Whole slide of small size. SSVS (small size virtual slide)

1. Telepathology and Distant DiagnosisTelepathology and Distant Diagnosis
with SMALL SIZEVIRTUAL SLIDESwith SMALL SIZEVIRTUAL SLIDES
(SSVS)(SSVS)
Eng. Marcano, Fco & Prof. Dr. O. Ferrer-RocaEng. Marcano, Fco & Prof. Dr. O. Ferrer-Roca 20072007..
UNESCO Chair in TelemedicineUNESCO Chair in Telemedicine
University of La LagunaUniversity of La Laguna
Quality Control in Telemedicine - BiobankingQuality Control in Telemedicine - Biobanking
CATAI - XVI Winter CourseCATAI - XVI Winter Course
ULL - XXI Image Analisys CourseULL - XXI Image Analisys Course
http://www.teide.net/catai

2. ContentsContents
• IntroductionIntroduction
• VSVS
• SSVSSSVS
• SSVS quality assessmentSSVS quality assessment
• ResultsResults
• ConclusionsConclusions

3. Virtual SlidesVirtual Slides
• Specimens converted to digitalSpecimens converted to digital
imagesimages
• Images are transmitted overImages are transmitted over
networks, Internetnetworks, Internet
• Remote Analysis, Diagnosis,Remote Analysis, Diagnosis,
teaching purposesteaching purposes © Telemedicine Research Group - University of Udine, Italy
Bone biopsy
Area: 2.8x8.2 mm
Pixels: about 290M

4. Virtual Slide Capture SystemsVirtual Slide Capture Systems
High power VS (40x) 
Image size in the order of Gigabytes
Expensive equipments
50000€ - 250000€

5. Virtual Slides SizeVirtual Slides Size
• Demands aDemands a
lot oflot of
storagestorage
• JPEG basedJPEG based
imagesimages
20x20x
compressioncompression
© Department of Pathology. Clínica Universitaria. University of Navarra. Pamplona. Spain.

6. Virtual Slides Size - QCVirtual Slides Size - QC
• Technique:Technique:
linearlinear
scanningscanning
• ImageImage
artifactsartifacts
• EquipmentEquipment
price vs.price vs.
ImageImage
qualityquality
??
© Department of Pathology. Clínica Universitaria. University of Navarra. Pamplona. Spain.

7. Virtual Slides Size - QCVirtual Slides Size - QC
• GoodGood
AlignmentAlignment
© Department of Pathology. Clínica Universitaria. University of Navarra. Pamplona. Spain.

8. VS – High PowerVS – High Power
 Not alwaysNot always
necessarynecessary
to haveto have
high-powerhigh-power
imagesimages
 Images:Images:
severalseveral
GigabytesGigabytes 1.3X 3.9X
11.1X 40X

9. e-Slidese-Slides
• Telemedicine Research Group - University of Udine, ItalyTelemedicine Research Group - University of Udine, Italy
© Telemedicine Research Group - University of Udine, Italy
 Technique:Technique:
stitching ofstitching of
imagesimages
 CheaperCheaper
approachapproach
 JPEG basedJPEG based
imagesimages
 Size: stillSize: still
very largevery large

10. e-Slides - QCe-Slides - QC
© Telemedicine Research Group - University of Udine, Italy
 Stitching ofStitching of
imagesimages 
more imagemore image
artifactsartifacts

11. e-Slides - QCe-Slides - QC
© Telemedicine Research Group - University of Udine, Italy
 ProblemsProblems
with imagewith image
alignmentalignment

12. Small Size Virtual Slides –Small Size Virtual Slides –
SSVS©SSVS©
• Novel TechniqueNovel Technique
• Generates digital slides small in sizeGenerates digital slides small in size
• High resolution cameras (8-12 Mpx)High resolution cameras (8-12 Mpx)
• Excellent achromatic planapochromatic (infinite)Excellent achromatic planapochromatic (infinite)
opticsoptics
SSVS© 2008

13. Small Size Virtual Slides –Small Size Virtual Slides –
SSVS©SSVS©
• Uses Image-Compression format: JPEG2000Uses Image-Compression format: JPEG2000
(ISO 15444-1, Wavelet)(ISO 15444-1, Wavelet)
• Take advantage of JPEG2000 Image format toTake advantage of JPEG2000 Image format to
facilitate:facilitate:
• navigation,navigation,
• zooming,zooming,
• transmission,transmission,
• storagestorage
SSVS© 2008

