Telepathology

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Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research.[1][2] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. The use of “television microscopy”, the forerunner of telepathology, did not require that a pathologist have physical or virtual “hands-on” involvement is the selection of microscopic fields-of-view for analysis and diagnosis.

A pathologist, Ronald S. Weinstein,M.D., coined the term “telepathology” in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services.[3] He, and his collaborators, published the first scientific paper on robotic telepathology.[4] Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks.[5] Dr. Weinstein is known to many as the "father of telepathology".[6] In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.[7] This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.

Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.

Types of Telepathology Systems

Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slide systems. Static image systems have benefits of being the most reasonably priced and usable systems. They have the significant drawback in only being able to capture a selected subset of microscopic fields for off-site evaluation. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety, from a distance. With real-time systems, the consultant actively operates a robotically controlled motorized microscope located at a distant site—changing focus, illumination, magnification, and field of view—at will. Either an analog video camera or a digital video camera can be used for robotic microscopy. Virtual slide systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). This file is stored on a computer server and can be navigated at a distance, over the Internet, using a browser.[8] Digital imaging is required for virtual microscopy. While real-time and virtual slide systems offer higher diagnositc accuracy when compared with static-image telepathology, there are drawbacks to each. Real-time systems perform best on local area networks (LANs), but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Expense is an issue with real-time systems and virtual slide systems as they can be costly. Virtual slide telepathology is emerging as the technology of choice for telepathology services. However, high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Also, virtual slide digital files are relatively large, often exceeding one gigabyte in size. Storing and simultaneously retrieving large numbers of telepathology whole slide image files can be cumbersome, introducing their own workflow challenges in the clinical laboratory.

Uses and Benefits of Telepathology

Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens,[9] primary histopathology diagnoses,[10] second opinion diagnoses,[11] subspecialty pathology expert diagnoses,[12] education,[13] compentency assessment,[14] and research. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a kidney pathologist (renal pathologist), nervous system pathologist ([neuropathologist]), and skin pathologist ([dermatopathologist]), for immediate consultations.

See also

Footnotes

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References

1. Cross SS, Dennis T, Start RD. Telepathology: current status and future prospects in diagnostic histopathology. Histopathology 2002; 41:91-109.

2. Della Mea V, Beltrami CA. Current experiences with internet telepathology and possible evolution in the next generation of Internet services. Anal Cell Pathol 2000; 21:127-34.

3. Frierson HF Jr, Galgano MT. Frozen-section diagnosis by wireless telepathology and ultra portable computer: use in pathology resident/faculty consultation. Hum Pathol 2007; 38:1330-4.

4. Halliday BE, Bhattacharyya AK, Graham AR, et al. Diagnostic accuracy of an international static-imaging telepathology consultation service. Hum Pathol 1997; 28:17-21.

5. Kaplan KJ, Burgess JR, Sandberg GD, et al. Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation. Mod Pathol 2002; 15:1197–1204.

6. Krupinski E, Weinstein RS, Bloom KJ, Rozek LS. Progress in telepathology: System implementation and testing. Advances in Path Lab Med 1993; 6:63-87.

7. Krupinski EA. Virtual slide telepathology workstation-of-the-future: lessons learned from teleradiology. Semin Diagn Pathol 2009; 26:194-205.

8. Leung ST, Kaplan KJ. Medicolegal aspects of telepathology. Hum Pathol 2009; 40:1137-1142.

9. Maiolino P, De Vico G. Telepathology in veterinary diagnostic cytopathology. In: Kumar S, Dunn BE, editors. Telepathology. Berlin, Springer, 2009; 6:63-69.

10. Nordrum I, Eide TJ. Remote frozen section service in Norway. Arch Anat Cytol Pathol 1995; 43:253-256.

11. O'Malley DP. Practical applications of telepathology using morphology-based anatomic pathology. Arch Pathol Lab Med 2008; 132:743-4.

12. Schroeder JA. Ultrasructural telepathology: remote EM diagnostic via Internet. In: Kumar S, Dunn BE, editors. Telepathology. Berlin, Springer, 2009; 14:179-204.

13. Sinard JH. Practical pathology informatics. New York, Springer. 2006:265-286.

14. Weinstein RS: Prospects for telepathology. (Editorial), Human Path 1986; 17:433 434.

15. Weinstein RS, Bhattacharyya AK, Graham AR, et al. Telepathology: a ten-year progress report. Hum Pathol 1997;28:1–7.

16. Weinstein RS, Bloom KJ, Rozek LS: Telepathology and the networking of pathology diagnostic services. Arch Path Lab Med 1987; 111:646-652.

17. Weinstein RS, Descour MR, Liang C, et al. Telepathology overview: from concept to implementation. Hum Pathol 2001; 32:1283-99.

18. Weinstein RS, Graham AM, Richter LC, Barker GP, Krupinski EA, Lopez AM, Erps KA, Yagi Y, Gilbertson JR, Bhattacharyya AK. Overview of telepathology, virtual microscopy and whole slide imagining: Prospects for the future. Hum Pathol, 2009; 40: 1057-1069.

19. Williams S, Henricks WH, Becich MJ, et al. Telepathology for patient care: what am I getting myself into? Adv Anat Pathol 2010; 17:130-49.

External links

Informative sites or links

Links to articles

Academic Digital Pathology Sites

System Vendors (Telepathology, Digital pathology, Image Analysis, Whole Slide Imaging, Laboratory Information Systems)

Other Digital Pathology Vendors

• Digital Pathology Consultants

• Flagship Biosciences

Other Relevant sites

  • ↑ Weinstein, RS; Graham, AM; Richter, LC; Barker, GP; Krupinski, EA; Lopez, AM; Yagi, Y; Gilbertson, JR; Bhattacharyya, AK (2009), "Overview of telepathology, virtual microscopy and whole slide imagining: Prospects for the future.", Hum Pathol, 40: 1057–1069 
  • ↑ Kumar, S (2009), Kumar S, Dunn BE (editors), ed., "Telepathology: An Audit", In: Telepathology (Springer-Verlag Berlin Heidelberg): 225–229 
  • ↑ Weinstein, RS (1986), "Prospect for telepatholgy (Editorial)", Hum Pathol, 17: 443–434 
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  • ↑ http://www.union.edu/N/DS/s.php?s=8942
  • ↑ Nordrum, I; Engum, B; Rinde, E`; et al., "Remote frozen section service: A telepathology project to northern Norway.", Hum Pathol, 1991: 514–518 
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  • ↑ Massone, C; Soyer, HP; Lozzi, GP; DiStefani, A; Leinweber, B; Gabler, G; et al., "Feasibility and diagnostic agreement in teledermatology using a virtual slide system", Hum Pathol, 38: 546–554 
  • ↑ Dee, FR (2009), "Virtual microscopy in pathology education", Hum Pathol, 40: 1112–1121 
  • ↑ Bruch, LA; De Young, BR; Kreiter, CD; Haugen, TH; Leaven, TC; Dee, FR (2009), "Competency assessment of residents in surgical pathology using virtual microscopy.", Hum Pathol, 40: 1122–1128 
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