Telepathology involves the digital transmission of pathological images for remote diagnosis. It was coined in 1986 and addresses the need for faster sharing of medical images between locations. Key components of a telepathology system include a microscope, high-resolution camera, computer workstation, and network connection. There are static, virtual slide, and real-time telepathology categories. Requirements include suitable image formats, interactive controls, and security/confidentiality tools. Telepathology provides benefits like second opinions and expertise in remote areas, while applications include biopsies, operations, and education. India has conducted telepathology sessions between medical colleges since 2001.

1. Telepathology
VADLAMUDI NAMRATHA
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2. Contents
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 History
 Introduction
 Need
 Equipment needed
 Procedure
 Categories
 Specific requirements for
Telepathology system.
 Compression methods
 Controlled sampling
 Liability formulas
 Security and
confidentiality tools
 Telequantitation
 Applications benefits
 In India
 Development over years
 References

3. History
 An academic pathologist, Ronald S. Weinstein M.D.,
coined the term “telepathology” in 1986.
 "father of telepathology“
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4. Introduction
 Area of telemedicine involving the transmission of
pathological specimen images for remote study and
diagnosis of disease.
 It is the practice of medical diagnosis facilitated by
digital transmission of pathological data using
information and communication technology.
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5. Need
 Telepathology makes it faster and easier to share
medical images.
 Biopsies can be cut, stained, scanned, magnified and
sent digitally during an operation.
 A pathologist can read the slides remotely in real-
time and provide the surgeon with an immediate
diagnosis.
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7. Equipment required for tele-pathology
 A light microscope.
 A high resolution camera either digital or analog with
a frame grabber card.
 PC work station.
 Access to telecommunication network, either by
modem or digitized data transfer card.
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8. Procedure
Begin End
Pathologist views the slides under a
microscope. Images are interpreted.
Captures images in a suitable format. Tele-pathologist reviews the images.
Transmits images to a distant site over a
communication link.
Images are shown on a display device at
the receiving end.
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9. Categories of telepathology:
 Static image-based systems
 Virtual slide systems
 Real-time systems
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10. Static image-based systems
 It is the simple and inexpensive as it does not require
a video-conferencing camera and high bandwidth for
the faster transmission of images.
 Images are captured from a digital camera connected
to a microscope. An image area is selected and
transmitted.
 significant drawback in only being able to capture a
selected subset of microscopic fields for off-site
evaluation.
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11. Virtual slide systems
 Pathology specimen slides are scanned and high-
resolution digital images created for transmission.
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12. Real-time systems
 The operator remotely guides a robotically
controlled motorized microscope. Real-time
telepathology systems allow the operator to adjust
the microscope as if it were local.
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13. Specific requirements for a
telepathology system
 Multimedia data base
 Color images
 Interactive control of color
 Controlled sampling security
 Confidentiality tools
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14. Multimedia database
To review previous biopsies :
 Query
 Clinical history
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15. Color images
 Color images should be of sufficient resolution
 Microscopic power dependent
Dynamic range
Spatial resolution
Compression methods
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16. Dynamic range of a system
 It is defined as the difference between the saturation
level and minimum detection level divided by the
capability of detection change.
 𝐷𝑟=𝑆 𝑚𝑎𝑥 − 𝑆 𝑚𝑖𝑛/𝑆 𝑑𝑖𝑓
Dynamic range of a color image to produce sufficient
information is 8 bits
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17. Spatial resolution
 It is defined as the mac spatial frequency( Fmax) able
to be detected or transmitted; for digital images.
 It represents 2-D pixel matrix of the acquisition device
Given utmost importance for an accurate visual
perception.
 Introduces variability on the minimum requirements
for a capture system depending on the microscopic
power used.
 It is directly related to capability of pathology images
to support lossy compression algorithms.
If min requirements on spatial resolution are satisfied
there would be no significant loss of visual
information due to compression.
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18. Sampling theory
 Tries to reduce the amount of information to a
reasonable limit that should be stored and processed
to avoid heavy computation processes and optimize
transmission times over the network.
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19. Compression methods
 To reduce the amount of data without a sensible loss
of information.
 The type of information varies according to the
subsequent analysis procedure:
a)Visual inspection or diagnosis
b)Image analysis
c)Image quantitation.
 Include techniques of luminance and reduction(color
, dynamic range , spatial resolution and data).
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20. Color reduction techniques
