Telepathology Impacts and Implementation Challenges: A Scoping Review.

PubMed

Meyer, Julien; Paré, Guy

2015-12-01

Telepathology is a particular form of telemedicine that fundamentally alters the way pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely technical feasibility issues and diagnosis accuracy. To synthesize the literature on telepathology implementation challenges and broader organizational and societal impacts and to propose a research agenda to guide future efforts in this domain. Two complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM (ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. This review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting research findings. Various network structures are associated with different benefits. Although the dominant rationale in single-site projects is financial, larger centralized and decentralized telepathology networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment, and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and scale of encountered implementation challenges also varies depending on the network structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the network scope widens, organizational and legal issues gain prominence.

Image sampling in static telepathology for frozen section diagnosis.

PubMed

Della Mea, V; Cataldi, P; Boi, S; Finato, N; Dalla Palma, P; Beltrami, C A

1999-10-01

A frozen section diagnostic service is often not directly available in small rural or mountain hospitals. In these cases, it could be possible to provide frozen section diagnosis through telepathology systems. Telepathology is based on two main methods: static and dynamic. The former is less expensive, but involves the crucial problem of image sampling. To characterise the differences in image sampling for static telepathology when undertaken by pathologists with different experience. As a test field, a previously studied telepathology method based on multimedia email was adopted. Using this method, three pathologists with different levels of experience sampled images from 155 routine frozen sections and sent them to a distant pathology institute, where diagnoses were made on digital images. After the telepathology diagnoses, the glass slides of both the frozen sections and the definitive sections were sent to the remote pathologists for review. Four of 155 transmissions were considered inadequate by the remote pathologist. In the remaining 151 cases, the telepathology diagnosis agreed with the gold standard in 146 (96.7%). There was no significant divergence between the three pathologists in their sampling of the images. Each case comprised five images on average, acquired in four minutes. The overall time for transmission was about 19 minutes. The results suggest that in routine frozen section diagnosis an inexperienced pathologist can sample images sufficiently well to permit remote diagnosis. However, as expected, the internet is too unreliable for such a time dependent task. An improvement in the system would involve integrated real time features, so that there could be interaction between the two pathologists.

World's first telepathology experiments employing WINDS ultra-high-speed internet satellite, nicknamed “KIZUNA”

PubMed Central

Sawai, Takashi; Uzuki, Miwa; Miura, Yasuhiro; Kamataki, Akihisa; Matsumura, Tsubasa; Saito, Kenji; Kurose, Akira; Osamura, Yoshiyuki R.; Yoshimi, Naoki; Kanno, Hiroyuki; Moriya, Takuya; Ishida, Yoji; Satoh, Yohichi; Nakao, Masahiro; Ogawa, Emiko; Matsuo, Satoshi; Kasai, Hiroyuki; Kumagai, Kazuhiro; Motoda, Toshihiro; Hopson, Nathan

2013-01-01

Background: Recent advances in information technology have allowed the development of a telepathology system involving high-speed transfer of high-volume histological figures via fiber optic landlines. However, at present there are geographical limits to landlines. The Japan Aerospace Exploration Agency (JAXA) has developed the “Kizuna” ultra-high speed internet satellite and has pursued its various applications. In this study we experimented with telepathology in collaboration with JAXA using Kizuna. To measure the functionality of the Wideband InterNet working engineering test and Demonstration Satellite (WINDS) ultra-high speed internet satellite in remote pathological diagnosis and consultation, we examined the adequate data transfer speed and stability to conduct telepathology (both diagnosis and conferencing) with functionality, and ease similar or equal to telepathology using fiber-optic landlines. Materials and Methods: We performed experiments for 2 years. In year 1, we tested the usability of the WINDS for telepathology with real-time video and virtual slide systems. These are state-of-the-art technologies requiring massive volumes of data transfer. In year 2, we tested the usability of the WINDS for three-way teleconferencing with virtual slides. Facilities in Iwate (northern Japan), Tokyo, and Okinawa were connected via the WINDS and voice conferenced while remotely examining and manipulating virtual slides. Results: Network function parameters measured using ping and Iperf were within acceptable limits. However; stage movement, zoom, and conversation suffered a lag of approximately 0.8 s when using real-time video, and a delay of 60-90 s was experienced when accessing the first virtual slide in a session. No significant lag or inconvenience was experienced during diagnosis and conferencing, and the results were satisfactory. Our hypothesis was confirmed for both remote diagnosis using real-time video and virtual slide systems, and also for teleconferencing using virtual slide systems with voice functionality. Conclusions: Our results demonstrate the feasibility of ultra-high-speed internet satellite networks for use in telepathology. Because communications satellites have less geographical and infrastructural requirements than landlines, ultra-high-speed internet satellite telepathology represents a major step toward alleviating regional disparity in the quality of medical care. PMID:24244882

New Technologies: Real-time Telepathology Systems-Novel Cost-effective Tools for Real-time Consultation and Data Sharing.

