177: From Curiosity to Confidence in Digital Pathology

Have you ever thought, “Digital pathology sounds amazing, but without a scanner, what’s the point of learning it now?”
 If so, this episode will change how you see your role in the future of pathology.

In this talk, I challenge one of the most persistent myths in our field: the belief that you need expensive hardware before you can begin your digital pathology journey. Through personal experience and the remarkable story of another pathologist who started with even less, I show why knowledge—not infrastructure—is what truly opens doors.

Highlights and Key Themes

0:00 – The Limiting Belief

I open with the core misconception I hear from pathologists worldwide: “I need a scanner before I can start.” I explain why hesitation, not lack of equipment, is the real barrier—and why waiting for perfect conditions keeps many people stuck.

2:24 – My Early Digital Pathology Story

I describe my residency in 2013, when a single scanner was “off limits” to trainees. Faced with a research project requiring consistent cell counting, I improvised using a microscope camera and Microsoft Paint.
 It wasn’t sophisticated, but it was digital, consistent, and reproducible.
 This experience taught me a foundational lesson: if you can measure something, measure it; don’t rely on visual estimation.

7:01 – How This Led to My First Digital Pathology Job

That basic Paint-and-dots project became my gateway to working at Definiens (now part of AstraZeneca).
 I wasn’t hired for computational expertise; I was hired because I understood tissue, biology, and the value of quantifying what we see. Working alongside image analysis scientists showed me the exponential power of combining tissue knowledge with computational tools.

10:03 – Dr. Talat Zehra’s Story

I share the inspiring journey of Dr. Talat Zehra from Karachi, Pakistan, who began with no access to scanners and only a microscope camera.
 During COVID shutdowns, she taught herself the foundations of digital pathology, joined global organizations, conducted a nationwide survey, and contacted AI vendors for access to platforms.
 After many rejections, one vendor offered a trial account. In just six weeks, she completed three AI projects using microscope camera images—each one published in a peer-reviewed journal.
 Her story highlights a universal truth: starting with curiosity and persistence matters far more than having perfect tools.

14:14 – Two Paths After a Conference

I explain the difference between the “forgetting loop” and the “learning path.”
 Many attendees leave inspired but slip back into routine. Others commit to one consistent learning habit—journal clubs, vendor webinars, DigiPath Digest sessions—and return a year later with clarity, confidence, and momentum. These individuals become the people others seek out for guidance in digital pathology.

18:04 – Where to Begin

You don’t need a scanner or an institutional budget to start. What you need is structured knowledge.
 I introduce my book, Digital Pathology One on One, and encourage listeners to choose one learning habit to build on after the episode. The only wrong choice is choosing nothing.

19:06 – Final Message

Knowledge drives adoption, not infrastructure.
Scanners, AI tools, and computational platforms already exist. What’s missing are people who understand how to interpret tissue digitally, collaborate with computational teams, and bridge biology with technology.
 You have

