Over and above its ability to detect cell types, the programme was useful because of its ability to store and share images. From 2010, with the help of Professor Didier Cataldo, co-director of the laboratory of Tumor & Development Biology at the University of Liège, the Cytomine platform was in the process of development at GIGA. Its early successes allowed it to go from 5 users then to over 100 today, coming from the CHU and from the university at large. “We have opened up a similar service for students in histology,” Stévens said. “There are more medical students every year, and the faculty has to confront new problems of organization, especially where laboratory practice is concerned. Ideally, we need one microscope for each student, which is a great expense. Then, every student needs a slide for every exercise. We can’t repeat the same samples, and some are not as good as others. Getting good quality slides can quickly become a matter of difficulty. In addition, with the microscope the professor does not see what the student sees. Sometimes students miss questions because they did not observe closely enough. For so many students, microscopes are not very practical.”

Cytomine aims at offering obvious solutions to these problems. The lab is no longer obliged to own hundreds of microscopes, and a single good quality slide can be digitized and studied by all students at the same time, while the programme tracks their progress in observation. In an effort to stimulate interest, some teachers annotated certain parts of certain images in order to generate exam questions or student exercises. They present samples along with questions aimed at finding out if students have observed what they needed to observe. It would be possible to make a game out of certain searches, so that at every step students are alerted (with flags or other signals) regarding what they are supposed to be looking for. The programme thus has interactive pedagogical implications.

Today, over 1,000 student and faculty accounts are registered to use the programme. The team will participate along with the faculty of the medical school and with IFRES in the Histoweb project, an extension of Cytomine for teachers and professors, which will look for novel teaching methodologies, including online exercises intended to be carried, outside of class. “We will see when each student logs on. We will track them with a tool (with their permission) that will record some information about the way they prepare for their exams. We will be able to correlate these observations with eventual test scores as a means of improving students’ study skills”.

In the emergency room

Outside of research and teaching, Cytomine could be valuable in a crucial setting, the clinical one: “This is an area where the replacement of microscopes is a controversial subject all by itself,” the researchers say. “Pathologists have to accept the technology. The diagnosis they produce based on an image has to be as good or better than the diagnosis based on something actually seen through a microscope.” There are three areas of potential difference. First, the possibility that digital compression of the image has altered it; next, the resistance of human experts to this technological change; finally, the eyes have it, because the field of vision presented on a flat screen is always smaller than the field of vision the eyes see through the microscope, including everything the eyes see, so that one can see right down into cells.

The mechanism of change is engaged, however. Taking into account only those who teach, the next generation of pathologists will have trained on flat screens. The leading microscope makers have accepted this change, and are now offering slide scanners at lower prices (a high speed scanner still costs about 200,000 Euros). At this moment, the CHU of Liège is asking this technology in specific kinds of cases. “For example,” according to Stévens, “when a surgeon operates, sometimes he wants to take a sample from a patient and have it analyzed quickly by a pathologist before going on. In a network of hospitals like the CHU of Liège a pathologist is not available at all hours, or in the right location. So an emergency call goes out, and the pathologist may spend quite some time driving for just a few minutes work with a microscope. With this technology the doctor can take the sample, and a technician can immediately digitize it. The pathologist gets the image as an e-mail and is able to answer the surgeon’s questions in a few minutes, after which the operation can continue.