167: Future of Pathology AI, Training & The Next Generation of Diagnostics

Live from Pathology Visions 2025 in San Diego, I share highlights from Day 2 of the world’s leading digital pathology conference, where experts explored how AI, empathy, and training are shaping the next generation of pathologists.

This episode captures the shift from technology as a tool to technology as a bridge — helping us connect with patients in more meaningful ways.

What I Talk About

1️⃣ From Pixels to Patients
We’ve built the infrastructure; now it’s about applying it. Pathology is no longer just digital — it’s personal, accessible, and human-centered.

2️⃣ Dr. Leah Lijah Joseph’s Keynote — Pathologists as Patients
Dr. Joseph, a cancer pathologist and survivor, shared her journey from diagnosing others to understanding her own slides. She now runs a patient pathology clinic, empowering people to see and learn from their own tissue samples.

3️⃣ The Power of Visualization
Dr. Joseph described how visualization and mental imagery support healing — a reminder that empathy and imagination can coexist with precision science.

4️⃣ AI & Imaging Innovation
From Google Research’s JPEG AXL format reducing file size by 30%, to discussions on color fidelity with DICOM’s David Clooney, we explored how innovation and accuracy must move hand-in-hand.

5️⃣ Cytology Goes Digital
With Hologic’s Genius Digital Diagnostic and AIXMed’s AI-assisted QC, cytology is entering a new era — faster, more accurate, and fully traceable through 100% AI quality control.

6️⃣ The Human Side of AI
I also share a personal story about my mother’s medical experience — and how even with all the tech, empathy remains the missing link. AI can’t replace compassion, but it can help us focus on it by automating what takes time away from patients.

Key Takeaways

• AI is enhancing accuracy and accessibility in diagnostics.
• Pathologists are taking on more patient-facing roles.
• Cytology digitization is revolutionizing quality and speed.
• Innovation must balance efficiency with color and data integrity.
• Empathy and communication will always define great medicine.

I hope this episode helps you see how AI, empathy, and education are shaping the next era of diagnostics.

Let’s continue building the bridge from pixels to patients, one slide at a time. 💡

#PathVision25

Transcript

00:00:03 - 00:01:23
Welcome my trailblazers. Uh last day of the pathology visions conference from San Diego reporting live to you from live stream. This one's going to be a short one but [Music] I definitely don't regret coming here. The updates from the conference uh are that uh we there were more than a thousand uh sub subscribers I wanted to say attendees. This is the biggest path visions to date. They are growing every year. Last year I think it was 800 people. Now it's over a thousand and they're expecting a few walk-ins today.


00:00:44 - 00:02:07
I'm going to switch on the chat so that they can see your messages if you're there. So um that's one thing. So so the biggest uh path visions to date. So this is the biggest com digital pathology conference in the US and in the world. Uh so if you're interested in digital pathology, this is the place to be and h as I told you for the last past days the through line is pixels to patients. So we have the infrastructure figured out more or less you know people are collaborating we're


00:01:24 - 00:03:05
trying to be more interoperative and now well not now it was in the from the very beginning it was with the patient in mind but now actually we prepared the baseline the floor to do it and um I hope I'm not going to cry. because the the keynote was pretty moving. So the the the keynote was by um Dr. Leah Lijah Joseph and uh by DD O'Brien. So Dr. Leah Joseph is a pathologist. She was a guest at on the digital pathology podcast and what she did and they uh DD and Nija they were both patients as well. So they


00:02:15 - 00:03:39
were talking about their experience and um it's always fascinates me how a pathologist is experiencing cancer. I hope I can maybe interview more pathologists who had cancer how do they go through their cancer journey. Um and but the long story short even though they know even though they uh like diagnose cancer all day long for a living when they are the patient they experiencing everything as any other patient experiences. So um there is a poem the digital pathology association u published from this keynote uh on


