Digital image documentation for quality assessment

Objective.-To demonstrate the feasibility of the use of digital images to d ocument routine cases and to perform diagnostic quality assessment. Methods.-Pathologists documented cases by acquiring up to 12 digital images per case. The images were sampled at 25:1, 50:1, 100:1, 200:1, or 400:1 ma gnifications, according to adequacy in aiding diagnosis. After each acquisi tion, the referral pathologist marked a region of interest within each acqu ired image in order to evaluate intrinsic redundancy. The extrinsic redunda ncy was determined by counting the unnecessary images. Cases were randomly selected and reviewed by one pathologist. The quality of each image, the po ssibility of accomplishing a diagnosis based on images, and the degree of a greement was evaluated. Results.-During routine practice, 1469 cases were documented using 3902 ima ges. Most of the images were acquired at higher power magnifications. From all acquired cases, 143 cases and their 373 related images were randomly se lected for review. In 88.1% (126/143) of reviewed cases, it was possible to accomplish the diagnosis based on images. In 30.2% (38/126) of these cases , the reviewer considered that the diagnosis could be accomplished with few er images. The referral pathologist and the reviewer found intrinsic redund ancy in 57.8% and 54.5% of images, respectively. Conclusions.-Our results showed that digital image documentation to perform diagnostic quality assessment is a feasible solution. However, owing to th e impact on routine practice, guidelines for acquisition and documentation of cases may be needed.