14. JPEG2000JPEG2000
• Created by theCreated by the JJointoint PPhotographichotographic EExpertsxperts GGroup committeeroup committee
(2000)(2000)
• Intended to supersede discrete cosine transform-based JPEGIntended to supersede discrete cosine transform-based JPEG
standard (1991)standard (1991)
• Standard Filename extension:Standard Filename extension:
jp2 (ISO/IEC 15444-1 conforming files)jp2 (ISO/IEC 15444-1 conforming files)
jpx (Extended part-2 specifications or ISO/IEC 15444-2)jpx (Extended part-2 specifications or ISO/IEC 15444-2)
• Included in DICOM sup. 61 (Jan 2002)Included in DICOM sup. 61 (Jan 2002)

15. JPEG2000 Standard - PartsJPEG2000 Standard - Parts
• Part 1, Core coding system (intended as royalty and license-fee free -
NB NOT patent-free)
• Part 2, Extensions (adds more features and sophistication to the core)
• Part 3, Motion JPEG 2000
• Part 4, Conformance
• Part 5, Reference software (Java and C implementations are available)
• Part 6, Compound image file format (document imaging, for pre-press
and fax-like applications, etc.)
• Part 7 has been abandoned
• Part 8, JPSEC (security aspects)
• Part 9, JPIP (interactive protocols and API)
• Part 10, JP3D (volumetric imaging)
• Part 11, JPWL (wireless applications)
• Part 12, ISO Base Media File Format (common with MPEG-4)

16. JPEG2000JPEG2000
•
Complex algorithm for compression / decompression takes a long timeComplex algorithm for compression / decompression takes a long time
Compressed
Image
decompression
Source
Image Color
Transformation
Tiling
Wavelet
Transform
Quantization
Tier-1
Encoder
(Modeling &
Arithmetic
Coding)
Tier-2
Encoder
(Stream
Creation)
Rate
Control
8 7 8 8 34 34 34 34
7 7 8 8 34 34 34 34
8 8 12 12 34 34 34 34
8 8 12 12 34 34 34 34
34 34 34 34 55 55 55 55
34 34 34 34 55 55 55 55
34 34 34 34 55 55 55 55
34 34 34 34 55 55 55 55
EBCOT - Embedded Block
Coding with Optimal
Truncation

17. JPEG2000JPEG2000
• Higher compression ratios, images get blurredHigher compression ratios, images get blurred
570k 57k 6k 2k

18. JPEG2000JPEG2000
Compression factor: 1:250Compression factor: 1:250
Jpeg2000 - blurred Jpeg - blocked

19. Distant Diagnosis - TEXCAN©-Distant Diagnosis - TEXCAN©-
IIII
• TEXCAN-II® implements SSVS technique,
allowing:
• Zoom-Focus©
• Spatial resolution  extreme digital zoom;
• High quality focused image
• Small size of compressed images
• Fast & efficient distant consultation
• Non-expensive digital virtual microscope

20. TEXCAN®-II Capture System
Intel 3.4 GHz Pentium® 4 /
Intel® Core™2 Duo,
4 Gb RAM
CCD Camera 8Mpixels,
firewire 1394.a
4x – 0.13 NA
20x – 0.46 NA (ROI’s)

