**2. Digital pathology**

Digital pathology (DP) can be shortly demarcated and, probably, clearly defined as the digitalization of gross and microscopic tissue specimens subject to electronic capture of the photons as well as the management, analysis, and distribution of images. DP has been considered a terrific technology that is transforming the benchmark and protocols of work of pathologists after the impressive revolution operated in imaging radiology a decade earlier. Telemetric measurement of body temperatures in experimental animals implanted with commercially available transmitters has been automated using the Commodore C-64 microcomputer since the 1980s [3]. Also, in the 1980s, digitalization of 2D gels started, and high-performance liquid chromatographic system based on the Commodore 64 personal computer were common [4, 5]. The routine work of pathologists involves the identification of data and patterns in gross and microscopic tissue sections to deliver a diagnosis that can be rendered to the clinician and to the patient for further investigation or for starting therapy. The work of the pathologist is not quite different from the radiologist's job focusing on images, although most of the radiologic images are on black and white, while the pathologists use some dyes to facilitate the discrimination of morphologic structures on the tissue. The work of the pathologist is crucial in closing the loop, and reaching the diagnosis. The pathologist is also focusing on teaching. In the past, cases valuable for teaching were cut and mounted on glass slides that have been used to be projected using a film-based camera mounted on light microscopes and archival slides used for clinical rounds or multidisciplinary clinical team meetings as well as educational seminar presentations. This analog presentation was also used for forensic (medico-legal) purposes being broadly accepted in court proceedings for both civil and criminal law systems. Currently, archival tissue collections and new teaching cases are scanned and converted to static digital images. The images of gross and microscopic pathology specimens are continuously captured by digital cameras, tablets, iPads, phablets, and smartphones and the images downloaded via media card, universal serial bus (USB) interphase or wireless connections into personal computers or university servers for storage ready for teaching or discussion in the

**155**

*Digital Pathology: The Time Is Now to Bridge the Gap between Medicine and Technological…*

setting of multidisciplinary team clinical meetings. The digitized images may have different extensions such as tiff, jpg, and gif and the quality of the image increases proportionally with the number of pixels of the image or a digitized static image. The term "virtual microscopy" has been used to describe the acquisition, management, and storage of digitalized microscopic images [6]. Virtual microscopy systems are capable of complete digitization of the histology and cytology slides. This process is also known as whole-slide digitation or whole-slide imaging (WSI). In 1997, the first virtual microscopy system was described by the Computer Science Department at the University of Maryland and the Pathology Department at Johns Hopkins Hospital, Baltimore, Maryland [7, 8]. Fifteen years ago, in 2003, the European

Organization for Research and Treatment of Cancer (EORTC) printed the results of a

microscopy-aided systems. The digital microscopes aim to create a digital image from an analogic image detected with a light microscope. Conversely, diagnosis-aided systems can detect the region of interest (ROI) and give data arising from the analysis of biomedical signals. There are two different devices including the motorized microscopes and scanners. In the motorized microscopes, there are two classes of components. The first class includes pieces of proper light microscopy (e.g., eyepieces, multiple lenses, motorized revolver, position control, and spotlight control), while the second component deals with the capture of the images using a camera joined up to the microscope. The virtual microscopy devices include an optical microscope system, an acquisition system (photography/camera), a software program that controls the scan process, and a digital slide viewer. Optional components of the virtual microscopy include the slide feeder or image-processing programs. The most critical components are the light microscope and the acquisition camera. Good microscopy needs to have an optical quality of high level. The optical quality is largely determined by the quality of the lenses (objective) and by the class of the eyepieces. Good, quality objective lenses have a standard, which are achromatic lenses. Since diverse colors refract through a curved lens at different angles, an achromatic lens produces an enhanced, "flatter" specimen image of the specimen than it would otherwise be obtained. However, achromatic lenses are of less quality than semi-plan or plan objectives, which are "perfect lenses" and are typically required for sophisticated biological research with double the price of achromatic objectives. Also, it is useful to confirm that the objectives are DIN (Deutsch Industry Norm) compatible. DIN objectives are convenient since they are interchangeable. They are transposable from one DIN compatible microscope to another. The wider the eyepieces are, the easier the viewing. Thus, "widefield" (WF) or "super wide field" (SWF) eyepieces are crucial, although the wider the lens, the smaller eye ports, which means there is a decrease of the size of the magnification power. There are four primary categories of illumination: tungsten, fluorescent, halogen, and light-emitting diode (LED). Tungsten is the basic illumination for entry-level microscopes, but halogen and LED microscopes are of higher quality. Halogen produces strong, white light and usually, includes a variable rheostat with adjustable light intensity, while LED, especially if used with rechargeable batteries, makes the microscope fully portable with the opportunity to use it in environments with limited electrical outlets. Fluorescent lighting or epi-fluorescent microscopes are for biological research and similar applications. Moreover, the microscope should have an iris diaphragm and good quality condenser—preferably, an Abbe condenser which allows for greater adjustments and most good quality microscopes include iris diaphragms and Abbe