Transcript

0:00: Thank you for being here this morning. 
 0:03: Before we dive in, I want to ask you something. 
 0:06: How many of you have ever thought digital pathology sounds amazing, but I don't have access to a scanner, so what's the point of learning about it right now? 
 0:15: Yeah, I see you, I was you. 
 0:18: Learn about the newest digital pathology trends in science and industry, meet the most interesting people in the niche, and gain insights relevant to your own projects. 
 0:29: Here is where pathology meets computer science. 
 0:33: You are listening to the digital pathology podcast with your host, Doctor Alexandra Zuraw. 
 0:40: Today, I want to challenge that belief, because I think it's the single biggest thing holding our field back, and it's not even true. 
 0:48: This is the myth. 
 0:49: This is what I hear from pathologists all over the world. 
 0:52: I need a scanner before I can start. 
 0:55: I need my institution to invest first. 
 0:58: I need someone to give me a project, and it sounds reasonable, right? 
 1:02: How can you do digital pathology without digital infrastructure? 
 1:06: But here's what I've learned from working with thousands of pathology professionals through my online platform, Digital Pathology Place. 
 1:14: you might be receiving emails from me if you're on my list, through courses, the podcast, the community, and the emails I send you. 
 1:23: The real barrier isn't hardware, it's hesitation. 
 1:29: The people who reach out to me, they're not skeptical, they're not resistant. 
 1:33: They want this. 
 1:34: You guys are all here because you wanna learn about it or you wanna work in this place. 
 1:40: But some of you and some of my readers who reach out to me, they're paralyzed. 
 1:46: They ask me, where do I start? 
 1:49: They ask me, do you have any projects for me? 
 1:52: And I understand this question, I really do, but here's the thing, they're waiting for permission, waiting for someone to hand them that opportunity, waiting for the perfect conditions, and while they wait, nothing happens. 
 2:08: So today, I want to share two stories with you. 
 2:12: My story and the story of someone who inspired me, and I want to show you that knowledge, not infrastructure, is what actually opens doors in this field. 
 2:24: So let's go back to 2013. 
 2:27: This is me in the photo, by the way, pretty young. 
 2:30: I mean 10 years, 1112, younger, and very naive. 
 2:35: I was doing my residency. 
 2:38: I was training for, the, for, for my, to be eligible for the American, ACVP, American College of Veterinary Pathologists, and. 
 2:50: At my institution, there was one scanner. 
 2:53: We had the 6 slide Aperia one, and it was basically off limits for people. 
 2:59: Now it's not, but when I was there, yes, the only person who could use it, it was this one PhD researcher, and it was reserved for special occasions, and by special occasions I mean some mystery slide sessions, some, you know, special cases that somebody had in the necropsy and. 
 3:18: Not really for use by normal people, so I looked at the scanner and I thought this is not for me, this is for the chosen one and the the researcher was not really like a chosen one, but this was the narrative in my mind that, you know, I'm just started, I'm from Poland, I'm like just beginning, it's not for me, it's for those who are the tech savvy elites, they have connections, they know the. 
 3:46: Right people and the right resources, so digital pathology was something that happened to other people, people who were more special than me. 
 3:55: Does that sound familiar? 
 3:57: Then something happened. 
 3:58: I had this research project. 
 4:00: I was working with skin sample and I was supposed to find a senescence marker and then count, I think, the fibroblasts or whichever cells that were older than the other cells with senescence marker. 
 4:14: And I wanted to do it consistently. 
 4:17: I looked at the staining and I'm like, Not happening, I wanted to do it consistently, repeatedly, and across many samples, and I tried to do it the traditional way, so looking through the microscope and just estimating, basically guesstimating. 
 4:34: And you know what, I couldn't repeat my own results, and I'd count the same sample twice. 
 4:40: I tried to estimate the numbers, different numbers, and my visual assessment was basically how I called it, it was a guesstimation and not really a good one, and I definitely needed something better, but I didn't have access to the scanner, so what was I supposed to do? 
 4:57: I could. 
 4:58: Scrappy, and there was a microscope with a camera that wasn't off limits, you could actually use that, so I had this camera attached, it wasn't a scanner, it was just my normal microscope or whichever was with the camera, and I started taking pictures of fields of view, just capturing fields of view, and then I opened them in paint. 
