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TTEELLEEPPAATTHHOOLLOOGGYY 
PRESENTER : DR.GURLEEN 
OBEROI 
MODERATOR: DR. RIDDHI 
JAISWAL
IINNDDEEXX 
Important Terminologies 
 Introduction 
 Brief history 
 Types of telepathology 
 Applications 
Telepathology vis-a-vis Teleradiology 
 Problems 
Telepathology in India
IIMMPPOORRTTAANNTT TTEERRMMIINNOOLLOOGGIIEESS 
AANNDD 
AABBBBRREEVVIIAATTIIOONNSS
VViirrttuuaall MMiiccrroossccooppyy 
A method of posting microscope images 
on, and transmitting them over, 
computer networks. This allows 
independent viewing of images by large 
numbers of people in diverse locations. It 
involves a synthesis of 
microscopy technologies and digital 
technologies
HHiissttoollooggyy WWoorrkkffllooww 
FFrroomm TTiissssuuee SSaammppllee ttoo HHiissttoollooggiiccaall EExxaammiinnaattiioonn 
Biopsy 
Frozen 
Section 
P 
Specimen 
Examination 
Histo-processing 
Sectioning Staining 
Tissue 
Sample 
Microscope 
Slide(s) 
Surgery Center Histology Lab 
P 
Microscopic 
Examination 
Pathologist Office 
P 
P Step that requires Pathologist 
In pathology, imaging begins in histology!
Scanning 
Digital 
Slide 
VViirrttuuaall MMiiccrroossccooppyy 
DDiiggiittaall SSlliiddee CCrreeaattiioonn,, MMaannaaggeemmeenntt && AAnnaallyyssiiss 
Biopsy 
Workflow Management 
Specimen 
Examination 
Histo-processing 
Sectioning Staining 
Tissue 
Sample 
Digital Slide(s) 
Surgery Center Histology Lab 
Frozen 
Section 
P 
P 
Microscopic 
Examination 
Pathologist Office 
P 
P Step that requires Pathologist 
Image Analysis 
Conferencing
AA DDiiggiittaall SSlliiddee 
A classical whole slide image is 
formed by imaging an entire 
physical (glass) slide, field by 
field, and then ‘knitting” these 
fields together to form a 
seamless montage 
The main virtual slide 
collection is the "Juan Rosai's 
collection of surgical 
pathology seminars", curated 
by USCAP. 
With some display software, 
one can pan and zoom 
around the image set
DDiiggiittaall PPaatthhoollooggyy 
It is an image-based information 
environment enabled by computer 
technology that allows for the 
management of information generated 
from a digital slide. Digital pathology is 
enabled in part by virtual microscopy.
LAN : Local Area Network 
WAN: Wide Area Network 
ISDN: Integrated Services For Digital 
Network 
L I S : Laboratory Information System 
 WSI : Whole Slide Imaging 
RTIS : Real Time Telepathology Imaging 
System
IINNTTRROODDUUCCTTIIOONN 
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, 
consultation and research.
HHIISSTTOORRYY 
 An academic pathologist Dr. Ronald S. Weinstein is 
known as the “father of Telepathology” 
 One of the earliest instances of telepathology took 
place in boston in 1968. 
 Ronald S. Weinstein coined the term “telepathology” in 
1986. In a medical journal editorial, Weinstein outlined 
the actions that would be needed to create remote 
pathology diagnostic services. 
 In Norway, Eide and Nordrum implemented the first 
sustainable clinical telepathology service in 1989.This is 
still in operational decades later.
A Telepathology system consists of: 
A conventional microscope. 
 A method for video capture. 
 A computer. 
Telecommunication links between sending 
and receiving site and 
 A work station at the receiving site with 
a high quality monitor to view the images.
DDiiggiittaall PPaatthhoollooggyy EEnnvviirroonnmmeenntt 
Scan 
View 
Manage 
Analyze 
Integrate 
Sharing
WWHHYY AARREE WWEE TTRRYYIINNGG TTOO 
IIMMPPLLEEMMEENNTT TTEELLEEPPAATTHHOOLLOOGGYY 
IINN OOUURR SSYYSSTTEEMM????