PubMed

Siegel, Gabriel; Regelman, Dan; Maronpot, Robert; Rosenstock, Moti; Nyska, Abraham

2017-12-01

Real-time telepathology for use in investigative and regulated preclinical toxicology studies is now feasible. Newly developed microscope-integrated telepathology systems enable geographically remote stakeholders to view the live histopathology slide as seen by the study pathologist within the microscope. Simultaneous online viewing and dialog between study pathologist and remote colleagues is an efficient and cost-effective means for consultation, pathology working groups, and peer review, facilitating good science and economic benefits by enabling more timely and informed clinical decisions.

Subspecialty surgical pathologist's performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study

PubMed Central

Braunhut, Beth L.; Graham, Anna R.; Lian, Fangru; Webster, Phyllis D.; Krupinski, Elizabeth A.; Bhattacharyya, Achyut K.; Weinstein, Ronald S.

2014-01-01

Background: The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists’ decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists’ postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists’ area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports. PMID:25057432

Teleconsultation in diagnostic pathology: experience from Iran and Germany with the use of two European telepathology servers.

PubMed

Mireskandari, Masoud; Kayser, Gian; Hufnagl, Peter; Schrader, Thomas; Kayser, Klaus

2004-01-01

Eighty pathology cases were sent independently to each of two telepathology servers. Cases were submitted from the Department of Pathology at the University of Kerman in Iran (40 cases) and from the Institute of Pathology in Berlin, Germany (40 cases). The telepathology servers were located in Berlin (the UICC server) and Basel in Switzerland (the iPATH server). A scoring system was developed to quantify the differences between the diagnoses of the referring pathologist and the remote expert. Preparation of the cases, as well as the submission of images, took considerably longer from Kerman than from Berlin; this was independent of the server system. The Kerman delay was mainly associated with a slower transmission rate and longer image preparation. The diagnostic gap between referrers' and experts' diagnoses was greater with the iPATH system, but not significantly so. The experts' response time was considerably shorter for the iPATH system. The results showed that telepathology is feasible for requesting pathologists working in a developing country or in an industrialized country. The key factor in the quality of the service is the work of the experts: they should be selected according to their diagnostic expertise, and their commitment to the provision of telepathology services is critical.

[The Eastern Quebec telepathology network: a real collective project].

PubMed

Têtu, Bernard; Boulanger, Jean; Houde, Christine; Fortin, Jean-Paul; Gagnon, Marie-Pierre; Roch, Geneviève; Paré, Guy; Trudel, Marie-Claude; Sicotte, Claude

2012-11-01

The aim of the Eastern Québec telepathology network is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region, in order to avoid unnecessary patient transfer. The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, a videoconferencing device and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory, two have no pathologist and 5 have only one pathologist on site. Signs of improvement of medical care in this region are already apparent since the Eastern Québec telepathology network has been implemented. However, it is important not to underestimate the challenges related to change management in the course of implementation of such a new technology. © 2012 médecine/sciences – Inserm / SRMS.

Performance evaluation of a dynamic telepathology system (Panoptiq™) in the morphologic assessment of peripheral blood film abnormalities.