 5:22: Microsoft Paint, yes, you are hearing me correctly, and then I put dots on the structure I was counting and little colored dots or or crosses or whatever, one by one, and then I was manually counting the dots. 
 5:35: I didn't even open. 
 5:37: Within a period image scope that has a counter. 
 5:40: I was doing it manually, but I know it sounds ridiculous, and it was incredibly manual, and it took quite a long time, but here's the thing, it was on a digital image. 
 5:52: And suddenly I could go back and check my work. 
 5:54: I could be consistent, I could show someone else exactly what I counted and why I actually get feedback, and it was so much more reliable than my visual guesstimation. 
 6:06: And since then it became a principle I live by. 
 6:11: I would rather calculate. 
 6:13: Then guesstimate every day of the week and twice on Sunday, and it hurts me personally when I see all these pathology scorings where we have to guesstimate. 
 6:22: I mean, this is what pathology is built on because we didn't have these tools, but if you can measure something, measure it, don't guess. 
 6:31: If it takes drawing dots. 
 6:33: In paint to get real data instead of rough impressions, I will do that every time. 
 6:38: That little project, that scrappy paint and dots project, taught me what digital pathology is really about. 
 6:44: It's not about having the fanciest scanner, it's about finding more objective and more consistent, more reproducible ways to evaluate what you're seeing. 
 6:54: And you can start this journey with very little. 
 6:57: Now, here is the part I didn't expect. 
 7:01: This crappy project, it led me to my first digital pathology job. 
 7:05: I was hired at a company called The Finians, an image analysis company that's now part of AstraZeneca, and they didn't hire me because I was a scanner expert, they didn't hire me because I had fancy computational skills, they hired me because I understood tissue. 
 7:20: I understood what mattered in the image, and I understood and had this little experience with, hey, we can actually quantify what's happening in the tissue, and the door opened, not because I waited for perfect conditions, but because I started with what I had before. 
 7:37: At the Finians, I worked alongside image analysis scientists, computational people out. 
 7:43: Algorithm builders and my job was to make sure their analysis actually matched the biology. 
 7:50: My job was to be the tissue expert in the room, and I was shocked how much can go wrong and how somebody who doesn't understand the tissue will not be able to figure it out. 
 8:04: So they had the, these, they had the software. 
 8:07: A pretty powerful software that could quantify things, but when I came, obviously I didn't have any idea about these computational tools. 
 8:16: They didn't have good tissue expertise. 
 8:20: So, but then together we could do the things neither of us, neither of us could have imagined alone. 
 8:28: They had the tech expertise. 
 8:30: I had the tissue. 
 8:30: Expertise and when these two come together, it's not just 1 + 1 equals 2 and that possibility is open and it grows exponentially. 
 8:40: This is when the magic happen where we work together and this is the insight I wanted to take home today. 
 8:47: Knowledge is the key that unlocks technology's real power. 
 8:51: The scanner exists. 
 8:52: They're getting cheaper. 
 8:54: , the AI tools are improving every year. 
 8:57: The computational power is there. 
 8:59: What's missing? 
 9:00: What is the bottleneck? 
 9:02: It's people who understand what matters, people who know the biology and the digital pathology principles, and I'm not saying like every single aspect of them, but basically people who can work together and make this exponential benefit for the patients, for research, for science happen. 
 9:23: That's you. 
 9:24: This is your expertise, your knowledge. 
 9:27: You don't need to wait for the. 
 9:28: Infrastructure, the infrastructure needs you, but it needs you to understand how this all works. 
 9:35: It needs you to learn. 
 9:37: Now, you might be thinking, OK, Alex, that is nice, you were in Europe, you had access to a microscope camera at last, at least you eventually got a job at this fancy digital pathology company, and your path isn't everybody else's path, which is. 
 9:55: Totally correct and you are right, I am just one story. 
 9:58: So let me tell you about someone who started with even less and achieved even more. 
 10:03: And this is Doctor Tala Zara. 