Telediagnosis 
Teleconsultation 
Teleconferencing 
With this access to global expert pathologists is no 
longer 
a limiting factor. Telepathology has been shown to be 
applicable for: 
Anatomical pathology including :- 
 Intra-operative consultation (frozen sections), 
 Surgical pathology (second opinions, immunostains), 
 Telecytology (e.g., on-site evaluation) 
 Ultrastructural pathology, as well as
Clinical pathology including -telehematology, 
microbiology (e.g. parasitology), and chemistry (e.g., 
interpretation of gels). 
The most recent advances in digital imaging 
techniques promise to change the life style of 
pathologist from the microscope to the computer 
screen. There are “Virtual slides” where the entire slide 
is scanned at a very high resolution and can be viewed 
by multiple pathologists and without any loss of 
resolution
TTYYPPEESS OOFF TTEELLEEPPAATTHHOOLLOOGGYY
SSttaattiicc ((SSttoorree aanndd FFoorrwwaarrdd)) 
TTeelleeppaatthhoollooggyy 
 Static (still) images (photographs) 
selected by referring provider sent to 
consultant 
 Requires skillful image collection by 
referrer
Advantages 
◦ Simple - minimal hardware needs (computer, camera) 
◦ Inexpensive - hardware and image transmission 
(Internet) 
◦ Adaptable - many computer systems can be adapted 
Disadvantages 
◦ Image selection – referrer 
◦ Real time interaction - difficult 
◦ Not suitable for primary diagnosis by surgical 
pathologist at a distance 
Example: Armed Forces Institute of Pathology 
consultation service
 DDyynnaammiicc TTeelleeppaatthhoollooggyy 
RReeaall--ttiimmee ((tteelleevviissiioonn)) iimmaaggeess sseelleecctteedd bbyy 
rreeffeerrrreerr aass iiff ooppeerraattiinngg aa ttwwoo--hheeaaddeedd 
mmiiccrroossccooppee.. 
HHyybbrriidd DDyynnaammiicc//SSttoorree aanndd 
FFoorrwwaarrdd ((HHDDSSFF)) TTeelleeppaatthhoollooggyy 
CCoommbbiinneess bbootthh ssttoorree aanndd ffoorrwwaarrdd aanndd ddyynnaammiicc 
tteelleeppaatthhoollooggyy ffuunnccttiioonnss
Advantages 
◦ Dynamic and store and forward imaging functions 
available 
◦ Real time interaction with consultant 
◦ Image transmission speed 
Disadvantages 
◦ More complex than static TP (camera(s), computer 
system, accessories) 
◦ More expensive than static TP - requires broad 
bandwidth 
◦ Image selection by sender.
 RRoobboottiicc HHyybbrriidd 
DDyynnaammiicc//SSttoorree aanndd FFoorrwwaarrdd 
((HHDDSSFF)) TTeelleeppaatthhoollooggyy 
Hybrid - combines both dynamic and 
store and forward telepathology 
functions 
Robotic - image selection at remote site 
(robotic microscope) controlled by 
consultant at the hub site
Advantages 
◦ Robotic control of remote microscope allows distant 
pathologist to view slides completely 
◦ Real time interaction with referrer/clinician 
◦ Allows performance of frozen sections 
Disadvantages 
◦ Most complex telepathology system 
◦ Most expensive telepathology system - requires 
broad bandwidth telecommunications
DDyynnaammiicc RRoobboottiicc TTeelleeppaatthhoollooggyy 
3 
Slides put onto stage 
of robotic microscope 
1 Tissue examined/sectioned by 
Pathologist in Agra. 
2 
4 5 
6 
7 
8 
9 
H & E Sections made 
WAN 
Hub Pathologist 
examines slides using 
robotic microscope 
Slides read in Lucknow 
Pathologist dictates 
report to PA 
PA enters 
report 
Report reviewed, printed 
signed, faxed 
Router Router
VVEENNDDOORRSS 
Aperio 
Bioimagene 
Olympus (nanozoomer) 
Omnyx 
3DHistech 
Leica
AApppplliiccaattiioonnss 
1)Remote access of slides: 
 Frozen Sections (night calls,intraoperative 
consultations and remote sites) 
 Telepathology for 2nd opinion 
www.secondslide.com 
www.pathxchange.com 
 Multi-institution collaborative studies 
 Retrospective and prospective collections 
of cases for world wide knowledge 
database, case series studies,etc
Telepathology can have a crucial role in Education And 
Training in the following ways:- 
Online cases and images are excellent tools of 
education, supplementing standard books. 