PubMed

Goswami, R; Pi, D; Pal, J; Cheng, K; Hudoba De Badyn, M

2015-06-01

The study evaluated the performance of a dynamic imaging telepathology system (Panoptiq(™) ) as a diagnostic aid to the identification of peripheral blood film (PBF) abnormalities. The study assumed a laboratory personnel working in a clinical laboratory were operating the telepathology system to seek diagnostic opinion from an external consulting hematopathologist. The study examined 100 blood films, encompassing 23 different hematological diseases, reactive or normal cases. The study revealed that with real-time image transmission in live scanning mode of operation, the telepathology system was able to aid reviewers in achieving excellent accuracy, that is correct interpretation of morphologic abnormalities obtained in 83/84 of the hematologic diseases and 12/12 of the reactive/normal conditions (Sensitivity: 0.99; Specificity: 1.00). In contrast, when only saved static images in digital capture mode of operation were reviewed remotely, interpretative omissions occurred in 8/84 of the hematologic diseases and 0/12 of the reactive/normal conditions (Sensitivity: 0.91; Specificity: 1.00). It is hypothesized that real-time operator-reviewer communication during live scanning played an important role in the identification of key morphologic abnormalities for review. Our study showed the Panoptiq system can be adopted reliably as a dynamic telepathology tool in aiding community laboratories in the triage of PBF cases for external diagnostic consultation. © 2014 John Wiley & Sons Ltd.

Feasibility and diagnostic accuracy of Internet-based dynamic telepathology between Uganda and Germany.

PubMed

Wamala, Dan; Katamba, Achilles; Dworak, Otto

2011-01-01

We assessed the feasibility and diagnostic accuracy of Internet-based telepathology compared with conventional microscopic examination. A total of 96 cases from the routine workload of the Department of Pathology at the Mulago Hospital in Uganda were examined by robotic telemicroscopy via the Internet at the Fuerth Hospital in Germany. The telepathology diagnoses were compared with those of conventional microscopy. Email and Skype telephony were used to exchange clinical and diagnostic information. The reference diagnosis (gold standard) was established by consensus between two or more experienced pathologists using both conventional microscopy and telemicroscopy; immunohistochemistry was used whenever it was necessary. It took approximately 30 min for a pathologist to learn to use the telepathology system and 4-25 min to read a case remotely. Internet speed was the main limiting factor. The images were of good quality and the pathologist at the remote site was able to navigate through the slide and change the magnification as necessary. In 92 of the specimens (97%), the pathologists at the two hospitals agreed exactly about the diagnosis. Agreement overall was moderate (kappa = 0.39). The discordant diagnoses were attributed to factors related to diseases morphologically difficult to diagnose, such as soft tissue sarcomas and primitive tumours. Internet-based conferencing systems offer an inexpensive method of obtaining a primary diagnosis by telepathology and consulting on cases that require subspecialty expertise.

Guidelines from the Canadian Association of Pathologists for establishing a telepathology service for anatomic pathology using whole-slide imaging

PubMed Central

Bernard, Chantal; Chandrakanth, S. A.; Cornell, Ian Scott; Dalton, James; Evans, Andrew; Garcia, Bertha M.; Godin, Chris; Godlewski, Marek; Jansen, Gerard H.; Kabani, Amin; Louahlia, Said; Manning, Lisa; Maung, Raymond; Moore, Lisa; Philley, Joanne; Slatnik, Jack; Srigley, John; Thibault, Alain; Picard, Donald Daniel; Cracower, Hanah; Tetu, Bernard

2014-01-01

The use of telepathology for clinical applications in Canada has steadily become more attractive over the last 10 years, driven largely by its potential to provide rapid pathology consulting services throughout the country regardless of the location of a particular institution. Based on this trend, the president of the Canadian Association of Pathologists asked a working group consisting of pathologists, technologists, and healthcare administrators from across Canada to oversee the development of guidelines to provide Canadian pathologists with basic information on how to implement and use this technology. The guidelines were systematically developed, based on available medical literature and the clinical experience of early adopters of telepathology in Canada. While there are many different modalities and applications of telepathology, this document focuses specifically on whole-slide imaging as applied to intraoperative pathology consultation (frozen section), primary diagnosis, expert or second opinions and quality assurance activities. Applications such as hematopathology, microbiology, tumour boards, education, research and technical and/or standard-related issues are not covered. PMID:24843826

The Eastern Québec Telepathology Network: a three-year experience of clinical diagnostic services