poll on virtual microscopy systems to that date [9]. Rojo et al. [10] provided a comparative description of 31 potential solutions available on the market as early as 2006 that can perform a whole slide imaging (WSI) or assistance in complete slide review for anatomic pathology applications. Digital imaging can be subdivided into two classes according to the aim, including the digital microscope and virtual

*DOI: http://dx.doi.org/10.5772/intechopen.84329*

#### *Digital Pathology: The Time Is Now to Bridge the Gap between Medicine and Technological… DOI: http://dx.doi.org/10.5772/intechopen.84329*

setting of multidisciplinary team clinical meetings. The digitized images may have different extensions such as tiff, jpg, and gif and the quality of the image increases proportionally with the number of pixels of the image or a digitized static image. The term "virtual microscopy" has been used to describe the acquisition, management, and storage of digitalized microscopic images [6]. Virtual microscopy systems are capable of complete digitization of the histology and cytology slides. This process is also known as whole-slide digitation or whole-slide imaging (WSI). In 1997, the first virtual microscopy system was described by the Computer Science Department at the University of Maryland and the Pathology Department at Johns Hopkins Hospital, Baltimore, Maryland [7, 8]. Fifteen years ago, in 2003, the European Organization for Research and Treatment of Cancer (EORTC) printed the results of a poll on virtual microscopy systems to that date [9]. Rojo et al. [10] provided a comparative description of 31 potential solutions available on the market as early as 2006 that can perform a whole slide imaging (WSI) or assistance in complete slide review for anatomic pathology applications. Digital imaging can be subdivided into two classes according to the aim, including the digital microscope and virtual microscopy-aided systems. The digital microscopes aim to create a digital image from an analogic image detected with a light microscope. Conversely, diagnosis-aided systems can detect the region of interest (ROI) and give data arising from the analysis of biomedical signals. There are two different devices including the motorized microscopes and scanners. In the motorized microscopes, there are two classes of components. The first class includes pieces of proper light microscopy (e.g., eyepieces, multiple lenses, motorized revolver, position control, and spotlight control), while the second component deals with the capture of the images using a camera joined up to the microscope. The virtual microscopy devices include an optical microscope system, an acquisition system (photography/camera), a software program that controls the scan process, and a digital slide viewer. Optional components of the virtual microscopy include the slide feeder or image-processing programs. The most critical components are the light microscope and the acquisition camera. Good microscopy needs to have an optical quality of high level. The optical quality is largely determined by the quality of the lenses (objective) and by the class of the eyepieces. Good, quality objective lenses have a standard, which are achromatic lenses. Since diverse colors refract through a curved lens at different angles, an achromatic lens produces an enhanced, "flatter" specimen image of the specimen than it would otherwise be obtained. However, achromatic lenses are of less quality than semi-plan or plan objectives, which are "perfect lenses" and are typically required for sophisticated biological research with double the price of achromatic objectives. Also, it is useful to confirm that the objectives are DIN (Deutsch Industry Norm) compatible. DIN objectives are convenient since they are interchangeable. They are transposable from one DIN compatible microscope to another. The wider the eyepieces are, the easier the viewing. Thus, "widefield" (WF) or "super wide field" (SWF) eyepieces are crucial, although the wider the lens, the smaller eye ports, which means there is a decrease of the size of the magnification power. There are four primary categories of illumination: tungsten, fluorescent, halogen, and light-emitting diode (LED). Tungsten is the basic illumination for entry-level microscopes, but halogen and LED microscopes are of higher quality. Halogen produces strong, white light and usually, includes a variable rheostat with adjustable light intensity, while LED, especially if used with rechargeable batteries, makes the microscope fully portable with the opportunity to use it in environments with limited electrical outlets. Fluorescent lighting or epi-fluorescent microscopes are for biological research and similar applications. Moreover, the microscope should have an iris diaphragm and good quality condenser—preferably, an Abbe condenser which allows for greater adjustments and most good quality microscopes include iris diaphragms and Abbe

*Interactive Multimedia - Multimedia Production and Digital Storytelling*

diagnostics and teaching are discussed.