The virtual slide technology can reduce the number of 
microscopes in a class. 
Telepathology is an excellent tool to distribute material 
from small biopsies that defy too many replicate 
sections. This helps in external quality assurance. 
Participants can see and discuss the same images and 
maintain a record for future reference. 
Example : www.uscap.org a well known site for these 
purposes.
CClliinniiccaall aapppplliiccaattiioonnss 
Archival & viewing of data: 
 Tumor Boards. 
 Quality Assurance. 
 Publications ( digital slide access as a part of 
case reports and case series in the future?) 
 Teaching sets for rare cases. 
 Scan in key diagnostic slides for outside 
review cases, to avoid having to borrow back 
slides for clinical or academic needs. 
 Access old cases for comparison for frozen 
sections and current cases
TTeelleerraaddiioollooggyy VViiss--àà--VViiss 
TTeelleeppaatthhoollooggyy 
Whilst teleradiology has taken off in a big way, in 
contrast, telepathology is still not that widespread. 
Multiple factors are responsible for this situation:- 
images produced in radiology are already digitised. 
Teleradiology has reached a stage where international 
standards for image acquisitions, storage and transfer 
have already been set. 
Radiologists are trained to interpret images and 
comprehend the underlying principles of digital imaging 
and factors influencing their quality.
Radiology images are viewed at a comparatively 
limited range of magnifications whereas in 
histopathology, selected areas may be viewed at 
a very wide range of magnification.To digitise all 
the material on a slide at a resolution of x 1000 
results in data files of differing magnitude much 
larger than digital radiology images.
IISSSSUUEESS NNEEEEDDIINNGG EEVVAALLUUAATTIIOONN 
Scanned image quality 
Image management software 
(interface with LIS system if intend for 
clinical use) 
Image analysis software 
Technical support 
Stability of vendor in the market 
Good fit between your need and 
vendor’s strong points
PPrroobblleemmss iinn TTeelleeppaatthhoollooggyy 
If used for routine workload (telemicroscopy), 
the problem arises if the centre lacks a 
pathologist who can use the facility well or is ill 
trained to read digital images. 
Acceptance of responsibility by the local 
pathologist for the final telepathology report 
that goes out is a point to be considered. 
Technical standards for image capture, storage 
and transfer need to be well set.
While viewing distant virtual slides, the factor 
of time lag has to be considered which does 
not happen in a light microscope set up. 
If a lab solely relies on telepathology, there can 
be damaging loss of local expertise. 
Telepathology may prove difficult in cases of 
large complex specimens that need to be 
grossed well and dissected in person.
PPRRAACCTTIICCAALL IISSSSUUEESS 
Cost (machine, software, storage & personal) 
Time for scan: 15x15 mm tissue 
◦ 20x < 1min; 40 x 6-7 min 
Memory: 20X scan: 250 MB; 40X scan: 800 MB 
◦ 1TB can hold 2,070 slides (assuming 500 
MB/slide), or 4000 slides for 20x (250 MB)
MMiiccrroossccooppee IImmaaggiinngg 
Histology slides 
If we try to send all information on a glass slide, 
It is more than 2.7GB/slide. 
For Static Image Telepathology, a referring pathologist 
has to be able to select appropriate diagnostic fields. 
To select suitable fields for consultation requires 
experience 
Needed virtual slide
TTEELLEEPPAATTHHOOLLOOGGYY IINN IINNDDIIAA 
 India was not lagging far behind in the field of 
telepathology. The first taste of telepathology in India 
was provided at a symposium organized in the 50th 
Annual Conference of the Indian Association of 
Pathologists and Microbiologists in Mumbai in 2001 
aptly named Telepathology: Today and Tomorrow 
A telepathology quiz page was opened in the popular 
pathoindia.com e-group 
http://ipath.ch is a free site offering an open source 
framework for building web- and email-based 
telemedicine applications.
With the experience of pathoindia.com came 
telepathologyindia.com (now telepathology.org.in).The 
use of "telepathology quizes" with images of cases 
hosted at telepathology.org.in has caught the 
imagination of pathologists. 
