Towards e‐parasitology: making use of virtual microscopy
Rashad A. Abdul-Ghani · Tropical Medicine & International Health · 2014
Advances in virtual microscopy (VM) and web-based technologies have revolutionised the e-learning of several biomedical disciplines, overcoming barriers of space, equipment and time. Web-based educational systems based on digital imaging and VM could effectively augment traditional light microscopy in teaching and learning of tropical parasitology. First strides of this approach began with the introduction of a method for panning and zooming of digital images with the aid of a microscope equipped with a precision scanning stage (Silage & Gil 1985). This was followed by the design of virtual microscopes that combine computer hardware and a software system as an emulation of a real microscope (Ferreira et al. 1997; Afework et al. 1998; Felten et al. 1999; Catalyürek et al. 2003). The integration of web-based digital technologies with conventional microscopy has then boosted the introduction of virtual microscopy to view high-resolution digitised 'virtual' slides online (Mikula et al. 2007; Jones et al. 2011). The four functions of a light microscope, that is displaying, panning, zooming and focusing, are simulated in a virtual or digital microscope, in which real slides are substituted with 'virtual slides' over a computer network, which can be viewed offline from electronic storage devices or online via the Internet (Lee 2005). This becomes feasible after the capacity to digitise virtual slides into images with high resolution, where thousands of images can be captured at high magnification from a single slide and then digitally stitched together to represent the whole glass-mounted slide. The role of VM in medical education and training is increasingly growing. This is attributed, in part, to the fact that it overcomes the difficulties encountered with the use of conventional microscopy, including the increasing numbers of students in laboratory sessions, difficulty in maintaining and archiving slides and increased cost of microscope maintenance (Braun & Kearns 2008; Alcala-Canto et al. 2012). Ease of access and simultaneous viewing, annotating and universal sharing of digital slides via web-accessible interfaces enhance their utility as interactive educational tools even from remote locations (Felten et al. 1999; Mikula et al. 2007; Neel et al. 2007), broadening the scope of use of VM in biomedical research and education. Virtual slides provide a better platform for interactive instruction and independent self-study than still computerised images by allowing the change of magnification properties (Harris et al. 2001). VM promotes teamwork collaboration, skills transfer to students and problem solving, which are required in biomedical education (Harris et al. 2001; Blake et al. 2003; Braun & Kearns 2008; Koch et al. 2009; Triola & Holloway 2011; Alcala-Canto et al. 2012; Tian et al. 2014). The question remains as to whether it will be possible to change from the use of web atlases adopting still images of parasites or parasite stages to web microscopes that mimic real ones in examining virtual slides. A major step forward has been achieved with the introduction of a novel web-based tool, known as WebMicroscope (http://www.webmicroscope.net/parasitology/), for education and quality assurance in medical parasitology (Linder et al. 2008). The Swiss Tropical and Public Health Institute has also adopted VM as a learning tool for the diagnosis of medically important parasites (www.parasite-diagnosis.ch/). Because educational virtual microscopes do not necessitate real-time scanning of slides but rather use stored virtual slides, their application as distance-learning tools within the context of e-parasitology is feasible. Virtual microscopy could play a role in quality control assessment through the provision of digitised virtual slides instead of glass-mounted real ones that can be viewed online using a user-friendly computer interface, saving time and eliminating the need for transportation. Difficulty in producing enough replicate glass-mounted slides makes virtual slides for quality control purposes a more easier and reliable alternative that can be deposited in digital atlases on web microscopes (Lundin et al. 2004). VM proves effective as an electronic resource to run external quality assessment compared to glass slide-based systems (Burthem et al. 2005). It could also be involved in distance diagnosis of parasites in remote settings by the electronic capture of parasitological specimens at point-of-contact (Johansen et al. 2010). For instance, Suhanic et al. (2009) showed the utility of a high-resolution digital telemicroscopy system in remote diagnosis of malaria and in quality assessment through the provision of easily accessible high-definition virtual slides. This could help addressing deficits in highly qualified personnel and in infrastructure and disseminating regional and global expertise in the diagnosis of infectious diseases. A major drawback of using VM in resource-limited settings is the large size of the three-dimensional scans of slides that can be several gigabytes. This makes real-time sharing of these virtual scans, the so-called live VM, from low-resource settings with pathology experts abroad virtually impossible due to the requirement of substantial bandwidth. Moreover, their subsequent transfer via Internet or their mailing on transportable data storage devices for interpretation is time-consuming. Great leaps and bounds in information and communication technologies could witness parallel advances in the utility, universality and ease of deploying real-time VM in the education, quality assurance and diagnosis in basic biomedical disciplines, including parasitology. Mobile phones have proved effective in strengthening microscopy-based diagnostic services in low- and middle-income country laboratories by simplifying the capture of microscopy images, transferring them on a review website/platform and feeding back to the sender (Tuijn et al. 2011). Therefore, research should be directed to the possibility of incorporating VM as an educational and diagnostic tool with smart or intelligent phones, widening the scope of VM applications. In conclusion, VM needs to be integrated within parasitology curricula as an additional supportive tool for educating fresh students who can find it difficult to learn using traditional one. It could also be used to design enhanced parasitology curricula that support distance and continued learning when integrated into open-access databases. Specialised web-based microscopes for teaching and learning parasites that need extensive training and expertise, such as malaria parasites, should be considered within the context of their control and elimination. Studies are required for the validation of VM, in comparison to traditional one, as a tool for the education, quality control and diagnosis of parasites in a step towards e-parasitology.