Digital AI in Hematology - Integration of the Scopio Labs x100 Scanner with Newly Implemented AI Capabilities into Routine Clinical Workflow
Authors: Salib Christian , Bhardwaj Swati , Hussein Shafinaz , El Jamal Siraj , Petersen Bruce , Scigliano Eileen , Dembitzer Francine R. , Teruya-Feldstein Julie 
Published: November 2021

Abstract
BACKGROUND
Digital pathology and artificial intelligence (AI) are areas of growing interest in pathology. A number of institutes have already integrated digital imaging into routine workflow, relying on AI algorithms for the detection of various cancers and mitotic activity quantification. Despite the use of whole slide imaging (WSI) for tissue evaluation, the field of hematology has lagged behind. While many hospitals rely on limited technologies for automated peripheral blood evaluation (e.g. CellavisionTM), the Scopio LabsTM X100 digital scanner provides high resolution oil-immersion level dynamic images of large scanned areas (https://scopiolabs.com/hematology/). With recent FDA-clearance and newly implemented AI capabilities, the Scopio Labs scanner allows for clear and accurate cytomorphologic characterization and cell quantification for peripheral blood smears (PBS). To this end, we aimed to be one of the few pioneering institutes in the United States to adopt early and implement this technology into our routine workflow as a 'hub and spoke' model for optimized case assessment, data sharing and result reporting across multiple satellite locations within our hospital health system.
DESIGN
A Scopio x100 digital scanner was deployed at our main hospital site, with an anticipated secondary scanner for installment at a satellite laboratory. PBS flagged for hematopathologist review from two satellite laboratories were scanned, and full-field digitalized slides were evaluated by hematopathologists following AI automated analyses.

RESULTS
311 peripheral smears were scanned since April 2021 and representative slides were digitalized at 100x magnification (Figure 1, weblink: https://demo.scopiolabs.com/#/view_scan/9231acaf-f898-4649-950d-a41c26c2baaa) with rapid monolayer, monolayer, full-field, and full-field cytopenia scan options available. The automated AI capabilities classified cells into lineage-specific categories with quantification based on cytomorphologic features (Figure 2). Other AI features include additional cell assignment, cell annotation and comments accessible to all users, finalized report PDF generation, export, upload into our current PowerPath TM software with linkage to the corresponding flow cytometry and bone marrow biopsy reports; and the ability to share digitalized slides with clinicians, laboratory personnel and trainees using uniquely generated weblinks. Images can be used for lectures and tumor boards. Additionally, an 80-case study set for PBS was created for medical students, residents and fellow teaching purposes, including cases displaying acute B-cell lymphoblastic leukemia (B-ALL), acute myelomonocytic leukemia (AMML), hypersegmented neutrophils in COVID-19(+) patients, myelodysplastic syndrome (MDS), atypical lymphocytes, hemoglobinopathies, platelet disorders and various lymphomas.
Overall improvements were made to the following areas:
CLINICAL WORK/DIAGNOSIS
1. Time-saving due to pre-categorization of cells into lineage-specific groups for pathologist review
2. Minimizes subjectivity in cell counting and cellularity assessment
EDUCATION
1. Case-based collection with flow and molecular being maintained here
2. Efficient case retrieval with retained annotations/comments for teaching purposes
3. Wide array of digitalized images for hematology atlas and publications
ARCHIVING
1. Collection of reference images (intra/inter departmental) for an array of morphological entities for clinical reference and refined diagnosis (e.g. Bethesda reference images for pap by ASC)
2. Digital catalogue for long-term case follow-up and retrospective review
CONCLUSION
The Scopio Labs X100 digital system provides an efficient and cost-effective web-based tool to streamline clinical workflow and enhance PBS evaluation. With its recent AI capabilities of cell quantification, lineage-assignment and report-generation, we aim to continue our efforts to fully integrate Scopio Labs into our routine daily clinical workflow for reviewing PBS specimens.
CONFLICT OF INTEREST STATEMENT
The authors have nothing to disclose with regard to the submitted work
Figure 1 Figure 1.

Disclosures
No relevant conflicts of interest to declare.