PubMed Central

2014-01-01

Background The Eastern Quebec Telepathology Network (called Réseau de Télépathologie de l'Est du Québec in French) was created to provide uniform diagnostic telepathology services in a huge territory with low population density. We report our first 3-year experience. Methods The network was funded equally by the Québec ministry of Health and Canada Health Infoway, a federal telehealth funding agency. The coverage includes intraoperative consultations (IOC), expert opinions, urgent analyses and supervision of macroscopic description. The deployment of the equipment and software started in 2010 and clinical activities began in January 2011. This network comprises 24 hospitals providing oncologic surgery, of which 7 have no pathology laboratory and 4 have a pathology laboratory but no pathologist. The real-time gross evaluation during IOC was performed using a macroscopy station and the sample selection was performed distantly by a technician, a pathology assistant or the surgeon under on-site pathologist supervision. Slides were scanned into whole-slide images (WSI). Results As per March 2014, 7,440 slides had been scanned for primary/urgent diagnosis; 1,329 for IOC cases and 2,308 for expert opinions. A 98% concordance rate was found for IOC compared to paraffin material and the average turnaround time was 20 minutes. Expert opinion reports were signed out within 24 hours in 68% of cases and within 72 hours in 85%. A recent multi-method evaluation study of the Network demonstrated that, thanks to telepathology: 1. interruption of IOC service was prevented in hospitals with no pathologist on site; 2. two-stage surgeries and patients transfers were prevented according to surgeons and pathologists; 3. retention and recruitment of surgeons in remote hospitals were facilitated; and 4. professional isolation among pathologists working alone was reduced. This study also demonstrated that wider adoption of telepathology would require technological improvement and that the sustainability of the network requires better coordination and the development of a supra-regional pathology organisation. Conclusion The Eastern Quebec Telepathology Network allowed the maintenance of rapid and high quality pathology services in more than 20 sites disseminated on a huge territory. A second phase is underway to expand telepathology to other regions across the province. PMID:25564940

The use of digital imaging, video conferencing, and telepathology in histopathology: a national survey.

PubMed

Dennis, T; Start, R D; Cross, S S

2005-03-01

To undertake a large scale survey of histopathologists in the UK to determine the current infrastructure, training, and attitudes to digital pathology. A postal questionnaire was sent to 500 consultant histopathologists randomly selected from the membership of the Royal College of Pathologists in the UK. There was a response rate of 47%. Sixty four per cent of respondents had a digital camera mounted on their microscope, but only 12% had any sort of telepathology equipment. Thirty per cent used digital images in electronic presentations at meetings at least once a year and only 24% had ever used telepathology in a diagnostic situation. Fifty nine per cent had received no training in digital imaging. Fifty eight per cent felt that the medicolegal implications of duty of care were a barrier to its use. A large proportion of pathologists (69%) were interested in using video conferencing for remote attendance at multidisciplinary team meetings. There is a reasonable level of equipment and communications infrastructure among histopathologists in the UK but a very low level of training. There is resistance to the use of telepathology in the diagnostic context but enthusiasm for the use of video conferencing in multidisciplinary team meetings.

E-learning for laurea in biomedical laboratory technicians: presentation of a pilote study.

PubMed

Giansanti, D; Castrichella, L; Giovagnoli, M R

2007-01-01

The aim of the paper is to afford the design and construction of an e-learning model answering to these requirements for the LHCP in Technician of Biomedical Laboratory. The SCENARIO of work for the technician in biomedical laboratory (TBL) is radically changed and e-learning should answer to these new challenges. In particular today He or She should be able to mange in tele-pathology applications the tissue on the so called virtual glass. An architecture for the e-learning based on Web-Dav and a Light software for the virtual glass tele-pathology consultation has been designed with also a special care for the teachers' and students' platforms. At the moment we are investigating Telepathology platforms for the extranet consulting of virtual glasses.

Portable telepathology: methods and tools.

PubMed

Alfaro, Luis; Roca, Ma José

2008-07-15

Telepathology is becoming easier to implement in most pathology departments. In fact e-mail image transmit can be done from almost any pathologist as a simplistic telepathology system. We tried to develop a way to improve capabilities of communication among pathologists with the idea that the system should be affordable for everybody. We took the premise that any pathology department would have microscopes and computers with Internet connection, and selected a few elements to convert them into a telepathology station. Needs were reduced to a camera to collect images, a universal microscope adapter for the camera, a device to connect the camera to the computer, and a software for the remote image transmit. We found out a microscope adapter (MaxView Plus) that allowed us connect almost any domestic digital camera to any microscope. The video out signal from the camera was sent to the computer through an Aver Media USB connector. At last, we selected a group of portable applications that were assembled into a USB memory device. Portable applications are computer programs that can be carried generally on USB flash drives, but also in any other portable device, and used on any (Windows) computer without installation. Besides, when unplugging the device, none of personal data is left behind. We selected open-source applications, and based the pathology image transmission to VLC Media Player due to its functionality as streaming server, portability and ease of use and configuration. Audio transmission was usually done through normal phone lines. We also employed alternative videoconferencing software, SightSpeed for bi-directional image transmission from microscopes, and conventional cameras allowing visual communication and also image transmit from gross pathology specimens. All these elements allowed us to install and use a telepathology system in a few minutes, fully prepared for real time image broadcast.

