FUTURE DIAGNOSTIC CRITERIA & REPORTING

1. TELE PATHOLOGY
DR.ABHINAV GOLLA
MEDICURE DIAGNOSRICS AND RESEARCH
CENTER
Vijayanagar colony, Hyderabad,
TELANGANA.

2. TELEPATHOLOGY
• Definition
• Parts
• Types
• Significant areas of development
• Applications
• Technical aspects of telepathology
• Future of telepathology

3. INTRODUCTION
• Tele is a Greek word meaning - distance .
• Pathos is a Greek word meaning - suffering
• Logia - study
• Telepathology - practice of pathology at a distance .

4. DEFINITION
• It is acquisition of histological & macroscopic images for
transmission along telecommunication pathways for
Diagnosis
Consultation
Continuing medical education

7. PARTS
• Telepathology system comprises a
1. Conventional microscope
2. Camera mounted on a light microscope
3. Telecommunications - link between sending & receiving
sites
4. Workstation at the receiving site with a high quality
monitor to view the images.

8. TYPES
Telepathology
Static telepathology
Robotic Interactive Pathology
Virtual Slide Telepathology

9. 1 .STATIC
TELEPATHOLOGY• Synonyms-Store & forward or passive telepathology .
• Advantages –
 It is cheap , simple , need a standard telephone line / internet
connection .
Images are static .
• There is no facility for recipient control .

11. STATIC TELEPATHOLOGY
• Number of images captured is limited for each case .(1-
40)
• Disadvantages -
Sampling errors
Interpretation & Video imaging quality has problems .

12. • Sampling errors/ Bias – can be prevented by using a trained
pathologist to select the images .
• There is some discordance between telepathology & glass
slide diagnosis .
• This discordance is due to
Field selection
Diagnostic interpretation
Video image quality

13. 2 .ROBOTIC
INTERACTIVE
PATHOLOGY
( RIT PATH)
• Synonyms – Dynamic telepathology /
Active telepathology /
Real time telepathology
• Advantage –
receiving pathologist can control the movement of the
slide on the stage .
To see the image in real time on a high resolution
monitor .

14. RIT PATH
• Limitation -
 Transmission time
• Examples -
1. HISTKOM RIT Path system
2. The Apollo image management system (IMS)/Corabi
dynamic module (CDT)

17. •Histkom rit path system :
• It consists of a
robotic zeiss microscope with triple charge coupled
device(CCD),
Sony video camera transmitting images to a remote station.

18. HISTKOM RIT PATH
SYSTEM :
• User is able to control all the functions of the
microscope , including the scanning stage , magnification
& light intensity.
• Soft ware at the receiving station stitches the images
together thus stimulating a moving image

19. • The apollo image management system / Corabi Dynamic
Module (IMS / CDT)
• This system provides remote stage management , focus , light
intensity & magnification .
• It has the capability of functioning as a bidirectional
telepathology system.
• Disadvantage of video conference technology in - its
susceptibility to blurring
- interruptions in image displays

20. • HYBRID system - capable of both the static telepathology
& dynamic telepathology.

21. 3 . VIRTUAL SLIDE
TELEPATHOLOGY
• It requires fast slide scanner.
• Highest image quality & speed .
• Offers better user experience & diagnostic accuracy than
robotic microscopy.
• Examination & storage in one step.

23. ADVANTAGES DISADVANTAGES
• Virtual Slide doesn't discolor • Not possible to focus the areas
that were not correctly acquired
during scanning due to irregular
surface of the sample.
• Multiple viewers can
observe Virtual Slide at the
same time
• Less space consuming
• Allows exploration of the
whole slide surface with
different magnification

24. SIGNIFICANT AREAS OF
DEVELOPMENT
• INTERNET : helps in video conferencing & presentation
of graphical images
• Adv: cost & availability
static images are sent as email attachments
• Disadvatages- slow
issue of security

25. • SLIDE DIGITISATION : It is the conversion of an
analogue source in to a digital format, so that can be
stored by a computer & recreated at a later date .
• Stained sections will fade with time , image stored in
digital form offers a longer lifespan ,

26. APPLICATIONS
• In places where full time pathologist is not available
telepathology helps in gaining a pathologist
consultation.
• Telepathology helps in taking an expert pathologist
opinion.
• Telepathology can overcome the delays associated with
the postal service .

27. • External Quality Assessment & Teaching :
 EQA programs has advantage in mass delivery .
Rather than cut multiple sections , selective images for
each case can be sent via E-mail .
Images can be reviewed later .
Educational cases can easily be distributed to trainees .

28. TECHNICAL ASPECTS OF
TELEPATHOLOGY• IMAGE ACQUISITION
• STORAGE
• IMAGE COMPRESSION
• NETWORKING & LINE SPEEDS
• COMPUTER NETWORKS

29. IMAGE ACQUISITION
• By camera mounted on the top of the microscope.
• CCD(charge coupled device) sensor convert the images to
an electronic form .
• Out put from the digital video cameras is converted
back either to an analogue signal for viewing on an
television monitor or sent unchanged to a computer
hardware & software for recording.

30. STORAGE
• 1. Short term storage - hard drive
• 2. Small computer system interface (SCSI) –
It handles multiple devices such as extra hard drives
,scanners ,CD-ROM’S ,simultaneously along a single interphase.

31. IMAGE COMPRESSION
• DICOM (SM) – Digital Imaging & Communications in
Medicine Standard- provides standardized formats
for image capture & storage .
• IMAGE FORMATS -
Lossy algorithms – discard unnecessary data in the
course of compression .
Lossless algorithms – preserve data at the expense
of compressed image size .

32. • JPEG - Joint Photographics Experts Group
• GIF - Graphics Interchange Format
• PNG - Portable Network Graphics
• Flash Pix
• WSQ - Wavelet Scalar Quantitisation
• TIFF - Tagged Image File Format
• Fractals Compression

33. COMPUTER NETWORKS
• This is the key tool used by companies & institutions
world wide .
• LAN (Local area network)
• WAN (Wide area network)

34. • LAN – it is a high speed communications system designed to
link computers & data processing devices together with in a
small geographic area .EX: ATM
• Multiple LANs are linked together to form a WAN .
• Example of WAN is Telephone network, modems ,ATM , ISDN.

35. NETWORKING
• Robotic telepathology is dependent on telecommunication
transmission speed.
 Plain old Telephone Services (POTS)
 Integrated Services Digital network (ISDN)
 Asynchronous Transfer mode (ATM)
 T -1/T-3 Carriers
 Cable Modems / Digital Subscriber Lines(DSL)

36. CODEC FROM ATM TO
Video/audio & vice versa

37. MULTIPLE ONE
ON ONE VIDEO
CONFERENCING
ONE ON ONE
VIDEO
CONFERENCING
STILL IMAGES,
DOCUMENT
CONFERENCING
CAPABILITI
ES
ISDNMODEM ATM
CAPABILITIES OF WAN

39. FUTURE OF
TELEPATHOLOGY
• Currently telepathology is far from being an
alternative to conventional reporting but it
offers a new approach to diagnostic services
• The quality of the digitisation of histological
images has to improve ,the pathologists skill
in interpreting these images has to improve
until it matches the conventional images.

40. TELEPATHOLOGY
WORD.DOCX
• References
• Recent advances in histopathology 18
• internet