00:02:57 - 00:04:29
LinkedIn. So I encourage you to go and check their website. Let's see if you can see well website and LinkedIn feed as well. Um they were po posting from the conference. So uh a patients if only by DD O'Brien they were my life my everyday. Oh my goodness. I cannot like read it through be without um starting to cry but let me try. They were my life, my everyday. I'd lose them soon. I knew. As each one's journey took its turn, I asked, "What can I do to find a way to keep them longer? More


00:03:43 - 00:05:17
laughter, love to share more, more memories that would sustain me when they're no longer there." All right. Breathe. To understand the path they're on, to comfort them. But how? So many questions left unanswered. Why him? Why her? Why now? It's natural curiosity and need to learn to see to not just accept as simply what will be will be. If we could understand the mystery behind behind their time to go, we could embrace each other's journeys. If only we could know. Okay. Let me calm down


00:04:29 - 00:06:03
now from the crying from the poem. Anyway, what I want to say with this is not necessarily cry online which sometimes happens when I uh hear these moving stories but uh what they conveyed with this keynote and I heard uh a lecture by Dr. Liia last year's at the digital diagnostics summit is that um pathologist is can be a part of patient care and what Dr. Joseph did she opened or organized a patient pathology clinic like open hours where path where patients can look at their slides. uh she or one of her


00:05:19 - 00:06:36
pathologist is going to sit with the patient and tell them what's on this slide why what they see on this slide is guiding the treatment in this way or another way. uh why maybe they had to have more procedures than just one procedure by showing them the the margins in some of the sections were not clean. But basically like showing them tangibly what it what these cells look like. She shared um other stories as well like uh that people figure out different way of coping with this situation with um


00:05:59 - 00:07:38
trying to heal themselves. And one of them are pretty powerful and it has been already proven in uh clinical trials that visualization and the um um like power of of placebo so to say power of mental work on um your condition can help you heal can help you enhance the drug uh efficacy. But uh one person wanted to just have a picture of this tumor on their medicine um bottle to every day look at it and imagine this very image of the tumor shrinking. So uh like giving this possibility to the patients giving these


00:06:48 - 00:08:10
pixels these digital uh whole slide image pixels to the patients in one way or another. Obviously uh this is a complex um environment the medical environment but uh patients are part of the care journey. uh they are more and more educated, understand more and more and have better tools to understand it. So including them in this journey is just going to like even more and and being there for them as a pathologist as well because a pathologist is always seen as the behind the scenes doctor, the one


00:07:29 - 00:08:46
that provides information to the um to the treating physician. But as she showed in her example, they are now partner in patient care and it's important for the patients to understand. So um and obviously this is digital pathology conference. So she I think she does it on a multi-headed scope and shows it to the patient. Um no I think uh it's on the on the screen that she she projects it from the microscope to the screen and then she shows on the screen. So this is already uh one way of digitization but


00:08:08 - 00:09:43
this could be done um and the patients have to um come in person but digital pathology could totally be leveraged for that for remote consultations like that for remote education of patients like that. So the power of digital pathology uh in connecting the patients with the pathologists with whatever like led to the a particular treatment that they are now undergoing and this is like next level. So and she's next level. Both of the speakers uh were next level. So if you are not at the conference and um when DPA digital


00:08:55 - 00:10:01
pathology uh association releases the recordings and if they're available for purchase definitely purchase if you're even like remotely thinking about digital pathology. Um just go through what people are talking about here because this is the cutting edge. This is what's happening now. They want to be here. They want to present it. uh they want to tell you what's what's happening. So um yeah, after the a little bit emotional update on the keynote, let me give you more technical updates because


00:09:27 - 00:10:31
I had the um so here I had the honor to be a host for a podcast with Dr. Joseph. So I know her and she was sitting behind me uh yesterday in one of the lectures and then she taps me on this should on the shoulder and says hi and so many digital pathology trailblazers did that. So thank you so much. I know that um this can be intimidating when somebody's like walking with the camera trying to record. I know people don't feel comfortable in front of the camera. So I know people like removing themselves