Portable telepathology: methods and tools

PubMed Central

Alfaro, Luis; Roca, Ma José

2008-01-01

Telepathology is becoming easier to implement in most pathology departments. In fact e-mail image transmit can be done from almost any pathologist as a simplistic telepathology system. We tried to develop a way to improve capabilities of communication among pathologists with the idea that the system should be affordable for everybody. We took the premise that any pathology department would have microscopes and computers with Internet connection, and selected a few elements to convert them into a telepathology station. Needs were reduced to a camera to collect images, a universal microscope adapter for the camera, a device to connect the camera to the computer, and a software for the remote image transmit. We found out a microscope adapter (MaxView Plus) that allowed us connect almost any domestic digital camera to any microscope. The video out signal from the camera was sent to the computer through an Aver Media USB connector. At last, we selected a group of portable applications that were assembled into a USB memory device. Portable applications are computer programs that can be carried generally on USB flash drives, but also in any other portable device, and used on any (Windows) computer without installation. Besides when unplugging the device, none of personal data is left behind. We selected open-source applications, and based the pathology image transmission to VLC Media Player due to its functionality as streaming server, portability and ease of use and configuration. Audio transmission was usually done through normal phone lines. We also employed alternative videoconferencing software, SightSpeed for bi-directional image transmission from microscopes, and conventional cameras allowing visual communication and also image transmit from gross pathology specimens. All these elements allowed us to install and use a telepathology system in a few minutes, fully prepared for real time image broadcast. PMID:18673507

The use of digital imaging, video conferencing, and telepathology in histopathology: a national survey

PubMed Central

Dennis, T; Start, R D; Cross, S S

2005-01-01

Aims: To undertake a large scale survey of histopathologists in the UK to determine the current infrastructure, training, and attitudes to digital pathology. Methods: A postal questionnaire was sent to 500 consultant histopathologists randomly selected from the membership of the Royal College of Pathologists in the UK. Results: There was a response rate of 47%. Sixty four per cent of respondents had a digital camera mounted on their microscope, but only 12% had any sort of telepathology equipment. Thirty per cent used digital images in electronic presentations at meetings at least once a year and only 24% had ever used telepathology in a diagnostic situation. Fifty nine per cent had received no training in digital imaging. Fifty eight per cent felt that the medicolegal implications of duty of care were a barrier to its use. A large proportion of pathologists (69%) were interested in using video conferencing for remote attendance at multidisciplinary team meetings. Conclusions: There is a reasonable level of equipment and communications infrastructure among histopathologists in the UK but a very low level of training. There is resistance to the use of telepathology in the diagnostic context but enthusiasm for the use of video conferencing in multidisciplinary team meetings. PMID:15735155

Intra-hospital use of a telepathology system.

PubMed

Ongürü, O; Celasun, B

2000-01-01

Utilization of telepathology systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for closer distances does not seem to be widely appreciated. In this study, we present data on the use of a simple telepathology system connecting the pathology department and the intra-operative consultation room within the operating theaters of the hospital. Ninety-eight frozen section cases from a past period have been re-evaluated using a real-time setup. Forty-eight of the cases have been re-evaluated in the customary fashion; allowing both ends to communicate and cooperate freely. Fifty of the cases, however, were evaluated by the consultant while the operating room end behaved like a robot; moving the stage of the microscope, changing and focusing the objectives. The deferral rate was lower than the original frozen section evaluations. Overall, the sensitivity was 100%, specificity 98%, negative predictive value 96, 5% and positive predictive value 100%. No significant difference was found for the diagnostic performances between the cooperative and robotic simulation methods.Our results strengthen the belief that telepathology is a valuable tool in offering pathology services to remote areas. The far side of a hospital building can also be a remote area and a low cost system can be helpful for intraoperative consultations. Educational value of such a system is also commendable.

Experience with distant pathology demonstrations for clinicians in hospitals without local pathologists through the Swedish telepathology work station.

