Clinical utility of telepathy

1. Shima K

2.  Acquisition of histological or macroscopic
images for transmission along
telecommunication pathways for diagnosis,
consultation or continuing medical
education

3.  Telepathology involves the ability to capture
images of visually based pathologic material
at one site and deliver them over distance to
another separate site

4.  camera system to capture images
 a way to store images
 a method to deliver and view the images

7.  Teleradiology
 Dr KT Bird, a Harvard physician in Boston in
1968.. Live black and white images of
histological sections and stained blood
smears were transmitted from a clinic at the
airport to far away hospital

8.  In 1974, satellite communication was used to
transmit histological images
 1986 ..a public demonstration of a satellite-
linked colour-video dynamic telepathology
system between Fort William Beaumont
Army Medical Center in El Paso, Texas and
Washington DC.

9.  Ronald S. Weinstein
 Outlined the actions
that would be needed
to create remote
pathology diagnostic
services
 Coined ‘telepathology’

11.  no two telepathology systems will be alike
 no standard of care system or single
telepathology model

12.  STATIC
 ROBOTIC INTERACTIVE TELEPATHOLOGY
(RITPATH)

13.  A microscope with a camera attached can take
static still images
 Saved as individual files and then transmitted
via e-mail to a remote individual
 One of the early methods of telepathology
 Most commonly used method in telepathology
today

14.  ‘Store-and-forward' approach
 Cheap, simple, basic infrastructure requirement
 Needs only a standard telephone line or internet
connection
 Only a limited number of images are captured for
each case, varying between one and forty
 Armed Forces Institute of Pathology consultation
service

16.  Sampling error
 Interpretation … require multiple pathologists
 Video image quality
 Lack of standardisation in hardware, image
resolution, storage format and colour-depth
 Limited to teaching

17.  Allow the receiving pathologist to control the
movement of the slide on the stage, and to see
the image in 'real-time' on a high-resolution
monitor
 Dynamic / Active / Real-time telepathology.

19.  provide the observer with the ability to control all
aspects of the microscope and to rapidly view
microscopic fields of the entire slide
 excellent diagnostic concordance, 97% or greater,
for fine-needle aspirates, frozen sections, and
hematoxylin-eosin–stained slides
 The Ohio State University Medical Center (Columbus)

20.  Most complex telepathology system
 Most expensive telepathology system -
requires broad bandwidth telecommunications

21.  Cytopathology ROSE service
 Microscope which has a device attached to it
with a camera capable of generating video
 The microscope is located in or close to the
FNA procedure site, is connected to the
network

22.  The operator at the originating
site where the FNA is being
performed controls the
microscope and has primary
physical control over the viewing
experience
 The remote site can verbally
communicate with the on-site
operator

23.  Digital Pathology, also referred to as virtual
microscopy, involves the capturing, managing,
analyzing and interpreting digital information
from a glass slide
 The most expensive of the options for
telepathology, forms a single image of a glass
slide

25.  Glass slides are converted to digital pathology
slides using digital pathology scanning solutions
 Combine an objective with automated stage and
digital camera with the computer power
 Rapidly obtain a series of images that are
automatically stitched together in software and
compressed to form a single image file of the slide

27.  The Ohio State University Medical Center
collaborating with members of the Colposcopy
and Cervical Pathology Society of South India
(Chennai) to establish a virtual-slide database
of World Health Organization–acquired
cervical biopsies
 Standardize diagnostic criteria for cervical
lesions

29.  sufficient bandwidth for viewing of these
slides…timing out of connections
 overcome by the use of virtual slides on
DVDs or portable hard drives that can
subsequently be downloaded directly
onto a computer

30.  Primary Diagnosis
 Intraoperative Consultation (Frozen Section)
 Rapid Cytology
 Secondary Consultation
 Special Studies
◦ immunohistochemistry, fluorescence in situ
hybridization..

31.  TEACHING
 IMAGE
LIBRARIES,
DATABASES,
ARCHIVING

32.  Interactive sessions , international
consortiums

33.  Quality control
◦ to monitor laboratory and or personnel quality
performance on a qualitative or quantitative basis,
and should be reviewed according to laboratory
standards.

34.  Cost of the equipments
◦ $30,000 for desktop-sized slide scanners
◦ $1 million for a comprehensive digital pathology
system
 Image sizes generated by DP systems are also
contributing to the slow uptake by clinical labs
and hospitals

35. Trained personnels

36.  Good telecommunication networks

38.  A camera is mounted on the top of a
microscope and the image viewed in a small
preview window within a computer software
package
 Captures the desired fields

39.  Charge-couple device sensor (CCD)… to
receive and convert images to an
electronic form
 CCD contains a series of tiny, light-
sensitive photosites capable of producing
varying amounts of charge in response to
the amount of light they receive
 Increase the area captured by increasing
the size of the CCD

40.  Complementary method of image acquisition
is to 'scan in' an entire glass slide using a
digital scanner
 Graphics software such as Adobe Photoshop,
or Paintshop Pro…… to improve the image
brightness, contrast or colour or even crop or
annotate the image

41.  Images are saved or stored on a physical device
such as the memory of the camera or on a
computer when the camera is connected to a PC
 Whole slide image scans are stored on a local
network for remote access or can be saved as a
single large file for delivery

42.  The camera/computer device which captures the
images needs to be connected to a computer
network in some manner
 Static images can be delivered via e-mail
 Wireless Wi-Fi system.. only limited amounts of
data
 Ethernet network.. accommodate high volume
data transfers

43.  network-connected PC with visual video
monitor
 smartphones and tablets (iPad ) have the
potential to provide high-resolution image
viewing and allow for more individual user
mobility than a fixed location static hard-wired
PC system.

44.  Remote site to be able to positively identify the
patient and obtain the necessary medical
information
 A VoIP (voice over IP) or computer microphone
transmitted between the two sites ….verbal
connection for a live real-time procedure.

45.  Nikon ,Leica, Olympus
systems
 Smart phones (iPhone,
iPod TM Touch, Android-
based phones, and
others)
◦ widely available, have built-
in high-resolution cameras
capable of still image
capture and live video
images
◦ connect to network
systems
◦ smart phone can be
connected to the
microscope eyepiece using
adaptors

46.  The CAP laboratory accreditation program
 The method and system used should be
appropriate for the intended clinical use
 The remote reviewer (telepathologist) should
ensure correct patient identification and have
access to pertinent clinical information at the
time of the case review
 The telepathology system should be included
in the laboratory quality management program
and monitored

47.  All data transmission shall be secure
 Privacy features should include audio muting,
video muting, and the ability to easily change
from public to private audio mode

48.  Multiple telepathology modalities exist
 Must balance clinical needs vs cost
 Users must be flexible, but do not have to be
computer experts
 Strong support of telecommunications
network is essential

49.  Telepathology: Clinical utility and
methodology;F Joel W-M Leong1, Andrew K
Graham1, Thomas Gahm2, James O'D
McGee1
 The Future of Telepathology for the
Developing World;Charles L. Hitchcock, MD,
PhD; Arch Pathol Lab Med—Vol 135, February
2011
 American Telemedicine Association clinical
guidelines for telepathology