**2. Digital pathology**

to read and execute central processing unit instructions) and 5G networks. This environment in information technology (IT) allows us a more efficient, stable, and faster communication than ever. Currently, the 5G network is considered the milestone that will open the conversation to the next level. There is crescent popularity, widespread use and increasing dependency on wireless technologies in our societies, both Western and Eastern civilizations. This demand has produced an unimaginable industrial revolution that may show some spectra of Orwellian nature [1]. There is increasing public exposure to broader and higher frequencies of the electromagnetic spectrum and data are transmitted as fast as never before [2]. The evolution from current 2G, 3G, and 4G to 5G wireless technologies is increasing worldwide. However, the promise of a convenient and comfortable lifestyle with a massive 5G interconnected telecommunications network has raised not only the expansion of broadband with shorter wavelength radiofrequency radiation but also highlighted the concern that health and safety issues may remain unknown [2]. Currently and in the future, the effects of radiofrequency electromagnetic radiation are and will be challenging if not impossible to identify epidemiologically. This challenge relies on the lack of an unexposed control group. Nevertheless, it is inconceivable to carry out some steps in our daily life without using the telecommunication network. In this chapter, some of the new exciting aspects of the evolution of digital pathology in

Digital pathology (DP) can be shortly demarcated and, probably, clearly defined as the digitalization of gross and microscopic tissue specimens subject to electronic capture of the photons as well as the management, analysis, and distribution of images. DP has been considered a terrific technology that is transforming the benchmark and protocols of work of pathologists after the impressive revolution operated in imaging radiology a decade earlier. Telemetric measurement of body temperatures in experimental animals implanted with commercially available transmitters has been automated using the Commodore C-64 microcomputer since the 1980s [3]. Also, in the 1980s, digitalization of 2D gels started, and high-performance liquid chromatographic system based on the Commodore 64 personal computer were common [4, 5]. The routine work of pathologists involves the identification of data and patterns in gross and microscopic tissue sections to deliver a diagnosis that can be rendered to the clinician and to the patient for further investigation or for starting therapy. The work of the pathologist is not quite different from the radiologist's job focusing on images, although most of the radiologic images are on black and white, while the pathologists use some dyes to facilitate the discrimination of morphologic structures on the tissue. The work of the pathologist is crucial in closing the loop, and reaching the diagnosis. The pathologist is also focusing on teaching. In the past, cases valuable for teaching were cut and mounted on glass slides that have been used to be projected using a film-based camera mounted on light microscopes and archival slides used for clinical rounds or multidisciplinary clinical team meetings as well as educational seminar presentations. This analog presentation was also used for forensic (medico-legal) purposes being broadly accepted in court proceedings for both civil and criminal law systems. Currently, archival tissue collections and new teaching cases are scanned and converted to static digital images. The images of gross and microscopic pathology specimens are continuously captured by digital cameras, tablets, iPads, phablets, and smartphones and the images downloaded via media card, universal serial bus (USB) interphase or wireless connections into personal computers or university servers for storage ready for teaching or discussion in the