PubMed

Boeryd, B R

1995-01-01

Conferences between pathologists and clinicians are routinely important at each hospital which has its own department of pathology. With the aid of telepathology, such conferences can be facilitated to provide results similar to those in hospitals with their own pathological service. Our Department serves the hospital in Motala, which is located 50 km west of Linköping. We now have telepathology conferences every second week with the surgeons and every second week with colleagues in internal medicine. The equipment we use is LabEye, which is produced by Innovativ Vision AB in Linköping. This equipment includes mouse pointers at both stations which are always visible in the images at both ends of the system. The quality of images received in Motala is very good, allowing discussion of details regarding the specimens, especially the cytological ones. Our experiences with these conferences have been very good.

[Telepathology in Mid-Norway].

PubMed

Haugen, O A; Halvorsen, T B; Aarset, H; Ovrehus, T A; Torp, S H; Edna, T H; Ruud, S

1999-01-30

Telepathology can provide frozen section service to hospitals without a pathology service of their own. Using a dynamic-robotic system with 6 ISDN B-channels (Telemed A200, AM Elektronikk A/S, Oslo, Norway), the pathologists at the University Hospital in Trondheim, Norway during a three-year period from 1995 successfully performed 116 diagnostic sessions for two rural Norwegian hospitals. In 90% of the cases a diagnosis was provided. There was no false positive diagnosis and only 3% false negative cases without clinical consequence. Deferred cases (10%) were mainly due to poor quality of the frozen sections and a conservative attitude among the pathologists. It is concluded that the diagnostic accuracy is good, but for safety reasons telepathology should be offered on a regular basis, so that the skills of the technicians and pathologists involved are kept up. In Mid-Norway, five more hospitals will be included in a telemedicine network comprising eight hospitals in the region.

Molecular digital pathology: progress and potential of exchanging molecular data.

PubMed

Roy, Somak; Pfeifer, John D; LaFramboise, William A; Pantanowitz, Liron

2016-09-01

Many of the demands to perform next generation sequencing (NGS) in the clinical laboratory can be resolved using the principles of telepathology. Molecular telepathology can allow facilities to outsource all or a portion of their NGS operation such as cloud computing, bioinformatics pipelines, variant data management, and knowledge curation. Clinical pathology laboratories can electronically share diverse types of molecular data with reference laboratories, technology service providers, and/or regulatory agencies. Exchange of electronic molecular data allows laboratories to perform validation of rare diseases using foreign data, check the accuracy of their test results against benchmarks, and leverage in silico proficiency testing. This review covers the emerging subject of molecular telepathology, describes clinical use cases for the appropriate exchange of molecular data, and highlights key issues such as data integrity, interoperable formats for massive genomic datasets, security, malpractice and emerging regulations involved with this novel practice.

Telepathology in Sweden. A national study including all histopathology and cytology laboratories.

PubMed

Busch, C

1992-12-01

Quality improvement and standardization of diagnosis in histopathology and cytology are important for the future of the discipline. Nominal scale diagnoses dominate the practice and their standardization depends on relevant and reproducibly identifiable criteria as well as on communication of these among pathologists. Telepathology, i.e. the transmission of adequately detailed colour images of microscopic fields over the telephone network is now a realistic possibility. All 30 laboratories for histopathology and cytology in Sweden will have access to Telepathology work stations for at least 8 weeks each during 1992-1993. Two centers will have permanent stations from September 1992. The images will be transmitted over the ISDN network, allowing a compressed image to appear instantaneously. This image is then gradually and imperceptibly decompressed during 15-60 seconds, the time depending on the complexity of the image. A program for consultation and quality testing is being set up, which will be evaluated during 1993. Based on a recognition of the conditions for diagnosis in pathology and cytology indicated above, the Swedish Society of Pathology has initiated a project called "Telepathology in Sweden". It is a joint effort with active participation by Swedish Telecom and the Swedish Planning and Rationalization Institute for the Health and Social Services, Stockholm as well as by Innovativ Vision AB, Linköping, a company providing hard- and software for image analysis, image banks and communication.

Teleeducation and telepathology for open and distance education.