00:10:01 - 00:11:09
from the field of view when I'm creating content. But then when the camera is off, a lot of people just tap me on the shoulder and said, "Hey, I listen to your podcast. Hey, I watch your videos. I look at uh what you create on LinkedIn." So, this basically keeps me going. So, a big thank you to all the digital pathology trailblazers who are here, who are tuning in virtually, and h it just makes my work worthwhile. like every time I experience something like that, I want to keep going. Uh so


00:10:35 - 00:11:38
then now the technical more technical stuff and you know these are just fragments. H what I'm going to do for you because obviously I didn't attend all the lectures I attended the ones I could but I am definitely going through all the recordings once they are available h and they're going to be a comprehensive uh write up about this. I know that signify research is going to have a write up on this. So go to their website pathology news their medical writer is here capturing every uh important


00:11:06 - 00:12:25
information from this conference. So um all the digital pathology media outlets are working hard for you to uh get the most up-to-date information even if you're not attending in person. So then um I go to this lecture that was the lecture I told you about yesterday about how uh veteran veteran administration and joint pathology centers are embracing digital pathology, embracing AI and then on one hand uh on one side I have Kenneth Filbrick from uh Google uh from Google research um and then on the


00:11:46 - 00:12:46
other side I have David Clooney. So no, first first I had uh I had Kenneth. I spoiled the story but whatever. So Kenneth is on my right h and I'm asking him, hey Kenneet, what are you presenting this year? Because last year Google presented um their like an environment for developer for developing um AI models. So this year I'm like Kenneth are you presenting? Of course I'm presenting. What time? Oh, today at whatever time like at 2 o'clock I don't know just don't um I don't remember but


00:12:17 - 00:13:23
I remember that I would have to be at the airport. So I'm like ah shoot I will miss your presentation. So he opens the laptop and shows me the presentation which he did last year as well. So uh you guys are fantastic everybody who is here and showing me their presentations in private if I can't attend the talk. Uh this is amazing and thank you so much. So he shows this presentation and tells me about oh there is this new like uh version of diccom it's called uh JPEG AXL and he shows me how this uh uh new


00:12:49 - 00:14:04
format can compress and decompress lossless decompression uh like the diccom discussions are very technical so um excuse my superficiality on this particular topic but it was just so funny. So he talks about how this fantastic uh this format is so great and how he likes it and how he uh is glad that it compresses. You can compress up to 30% of the image and if you know like these images are huge like one of them can like a full resection can be as much data as a 2hour HD movie. So uh this is serious right? So if you figure out a


00:13:27 - 00:14:28
format that can compress it and recompress it fantastic. And then David Clooney comes passes and sits on my other side. H and I'm like, "Oh yeah, David, you guys have this new uh JPEG XL." And he's like, "Let's see what kind of a disaster it's going to be." And I'm like, "What? You are like the medical image format expert. You like live and breathe dam." And they basically obviously as uh with every technology there are different sides of the same


00:13:57 - 00:15:14
coin. And um Kenneet was pretty enthusiastic and they both said that oh yeah I'm like more glass half full and he's more glass half empty on this one. Uh and obviously reality and the implementation in integration is going to uh show. It was so cool to just like have these two experts uh on this particular topic like semi not not arguing but like having this uh disagreement with each other and that was so nice. Then I had a chance to sit with David uh a little bit longer after after the um


00:14:36 - 00:15:40
when they were closing the exit hole. Uh I was I missed dinner and uh then people the the people who were cleaning the dishes uh they I just asked one of them, "Hey, do you have any food left?" Cuz I was so hungry. And he was so fantastic. He said, "What do you like what do you want? What do you eat?" And I'm like, "I eat anything." I'm just like very hungry because I missed the meal times. and he goes to the kitchen and brings me out a full tray of one of these snacks that


