.5.2). Three virtual 3D slides (lossy compression ratio: 20:1; waveletfilter: 5 × 7; wavelet levels: 8; tiles per image: 1; images per multidocument: 9; code block size 64 × 64; progression: RPCL; quality level: 4) as used in our previous study [4] with file sizes of 0.9, 1.1, and 1.4 GB, were used for repeated measurements of times (in seconds) needed for (a) presentation of the image overview, (b) presentation of a detail at maximum resolution (100%-zoom), and (c) switching between 2 focus planes (z-stack) on a display with 1600 × 1200 pixels. In addition, the times for image reloading from the cache were measured in each case. The results are shown in Table 1. Most significant differences between the softwares were detected in time
To the Editor, In the August issue of HUMAN PATHOLOGY, Fred R. Dee provided a detailed overview of virtual microscopy in pathology education [1]. As requested by the author, we would like to supplement his contribution by findings on the current speed and efficiency of virtual 3-dimensional (3D) microscopy, and by further trends in image distribution using common standards. Apart from sufficient image quality, reliable and rapid presentation of virtual slides certainly is a major criterion for the successful application of virtual microscopy in education and, particularly, in upcoming diagnostic virtual microscopy. In this regard, we and others have identified JPEG2000 using JPEG2000 interactive protocol as the most appropriate format for virtual 2-dimensional (2D) and 3D microscopy [2-5]. The speed and efficiency of virtual microscopy may be influenced by several factors including the hardware of the server and clients, the network, and the software, particularly with the latter being the most promising target for further improvements. To give the readers a notion of the speed and efficiency of virtual 3D microscopy, we tested 3 currently available JPEG2000 server softwares based on the Kakadu library of David Traubman (Kakadu Software, Sydney, Australia): (1)
Table 1 Speed and efficiency of virtual 3D microscopy using three currently available JPEG2000 softwares (1, kdu_server v6.0; 2, JVSServ v1.0; 3, JPView v1.8) Time (s)
a. b.
c.
Presentation of the image overview Reload from cache Presentation of a detail at maximum resolution (100%) Reload from cache Switching between two focus planes Reload from cache
Slide 1 (24 576 × 26 368 pixels; 0.9 GB)
Slide 2 (28 672 × 35 584 pixels; 1.4 GB)
Slide 3 (28 672 × 29 440 pixels; 1.1 GB)
1
2
3
1
2
3
1
2
3
12.2 0.75 43.6
3.6 0.75 7.45
3.0 1.0 1.45
6.15 0.6 52.7
1.95 0.55 12.05
2.5 0.85 1.5
19.75 0.7 48.2
5.25 0.8 8.75
3.95 0.75 1.45
0.55 0.55 0.35
0.55 0.75 0.35
0.6 1.9 0.7
0.65 0.65 0.3
0.65 0.7 0.3
0.6 1.95 0.55
0.5 0.55 0.4
0.5 0.7 0.35
0.6 2.3 0.6
0046-8177/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
458
Correspondence
needed for presentation of a detail at maximum resolution (b), whereas cached data was rapidly presented in all applications (≤1.0 s). Speedy switching between the focus planes (virtual focusing) was possible, especially if the data were cached (≤0.7 s). We conclude that the currently available maximum speed in virtual 3D microscopy, which depends on the software, is acceptable for education, if not also for diagnosis, as zooming and panning (which equates to zooming speed) are the most frequent actions in routine. Actually, we use JPView (Imassense) for education in large group teaching with 120 workstations and Web presentation of 2D and 3D slides, and 3D specimens [6] with great success (http://patho. med.uni-magdeburg.de). Moreover, we intend to use the same hardware and JPEG2000 application also for all other types of medical images such as macroscopic photos, scanned documents, and others, incorporated in the DICOM standard [2]. AJAX based applications do not require the installation of a local viewer software, and are therefore fail-safe. Moreover, AJAX provides more speed in initial zooming and panning, as it uses the processing power of the server hardware. We suppose that non-proprietary DICOM-JPEG2000 format will become the gold standard in virtual 2D and 3D microscopy in education and upcoming diagnostic virtual microscopy. The function of labeling virtual slides, which is important not only for education, and which is actually not provided by the current JPEG2000 software versions, is already included in DICOM as structured reports. Ralf Zwönitzer Department of Pathology Otto-von-Guericke-University Magdeburg, Germany Imassense Deuthschland GmbH Berlin, Germany Harald Hofmann Medical Computer Center Otto-von-Guericke-University Magdeburg, Germany Albert Roessner MD Thomas Kalinski MD Department of Pathology Otto-von-Guericke-University Magdeburg, Germany doi:10.1016/j.humpath.2009.10.012
References [1] Dee FR. Virtual microscopy in pathology education. HUM PATHOL 2009: 1112-21. [2] Zwönitzer R, Kalinski T, Hofmann H, et al. Digital pathology: DICOMconform draft, testbed, and first results. Comput Methods Programs Biomed 2007;87:181-8.