PubMed

Szymas, J

2000-01-01

Our experience in creating and using telepathology system and multimedia database for education is described. This program packet currently works in the Department of Pathology of University Medical School in Poznan. It is used for self-education, tests, services and for the examinations in pathology, i.e., for dental students and for medical students in terms of self-education and individual examination services. The system is implemented on microcomputers compatible with IBM PC and works in the network system Netware 5.1. Some modules are available through the Internet. The program packet described here accomplishes the TELEMIC system for telepathology, ASSISTANT, which is the administrator for the databases, and EXAMINATOR, which is the executive program. The realization of multi-user module allows students to work on several working areas, on random be chosen different sets of problems contemporary. The possibility to work in the exercise mode will image files and questions is an attractive way for self-education. The standard format of the notation files enables to elaborate the results by commercial statistic packets in order to estimate the scale of answers and to find correlation between the obtained results. The method of multi-criterion grading excludes unlimited mutual compensation of the criteria, differentiates the importance of particular courses and introduces the quality criteria. The packet is part of the integrated management information system of the department of pathology. Applications for other telepathological systems are presented.

TeleProbe: design and development of an efficient system for telepathology

NASA Astrophysics Data System (ADS)

Ahmed, Wamiq M.; Robinson, J. Paul; Ghafoor, Arif

2005-10-01

This paper describes an internet-based system for telepathology. This system provides support for multiple users and exploits the opportunities for optimization that arise in multi-user environment. Techniques for increasing system responsiveness by improving resource utilization and lowering network traffic are explored. Some of the proposed optimizations include an auto-focus module, client and server side caching, and request reordering. These systems can be an economic solution not only for remote pathology consultation but also for pathology and biology education.

Telepathology and Optical Biopsy

PubMed Central

Ferrer-Roca, Olga

2009-01-01

The ability to obtain information about the structure of tissue without taking a sample for pathology has opened the way for new diagnostic techniques. The present paper reviews all currently available techniques capable of producing an optical biopsy, with or without morphological images. Most of these techniques are carried out by physicians who are not specialized in pathology and therefore not trained to interpret the results as a pathologist would. In these cases, the use of telepathology or distant consultation techniques is essential. PMID:20339507

Image selection in static telepathology through the Internet.

PubMed

Della Mea, V; Cataldi, P; Boi, S; Finato, N; Della Palma, P; Beltrami, C A

1998-01-01

A telepathology study was carried out to examine the differences occurring when the images were selected by an experienced pathologist, a junior pathologist and a first-year resident. One hundred and fifty-five consecutive frozen-section pathology cases were collected and sent for consultation to a remote experienced pathologist using multimedia email. Local diagnoses (as reported in the files of the Institute, not from the image selector) and remote diagnoses (based on the images) were compared with those performed on paraffin-embedded sections. Acquisition time and number of selected images were recorded for each case and used to compare the different behaviour of the three local pathologists. Of the 155 cases sent by telepathology, four were considered insufficient for a diagnosis by the remote pathologist and thus the diagnosis was postponed. In the remaining 151 cases, the overall diagnostic agreement between remote and definitive diagnosis was 96.7%. The results indicate that in the routine diagnostic work of a frozen-section service, an inexperienced pathologist can select images which are sufficiently informative for a remote diagnosis, in a sufficiently short time.

Robotic telepathology for intraoperative remote diagnosis using a still-imaging-based system.

PubMed

Demichelis, F; Barbareschi, M; Boi, S; Clemente, C; Dalla Palma, P; Eccher, C; Forti, S

2001-11-01

The aim of the present study was to assess whether a telemicroscopy system based on static imaging could provide a remote intraoperative frozen section service. Three pathologists evaluated 70 consecutive frozen section cases (for a total of 210 diagnoses) using a static telemicroscopy system (STeMiSy) and light microscopy (LM). STeMiSy uses a robotic microscope, enabling full remote control by consultant pathologists in a near real-time manner. Clinically important concordance between STeMiSy and LM was 98.6% (95.2% overall concordance), indicating very good agreement. The rates of deferred diagnoses given by STeMiSy and LM were comparable (11.0% and 9.5%, respectively). Compared with the consensus diagnosis, the diagnostic accuracy of STeMiSy and LM was 95.2% and 96.2%. The mean viewing time per slide was 3.6 minutes, and the overall time to make a diagnosis by STeMiSy was 6.2 minutes, conforming to intraoperative practice requirements. Our study demonstrates that a static imaging active telepathology system is comparable to dynamic telepathology systems and can provide a routine frozen section service.