00:15:07 - 00:16:33
they were uh they were giving during the exhibit hall opening. I thought that was so sweet. That was just so nice. So, I I had that for dinner. Uh maybe on my end I should plan better and make healthier choices. But on the other hand, I I thought this was really heartwarming as well. So I have this like plate of these rolls or whatever that was and uh David was there. So we we talked a little bit and um he was explaining to me uh about what the uh consequences of JPEG XL uh might be and it comes down or at least


00:15:51 - 00:17:02
the uh thing I understood the best was that it comes down to color and color representation. And oh my goodness, the caller question in digital pathology uh like it's like almost a philosophical discussion. So I recently um had a guest uh Tom Kimpe from Barco and they have medical displays medical grade displays and one of uh the displays that they have I don't know they probably have more but one of the ones that they were showing at their booth was specific for digital pathology and we had like a


00:16:26 - 00:17:46
really long podcast one and a half hour on the importance of color and he was uh explaining the color spaces and like oh my goodness diving deep into color for uh medical imaging is like next level of expertise and obviously both Tom uh my podcast guest and David have this expertise so he was trying to explain the color to me and why JPEG uh may cause trouble um and basically um what he told me that the color information in the normal DICOM is kind of like assigned to all tiles when you um when


00:17:07 - 00:18:15
you do the format and then compress recompress whatever this color um and it's probably the it's usually the ICC profile international color consortium profiles and if you are a color expert and you hear me saying something that is incorrect just put it in the comment and tell me okay at this time stamp you said something and actually it's uh something else like don't hesitate to correct uh anything that needs to be corrected just you know we do it respectfully Y h and then everybody benefits. So yeah the the


00:17:41 - 00:18:45
the normal diccom has like this color information applied to the whole whole all the tiles. So if you like compress tiles and recompress uh they get the same color information let's assume it's the international colum color consortium profile and each tiles get that. When you do the JPEG XL, you would need to have this color profile with every tile and that significantly increases the size of the tile because sometimes tiles are very small but the coral color profile would have to go uh with each


00:18:13 - 00:19:22
tile like it's the same color profile and sometimes it can exceed the size of the tile. So what do you do? Like you somehow kick it out and then when you recompress it may look different color-wise. Um, so who takes responsibility for the color reproducibility? And like when I was listening to him, I'm like, "Oh my goodness, this is like a whole philos not philosophical, it's physics." But to me it sounds like philosophy a little bit on the color and um I always remember so for pathologist the information in


00:18:50 - 00:20:11
the color is crucial but I also remember an instance where um I was uh I had two monitors with different IHC slides and I was working um I don't know what I was doing why I even had two slides on two monitors. Usually I just use one but um it was um there was an audit as well and an auditor uh came to me and asked this questions like why uh like you have two monitors they look these colors look differently and um my response was well yes they do uh but also the slide is a a self-referencing entity so when I am


00:19:30 - 00:20:48
looking at the slide I know what is the level of my background and it doesn't really h for my evaluation for my scoring um like it's like it has to be good enough so the um monitor the screen has to be high quality and I have to see the um necessary color gamut that I can perceive but if it looks slightly different on a different monitor I still have my information to compare to like uh if something is hyper xenophilic, basopilic, uh darker, lighter, um you know, all this stuff is within this


00:20:10 - 00:21:16
slide. I compare it to other things in this slide and that kind of tracks with okay, you may have the medical monitor, everything, ICC profiles. Your light in the uh room is different than in another room. It looks differently. That's why I'm like so many variables for this color thing. um that I actually what I need to do I need to invite two color experts. Maybe I should invite Kenneet and David so that they can have a debate. Let me know what you think about this debate concept. If I see them today