The experience of Desai et al. in using static 
telepathology consultation between a tertiary cancer 
centre (Tata Memorial Hospital) and a rural cancer 
hospital (Nargis Dutt Memorial Cancer Hospital) in 
Barshi, Maharastra is an eye-opener.There was a big 
contribution by various organizations such as 
Department of Telecommunications (DOT), Mahanagar 
Telephone Nigam Limited (MTNL), and Bharat Sanchar 
Nigam Limited (BSNL).
CCoonncclluussiioonnss 
Multiple telepathology modalities exist. 
Must balance clinical needs vs cost. 
Users must be flexible and updated, but 
do not have to be computer experts 
Strong support of telecommunications 
network is essential.
RREEFFEERREENNCCEESS 
 Weinstein, RS; Graham, AM; Richter, LC; Barker, GP; Krupinski, EA; Lopez, AM; 
Yagi, Y; Gilbertson, JR; Bhattacharyya, AK et al. (2009), "Overview of 
telepathology, virtual microscopy and whole slide imagining: Prospects for the 
future", Hum Pathol 40(8): 1057– 
1069, doi:10.1016/j.humpath.2009.04.006,PMID19552937 
 Kumar, S (2009), "Telepathology: An Audit", in Kumar S, Dunn BE (editors), In: 
Telepathology (Springer-Verlag Berlin Heidelberg): 225–229 
 Kayser, K; Molnar, B; Weinstein, RS (2006), "Digital pathology virtual slide 
technology in tissue-based diagnosis, research and education.", VSV Interdisciplinary 
Medical Publishing (Berlin): 1–193 
 Dunn, BE; Choi, H; Recla, DL; Kerr, SE; Wagenman, BL (2009), "Robotic surgical 
telepathology between the Iron Mountain and Milwaukee Department of Veterans 
Affairs Medical Centers: a 12-year experience", Hum Pathol 40 (8): 1092–1099,doi 
 Graham, AR; Bhattacharyya, AK; Scott, KM; Lian, F; Grasso, LL; Richter, LC; 
Henderson, JT; Carpenter, JB; Lopez, AM; Barker, GP; Weinstein, RS; Weinstein, 
R. S. (2009), "Virtual slide telepatholgoy for an academic teaching hospital surgical 
patholgoy quality assurance program", Hum Pathol 40 (8): 1129– 
1136,doi:10.1016/j.humpath.2009.04.008,PMID 19540562 
 Information Resource Management Plan 2007/08,British Columbia Ministry of Health 
Knowledge Management and Technology Division, retrieved November 23, 2011
Telepathology-An overview

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Telepathology-An overview

  • 1. TTEELLEEPPAATTHHOOLLOOGGYY PRESENTER : DR.GURLEEN OBEROI MODERATOR: DR. RIDDHI JAISWAL
  • 2. IINNDDEEXX Important Terminologies  Introduction  Brief history  Types of telepathology  Applications Telepathology vis-a-vis Teleradiology  Problems Telepathology in India
  • 4. VViirrttuuaall MMiiccrroossccooppyy A method of posting microscope images on, and transmitting them over, computer networks. This allows independent viewing of images by large numbers of people in diverse locations. It involves a synthesis of microscopy technologies and digital technologies
  • 5. HHiissttoollooggyy WWoorrkkffllooww FFrroomm TTiissssuuee SSaammppllee ttoo HHiissttoollooggiiccaall EExxaammiinnaattiioonn Biopsy Frozen Section P Specimen Examination Histo-processing Sectioning Staining Tissue Sample Microscope Slide(s) Surgery Center Histology Lab P Microscopic Examination Pathologist Office P P Step that requires Pathologist In pathology, imaging begins in histology!
  • 6. Scanning Digital Slide VViirrttuuaall MMiiccrroossccooppyy DDiiggiittaall SSlliiddee CCrreeaattiioonn,, MMaannaaggeemmeenntt && AAnnaallyyssiiss Biopsy Workflow Management Specimen Examination Histo-processing Sectioning Staining Tissue Sample Digital Slide(s) Surgery Center Histology Lab Frozen Section P P Microscopic Examination Pathologist Office P P Step that requires Pathologist Image Analysis Conferencing
  • 7. AA DDiiggiittaall SSlliiddee A classical whole slide image is formed by imaging an entire physical (glass) slide, field by field, and then ‘knitting” these fields together to form a seamless montage The main virtual slide collection is the "Juan Rosai's collection of surgical pathology seminars", curated by USCAP. With some display software, one can pan and zoom around the image set
  • 8.
