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This is Lab Medicine
Rounds, a curated podcast

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for physicians, laboratory
professionals, and students.

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I'm your host, Justin Krueter,
the Bow Tie Bandit of Blood,

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a Transfusion Medicine
pathologist at Mayo Clinic.

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Today we are rounding with Shane Ferraro,

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a Pathologists' Assistant,
Assistant Supervisor

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in the Division of Anatomic Pathology

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at Mayo Clinic in Rochester, Minnesota,

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to talk about the important
innovation of 3D scanning.

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Thanks for joining us today, Shane.

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Yeah, my pleasure.

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Thanks for having me.

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Very exciting.

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Yeah. So 3D scanning is
something that I think a lot

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of us are starting to kind of hear about.

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Some of us are probably
getting a chance to see

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about this innovation.

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I'm curious, from your perspective

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why is 3D scanning an an
important innovation in pathology?

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Yeah, it's a, it's a
very exciting question

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and a very exciting topic.

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So from all of my experiences

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with our 3D scanning system so far

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I think the most important
impact is on education.

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And for instance, so

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with our pathologist assistant team,

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we're heavily invested in
resident and PA student education.

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So the applications of this
technology really allow

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for like a versatile and
kind of conducive approach

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to how people in anatomic pathology learn.

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So we're very visual learners,

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we're very hands-on, and
that's an extension

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from our experience in like cadaver labs.

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And, you know,

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as we were to the frozen section lab here,

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surgical pathology labs in general.

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So the the applications
of the technologies here,

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can really be fostered in a way to,

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create environments that
are more conducive to learning.

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So for instance, with this
technology, we can create things

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like QR codes, which you
can bring to a presentation

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and you can have the audience kind of scan

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that with your phone,
and then they could look

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at a 3D model that you
created on their phone.

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So they get a really interactive
experience with that.

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In addition to that

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we also have the ability to
create actual tangible 3D models

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from the specimens that we have scanned.

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So when we do that

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we can actually have those models shared

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in an environment that's, that's not a

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an actual like pathology lab.

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So you don't have to worry
about safety precautions.

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You don't have to worry

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about balancing clinical
care with resident education.

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So you can really hone in
on some of those skills

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and really foster a good
environment for them to learn

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in. So, very exciting
from that angle for us.

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Yeah, I mean, it sounds really
almost transformative, right?

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I think you mentioned a couple
of things that you can do

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that we haven't really
been able to do before.

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You mentioned, so with a 3D scan

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that we're able to really
take anatomic models

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and we can kind of,

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the audience can play
with them on their phone.

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And I'm curious, like when
you talk about, you know

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educational change that's happening

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because you can get the audience do that

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are there certain
activities that you can do

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with the audience that you
weren't able to do before?

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Are there certain insights
that you're hearing

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from the learners when you're
doing that kind of approach?

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It's hard to really know

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because this is
something that we just received

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and as I mentioned, like, so all

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all of our PA educators
are, are really excited.

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I've had several of them already asking

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about the opportunities to
actually get their own specimens

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and their QR codes to share.

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So the enthusiasm is there.

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I can't quite comment
on how it might transfer

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into an audience kind of
engagement, but just the fact

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that somebody could get
their phone, scan the QR code

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and then just you can
hear all the audible ooh's

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and ah's as they go through a specimen.

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It sounds like a very exciting thing.

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And I look forward

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to having those opportunities with people.

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So

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Yeah. Absolutely.

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So what do you think is important

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for our audience to
understand about 3D scanning?

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So two, two things come to mind.

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You know, we talk

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about 3D scanning as if
it's like some kind of

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really like futuristic abstract technology

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when in reality it's,
it's more simple than that.

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So the machine is, you know,

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it's this big cube and
we would put the specimen

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inside this chamber
and it would have,

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it's mounted on a rotating platform

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and we could kind of choose
like what kind of, you know

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mount it's on, it could be
a glass surface, it could be

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like a pin mounted method,
or we can do like,

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it's a resting kind
of mesh kind of screen.

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So it's on this, this, this mount

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and then it's in the chamber

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and there's several cameras
kind of lined along the edge.

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So the specimen will rotate

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and the cameras are just
taking multiple photos

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of it as it rotates.

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So it's just a really
fancy kind of camera setup.

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So those photos actually act as the

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the data for the 3D model to be rendered.

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And these models are
really like crisp and clean

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and this is like, it's
very simple and very scalable.