00:20:43 - 00:22:18
I'm going to ask them if no I'm going to reach out to um to them online and see if they would be open for a debate. And so that was on the technical update. Let me see if I have any notes. Ah yeah yeah yeah obviously cytology psychology is another uh thing that um is now being better supported by the digital pathology vendors. So um let me just fact check something for you because I need to fact check it. Give me one second. I'm checking a company of a scanner. Yes. Okay. So, I have it right. Hologic


00:21:37 - 00:22:56
is a scanner for uh cytologology now and it's FDA cleared system. Um it's called let me tell you it's called Genius Genius digital diagnostic system. H and you can diagnose now um from tiles. So what does that mean diagnose from tiles? And if you're doing cytology, cyto pathology, you know, but um like in anatomic pathology, uh you scan the whole slide and you like do as if it was a map, right? In cytology, you can do the same, but it's going to take you so much time because you go uh higher


00:22:17 - 00:23:39
magnification. These are single cells and if you have to search for them in the whole slide it's it's less of a pattern recognition exercise and more of cell feature recognition. So you have to go uh on the cellular level. So um what happens is that um there is also AI. So uh one company that does this is AIXMed. Um they have a solution for um for urine psychology. and working on some other solutions. But basically what they do, they they run an algorithm that recognizes cells or recognizes specific characteristics of


00:22:58 - 00:23:52
cells. It can label it or just recognize them and gives you a bunch of tiles. So you don't have to go to the whole slide and I have it in a video that I recorded yesterday with whole logic how it looks. You can go to the to the slide and zoom in and zoom out and look for it yourself, but you don't have to. And it's so much easier. So this is something that's being done in hematology at least I know it from venary hematology when you scan you like get the like a bunch of tiles with cells


00:23:25 - 00:24:37
and you can recognize the cells immediately and basically if you have like one or how many depending on the scoring confirmatory tiles you don't have to go to the full slide so it speeds it up significantly so cytoathologists everybody who needs digitization for cytologology uh be happy because there are solutions and other solutions Obviously, Aprilia has a scanner that does that and they did the collaboration with a core plus in Puerto Rico on um Parsmere screening um with an AI uh algorithm that does 100% QC of the


00:24:01 - 00:25:41
slides uh which now st industry standard is 10% QC now they do 100% and are finding additional cases for evaluation. Um then there was also um a person I talked to that is um implementing this kind of algorithms in Latin America and India. So uh and that's another um testimony or or something that fits very well into the through line of from pixels to patients because cytologology is a procedure that does not require you to create uh to to get tissue right. It's like a a procedure that can be done


00:24:51 - 00:26:12
in the practice and can be immediately put on slide and immediately digitized. So you basically cytology you skip the whole uh block preparation and slide well you still prepare slide that you would need to digitize but it's like directly from patient to slide. Uh so you can stain it bright then and there digitize it as well and evaluate. So and not only uh digitize and evaluate you can also show this to the patient um if you feel like it and obviously that's a depends on the relationship with the


00:25:32 - 00:26:39
patient and the um the healthcare provider but let me give you my story. So um my story I don't know how much of the story I want to share but basically one time when I went to the doctor uh they did cytology on me and they showed it to me under the microscope and I kind of like coaxed them into showing it to me by showing them hey on my Instagram I'm a veterary pathologist like I understand the cells look what I have on my Instagram it's all cells and different like uh lesions and stuff like that. So


00:26:07 - 00:27:19
basically uh they took me with them to the microscope. It wasn't digital or anything. H they took me to the microscope and I could look at what they were looking at and and they found it like nice, warm. It wasn't that like oh well like why do you want to know this? Uh why are you like what are you checking me as a doctor? Totally not this vibe. It was more like collaboration. Oh, so you have the background knowledge to actually look at this and understand what's there. Then why not? Uh so basically they met me at


00:26:43 - 00:28:03
my level and I think that's super important in this discussion. Okay, how do you um work with patients to empower them but not to overwhelm them? And many people who are here are pathologists, doctors or have some um medical knowledge. So they will perceive care and treatment differently than somebody who does not have medical background. So the the key thing here for me would be to meet the patient at their level and there are like as many levels that patients are as uh many patients, right? And this is um


00:27:23 - 00:28:50
like this empathy um something that is crucial to be able to empower the patients with the right information in the right form and and that brings me to to like the tail end of of the topic um of today is um like okay what about AI what about the future uh so along those lines AI um well governed Ed and uh with all the cyber security regulation and you know all all the guard guard rails that we need to put in place this is going to be something that can bring back the relationship between doctor and patient.