21. TEXCAN®-II Assessment
Tools
Preparación Diagnóstico conocido Maligno Inflamación F.S.M.*
1
CITOLOGIA ORINA: Positivo para celulas
malignas. Sugestivo de Carcinoma de
celulas claras +
2
CITOLOGÍA ORINA: Citologia positiva
para celulas tumorales malignas. Frotis
sugestivo de Carcinoma. +
3
CITOLOGÍA DE LÍQUIDO PLEURAL.
CITOLOGÍA SOSPECHOSA DE
MALIGNIDAD. FROTIS CON INTENSA
LINFOCITOSIS. + +
4
CITOLOGÍA DE LÍQUIDO PLEURAL:
CITOLOGÍA POSITIVA PARA CÉLULAS
TUMORALES MALIGNAS. Frotis sugestivo
de Carcinoma. +
5
PUNCIÓN ASPIRACIÓN DE MAMA: Frotis
sugestivos de mastopatía fibroquística
con lesión epitelial proliferativa benigna
intraquística.
6
CITOLOGÍA DE LAVADO PERITONEAL:
CITOLOGÍA POSITIVA PARA CÉLULAS
TUMORALES MALIGNAS. Frotis sugestivo
de Carcinoma +
7
CITOLOGÍA DE LÍQUIDO PLEURAL:
CITOLOGÍA SOSPECHOSA DE
MALIGNIDAD. + +
8
Frotis con estimulo estrogenico mediano,
algo inflamatorio, con espermatozoides,
elementos cervicales asi como cambios
celulares queratosicos y celulas
pavimentosas con atipias nucleares
moderadas. HSIL (High grade squamous
intraepitelial lesion) + + +
9
Frotis pseudoluteal, algo inflamatorio,
con elementos endocervicales sin
anomalias. Hay cambios celulares
queratosicos, asi como binucleaciones y
elementos pavimentosos con atipias
nucleares. LSIL-HPV? (Lesion escamosa
intraepitelial de bajo grado-Human
Papiloma Virus?) + +
10
Frotis mixto, moderadamente
inflamatorio, con alteraciones celulares
degenerativas, asi como escasos
elementos pavimentosos con atipias
ligeras, de probable origen reactivo. +
11
Estimulo estrogenico moderado, con
citolisis, algo inflamatorio. Elementos
cervicales bien conservados y escasos
elementos pavimentosos con atipias
ligeras. ASCUS (Atipical scamous cells of
unknown significance). +
12
Estimulo estrogenico moderado, con
citolisis, algo inflamatorio. Elementos
cervicales bien conservados y celulas
metaplasicas con atipias nucleares y
algun pseudokoilocito, asi como cambios
queratosicos. LSIL-HPV (Lesion escamosa
intraepitelial de bajo grado-Human
Papiloma Virus) +
13 Microcarcinoma papilar de tiroides. +
14 Adenoma tubular
15 Adenoma tubulovelloso
(*) F.S.M.: Fase secretora Menstrual
+ : Positivo para el caso
JPIP
JPEG2000
www.cataibreezee.ull.es:81.
V5.2
Samples
Stat. Software
Viewer & Transmissione-forms

22. SSVS CaptureSSVS Capture
• SSVS captured with the 4x objectiveSSVS captured with the 4x objective
• ROI’s (Region of Interest) selected byROI’s (Region of Interest) selected by
technician, captured with the 20xtechnician, captured with the 20x
objectiveobjective
• Some clinical data included in eachSome clinical data included in each
SSVSSSVS

23. SSVS – samplesSSVS – samples
• Small powerSmall power
enough forenough for
having anhaving an
image withimage with
diagnosticdiagnostic
qualityquality
53MB
68MB
7.8x 250x
1.6x 6.3x
Digital zoom 500x

24. 6x
3x
SSVS - samplesAreas identified by pathologist / technician
Random captured areas
26Mb 16Mb
40x
40x

25. SSVS Samples
1Mb8Mb
31.3x
42.5x
250x
250x

26. SSVS AssessmentSSVS Assessment
• 10 pathologists, not trained in10 pathologists, not trained in
TelepathologyTelepathology
• 3 pathologists, trained in TelePathology3 pathologists, trained in TelePathology
• 9 cytological/histological samples9 cytological/histological samples

27. Evaluation formEvaluation form

28. Results – ROCResults – ROC
SSVS - Validity for diagnosis:SSVS - Validity for diagnosis:
• Area under the ROC curve ofArea under the ROC curve of 0.95 p<0.0010.95 p<0.001, (good diagnostic quality), (good diagnostic quality)

29. Results - KappaResults - Kappa
Concordance and precision was high forConcordance and precision was high for
telepathology trained pathologiststelepathology trained pathologists
• k=0.73, p<0.001k=0.73, p<0.001
• Concordance and precision was low forConcordance and precision was low for
pathologists non-trained in telepathologypathologists non-trained in telepathology
• low k=0.4, p<0.001low k=0.4, p<0.001
• Comments of the users where mainly devoted toComments of the users where mainly devoted to
improve the sampling area of the ROI.improve the sampling area of the ROI.

30. ConclusionsConclusions
• The SSVS technique allows the technicians to digitize aThe SSVS technique allows the technicians to digitize a
virtual slide easy to storage due to its small size.virtual slide easy to storage due to its small size.
• SSVS is perfectly suitable for discussion and diagnosis atSSVS is perfectly suitable for discussion and diagnosis at
distance through intranet and Internet providing a cheapdistance through intranet and Internet providing a cheap
digital microscope and an online collaborative system.digital microscope and an online collaborative system.
• For specimens that require high power to make diagnosis,For specimens that require high power to make diagnosis,
the SSVS+ROI technique has been proved of value.the SSVS+ROI technique has been proved of value.

31. Thanks!Thanks!