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So it's something

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that I think will be much
more prevalent going forward.

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The other

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the other thing that I
think is really interesting

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about this is, I talk about
the education side a lot

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and that actually transfers
over towards patients too.

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So for instance, here

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with our PA service and
our pathology service,

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we see a lot of heart
and lung transplants.

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So we actually have a
service where patients

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can request this upfront.

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They can,

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they can request to see
a scan of their specimen.

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So the, the patient could come

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in after they've had
their lungs, you know, removed.

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They have a new set of lungs

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they can come in with
their family and they could,

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they can talk to the
actual pathologist who

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reviewed the actual specimen,
the, the patient's lungs.

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They took sections to
look at microscopically

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and they could get a one-on-one
interactive session to

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kind of go over the specimen

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and kind of really see

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the cycle of care.

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And then they can also go
home with that specimen

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so they can have a, a memento
and a reminder of the service

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and the care that they
experience here at the clinic.

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So there's some
really cool things, you know

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that are happening in addition to like

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just the education that
goes along with this.

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So

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You know, another thing that
comes up in my mind is, I

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I mean, you're a pathologist
assistant, you know

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are you taking this
home to show your family

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members what kind of stuff you deal with?

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I'm excited to,
I have to be careful.

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I mean, I could tell my wife
about some of these things

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but she doesn't wanna hear it as much.

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So I gotta, I have to
make sure I pick the right

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kind of specimen to bring
home that might not

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hit those kinds
of buttons for some people.

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Oh, I,

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I understand that. That
kind of gets us into, you know

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what are some of the practicalities

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for implementing 3D scanning
and a pathology practice?

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Right. You mentioned that
you're seeing this as really a

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a very scalable technology.

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Yes. So going back to kind of how

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I mentioned how
it's, yeah, it is scalable

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and it's a really
simplified kind of setup.

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So right now we're

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launching this system
in our frozen section lab

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which is a rapid
intraoperative diagnosis lab.

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So it's a very clinical heavy setting.

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We, provide intraoperative
results to surgeons

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so that they can know how to
advance with their procedures.

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So balancing that kind of aspect

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of our work with getting some

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of these educational
requests, is a hurdle.

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You know, so as we kind
of learn how to, how to

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balance our work and really
accommodate these requests

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because for the most part

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this is primarily an
educational kind of setup.

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There are, you know, ideas
to kind of expand this

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into a more clinical kind of
aspect, but right now it's

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it's really finding that, that
that sweet spot to get the

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get our pathologist and the
surgeons the answers they need

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and really make sure that we
can streamline our processes.

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And, you know, that, that
might be something as simple as,

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as I mentioned earlier

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there's different mounting techniques.

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So for instance

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if you have something that
might be more soft, like a

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like a fatty kind of tumor
that's really squishy

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and just kind of sits, you're

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you're not going to be able
to put that on like a

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a pin mounted method.

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You're going to have to put
it on the glass surface.

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If you have something like a
bone, which might look weird

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or it might stand at an awkward angle

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using that glass might not work.

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So kind of making sure
that we can rapidly kind

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of put together the mounting
technique, get a good scan,

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get the surgeon what they need,

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get the consultant what they need,

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and make sure all kind
of parties are involved,

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is probably the biggest
hurdle in, in my mind.

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And are there different teams
that you are interacting with

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like outside of pathology
that is helping to kind

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of bridge to make some bridges

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between pathology and
other clinical departments?

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So, right, so the system that we use

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the actual scanning system
is called Med Creator.

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We're supported by a thing,
which is the company named

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they're based out of Chicago

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and they have other
departments here that they

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they collaborate with.

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So we haven't really worked too much

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outside of our department.

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We work closely with the
autopsy lab who really

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pioneered a lot of this, these techniques

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and kind of helping support
this growth of the technology.

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So we work closely with them

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but otherwise outside of
like surgical pathology and

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you know, anatomic pathology

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we haven't worked with too
many other departments.

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I'm excited for those opportunities.

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I know in the past

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as this kind of technology
was more experimental

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there were different
opportunities we had with

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I think it was radiology
who did want to like

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coordinate with certain specimens.

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So we did have those
opportunities in the past

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which was a lot of fun.

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I had a lot of fun with that.

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So

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Yeah. And you mentioned,
you know, in pathology

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it sounds like it kind of
got its route started

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with forensic pathologists

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and then you're saying now
it's kind of being brought

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out to the surgical practice?

