This document discusses small size virtual slides (SSVS) for telepathology. SSVS uses high resolution cameras and excellent optics to generate digital slides that are much smaller in size than traditional virtual slides, facilitating storage, transmission and viewing. SSVS uses JPEG2000 compression to provide diagnostic quality while maintaining small file sizes. A study evaluated SSVS on 9 samples and found the technique allowed accurate diagnosis, with an ROC curve of 0.95. Pathologists trained in telepathology showed higher concordance on diagnoses than untrained pathologists. SSVS was concluded to be suitable for remote consultation and online collaboration through providing a cheap digital microscope.
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2007- SSVS for hand held microscopes
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
4. Virtual Slide Capture SystemsVirtual Slide Capture Systems
High power VS (40x)
Image size in the order of Gigabytes
Expensive equipments
50000€ - 250000€
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
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)
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
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.