  • 9. DDiiggiittaall PPaatthhoollooggyy It is an image-based information environment enabled by computer technology that allows for the management of information generated from a digital slide. Digital pathology is enabled in part by virtual microscopy.
  • 10. LAN : Local Area Network WAN: Wide Area Network ISDN: Integrated Services For Digital Network L I S : Laboratory Information System  WSI : Whole Slide Imaging RTIS : Real Time Telepathology Imaging System
  • 11. IINNTTRROODDUUCCTTIIOONN 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, consultation and research.
  • 12. HHIISSTTOORRYY  An academic pathologist Dr. Ronald S. Weinstein is known as the “father of Telepathology”  One of the earliest instances of telepathology took place in boston in 1968.  Ronald S. Weinstein coined the term “telepathology” in 1986. In a medical journal editorial, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services.  In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.This is still in operational decades later.
  • 13.
  • 14. A Telepathology system consists of: A conventional microscope.  A method for video capture.  A computer. Telecommunication links between sending and receiving site and  A work station at the receiving site with a high quality monitor to view the images.
  • 15.
  • 16. DDiiggiittaall PPaatthhoollooggyy EEnnvviirroonnmmeenntt Scan View Manage Analyze Integrate Sharing
  • 17.
  • 18. WWHHYY AARREE WWEE TTRRYYIINNGG TTOO IIMMPPLLEEMMEENNTT TTEELLEEPPAATTHHOOLLOOGGYY IINN OOUURR SSYYSSTTEEMM????
  • 19. Telediagnosis Teleconsultation Teleconferencing With this access to global expert pathologists is no longer a limiting factor. Telepathology has been shown to be applicable for: Anatomical pathology including :-  Intra-operative consultation (frozen sections),  Surgical pathology (second opinions, immunostains),  Telecytology (e.g., on-site evaluation)  Ultrastructural pathology, as well as
  • 20. Clinical pathology including -telehematology, microbiology (e.g. parasitology), and chemistry (e.g., interpretation of gels). The most recent advances in digital imaging techniques promise to change the life style of pathologist from the microscope to the computer screen. There are “Virtual slides” where the entire slide is scanned at a very high resolution and can be viewed by multiple pathologists and without any loss of resolution
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 30. SSttaattiicc ((SSttoorree aanndd FFoorrwwaarrdd)) TTeelleeppaatthhoollooggyy  Static (still) images (photographs) selected by referring provider sent to consultant  Requires skillful image collection by referrer
  • 31. Advantages ◦ Simple - minimal hardware needs (computer, camera) ◦ Inexpensive - hardware and image transmission (Internet) ◦ Adaptable - many computer systems can be adapted Disadvantages ◦ Image selection – referrer ◦ Real time interaction - difficult ◦ Not suitable for primary diagnosis by surgical pathologist at a distance Example: Armed Forces Institute of Pathology consultation service
  • 32.  DDyynnaammiicc TTeelleeppaatthhoollooggyy RReeaall--ttiimmee ((tteelleevviissiioonn)) iimmaaggeess sseelleecctteedd bbyy rreeffeerrrreerr aass iiff ooppeerraattiinngg aa ttwwoo--hheeaaddeedd mmiiccrroossccooppee.. HHyybbrriidd DDyynnaammiicc//SSttoorree aanndd FFoorrwwaarrdd ((HHDDSSFF)) TTeelleeppaatthhoollooggyy CCoommbbiinneess bbootthh ssttoorree aanndd ffoorrwwaarrdd aanndd ddyynnaammiicc tteelleeppaatthhoollooggyy ffuunnccttiioonnss
  • 33. Advantages ◦ Dynamic and store and forward imaging functions available ◦ Real time interaction with consultant ◦ Image transmission speed Disadvantages ◦ More complex than static TP (camera(s), computer system, accessories) ◦ More expensive than static TP - requires broad bandwidth ◦ Image selection by sender.
