Milestone offers gross stations with digital imaging documentation of the surgical dissection process. The modular gross stations are specifically designed to integrate state of the art tools and standardization into a 21st century system for gross tissue dissection featuring enhanced process documentation, safety, ergonomics, flexibility and cost-effectiveness.
The first to hardwire the digital power of specimen identification, creating a standardized, digital image documented, protocol. It can create a chain of custody that assures quality at the source of tissue selection and cassette generation from the grossing room throughout histology to the pathologist’s desk.
Capture of digital image documentation enables innovative laboratories to pursue not only high quality but also work simplification and standardization in pursuit of the “virtual” and dictation- less lean laboratory operation.
The MacroPATH QX, integrated within the gross station, is a user-orientated capture and storage system for digital macro images of patient specimens. It dramatically reduces specimen turn-around time at the gross station compared to conventional shoot and capture handheld systems.
Autofocus, auto-light adjustments and hands-free operation through a foot pedal enables users to concentrate on the patient case without manual intervention.
In addition to stand-alone operation. The gross stations can interface with PAC or LIS through coded solution, TWAIN mode, or targeted folder use.
Milestone gross stations with built-in MacroPATH digital imaging technology is the most advanced system for full documentation of grossed surgical specimens. It is a tool for optimized quality assurance, improved productivity and workflow. It operates with icon driven, user friendly software.
Milestone offers the eGROSS gross station, the WorkSTATION BX and partners with Mopec.
The Milestone eGROSS is an all-n-one gross station with digital image documentation of surgical specimens. The eGROSS gross station provides the end user Life Long Operation, High Safety Standards. Ergonomics, Easy Operation, Full Documentation, and is Highly Flexible.
The Milestone provides lifelong operation due to design using high resistant stainless steel (AISI304) structure and work surfaces.
The high safety standards consist of but are not limited too downdraft plus backdraft high power exhaust, slide out waste paper basket with a trap door connected to exhaust, easily accessible exhaust ports and twin tanks (up to 10 liters-2 gallon each) with safety valve to store fresh and exhausted formalin.
Milestone’s eGROSS is economically designed to easily adjust the working height to accommodate standing or sitting. With a push of a button the user can raise or lower the gross station form it lowest setting of 90cm to the highest at 120cm or anywhere in between.
For ease of use the eGROSS has a large working area of 50x40cm with cutting board on special supports to allow unrestricted downdraft flow, large sink 40x34x18cm with filter and shower type faucet, a slide-out waterproof keyboard with built in mouse (optional bar code reader and microphone for dictation), all-in-one control panel places major functions within easy reach, and can be foot pedal controlled, which enables hands-free control of the major camera functions (zoom in/out, save, audio/video recording).
The Milestone eGROSS combined with the MacroPATH software digital imaging system the user automatically and rapidly documents all the steps in grossing of surgical pathology specimens.
The Milestone eGROOS is highly flexible due to incorporating industrial casters to position the unit wherever required.Milestone also offers grossing stations for small to medium size tissues call the WorkSTATION pro-x that provides the same safety, ergonomic and full documentation while grossing. The end user enters the case number into the MacroPATH software and within two minutes digital images can be captured to include the Requisition form, label of the specimen container, ID of the case, number of biopsy and sizes for the biopsies. This information is very important for quality assurance purposes at the embedding stage to verify the correspondence before and after processing of biopsies.With all of the Milestone and Mopec grossing stations paired with MacroPATH software all cases are stored in a searchable database. Images can be sorted by Case Number, Individual capturing the image, last edit date, or tags. This is a very important tool when working in teaching institutions and when presenting cases in front of the tumor board.The MacroPATH camera and Point of Care computer with software can be integrated into the Mopec grossing stations allowing the end user to take advantage innovative Milestone digital image solution.When interfacing the digital imaging system to a LIS at any workstation the MacroPATH software is running in the background and monitors a local or network location for image storage. The grossing station acts as a secondary application to the LIS. The patient case identifier is held by the LIS. When working with a TWAIN protocol the LIS launches the MacroPATH software, digital images are captured, annotations are made, and all assets are transferred to the LIS.When digital images features are not required, the Workstations are available without the MacroPATH system, while maintaining all of the other features and technical characteristics.The Milestone grossing stations with the MacroPATH digital imaging system allows the end user to easily capture, annotate, measure, share, and save high quality images of gross specimens in the AP lab along with the frozen section room. The camera and touch screen monitor take up minimal workspace in your grossing station. The automatic focusing makes it simple to get crisp, detailed pictures. Removing gloves is unnecessary because the system can be controlled hands-free with the foot pedal.Optional barcode scanning facilitates sample tracking and quality assurance. Through the software remote conferencing enables high resolution live consultation between the grossing technician and pathologist. Annotations and scale bars can be added once the original image is captured, taking no time at all.Milestone workstations come with everything you need to add image capture to your grossing process without workflow disruption. Case numbers can be scanned in with the bar code scanner or manually entered. The camera displays live video and can be controlled hands free with the foot pedal. Annotations can be added with a gloved finger on the touchscreen computer. The workstations are an innovative system thoughtfully designed for optimal productivity.The MacroPATH camera and POC can be added to any brand of grossing station, including those from Mopec®, Sakura and Thermo Scientific. Due to the small size of the camera, minimal workspace is used.Below is an article discussing the importance of digital imaging systems within Anatomical Pathology.
Integration of digital gross pathology images for enterprise-wide access [1]

Equip your pathology laboratory with the safest and most personalized grossing station ever offered. Mopec understands that each pathology professional has their own workspace preferences, and each laboratory holds their own safety, ergonomic and workflow requirements. Because of this, we’ve designed the Mopec Maestro Grossing Station. The MacroPATH digital imaging system can easily be interrogated with the Mopec Grossing Stations and Milestone partners with Mopec to ensure the proper mounts and brackets are provided to do so.