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Yeah, so our, our autopsy
lab, it, it functions as a

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a medical or an in-house
autopsy lab

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in addition to the, the
forensics pathology service.

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So those, it was more
or less those medical,

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those kinds of autopsies, those
educationally approved

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for cases where we were kind of expanding

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on some of this technology.

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Their interfaces
are a little bit more complex

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and as I mentioned before

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thing has been able to really condense

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and simplify all the
applications and, you know

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for instance, the software
that controls how the

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the mounting station
kind of rotates, stops

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the cameras engage, all

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of all that stuff was kind
of worked together in autopsy

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and they really like
consolidated those applications.

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Hmm. And, and how long does
it take to scan some tissue?

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00:11:27,330 --> 00:11:30,760
Is this something
that is relatively quick

256
00:11:30,760 --> 00:11:34,150
or is this like a day long process?

257
00:11:34,150 --> 00:11:36,460
It's actually, yeah, I
didn't even think about how

258
00:11:36,460 --> 00:11:38,240
I'm commenting on how interesting this is.

259
00:11:38,240 --> 00:11:41,110
So it's really simple.

260
00:11:41,110 --> 00:11:42,570
It's really quick actually.

261
00:11:42,570 --> 00:11:45,200
So we would just need
to go into the software

262
00:11:45,200 --> 00:11:48,410
the software that they've
made, this kiosk application

263
00:11:48,410 --> 00:11:50,640
we would just need to basically adjust the

264
00:11:50,640 --> 00:11:54,559
the camera settings and you could adjust

265
00:11:54,559 --> 00:11:57,160
like the model quality,
but it's not necessary.

266
00:11:57,160 --> 00:12:00,260
So you would just put in
your settings, name your file

267
00:12:00,260 --> 00:12:03,460
hit the button, and it
takes about five minutes

268
00:12:03,460 --> 00:12:06,170
for these pictures to be taken.

269
00:12:06,170 --> 00:12:09,120
So once the pictures are taken,
you can open up the chamber

270
00:12:09,120 --> 00:12:10,120
and retrieve your specimen.

271
00:12:10,120 --> 00:12:12,390
And then the, the actual
rendering of the model

272
00:12:12,390 --> 00:12:14,730
will take 20 minutes.

273
00:12:14,730 --> 00:12:18,730
So you can, you can have a
really quick turnaround, but

274
00:12:18,730 --> 00:12:21,040
in the grand scheme of things,
those five minutes are really

275
00:12:21,040 --> 00:12:23,600
important for a patient who's
on the operating table.

276
00:12:24,690 --> 00:12:27,960
So you have to still
balance making, you know

277
00:12:27,960 --> 00:12:29,600
making sure you're
getting those results back

278
00:12:29,600 --> 00:12:31,740
to your surgeon and the consultant.

279
00:12:31,740 --> 00:12:35,780
But it, it is very quick,
relatively speaking, so

280
00:12:35,780 --> 00:12:36,613
Oh wow.

281
00:12:36,613 --> 00:12:37,480
It's interesting.

282
00:12:37,480 --> 00:12:39,570
Yeah. You know, so quick to scan.

283
00:12:39,570 --> 00:12:42,370
And then also it sounds like
if everybody's able to get

284
00:12:42,370 --> 00:12:45,610
on their cell phone and
manipulate it, it's not like

285
00:12:45,610 --> 00:12:48,250
the old kinda lag time of, you know

286
00:12:48,250 --> 00:12:49,970
you have to make sure
you're on good internet.

287
00:12:50,980 --> 00:12:52,809
Correct. And yeah, so we can look

288
00:12:52,809 --> 00:12:54,490
at the model real time on the system.

289
00:12:54,490 --> 00:12:56,170
Once it's, we can

290
00:12:56,170 --> 00:12:59,450
we can look at it on our
screen as, as it's rendered

291
00:12:59,450 --> 00:13:00,970
and we can kind of look at
it and say, you know what

292
00:13:00,970 --> 00:13:03,890
maybe maybe we should try
to get a better angle or, no

293
00:13:03,890 --> 00:13:04,723
this is great.

294
00:13:04,723 --> 00:13:05,283
You know, we can

295
00:13:05,283 --> 00:13:08,640
we can know real time if
what we have is good.

296
00:13:08,640 --> 00:13:10,809
Is the thought is this going to replace?

