title: NDER: A novel web application using annotated whole slide images for rapid improvements in human pattern recognition.
abstract: BACKGROUND
  Whole-slide images (WSIs) present a rich source of information for education, training, and quality assurance. However, they are often used in a fashion similar to glass slides rather than in novel ways that leverage the advantages of WSI. We have created a pipeline to transform annotated WSI into pattern recognition training, and quality assurance web application called novel diagnostic electronic resource (NDER).
  
  
  OBJECTIVE
  Create an efficient workflow for extracting annotated WSI for use by NDER, an attractive web application that provides high-throughput training.
  
  
  METHODS
  WSI were annotated by a resident and classified into five categories. Two methods of extracting images and creating image databases were compared. Extraction Method 1: Manual extraction of still images and validation of each image by four breast pathologists. Extraction Method 2: Validation of annotated regions on the WSI by a single experienced breast pathologist and automated extraction of still images tagged by diagnosis. The extracted still images were used by NDER. NDER briefly displays an image, requires users to classify the image after time has expired, then gives users immediate feedback.
  
  
  RESULTS
  The NDER workflow is efficient: annotation of a WSI requires 5 min and validation by an expert pathologist requires An additional one to 2 min. The pipeline is highly automated, with only annotation and validation requiring human input. NDER effectively displays hundreds of high-quality, high-resolution images and provides immediate feedback to users during a 30 min session.
  
  
  CONCLUSIONS
  NDER efficiently uses annotated WSI to rapidly increase pattern recognition and evaluate for diagnostic proficiency.
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Nicholas P
authors: NP
authors: Reder
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Daniel
authors: D
authors: Glasser
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Suzanne M
authors: SM
authors: Dintzis
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Mara H
authors: MH
authors: Rendi
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Rochelle L
authors: RL
authors: Garcia
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Jonathan C
authors: JC
authors: Henriksen
authors: Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
authors: Mark R
authors: MR
authors: Kilgore
keywords: Adaptive learning; pathology education; smartphone; web application; whole-slide images