Practice Tips & Efficacy Corner

As of May 2, 2012, the ACMS officially purchased a Leica SCN400 slide scanner which is considered a fast, reliable and flexible way to scan and digitize Mohs slides. Dr. Fred Fish, III, a member of the Board of Directors (2010 - 2013), spearheaded the campaign to purchase this machine due to the benefits that it will provide the ACMS and all of its members for a long period of time.

Dr. Fish allowed us the opportunity to ask him a few questions about the slide scanner to relay to the membership.

1. What was your main drive behind proposing that the ACMS purchase a slide scanner?

The Mohs College has been involved with slide review for a number of years, and we have been looking for a way to streamline and improve the process. The technology has finally arrived so that high quality images can be produced for review by slide scanners. The slide scanner allows for remote review of the slide material once it is scanned in. It permits tremendously greater efficiency and uniformity of review. All reviewers will have the same images to examine, and review can occur either via a conferencing option or individually. The scanner will also provide a platform for developing a teaching library as well as CME programs and educational modules.

2. Describe how the Board vetted and ultimately chose this slide scanner.

The ACMS Board of Directors looked at several brands of slide scanners available on the market. Ultimately, we chose the Leica SCN400 based on its technology, extensive software options and ease of use. In Chicago, while at the ACMS Annual Meeting, we were all give the opportunity to see and view the machine in person and meet with the sales representatives for Leica to make the final arrangements for purchase. Aside from the scanner itself, the Board approved purchase of additional software that will benefit in other areas aside from just basic slide scanning.

3. What do you anticipate being the short-term uses of the slide scanner?

In the short term, at next year's annual meeting, we anticipate having a portion of the DQC exam be computer-based. Ultimately, we will look to phase out the slide/microscope viewing entirely and move to an all-electronic version of the DQC exam.

The slide scanner will be housed in the administrative building of the ACMS (Executive Director, Inc. in Milwaukee, Wisconsin). Once the machine is in place, we will work on establishing training, both for staff and member users. We plan on having several opportunities for training and general overview for College members as to the uses of the slide scanner and how to go about sending in slides, etc. This is very user-friendly technology, which we feel will benefit all members in the long run.

4. What do you anticipate being the long-term uses of the slide scanner?

After the initial education phase, we anticipate there will be a number of long-term uses. We are planning to work with the ACGME and the RRC to establish a slide review program for the ACGME fellowship programs.

Secondly, with the establishment of the Centers of Excellence Program, under Dr. Tom Stasko, the slide scanner will be put to use as an element of establishing a center for excellence. It will allow for a larger volume of slides to be reviewed in an efficient manner with easy access to high quality images for the reviewers.

Thirdly, ACMS is in the processes of becoming CME certified, meaning in the next few years, we will no longer have a third party accreditation service for our meetings and other educational services. This will allow for year-round CME opportunities, not just once-per-year at the Annual Meeting, and we can use the slide scanner to assist in setting up quality control reviews and exams to gain CME credits on an ongoing basis.

Fourthly, an ultimate goal of the slide scanner is to build a teaching library, accessible to all ACMS members. The slide scanner will solve the problem we had in previous attempts to create a slide library, which is decaying stains and compromised slides after a few years in storage. Scanning and storing the slides online will allow for review of slides long after the original slide is no longer able to be interpreted. Additionally, this could open the door for members to send in slides of difficult cases, to be reviewed by a group of peers online.

Fifthly, we hope to work with the RRC and ACGME fellowship programs to develop teaching modules for fellowship training. This will ensure a consistent element of training in pathology across all fellowship training programs.

Last, but not least, we foresee the ASMH (American Society for Mohs Histotechnology) being able to utilize the slide scanner for their MTQA (Mohs Technology Quality Assurance) program. Currently, this program is all manual and is not held as often as it should ideally be.

5. What do you anticipate to be the main benefit for the ACMS having the slide scanner on hand?

The all-encompassing benefit of the slide scanner will be providing the ACMS membership with cutting-edge technology that will facilitate slide review and serve as a platform for improving slide quality, while educating our membership about new discoveries and techniques in pathology that are pertinent to Mohs surgery. This cutting-edge technology will help to ensure that the Mohs College and its members continue to be at the forefront of Mohs surgery.

Fiona Zwald, MD
Emory University