**154**

condensers as standard. Finally, a mechanical stage is also valuable for compound microscopes. This situation is critical particularly when viewing specimens at high magnifications. A good camera is also a crucial component and a charged coupled device (CCD) sensor in the camera provides an analog signal. Digital cameras convert the analog signal into digital. It is important to choose the right image resolution or CCD size, i.e., the number of pixels the sensor can detect. The connection of the camera with the personal computer is through a FireWire port, and card adapters may be needed. In virtual microscopy, the high resolution can move at different speeds. There is about 32 mm/s (Zeiss Mirax Scan), or more at 38 mm/s (Aperio ScanScope T2), 41.22 mm/s (LifeSpan Alias), or even 180 mm/s (Olympus SIS.slide). The stage accuracy is about 1–3 μm, although some types can get accuracy or minimum distance of 2 nm (0.002 μm) to 15 nm (0.015 μm) for the z-axis and 250 nm (0.25 μm) for the x-axis and y-axis. About the computer hardware, most DP solutions should be based on workstations with at least two microprocessors, 2.8– 3.6 GHz or higher, and at least 4 GB of random-access memory (RAM). The operating system used by the control devices and the workstations is usually Windows XP Professional, Vista, 7, 8 or 10 (Microsoft Redmond, Wash.). The endorsed way for handling the storage is using centralized (enterprise) storage servers of the hospital or healthcare institution. This solution may not be an option if IT personnel or healthcare administrators raise security issues. Thus, alternatives would use intranet servers or with storage up to 100 terabytes (TB). Recently, the Nimbus Data company unveiled a new 100 TB solid-state drive (SSD) making it the world's largest SSD currently available. Different from the hard-disk drive (HDD), an SSD is like a memory stick. There are no moving parts and information is stored in microchips. Nimbus Data developed advanced flash memory solutions that power data-driven innovation and one of these solutions include ExaFlash® All-Flash Arrays and ExaDrive® Solid State Drives. This solution is accelerating data storage, simplifying data management, and improving data protection for cloud infrastructure, data analytics, AI-rich content, high scientific computing, and numerous other applications that may be considered unconceivable currently. However, the minimum recommended configuration should include six disks, each of 300 GB (0.3 TB); 10 k rpm hot swap for a total of 3.8 TB. All virtual microscopy solutions comprise a flat thin film transistor (TFT) monitor (20–23 inches). These screens must be high resolution with a TFT screen of 2560 × 1600 pixels, with 200-ppm resolution. This screen size allows a visual field four times larger than the standard microscope field of view. Different aspects should be considered during the digitalization process, such as the digitization speed, the maximum size of the sample, the focus quality, the digitization at diverse planes, the procedures for slide scanning and image assembling (with or without correction), and the formats used to store the scanned samples. The digitization speed, also known as total scanning time, is probably one of the most important aspects to consider before choosing among these systems. The evaluation should be based on specific factors. It is wise to list the area size to be scanned and the objective lens used (e.g., ×20 or ×40 as objective). Further, we list the charge-coupled device (CCD) camera size, the model of motorized stage, the required time on the previsualization stage, the time for a panoramic view, the selection of the area of interest, the choice of focusing method, as well as the number of points (focusing) needed. It is crucial to remember that slides with irregular surface require a higher number of points, which reduces the scanning speed. Moreover, it is important to consider the number of planes at the z-axis to be digitized, the speediness to obtain data from the CCD camera to the personal computer (PC), and the transfer from the PC to the storage device. Devices with a slide feeder have time to upload and download a slide in about 6–8 seconds, which is a good time for many laboratories. The total time, including the code bar reading, maybe around 15 seconds. The total

**157**

*Digital Pathology: The Time Is Now to Bridge the Gap between Medicine and Technological…*

necessary bandwidth on networks, requirements for storage, user interfaces, improvement of focusing, and detection of tissue or cytology areas. The intellectual process of analyzing and interpreting pathology images to provide a final diagnostic is one of the central aspects of the pathologist's work. Therefore, both image and report must always include the name of the consultant pathologist and department where that intellectual work has been performed. The enterprise-centralized and electronic storage is the best option and should be based on what is labeled the

scanning surface is forced to the motorized stage used and to the histologic slide type. The number of focusing points, also known as "focusing map" may be manual or automatically set. Multiple planes digitization through the z-axis may be a requirement for visualizing thick tissue slides or cytology slides with 3D clusters. Thus, the scanning system should work similar to the microscope fine focus control of the light microscopy on conventional histologic slides. Different systems can provide the digitization through the z-axis, at least in one area of the slide. For diagnostic purposes, scanning only a region of interest is not an option, because the pathologist may need to scan on the whole slide. Thus, WS Scanning method and stitching may be an option in some cases. Typically, the acquisition of microscopic fields is squareby-square, from the slide's upper left corner to the lower right one and the final image is a mosaic composed of multiple files. The assembling procedure of the slide squares may be performed in two different ways. We can use a mechanical adjustment tiling the borders of each fragment. Alternatively, we can use some software adjustment, which stitches the images. The final result may be considered as multiple files (typically thousands of Joint Photographic Experts Group or JPEG files)—in one or several folders, several files with one or multiple resolutions with the method used by Zeiss Mirax Scan and Zoomify viewer, and/or a single compressed file (JPEG2000, JPEG, TIFF). Flashpix (MicroBrightField Virtual Slide), or other formats (VSI extension in Olympus SIS.slide, .svs) may be encountered. SVS files are used by some medical/microscope scanners such as Aperio, scan scope (AxioVision), and others. They are essentially based upon the TIFF format and utilize the tiled image capabilities. Digital Slide Visualization and processing include x-axis and y-axis movements (lateral and vertical) displacement through the screen, objective shifting or zooming, displacement of the z-axis, and the x-axis and y-axis movements. One of the original problems was the low screen refreshment during the horizontal and vertical displacements. This disadvantage was due to the large amount of data that needed to be transferred between the different parts of the computer (central processing unit, hard disk, graphic card, and memory) or through the communication network. The fragmentation of the images may be quite disturbing for the pathologist who needs to review several files for diagnostic purposes. A solution is partitioning large images into small pieces according to the required magnification and buffering adjacent pieces (prefetching) in the viewer. However, quad-core processor based computer and 5G networks may be part of the solution as well. Histological slides, and especially cytopathology slides, may require the capture of multiple z-planes to get a perfectly focused image. Simultaneous and synchronized displacement on multiple windows is also useful options. Moreover, it is possible to include bookmarks on digital slides, facilitating the retrieval of interesting positions in subsequent case reviews. Virtual slides can be visualized and interpreted simultaneously by several consultants in pathology creating the virtual "multi-headed microscope" allowing innumerable users to review the same areas considering that not only one takes control of the session. Thus, different pathologists can review different parts of the same slide at the same time. Most of the systems can scan a digital slide using the highest image quality available (objective ×40) in about 1 hour. This time may be a limiting factor and shortening to 10–15 minutes should be a choice in the future. Future systems should improve the technical aspects, such as the scanning speed, the