  • 34.  RRoobboottiicc HHyybbrriidd DDyynnaammiicc//SSttoorree aanndd FFoorrwwaarrdd ((HHDDSSFF)) TTeelleeppaatthhoollooggyy Hybrid - combines both dynamic and store and forward telepathology functions Robotic - image selection at remote site (robotic microscope) controlled by consultant at the hub site
  • 35. Advantages ◦ Robotic control of remote microscope allows distant pathologist to view slides completely ◦ Real time interaction with referrer/clinician ◦ Allows performance of frozen sections Disadvantages ◦ Most complex telepathology system ◦ Most expensive telepathology system - requires broad bandwidth telecommunications
  • 36. DDyynnaammiicc RRoobboottiicc TTeelleeppaatthhoollooggyy 3 Slides put onto stage of robotic microscope 1 Tissue examined/sectioned by Pathologist in Agra. 2 4 5 6 7 8 9 H & E Sections made WAN Hub Pathologist examines slides using robotic microscope Slides read in Lucknow Pathologist dictates report to PA PA enters report Report reviewed, printed signed, faxed Router Router
  • 37. VVEENNDDOORRSS Aperio Bioimagene Olympus (nanozoomer) Omnyx 3DHistech Leica
  • 38. AApppplliiccaattiioonnss 1)Remote access of slides:  Frozen Sections (night calls,intraoperative consultations and remote sites)  Telepathology for 2nd opinion www.secondslide.com www.pathxchange.com  Multi-institution collaborative studies  Retrospective and prospective collections of cases for world wide knowledge database, case series studies,etc
  • 39. Telepathology can have a crucial role in Education And Training in the following ways:- Online cases and images are excellent tools of education, supplementing standard books. The virtual slide technology can reduce the number of microscopes in a class. Telepathology is an excellent tool to distribute material from small biopsies that defy too many replicate sections. This helps in external quality assurance. Participants can see and discuss the same images and maintain a record for future reference. Example : www.uscap.org a well known site for these purposes.
  • 40.
  • 41.
  • 42. CClliinniiccaall aapppplliiccaattiioonnss Archival & viewing of data:  Tumor Boards.  Quality Assurance.  Publications ( digital slide access as a part of case reports and case series in the future?)  Teaching sets for rare cases.  Scan in key diagnostic slides for outside review cases, to avoid having to borrow back slides for clinical or academic needs.  Access old cases for comparison for frozen sections and current cases
  • 43. TTeelleerraaddiioollooggyy VViiss--àà--VViiss TTeelleeppaatthhoollooggyy Whilst teleradiology has taken off in a big way, in contrast, telepathology is still not that widespread. Multiple factors are responsible for this situation:- images produced in radiology are already digitised. Teleradiology has reached a stage where international standards for image acquisitions, storage and transfer have already been set. Radiologists are trained to interpret images and comprehend the underlying principles of digital imaging and factors influencing their quality.
  • 44. Radiology images are viewed at a comparatively limited range of magnifications whereas in histopathology, selected areas may be viewed at a very wide range of magnification.To digitise all the material on a slide at a resolution of x 1000 results in data files of differing magnitude much larger than digital radiology images.
  • 45. IISSSSUUEESS NNEEEEDDIINNGG EEVVAALLUUAATTIIOONN Scanned image quality Image management software (interface with LIS system if intend for clinical use) Image analysis software Technical support Stability of vendor in the market Good fit between your need and vendor’s strong points
  • 46. PPrroobblleemmss iinn TTeelleeppaatthhoollooggyy If used for routine workload (telemicroscopy), the problem arises if the centre lacks a pathologist who can use the facility well or is ill trained to read digital images. Acceptance of responsibility by the local pathologist for the final telepathology report that goes out is a point to be considered. Technical standards for image capture, storage and transfer need to be well set.
  • 47. While viewing distant virtual slides, the factor of time lag has to be considered which does not happen in a light microscope set up. If a lab solely relies on telepathology, there can be damaging loss of local expertise. Telepathology may prove difficult in cases of large complex specimens that need to be grossed well and dissected in person.
  • 48. PPRRAACCTTIICCAALL IISSSSUUEESS Cost (machine, software, storage & personal) Time for scan: 15x15 mm tissue ◦ 20x < 1min; 40 x 6-7 min Memory: 20X scan: 250 MB; 40X scan: 800 MB ◦ 1TB can hold 2,070 slides (assuming 500 MB/slide), or 4000 slides for 20x (250 MB)
  • 49. MMiiccrroossccooppee IImmaaggiinngg Histology slides If we try to send all information on a glass slide, It is more than 2.7GB/slide. For Static Image Telepathology, a referring pathologist has to be able to select appropriate diagnostic fields. To select suitable fields for consultation requires experience Needed virtual slide
  • 50. TTEELLEEPPAATTHHOOLLOOGGYY IINN IINNDDIIAA  India was not lagging far behind in the field of telepathology. The first taste of telepathology in India was provided at a symposium organized in the 50th Annual Conference of the Indian Association of Pathologists and Microbiologists in Mumbai in 2001 aptly named Telepathology: Today and Tomorrow A telepathology quiz page was opened in the popular pathoindia.com e-group http://ipath.ch is a free site offering an open source framework for building web- and email-based telemedicine applications.