297
00:13:10,809 --> 00:13:14,940
I know there's always been
kind of surgical photography

298
00:13:14,940 --> 00:13:18,020
or surgical pathology photography.

299
00:13:18,020 --> 00:13:20,490
Is, is this thought to replace this

300
00:13:20,490 --> 00:13:22,929
in the next five, 10 years?

301
00:13:22,929 --> 00:13:24,390
In my mind, no.

302
00:13:24,390 --> 00:13:25,630
I don't.

303
00:13:25,630 --> 00:13:29,410
I think that there's too much
value in photography itself.

304
00:13:29,410 --> 00:13:32,320
3D models have their place
and you know, they really

305
00:13:32,320 --> 00:13:34,679
they really can fit into the picture.

306
00:13:34,679 --> 00:13:35,900
Sorry for the pun,

307
00:13:35,900 --> 00:13:39,480
but I don't think that
photography is gonna go away.

308
00:13:39,480 --> 00:13:43,280
There's just you, there's too
much pop, there's too much pop

309
00:13:43,280 --> 00:13:45,720
to photographs that you
kind of lose in a 3D model.

310
00:13:46,640 --> 00:13:50,920
And I, I enjoy taking
photos of our specimens

311
00:13:50,920 --> 00:13:52,040
and I take a lot of pride in it

312
00:13:52,040 --> 00:13:54,480
so I don't want to see that
go away anytime soon.

313
00:13:55,470 --> 00:13:58,800
Yeah, no, I, I really appreciate
your kind of nuance too.

314
00:13:58,800 --> 00:13:59,633
You know, it's not

315
00:13:59,633 --> 00:14:02,960
like the panacea that's
gonna replace everything.

316
00:14:02,960 --> 00:14:05,130
There's a time and a place
these certain things.

317
00:14:05,130 --> 00:14:06,800
So I guess that kind of brings me

318
00:14:06,800 --> 00:14:09,320
to my final question of
where do you see, you know

319
00:14:09,320 --> 00:14:13,990
this innovation going over
these next five, 10 years?

320
00:14:13,990 --> 00:14:16,200
Yeah, it's, it's fun.

321
00:14:16,200 --> 00:14:17,640
It's really fun to think about that.

322
00:14:17,640 --> 00:14:20,480
And it's, I get a lot

323
00:14:20,480 --> 00:14:23,600
of like insights from
our PA team and

324
00:14:23,600 --> 00:14:25,950
they have some plans,
they have some concepts.

325
00:14:25,950 --> 00:14:27,840
One of the really interesting things is

326
00:14:27,840 --> 00:14:29,360
as I mentioned before, you know, we could

327
00:14:29,360 --> 00:14:31,840
you can print 3D models, but what you

328
00:14:31,840 --> 00:14:35,160
you can also do is you could change colors

329
00:14:35,160 --> 00:14:37,610
of certain anatomic sites or
structures on these models.

330
00:14:37,610 --> 00:14:39,080
So we can create like unique

331
00:14:40,030 --> 00:14:42,400
really unique models to
show the relationships

332
00:14:42,400 --> 00:14:43,440
of adjacent structures.

333
00:14:43,440 --> 00:14:44,360
And that's, that's a significant

334
00:14:45,200 --> 00:14:46,850
it's a really important skill to have

335
00:14:46,850 --> 00:14:49,320
in anatomic pathology and gross anatomy.

336
00:14:50,160 --> 00:14:51,500
So we can do that.

337
00:14:51,500 --> 00:14:55,120
And I think another kind
of step I would like to see

338
00:14:55,120 --> 00:14:58,620
which really kind of
takes that to like the enth

339
00:14:58,620 --> 00:15:00,700
degree would potentially
be the applications

340
00:15:00,700 --> 00:15:05,430
for augmented or virtual reality options.

341
00:15:05,430 --> 00:15:07,880
So what I'm thinking is, like,

342
00:15:07,880 --> 00:15:09,070
you could take a specimen,

343
00:15:09,070 --> 00:15:11,700
so you could take a kidney specimen,

344
00:15:11,700 --> 00:15:14,160
so you could take an
overall scan of the specimen,

345
00:15:14,160 --> 00:15:16,750
and then you could do
like a step-by-step scan

346
00:15:16,750 --> 00:15:19,120
as you would grossly examine the specimen

347
00:15:19,120 --> 00:15:21,820
and grossly examine like
if there's a tumor present,

348
00:15:21,820 --> 00:15:23,580
how it relates to adjacent structures.