*DOI: http://dx.doi.org/10.5772/intechopen.84329*

#### *Digital Pathology: The Time Is Now to Bridge the Gap between Medicine and Technological… DOI: http://dx.doi.org/10.5772/intechopen.84329*

scanning surface is forced to the motorized stage used and to the histologic slide type. The number of focusing points, also known as "focusing map" may be manual or automatically set. Multiple planes digitization through the z-axis may be a requirement for visualizing thick tissue slides or cytology slides with 3D clusters. Thus, the scanning system should work similar to the microscope fine focus control of the light microscopy on conventional histologic slides. Different systems can provide the digitization through the z-axis, at least in one area of the slide. For diagnostic purposes, scanning only a region of interest is not an option, because the pathologist may need to scan on the whole slide. Thus, WS Scanning method and stitching may be an option in some cases. Typically, the acquisition of microscopic fields is squareby-square, from the slide's upper left corner to the lower right one and the final image is a mosaic composed of multiple files. The assembling procedure of the slide squares may be performed in two different ways. We can use a mechanical adjustment tiling the borders of each fragment. Alternatively, we can use some software adjustment, which stitches the images. The final result may be considered as multiple files (typically thousands of Joint Photographic Experts Group or JPEG files)—in one or several folders, several files with one or multiple resolutions with the method used by Zeiss Mirax Scan and Zoomify viewer, and/or a single compressed file (JPEG2000, JPEG, TIFF). Flashpix (MicroBrightField Virtual Slide), or other formats (VSI extension in Olympus SIS.slide, .svs) may be encountered. SVS files are used by some medical/microscope scanners such as Aperio, scan scope (AxioVision), and others. They are essentially based upon the TIFF format and utilize the tiled image capabilities. Digital Slide Visualization and processing include x-axis and y-axis movements (lateral and vertical) displacement through the screen, objective shifting or zooming, displacement of the z-axis, and the x-axis and y-axis movements. One of the original problems was the low screen refreshment during the horizontal and vertical displacements. This disadvantage was due to the large amount of data that needed to be transferred between the different parts of the computer (central processing unit, hard disk, graphic card, and memory) or through the communication network. The fragmentation of the images may be quite disturbing for the pathologist who needs to review several files for diagnostic purposes. A solution is partitioning large images into small pieces according to the required magnification and buffering adjacent pieces (prefetching) in the viewer. However, quad-core processor based computer and 5G networks may be part of the solution as well. Histological slides, and especially cytopathology slides, may require the capture of multiple z-planes to get a perfectly focused image. Simultaneous and synchronized displacement on multiple windows is also useful options. Moreover, it is possible to include bookmarks on digital slides, facilitating the retrieval of interesting positions in subsequent case reviews. Virtual slides can be visualized and interpreted simultaneously by several consultants in pathology creating the virtual "multi-headed microscope" allowing innumerable users to review the same areas considering that not only one takes control of the session. Thus, different pathologists can review different parts of the same slide at the same time. Most of the systems can scan a digital slide using the highest image quality available (objective ×40) in about 1 hour. This time may be a limiting factor and shortening to 10–15 minutes should be a choice in the future. Future systems should improve the technical aspects, such as the scanning speed, the necessary bandwidth on networks, requirements for storage, user interfaces, improvement of focusing, and detection of tissue or cytology areas. The intellectual process of analyzing and interpreting pathology images to provide a final diagnostic is one of the central aspects of the pathologist's work. Therefore, both image and report must always include the name of the consultant pathologist and department where that intellectual work has been performed. The enterprise-centralized and electronic storage is the best option and should be based on what is labeled the