[3] Tuominen VJ, Isola J. The application of JPEG2000 in virtual microscopy. J Digit Imaging 2009;22:250-8. [4] Kalinski T, Zwönitzer R, Sel S, et al. Virtual 3D microscopy using multiplane whole slide images in diagnostic pathology. Am J Clin Pathol 2008;130:259-64. [5] Kalinski T, Zwönitzer R, Grabellus F, et al. Lossy compression in diagnostic virtual 3-dimensional microscopy—where is the limit? HUM PATHOL 2009;40:998-1005. [6] Kalinski T, Zwönitzer R, Jonczyk-Weber T, Hofmann H, Bernarding J, Roessner A. Improvements in education in pathology: Virtual 3D specimens. Pathol Res Pract 2009;205:339-45.
Re-evaluation of IgG4 in systemic fibroinflammatory disease with intracardiac involvement To the Editor: We previously published a case report in HUMAN PATHOLOGY entitled “A case of multifocal fibrosclerosis with intracardiac solid masses” [1]. Briefly, a 70-year-old woman had fibrosclerotic intracardiac solid masses contiguous to thickened pericardium and fibrosclerosis in the pericardium, mediastinum, abdominal cavity, and retroperitoneum. Because the areas of fibrosis were observed in multiple lesions, her disease was diagnosed as multifocal fibrosclerosis accompanied with peculiar intracardiac masses. This systemic disease overlaps recently established clinicopathologic entity of IgG4-related systemic disease. However, the concept was not completely developed when the report was published, and we did not evaluate IgG4 expression in the plasma cells in this case. IgG4-related systemic disease was originally found in patients with autoimmune pancreatitis with elevated serum level of IgG4 [2]. Its histopathologic characteristics are diffuse lymphoplasmacytic infiltration with irregular fibrosis, occasional infiltration by eosinophils, obliterative phlebitis, and high ratio of IgG4-positive plasma cells/IgGpositive plasma cells. The spectrum of IgG4-related systemic disease has been expanding, but intracardiac lesion such as our case has not yet been reported. Accordingly, we have re-evaluated whether this peculiar case is IgG4-related systemic disease. Review of the slides revealed that our case had prominent fibrosclerotic lesions with infiltration of histiocytes and less number of plasma cells, compared with the histology of the recently reported cases of IgG4-related diseases [3]. Infiltration of eosinophils and obliterative phlebitis were not observed. The immunohistochemical analysis of IgG and IgG4 demonstrated that IgGpositive cells were scattered in fibrosclerotic lesions in the intracardiac masses and other fibrosclerotic lesions, but the ratio of IgG4-positive cells/IgG-positive cells was low. These results suggest that systemic fibroinflammatory disease accompanied with fibrosclerotic solid masses may not be specified as IgG4 related. Recently, Zen et al [4] reported that retroperitoneal fibrosis could be classified as IgG4 related or not. They raised an issue whether non–IgG4-related