 10:05: She's an assistant professor at the university in Karachi in Pakistan, and I had the honor of having her on my podcast and hear her story, and it absolutely blew my mind. 
 10:16: So look at these numbers. 
 10:18: Pakistan has over 220 million people. 
 10:22: And you know how many pathologists, about 500. 
 10:26: So that's the same number, it's a low number of pathologists, the same number as we have in Poland, but we have only 38 million people in Poland. 
 10:34: So yeah, different scale. 
 10:36: For context, Poland, where I'm from, has 38 million people and roughly the same number of pathologists. 
 10:43: Pakistan has nearly. 
 10:44: 6 times the population with the same pathologists workforce and scanners, and she had zero, no access, nothing, just a microscope with a built-in camera connected to a screen. 
 10:57: That's it. 
 10:58: Then 2020 happened, COVID, everything shut down, her university closed, her private practice stopped. 
 11:04: She was stuck at home. 
 11:05: Isolated, missing pathology. 
 11:08: So what did she do? 
 11:09: She joined the Digital Pathology Association. 
 11:11: She started reading papers, learning about hall slide imaging, computational pathology, deep learning concepts she had never worked with before. 
 11:20: She conducted a nationwide survey about digital pathology awareness in Pakistan and published it. 
 11:26: She didn't have. 
 11:28: The infrastructure, but she built the knowledge, and then she wanted to go further, she wanted to try AI tools on her microscope camera images, so she started reaching out to vendors, international companies with AI platforms, and you know what happened, they said no. 
 11:44: When they found, they said no, basically, often when they found out that she didn't have a scanner, they refused. 
 11:53: They didn't think AI could work on microscope camera images. 
 11:56: They didn't see the point because all these algorithms are built on hall slide images, and it was rejection after rejection. 
 12:02: She didn't stop. 
 12:03: She kept contacting people, she kept asking, and finally one company, and you can go and visit their booth in the exhibit hall. 
 12:13: Aora said yes. 
 12:14: They gave her a demo account for a month and a half. 
 12:17: They gave her access to their AI platform, and now at this point, Dr. 
 12:22: Tala Zara knew nothing about annotations, nothing about training algorithms, nothing about testing AI models, and in her own words, she said, I was completely like zero. 
 12:35: I had completely zero knowledge, but she learned, and a customer. 
 12:40: Success manager taught her how to annotate, how to build algorithms, and how to test and train. 
 12:46: So kudos to the team at Euphoria, and this is a point I want to make here, a little pause that vendors, I call them the unsung heroes of digital pathology, they can teach you so much. 
 12:59: so she learned all that from the success customer, customer success manager at Euphoria and. 
 13:08: In that month and a half, she completed 3 projects, 3 AI projects on microscope camera images. 
 13:14: Those 3 projects, all published in peer-reviewed journals. 
 13:18: She won the Path Vision's Travel Award. 
 13:20: She worked with more vendors, more platforms, more collaborators, and today she has over, I don't know how many exactly, but definitely over 10 published projects in computational pathology, and all done on microscope camera images, not whole slide scans. 
 13:35: She. 
 13:35: Her entire career from a clinical pathology to computational pathology research and she also said if you work hard and you are sincere in your efforts, you can get the results. 
 13:47: No need to be disheartened if you don't have a scanner or if you don't have an image management system or if you don't have something. 
 13:55: Figure out what you have. 
 13:56: So there's no need for you to be disheartened that there is not everything in place where you want to do. 
 14:03: Digital pathology. 
 14:04: So do you see the pattern my story, her story, they're structurally the same even though you know we were in different places of the world. 
 14:14: We didn't wait for perfect infrastructure. 
 14:17: We started learning with what we had and the knowledge opened doors we didn't know existed. 
 14:22: Knowledge first, technology followed, not the other way around in our cases. 
 14:28: So let's talk about us. 
 14:30: Let's talk. 
 14:31: About you and let's talk about what happens after today, because here's the truth about conferences like this one. 
 14:37: It's an amazing event. 
 14:40: It's like a Christmas party, like a company Christmas party. 
 14:43: I mean that in a good way, it's exciting, it's energizing, you see people you haven't seen in all year, you learn new things, you feel inspired, but what happens after the Christmas party? 