 Through YUV encoding – based on color sampling
reduction of 8/4/4 bits information acquisition.
 Reduction of color palette to 256 colors(8 bits)
 Median cut color quantization – technique that
optimizes the representation to the original color in
the final palette.
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21. Spatial resolution reduction
• Includes sampling reduction with or without Inter-
pixel interpolation i.e. digitize one every two pixels.
Data reduction
• Lossy and lossless compression methods.
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22. Interactive control of color
Important cause of error in sampling problems I
misinterpretation of color.
Hence minimum knowledge of color theory is
required to understand the need for interactivity due
to :
 Various spectral responses
 Built in gamma correction-cameras and display
provide that affects the colors and visual perception.
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23. Controlled sampling
 Diagnostic discrepancies due to sampling error range
of 9 to 6.3%.
The sampling control can be done by different
procedures:
 Sampling done by another person
 Sampling self taken (robotics microscope)
 Virtual slide or complete specimen digitization
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24. Minimum requirements
For sampling possibilities :
 Include an application that allows us to ensure
where we located in the specimen.
 Which parts of the specimen is already analyzed.
For virtual slide:
All fields at a higher power(min 5.2)
Low power capture with high resolution camera that
will allow thereafter a digital zooming.
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25. Liability formulas
 In any case diagnosis based at distance that do not
allow robotics or interactive sampling should include
the statement: "based on the images received”
 For real overseas consultations
“if confirmed and cross-signed by the responsible
pathologist”
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27. Security and confidentiality tools
 A digital signature
 Authentication of data and control
 Register of any modification in a diagnostic system
which is based on data available.
 Organizational requirements(appointment
management) – for an efficient and functional “on
line” supervision or diagnostic service.
 Staff has to be aware of the information protection
techniques for manipulating personal sensitive data,
as well as liability linked to the task.
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28. Telequantitation It is an application of pathology.
 Some of the pathology techniques like Morphometry,
Immunohistochemistry and DNA quantitation require
distance telequantitation.
 For a better distance telequantitation the system should
have
 a good image reception quality and quick algorithms for
image processing.
 For this any one of the devices should perform an
integration of image algorithms using low pass filter
effect hence we can reduce the noise.
 Besides all these gamma correction (color evaluation)
and image format handling should be controlled in both
sides.
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29. Benefits
 Medical professionals in different locations can view images
simultaneously and discuss diagnoses through
teleconferencing.
 A doctor can consult with a pathologist who specializes in the
patient’s area of concern, such as liver pathology or lung
pathology.
 A healthcare provider can get second opinions more easily.
 Patient data can be synchronized across various electronic
health information systems.
 Once implemented, a telepathology system is less expensive
to operate than the traditional system.
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30. Applications
 Helps pathologists and patients of the remote areas
to get timely and expert reports which in turn leads
to the correct diagnosis and treatment.
 Tele-pathology can be applied for various aspects of
pathology such as biopsies, surgical specimens, intra-
operative frozen section, cytology, e.c.t.
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31. INDIA
 The first interactive real time tele-pathology sessions
between SGPGIMS and PGIMER, Chandigarh is
conducted in February 2001.
 Later from September 2001 onwards SGPGIMS has
used both the static and dynamic form of tele-
pathology with the medical colleges of Orissa for the
education and consultation purposes twice a month.
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In

32. In INDIA contd..
 Instrument used four megapixel digital camera for
still images and charged coupled device
(CCD) camera for real time microscopic images.
 Data transmission was done either by ISDN or VSAT
communication link.
 The interesting and uncommon cases in specialties
like real pathology, gastrointestinal and hepatic
pathology, endocrine pathology, urology and
neurology pathology were discussed.
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33. Development over years..
 Has advanced continuously since 1986.
 Today, fourth-generation telepathology systems, so-
called virtual slide telepathology systems, are being
used for education applications.
 Both conventional and innovative surgical pathology
diagnostic services are being designed and
implemented as well.
 The technology has been commercialized by more
than 30 companies in Asia, the United States, and
Europe.
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34. References
 http://www.ukessays.com/essays/nursing/teleradiol
ogy-and-other-telemedicines-nursing-
essay.php#ixzz3GL4175Eb
Handbook of telemedicine by FERRER –ROCA
 http://books.google.co.in/books?id=-
PQV04UFxsoC&printsec=frontcover#v=onepage&q=c
olour%20theory&f=false
 http://www.telemedindia.org/telepathology.html
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35. THANK YOU !!
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