Case Study: Cloudscaler and Royal Marsden - Digital Pathology Imaging
Challenge
The Royal Marsden NHS Foundation Trust is one of the world’s leading cancer centres, where diagnostic speed and accuracy directly affect patient outcomes. As part of its digital transformation programme, the Trust invested in the Halo AP Digital Pathology Image Management System from Indica Labs, replacing traditional microscopy with high-resolution digital slide analysis.
This shift introduced significant infrastructure demands. Each scanned pathology slide generates image files approaching several gigabytes. These files must be stored securely, retained for long periods, and accessed rapidly during clinical workflows. As digital pathology adoption grew, the Trust needed a platform capable of managing petabyte-scale data growth without compromising performance.
The infrastructure also had to meet strict NHS governance requirements. Sensitive clinical data needed to remain within a Trust-owned cloud tenant, hosted in UK data centres, and aligned with NHS Digital’s Public Cloud First strategy. Performance was non-negotiable: pathologists rely on immediate access to digital slides during diagnosis, and any delay in image retrieval could disrupt clinical decision-making.
Beyond technical requirements, the Trust wanted the platform delivered as a managed service. Internal IT teams needed confidence that the infrastructure would be monitored, maintained, and optimised continuously—without adding operational burden. The objective was to establish a resilient digital foundation capable of supporting pathology services for years to come.
Solution
Cloudscaler designed, implemented, and now manages a scalable cloud infrastructure supporting the Royal Marsden’s digital pathology environment.
The engagement began with a collaborative discovery phase. Cloudscaler worked with technical and clinical stakeholders to understand the operational requirements of the HaloAP Image Management System and the expected trajectory of digital pathology data growth. This early engagement ensured the final architecture aligned with both application performance needs and day-to-day clinical workflows.
The resulting platform runs within a Royal Marsden–owned AWS tenant, architected using AWS best practices for security, resilience, and cost efficiency. At its core is a tiered storage architecture capable of supporting multiple petabytes of diagnostic imagery. Frequently accessed images remain on high-performance storage, while older images transition automatically to lower-cost tiers—remaining accessible for clinical review or research without manual intervention.
The compute environment provides consistent performance through resilient infrastructure patterns, load balancing, and distributed architecture, ensuring the Halo AP application remains available even during component failures. Secure connectivity between the Trust’s on-premises pathology scanners and the cloud platform allows digital slides to transfer directly into storage while remaining within the Trust’s controlled network.
Following implementation, Cloudscaler assumed end-to-end management of the platform: monitoring system health, maintaining security controls, responding to incidents, and continuously optimising for performance and cost.
Benefits
Clinicians now access large diagnostic images quickly and reliably, supporting faster clinical decision-making. The tiered storage architecture provides a sustainable model for managing continued data growth—as additional scanners and digital workflows come online, the platform expands to meet demand without service disruption.
Reliability improved considerably. The architecture eliminates single points of failure across critical services, which is essential in a clinical environment where diagnostic systems must remain continuously available. By adopting a managed infrastructure service, the Trust’s internal IT teams can focus on developing and improving clinical services rather than maintaining cloud infrastructure.
Value
Cloudscaler’s role extended beyond deploying infrastructure. The project delivered a long-term digital platform designed to support innovation—including advanced analytics and AI-driven image analysis—without requiring the Trust to redesign its underlying environment.
Andy Astley, Founder and CTO of Cloudscaler:
“Digital pathology pushes infrastructure to its limits because of the size, sensitivity, and longevity of the data involved. Our goal was to design an AWS environment that could scale to petabytes of diagnostic imagery while remaining secure, resilient, and straightforward for the Trust to operate. By managing the platform end to end, we enable the Royal Marsden’s teams to focus on delivering exceptional patient care rather than worrying about the infrastructure behind it.”
Lee Gumble FIBMS, Digital Pathology Manager, The Royal Marsden NHS Foundation Trust:
“At The Royal Marsden NHS Foundation Trust, patient diagnostic turnarounds rely heavily on a seamless digital pathology service. This requires maintaining secure, efficient, and highly stable storage alongside compute in an AWS cloud environment. Working with Cloudscaler to manage this simplifies administration, making it almost effortless. From implementation to ongoing support, their rapid response far exceeds our expected Key Quality Indicators. It is a fabulous collaboration that underpins a highly dependable clinical workflow.”
Lessons Learned
The project demonstrated the importance of designing cloud infrastructure around clinical workflows rather than simply migrating applications into the cloud. Digital pathology environments generate extremely large datasets that must remain accessible for extended periods while meeting strict governance requirements. Designing with lifecycle management and resilience at the core ensured the platform supports both immediate operational needs and long-term data growth.
Close collaboration between cloud specialists, IT teams, and clinical stakeholders proved essential. By working together throughout design and implementation, the final environment supports the practical realities of diagnostic workflows while maintaining strong security and operational standards.
Through this partnership, the Royal Marsden now operates a digital pathology platform that is resilient, governed, and ready to support future innovation in diagnostic medicine.