In a small unit in the Department of Pathology and Laboratory Medicine at the Nationwide Children’s Hospital, Andrew Mullen has a sizeable responsibility. As Digital Pathology Laboratory Supervisor, he oversees both clinical and research programs that are shaping the future of pediatric pathology.
We connected with Mullen to learn more about his unusual role and the impacts of his progressive laboratory.
What led to the creation of the Digital Pathology Laboratory as a new department at your institution?
Digital pathology has actually been part of Nationwide Children’s for nearly two decades. We purchased our first scanner in 2006, then in 2010 we became the biospecimen archive for The Cancer Genome Atlas. The team scanned and released tens of thousands of whole slide images for public use. Many of today’s AI and foundation models have been trained on datasets like those – so we were involved early in laying groundwork for where the field is headed.
We explored primary diagnosis as early as 2015, but the technology simply wasn’t ready. Scan times were slow, and adoption stalled. We continued scanning for consults, education, and archival purposes until the telepathology push around 2020 accelerated progress.
With strong leadership under Shamlal Mangray and Diana Thomas, we validated our first scanner for primary diagnosis in 2024 and began scanning prospectively. Digital pathology is not a large standalone department, but we have meaningful impact across both clinical and research programs.
What's your career background, and how did that lead to your position as Digital Pathology Laboratory Supervisor?
Honestly, it was timing and diligence.
I studied biology on a pre-med track but always had a passion for technology. After college, while studying for the Medical College Admission Test (MCAT), I was offered a role as a biomedical imaging technician on the digital pathology team. I had little exposure to pathology and no formal technical background, but I found myself at the intersection of medicine and technology – and was hooked.
While my MCAT results were exceptionally average, I realized what energized me was closing that technical gap. I taught myself programming through online courses and certifications. Over time, I moved from technician responsibilities, to managing digital archives and validating scanners, implementing systems, and now helping lead operational strategy and AI exploration in pediatric pathology.
Luck opened the door. Hard work helped me grow.
What challenges were encountered in creating a new department and leadership role?
In short, resources have been the biggest challenge.
We’ve faced limited informatics bandwidth, staffing shortages, and constant contingency planning. Both the clinical and research sides of our program are undergoing overhauls of their laboratory information management systems (LIMS), so we’re not yet fully integrated. That creates complexity, especially when bridging systems with middleware and trying to balance transparency with efficiency.
Staffing is another real challenge. As a smaller-volume institution, we can’t justify 24/7 operations or dedicated scanning teams, so we’ve cross-trained responsibilities across lab staff, to ensure coverage and interoperability.
And digital pathology isn’t plug-and-play. Contingency planning is equally critical. What happens when a scanner fails? When the network goes down? When software introduces bugs? These are not hypothetical scenarios, they are realities in digital adoption. Without people who understand both laboratory operations and informatics, adoption can stall quickly.
What have been the key achievements of the Digital Pathology Laboratory to date?
Beyond The Cancer Genome Atlas, one of our biggest accomplishments has been implementing prospective digital scanning for primary diagnosis – even without full LIMS integration.
We operate in a hybrid model: scan everything first, then distribute slides. This gives our pathologists digital access while maintaining availability of glass. We’ve done this without increasing turnaround times or negatively impacting patient care. It’s not the textbook implementation model – but it shows what’s possible even with constraints.
On the research side, we serve as a primary biobank for several sponsor groups, including the Children’s Oncology Group. Through initiatives like the Molecular Characterization Initiative, we support molecular profiling shortly after diagnosis and help distribute large image datasets for global research use.
How would you summarize the impact of digital pathology, both to the patients you serve and to pathology in general?
Clinically, we’re still unlocking the full potential – but even in a hybrid model, digital pathology has changed how we collaborate, review cases, and run tumor boards. Microscopes are still present, but they’re no longer the only tool. In research, as COG’s biobank, our impact extends globally. Pediatric pathology cases are rare and expertise is limited, therefore digital access and data sharing aren’t conveniences – they’re essential.
Digital pathology isn’t just a “cool” field. It expands reach, builds collaboration, and sets the foundation for the future of pediatric diagnostics. We are currently piloting image analysis software that will help shape the future of pediatric pathology by providing our pathologists with objective insights into the complexity of these rare cases.
What's your favorite "good news story" that speaks to the impact of digitizing pathology?
Nationwide Children’s Hospital is the third largest pediatric institution in the US, yet there are fewer than 400 pediatric pathologists nationwide. Digital pathology allows us to recruit and retain specialized talent regardless of geography. Exemplifying this, we now have a full-time pathologist who works almost entirely remotely.
That flexibility directly impacts patient care – especially in pediatrics, where expertise is limited.
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