  • 51. With the experience of pathoindia.com came telepathologyindia.com (now telepathology.org.in).The use of "telepathology quizes" with images of cases hosted at telepathology.org.in has caught the imagination of pathologists. The experience of Desai et al. in using static telepathology consultation between a tertiary cancer centre (Tata Memorial Hospital) and a rural cancer hospital (Nargis Dutt Memorial Cancer Hospital) in Barshi, Maharastra is an eye-opener.There was a big contribution by various organizations such as Department of Telecommunications (DOT), Mahanagar Telephone Nigam Limited (MTNL), and Bharat Sanchar Nigam Limited (BSNL).
  • 52. CCoonncclluussiioonnss Multiple telepathology modalities exist. Must balance clinical needs vs cost. Users must be flexible and updated, but do not have to be computer experts Strong support of telecommunications network is essential.
  • 53. RREEFFEERREENNCCEESS  Weinstein, RS; Graham, AM; Richter, LC; Barker, GP; Krupinski, EA; Lopez, AM; Yagi, Y; Gilbertson, JR; Bhattacharyya, AK et al. (2009), "Overview of telepathology, virtual microscopy and whole slide imagining: Prospects for the future", Hum Pathol 40(8): 1057– 1069, doi:10.1016/j.humpath.2009.04.006,PMID19552937  Kumar, S (2009), "Telepathology: An Audit", in Kumar S, Dunn BE (editors), In: Telepathology (Springer-Verlag Berlin Heidelberg): 225–229  Kayser, K; Molnar, B; Weinstein, RS (2006), "Digital pathology virtual slide technology in tissue-based diagnosis, research and education.", VSV Interdisciplinary Medical Publishing (Berlin): 1–193  Dunn, BE; Choi, H; Recla, DL; Kerr, SE; Wagenman, BL (2009), "Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience", Hum Pathol 40 (8): 1092–1099,doi  Graham, AR; Bhattacharyya, AK; Scott, KM; Lian, F; Grasso, LL; Richter, LC; Henderson, JT; Carpenter, JB; Lopez, AM; Barker, GP; Weinstein, RS; Weinstein, R. S. (2009), "Virtual slide telepatholgoy for an academic teaching hospital surgical patholgoy quality assurance program", Hum Pathol 40 (8): 1129– 1136,doi:10.1016/j.humpath.2009.04.008,PMID 19540562  Information Resource Management Plan 2007/08,British Columbia Ministry of Health Knowledge Management and Technology Division, retrieved November 23, 2011

Editor's Notes

  1. A biopsy is taken in the Surgery Center. In some cases, frozen sections are prepared to assist the surgeon, for example, to help decide if the margins are clean. In all cases, a tissue sample is provided to the histology lab where the tissue is converted into microscopes slides by performing the following steps: (i) accessioning, (ii) grossing, (iii) tissue processing, (iv) embedding, (v) sectioning, (vi) H&amp;E staining and (vii) cover-slipping. A pathologist then reviews multiple glass microscope slides under a microscope to make an assessment. Currently, the pathologist and the glass slide must be co-located. Transition: Aperio’s Virtual Microscopy technology makes the pathologist less dependent on the glass slide by adding the step of slide scanning in the workflow of the histology lab.
  2. Now, instead of generating microscope slides, the histology lab scans the glass slides and created digital slides. Digital slides are reviewed by the pathologist on a computer monitor. Additionally, (i) digital slides can be managed in digital form using workflow management software, (ii) they can be analyzed using image analysis software and (iii) they can be shared in a conference session with anyone in the world. Aperio’s Virtual Microscopy product allow pathologists create, manage and analyze digital slides, allowing pathologists to accomplish their work—in a digital environment—without having to depend on glass slides. Transition. So what is Virtual Microscopy?