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‘Live from The Johns Hopkins Hospital, welcome to pathCast’

‘Live from The Johns Hopkins Hospital, welcome to pathCast’

Ralph Hruban brings his pathology lecture to a global audience.

In a room full of microscopes, Ralph Hruban, director of the Johns Hopkins University School of Medicine’s Department of Pathology, sits tall behind the main scope. His weathered portfolio contains hundreds of glass slides, each stained with a sample from a patient’s pancreas.

Hruban has selected a dozen or so examples to illustrate what he calls “probably one of the most important [parts of] pancreas pathology.” For the next hour, he will use social media to demonstrate to pathologists in India, Romania, Kenya, Iraq and dozens of other countries the difference between benign cells reacting to chronic pancreatitis and dangerous malignant cells. 

Facebook has your aunt’s cat videos. It has your neighbor’s baby pictures. And, since 2016, it also has pathCast: live, interactive lectures by some of the world’s most prominent pathologists.

Johns Hopkins pathology fellow Rifat Mannan and Emilio Madrigal, a colleague at Emory University, are the founders and hosts of this online lecture series of pathology cases both common and uncommon.

Sessions for pathCast are broadcast live on Facebook and YouTube. Afterward, recorded versions are available on demand on those platforms.

They’re completely free to anyone who wants to watch.

“We wanted to share knowledge around the world,” says Mannan, who this summer will begin a faculty position at the University of Pennsylvania while continuing to host pathCast. “This allows anyone who has an internet connection to see and hear some of the leaders in our field.”

Hruban looks into the microscope and tucks a slide under its magnifying lens. Pancreatic cancer, while relatively uncommon, is among the most deadly cancers humans encounter. A misdiagnosis could cost valuable time in a patient’s treatment.

Viewers of pathCast can observe the same image Hruban sees: red-and-blue-stained pancreatic cell formations that cluster together and swirl in all directions. He notes that, at first glance, the clusters and patterns look the same. Adjusting the magnification on the image, he describes the subtle differences between inflammation and cancer.

Mannan, meanwhile, sits nearby, monitoring pathCast and making sure the broadcast is streaming properly. He also prompts discussion in the live comments section.

During Hruban’s hour-long lecture, chat messages pop across the Facebook screen like bubbles in Champagne. When the professor demonstrates that pancreatic duct cancer’s evolution mimics a benign process, the pathCast viewers use emoji to signal they understand him. Smiley faces and happy-dance icons burst across the screen.

When Mannan and Madrigal did their pathology residencies at The Mount Sinai Hospital in New York from 2013 to 2017, they thought about ways to share information among the program’s residents.

“But Rifat and I realized quickly that our project had the potential to reach much farther than just our co-residents,” says Madrigal, who is completing a fellowship in cytopathology at Emory and soon will pursue a clinical informatics fellowship at Massachusetts General Hospital. “Using online social networks lets us share this information globally, without expensive travel or fees.”

Mannan and Madrigal invite lectures from friends, colleagues and faculty members who they’ve encountered in their studies and through social media networks; there are two or three broadcasts each month. Through Facebook and YouTube, Mannan and Madrigal have popularized pathCast around the world, racking up more than 4,300 Facebook followers and over 2,000 YouTube subscribers in nearly 50 countries. Their Twitter handle, @pathologyCast, has more than 1,000 followers.

Of the 52 pathCast lectures, 12 have been delivered by Johns Hopkins faculty. Others have come courtesy of pathologists at McGill University, Harvard Medical School, the University of California San Francisco, Stanford University, Brown University and other colleges. Most pathCasts are in English, but pathologists have delivered lectures in Spanish, French, Portuguese, German, Italian and Mandarin. A January pathCast session that was presented in Japanese drew nearly 600 viewers.

“It’s important to remember that not everyone speaks English,” says Mannan. “If we want to truly share this around the world, we need to offer it in as many languages as we can.”

Though Mannan specializes in gastrointestinal pathology and Madrigal’s field is cytopathology, the pathCasts cover many fields. Bladders, breasts and brains have all been subjects.

As Hruban’s lecture wraps up, a medical resident in New York comments, “I love these pathCasts! I’ve made a point to watch one every weekend.”

A pathologist in India writes, “Informative and well-described … thanks!”

When Hruban points out cancerous cells in a pancreatic duct, a physician in Egypt has an “aha” moment, commenting “cancerization of duct!” followed by a thumbs-up emoji.

Hruban says pathCast gives pathologists everywhere a chance to participate in academic discussions without having to fly to an international conference. While Hruban’s real-time session drew several hundred viewers, the archived version has been seen more than 6,000 times.

“What I love about this is that it’s designed purely for sharing knowledge,” he says. “This amazing technology is bringing people together in the cause of better medicine and science. It’s not about dollars.”

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