Sharing digital pathology images for enterprise- wide use into a picture archiving and communication system (PACS) is not yet widely adopted. We share our solution and 3-year experience of transmitting such images to an enterprise image server (EIS).

Gross pathology images acquired by prosectors were integrated with clinical cases into the laboratory information system’s image management module, and stored in JPEG2000 format on a networked image server. Automated daily searches for cases with gross images were used to compile an ASCII text file that was forwarded to a separate institutional Enterprise Digital Imaging and Communications in Medicine (DICOM) Wrapper (EDW) server. Concurrently, an HL7-based image order for these cases was generated, containing the locations of images and patient data, and forwarded to the EDW, which combined data in these locations to generate images with patient data, as required by DICOM standards. The image and data were then “wrapped” according to DICOM standards, transferred to the PACS servers, and made accessible on an institution-wide basis.

In total, 26,966 gross images from 9,733 cases were transmitted over the 3-year period from the laboratory information system to the EIS. The average process time for cases with successful automatic uploads (n=9,688) to the EIS was 98 seconds. Only 45 cases (0.5%) failed requiring manual intervention. Uploaded images were immediately available to institution- wide PACS users. Since inception, user feedback has been positive.

Enterprise- wide PACS- based sharing of pathology images is feasible, provides useful services to clinical staff, and utilizes existing information system and telecommunications infrastructure. PACS-shared pathology images, however, require a “DICOM wrapper” for multisystem compatibility.

In total, 26,966 gross images from 9,733 cases were transmitted from the laboratory information system to the EIS. The average process time for cases with successful automatic uploads (n=9,688) to the EIS was 98 seconds; these times represent the processing time for the patient data and images to run though the EDW system into the EIS, but does not include any processing time in the LIS. Only 45 cases (0.5%) failed, requiring a manual transmission by the information technology support staff; for these cases, the average process time was 1 day, 8 minutes and 10 seconds. More specifically, these 45 cases failed due to a reported “time synchronization” error between the batch process creating the text file and availability of the jpeg images. Moving the batch an hour or so past the end of the working day resolved these errors.

Uploaded images were immediately available to institution-wide PACS users. Since inception, user feedback has been positive (informally evaluated via correspondence and at tumor boards) in several ways. First, digital gross pathology images were readily available to surgeons to help determine follow-up treatment protocols for their patients (e.g., transplant trials based on the amount and type of resected tissue). Second, surgeons no longer had to repeatedly contact pathologists to request gross pathology images of the specimens they removed. Third, these images were available for immediate review in subspecialty-based surgical oncology conferences and for counseling specific patients during clinic appointments. Access to these images has also allowed surgeons to more easily interpret the text-based gross description, including the locations of lesions and the orientation of the specimen, in the pathology reports they receive.

Based on our experience, enterprise-wide PACS-based sharing of pathology digital images is feasible, at least in a large academic hospital setting. As we have demonstrated, this service can be cost effective if existing technology and communications infrastructure can be leveraged. The LIS-PACS partnership described herein, however, involved significant resource commitments, including 15 months of in-house programming time. Similar commercially available methods have since emerged.[13,14] While there is certainly much potential with digital pathology, one of the challenges facing many institutions remains the feasibility of permanently archiving large volumes of pathology images for long periods of time because of their size, compared to imaging from most other disciplines. Advantages of utilizing DICOM compliant digital pathology images include the ease of image distribution to a PACS, downstream multi-system compatibility with other electronic health records, and widespread sharing of images intended to improve client satisfaction and hopefully improve patient care. There is a concerted effort for institutions to begin leveraging their PACS beyond the radiology department for enterprise-wide initiatives such as integration of digital images into the EMR, building decision support tools, supporting quality assurance programs and as a research tool.[15] The LIS-PACS partnership at our institution continues to grow, with future plans for digital gross pathology images acquired at all of our centers to be sent to the PACS, to facilitate enterprise-wide sharing of digital photomicrographs, and perhaps even whole-slide images given the recent push to link these images with DICOM[16] and for PACS to handle whole-slide microscopic images.[17]

1. Integration of digital gross pathology images for enterprise-wide access
Milon Amin, Gaurav Sharma,1 Anil V. Parwani, Ralph Anderson,2 Brian J Kolowitz,2 Anthony Piccoli,2 Rasu B. Shrestha,2 Gonzalo Romero Lauro,2 and Liron Pantanowitz*

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14. Apollo PACS. PathPACS: Apollo Enterprise Patient Media Manager. Apollo Enterprise Patient Media Services. [Last accessed on 2011 Dec 9]. Available from: http://apollopacs.com/products-solutions/pathpacs.php .
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