00:28:07 - 00:29:08
So something that is being cited a lot and I experienced it every time I go to the doctor like uh they ask you five times the same thing. They they they make you register online and fill on the questions. And I would think, okay, then it goes to the electronic health records and they have it and they greet you and say, "Oh, I see you uh are 40 years old and have two kids and whatever." No, they ask you the same question again. like let me not get on my soap box to to talk about that because you know I


00:28:37 - 00:29:56
obviously read a lot of books on how this should be changed and it still is not changed in Wesboro Pennsylvania where I went to the doctor last time to have a mamography but let me go back to to my train of thought AI right so I went to um another conference uh where they were talking about the AI ambient recording recording. So basically that the doctor talks to the patient and there is a recording happening and obviously there needs to be there need to be a consent for that but from this recording the notes are being created


00:29:17 - 00:30:30
for the doctor for uh for the doctor that is uh doing the physical exam interviewing the patient for other specialists that might need to be involved in care and also for the patient uh and I don't know if that's already happening but to me for example the potential would be okay the AI is hearing the patient speak so and hearing the way they um talk about their condition so from that information you can already extract okay what is going to be the way to present the healthcare information to this person obviously


00:29:54 - 00:31:30
it's going to be in the way they communicate right because this is the way they understand so um this for example then applied to pathology reports to pathology uh the clinics that Dr. Joseph is organizing and everything. So it it is the missing link uh it could be the missing link uh to making patients more empowered but also part of the caregiving team. So let me tell you like a sad story what I experienced two years ago that was kind of I don't know I experienced it as inappropriate.


00:30:43 - 00:32:07
Anyway let's let's hope I don't cry. So um in 20 23 my mom had an accident and uh she was in a hospital and she had a traumatic brain injury. She was in a coma for two weeks and she didn't make it. And with my sister, we would go and uh so we live very close to the German border and she went for a bike trip to Germany because they have beautiful uh bike paths and fell off a bike and went to the hospital there. So that's why we were going to the hospital in Germany and to visit her


00:31:27 - 00:32:58
every day. And I speak fluent German. I did my PhD in Germany and obviously I'm a veterary pathologist. uh I'm can read medical papers and not only that my cousin uh at that time she was an anesthesiologist at one of the hospitals in Berlin. So I would like consult her and everything and then go and ask the doctors uh and like just talk to the doctors. They felt pretty intimidated and at some point uh the um the chief doctor basically told me called me and and said that uh I'm not supposed to ask so many questions


00:32:13 - 00:33:52
because uh this comes across as interfering with care which like I had zero like care suggestions. It was like my questions about like okay what happened what uh what what is the plan what are the potential outcomes from the best to the worst. Um but yeah, we were briefly considering filing a complaint. Uh then we didn't decide to do it cuz whatever. But I would not wish anybody to experience something like that. And regardless like at which level of healthc care um savviness you are and obviously if


00:33:03 - 00:34:14
you're a doctor yourself, veterinarian, any kind of medical professional, you're not going to be at the same level as a non-medical professional. So I would expect the care provider to meet me at that level and that was the message at path visions u to to be there for the patients also as a pathologist with special initiative like Dr. Joseph's initiatives um because it matters. Yeah, I don't know a few of heavy heavy topics you hear in this live stream, but I hope you enjoy it. Thank


00:33:39 - 00:33:48
you so much for joining me and I talk to you in the next episode.