 14:54: You go back to your normal life, back to your caseload, back to your routine. 
 14:59: And all that energy, that inspiration, it fades. 
 15:02: So, path number one, I call it the forgetting loop. 
 15:06: You came to the conference, you learned things, you took notes, maybe you even remembered to watch the recordings later, and then you forget. 
 15:14: Life takes over and months pass, and next year, you come back to a conference like this, and you're starting over, asking the same questions, feeling the same overwhelmed. 
 15:24: Where do I start? 
 15:25: What should I focus on? 
 15:27: Do you have any projects for me, and the loop repeats. 
 15:29: And I see this from people who have sent me these emails a couple of years in a row. 
 15:35: And there's also a path number to another path. 
 15:39: You came, you learned, and you committed to keep learning beyond today. 
 15:45: Not in a vague, oh, I should really learn more about this way, in a concrete way. 
 15:50: You pick one thing you'll do regularly, one learning habit. 
 15:55: Maybe it's setting, PubMed alerts for digital pathology papers, maybe it's joining a journal club, maybe it's picking one vendor whose webinars really, you really actually watch. 
 16:06: Maybe it's my platform, maybe you want to join me on Friday at 6:00 a.m. for our Digipath Digest journal club activity. 
 16:15: I have regulars who are joining, but it doesn't really matter, it doesn't have to be. 
 16:20: Pick whatever resonates with you, the point is, you make it a habit. 
 16:25: Not a one-time event, a habit, something you do weekly, I don't know if you want to do daily, more power to you, but if you do that, imagine yourself here next year, same conference, same community, but you're different. 
 16:39: You're not a kid in a candy shop anymore, overwhelmed by all the options, not knowing where to look. 
 16:46: You know exactly what candy you came for. 
 16:49: You're asking specific questions, making focused connections. 
 16:54: Having deeper conversations. 
 16:57: You have your map for advancing digital pathology in your environment, because this is super crucial to understand what you need. 
 17:06: There is no, as much as we want standards and everything, there's no one size fits all in digital pathology. 
 17:13: And that's what a year of consistent learning does. 
 17:17: And here's what becomes possible. 
 17:20: You start seeing opportunities that were impossible, that were invisible before. 
 17:24: Projects you can contribute to, problems you can solve, gaps you can fill, and you don't just see them, you lead them. 
 17:34: You become the person others come to with questions. 
 17:38: You land roles you didn't know existed, project, project leader, project leader, research collaborator, the person who makes things happen in the digital pathology space. 
 17:48: You start pilots at institutions, everyone said weren't ready to, to do digital. 
 17:55: You improve patient care in ways you couldn't have imagined. 
 17:57: This isn't fantasy. 
 17:59: I've seen it happen, I've seen people transform. 
 18:02: So where do you start? 
 18:04: I'm not going to hand you a project, I'm not going to give you a scanner, but I will give you this. 
 18:09: This is my book, Digital Pathology One on One, Everything You Need to Know to Start and Continue your digital pathology journey, and you need no scanner to read it, you just need curiosity. 
 18:21: You can scan this code, download it, and start reading. 
 18:24: And this can be your first step today and then pick something and keep going. 
 18:30: You can join my email list if you want. 
 18:33: I report from conferences and if you've seen me online, you know what I'm doing online. 
 18:38: Then we have this journal club on Friday which I'm super proud of and super proud of the trailblazers who join me almost every week, but if this is not your style, that is totally fine. 
 18:51: You pick something else. 
 18:52: The only wrong choice is choosing nothing. 
 18:56: The only wrong choice is waiting. 
 18:58: Pick your path and commit to progress, commit to understanding different aspects of digital pathology. 
 19:06: So let me leave you with this knowledge drives adoption, not infrastructure. 
 19:11: You don't need to wait for someone to hand you that technology. 
 19:15: The technology is waiting for you, but it needs you to understand it, to learn it, to bring your expertise to the table, and also find the other experts who need to contribute to your project. 
 19:27: You have everything you need to start today, not tomorrow, not when you finish your current projects, not when your institution gets a scanner today. 
 19:37: Thank you very much.