*Interactive Multimedia - Multimedia Production and Digital Storytelling*

condensers as standard. Finally, a mechanical stage is also valuable for compound microscopes. This situation is critical particularly when viewing specimens at high magnifications. A good camera is also a crucial component and a charged coupled device (CCD) sensor in the camera provides an analog signal. Digital cameras convert the analog signal into digital. It is important to choose the right image resolution or CCD size, i.e., the number of pixels the sensor can detect. The connection of the camera with the personal computer is through a FireWire port, and card adapters may be needed. In virtual microscopy, the high resolution can move at different speeds. There is about 32 mm/s (Zeiss Mirax Scan), or more at 38 mm/s (Aperio ScanScope T2), 41.22 mm/s (LifeSpan Alias), or even 180 mm/s (Olympus SIS.slide). The stage accuracy is about 1–3 μm, although some types can get accuracy or minimum distance of 2 nm (0.002 μm) to 15 nm (0.015 μm) for the z-axis and 250 nm (0.25 μm) for the x-axis and y-axis. About the computer hardware, most DP solutions should be based on workstations with at least two microprocessors, 2.8– 3.6 GHz or higher, and at least 4 GB of random-access memory (RAM). The operating system used by the control devices and the workstations is usually Windows XP Professional, Vista, 7, 8 or 10 (Microsoft Redmond, Wash.). The endorsed way for handling the storage is using centralized (enterprise) storage servers of the hospital or healthcare institution. This solution may not be an option if IT personnel or healthcare administrators raise security issues. Thus, alternatives would use intranet servers or with storage up to 100 terabytes (TB). Recently, the Nimbus Data company unveiled a new 100 TB solid-state drive (SSD) making it the world's largest SSD currently available. Different from the hard-disk drive (HDD), an SSD is like a memory stick. There are no moving parts and information is stored in microchips. Nimbus Data developed advanced flash memory solutions that power data-driven innovation and one of these solutions include ExaFlash® All-Flash Arrays and ExaDrive® Solid State Drives. This solution is accelerating data storage, simplifying data management, and improving data protection for cloud infrastructure, data analytics, AI-rich content, high scientific computing, and numerous other applications that may be considered unconceivable currently. However, the minimum recommended configuration should include six disks, each of 300 GB (0.3 TB); 10 k rpm hot swap for a total of 3.8 TB. All virtual microscopy solutions comprise a flat thin film transistor (TFT) monitor (20–23 inches). These screens must be high resolution with a TFT screen of 2560 × 1600 pixels, with 200-ppm resolution. This screen size allows a visual field four times larger than the standard microscope field of view. Different aspects should be considered during the digitalization process, such as the digitization speed, the maximum size of the sample, the focus quality, the digitization at diverse planes, the procedures for slide scanning and image assembling (with or without correction), and the formats used to store the scanned samples. The digitization speed, also known as total scanning time, is probably one of the most important aspects to consider before choosing among these systems. The evaluation should be based on specific factors. It is wise to list the area size to be scanned and the objective lens used (e.g., ×20 or ×40 as objective). Further, we list the charge-coupled device (CCD) camera size, the model of motorized stage, the required time on the previsualization stage, the time for a panoramic view, the selection of the area of interest, the choice of focusing method, as well as the number of points (focusing) needed. It is crucial to remember that slides with irregular surface require a higher number of points, which reduces the scanning speed. Moreover, it is important to consider the number of planes at the z-axis to be digitized, the speediness to obtain data from the CCD camera to the personal computer (PC), and the transfer from the PC to the storage device. Devices with a slide feeder have time to upload and download a slide in about 6–8 seconds, which is a good time for many laboratories. The total time, including the code bar reading, maybe around 15 seconds. The total

**156**

Picture Archiving and Communication System (PACS), which will permit an efficient way of seeking pathology images. This aspect will be possible, thanks to the Digital Imaging and Communications in Medicine (DICOM) image format, which is being used for radiology images and adapted to be also used for pathology images.