349
00:15:23,580 --> 00:15:26,860
And you can provide a
step-by-step gross examination

350
00:15:26,860 --> 00:15:27,780
of that for a learner.

351
00:15:27,780 --> 00:15:29,780
And they could have, they could pop

352
00:15:29,780 --> 00:15:32,660
on a VR set and kind of go
through the whole, you know

353
00:15:32,660 --> 00:15:34,100
the whole steps and the

354
00:15:34,100 --> 00:15:37,950
the maneuvers of grossing in
a, like a surgical specimen.

355
00:15:37,950 --> 00:15:40,620
Or they can have some kind of a

356
00:15:40,620 --> 00:15:43,660
some other kind of like
goggle system that provides

357
00:15:43,660 --> 00:15:46,480
like an augmented reality
system so that they can see

358
00:15:46,480 --> 00:15:48,770
out of their periphery of
the side of their vision

359
00:15:48,770 --> 00:15:51,260
like the actual step-by-step process of it

360
00:15:51,260 --> 00:15:53,380
while they're going through
an actual surgical specimen.

361
00:15:54,260 --> 00:15:56,140
It's, it's a lot of fun to
kind of think of these things.

362
00:15:56,140 --> 00:15:58,540
I have no idea if they're 100% applicable

363
00:15:58,540 --> 00:16:00,380
but it's a lot of fun to
kind of get these ideas

364
00:16:00,380 --> 00:16:02,090
and see if they're, they're possible.

365
00:16:02,090 --> 00:16:03,780
Yeah, I'm really excited by that.

366
00:16:03,780 --> 00:16:07,900
I think something that
young learners in the field

367
00:16:07,900 --> 00:16:10,500
of pathology struggle
with is sometimes looking

368
00:16:10,500 --> 00:16:13,780
at something that's 2D and
having to kind of construct this

369
00:16:13,780 --> 00:16:18,330
as a 3D and it, it sounds
like there's some wonderful

370
00:16:18,330 --> 00:16:20,580
that may not always be
the case going forward.

371
00:16:21,610 --> 00:16:26,090
Yeah, it's, I get, I'm excited.

372
00:16:26,090 --> 00:16:28,620
I think this provides
a unique opportunity

373
00:16:28,620 --> 00:16:30,060
for people to learn because maybe

374
00:16:30,060 --> 00:16:32,380
maybe they're really
intimidated by an actual

375
00:16:32,380 --> 00:16:33,940
like specimen when they first see it

376
00:16:33,940 --> 00:16:37,660
so can provide a more
controlled environment

377
00:16:37,660 --> 00:16:40,060
for them to get that hands-on experience

378
00:16:40,060 --> 00:16:42,220
and the visual kind of
correlation between what they read

379
00:16:42,220 --> 00:16:43,990
in the book, versus what it actually is.

380
00:16:43,990 --> 00:16:46,060
So, very cool opportunities.

381
00:16:46,060 --> 00:16:49,740
Brilliant. Hey, we've been
rounding with Shane Ferraro.

382
00:16:49,740 --> 00:16:51,900
Thank you for taking the time to talk

383
00:16:51,900 --> 00:16:54,450
about 3D scanning with us today.

384
00:16:54,450 --> 00:16:55,540
Yeah, my pleasure.

385
00:16:55,540 --> 00:16:57,060
Thanks so much.

386
00:16:57,060 --> 00:16:58,820
And if you'd like to
hear more on this topic,

387
00:16:58,820 --> 00:17:00,420
Shane will be presenting

388
00:17:00,420 --> 00:17:05,220
at the 2023 Pathologist's
Assistant Symposium in June.

389
00:17:05,220 --> 00:17:10,220
Please visit
mayocliniclabs.com/2023PAsymposium

390
00:17:11,599 --> 00:17:14,579
for more information.
To all of our listeners,

391
00:17:14,579 --> 00:17:15,940
thank you for joining us today.

392
00:17:15,940 --> 00:17:17,540
We invite you to share your thoughts

393
00:17:17,540 --> 00:17:19,170
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394
00:17:19,170 --> 00:17:21,030
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395
00:17:21,030 --> 00:17:26,030
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396
00:17:26,270 --> 00:17:28,339
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397
00:17:28,339 --> 00:17:30,950
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398
00:17:30,950 --> 00:17:34,520
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399
00:17:34,520 --> 00:17:37,940
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