Forecast on the application of Japanese universal service fund to remote diagnosis for frozen section.

PubMed

Nakajima, Isao

2010-12-01

Due to the socioeconomic reason in Japan, some cancer patient is sometimes operated at a rural hospital where only several surgeons perform and no pathologist checks its malignancy. Therefore, the system of the remote diagnosis for frozen section has been standing up in this country for 7 years. In Japan, the USF has started from February 2007 to support only telecommunications operator's hardware (NTT's equipment such as digital switch board) in high cost areas, not for the reimbursement of the tariff of the public users, such as telepathology. To solve such social cormorant equality, when the USF and PAs were supported in the present quick frozen intraoperative telepathology diagnosis, the quality of the cancer treatment in rural area will be improved. Based on the past data of the Japanese telepathology with beta distribution function, it can be estimated that user terminals becomes five times more than present users with support of USF and PAs. Moreover, using VPN on the B'FLETS, the effect of other teleconsultations will spread to the nationwide.

New developments in digital pathology: from telepathology to virtual pathology laboratory.

PubMed

Kayser, Klaus; Kayser, Gian; Radziszowski, Dominik; Oehmann, Alexander

2004-01-01

To analyse the present status and future development of computerized diagnostic pathology in terms of work-flow integrative telepathology and virtual laboratory. Telepathology has left its childhood. The technical development of telepathology is mature, in contrast to that of virtual pathology. Two kinds of virtual pathology laboratories are emerging: a) those with distributed pathologists and distributed (>=1) laboratories associated to individual biopsy stations/surgical theatres, and b) distributed pathologists working in a centralized laboratory. Both are under technical development. Telepathology can be used for e-learning and e-training in pathology, as exemplarily demonstrated on Digital Lung Pathology Pathology (www.pathology-online.org). A virtual pathology institution (mode a) accepts a complete case with the patient's history, clinical findings, and (pre-selected) images for first diagnosis. The diagnostic responsibility is that of a conventional institution. The internet serves as platform for information transfer, and an open server such as the iPATH (http://telepath.patho.unibas.ch) for coordination and performance of the diagnostic procedure. The size of images has to be limited, and usual different magnifications have to be used. A group of pathologists is "on duty", or selects one member for a predefined duty period. The diagnostic statement of the pathologist(s) on duty is retransmitted to the sender with full responsibility. First experiences of a virtual pathology institution group working with the iPATH server (Dr. L. Banach, Dr. G. Haroske, Dr. I. Hurwitz, Dr. K. Kayser, Dr. K.D. Kunze, Dr. M. Oberholzer,) working with a small hospital of the Salomon islands are promising. A centralized virtual pathology institution (mode b) depends upon the digitalisation of a complete slide, and the transfer of large sized images to different pathologists working in one institution. The technical performance of complete slide digitalisation is still under development and does not completely fulfil the requirements of a conventional pathology institution at present. VIRTUAL PATHOLOGY AND E-LEARNING: At present, e-learning systems are "stand-alone" solutions distributed on CD or via internet. A characteristic example is the Digital Lung Pathology CD (www.pathology-online.org), which includes about 60 different rare and common lung diseases and internet access to scientific library systems (PubMed), distant measurement servers (EuroQuant), or electronic journals (Elec J Pathol Histol). A new and complete data base based upon this CD will combine e-learning and e-teaching with the actual workflow in a virtual pathology institution (mode a). The technological problems are solved and do not depend upon technical constraints such as slide scanning systems. Telepathology serves as promotor for a new landscape in diagnostic pathology, the so-called virtual pathology institution. Industrial and scientific efforts will probably allow an implementation of this technique within the next two years.

The effects of time delays on a telepathology user interface.

PubMed Central

Carr, D.; Hasegawa, H.; Lemmon, D.; Plaisant, C.

1992-01-01

Telepathology enables a pathologist to examine physically distant tissue samples by microscope operation over a communication link. Communication links can impose time delays which cause difficulties in controlling the remote device. Such difficulties were found in a microscope teleoperation system. Since the user interface is critical to pathologist's acceptance of telepathology, we redesigned the user interface for this system, built two different versions (a keypad whose movement commands operated by specifying a start command followed by a stop command and a trackball interface whose movement commands were incremental and directly proportional to the rotation of the trackball). We then conducted a pilot study to determine the effect of time delays on the new user interfaces. In our experiment, the keypad was the faster interface when the time delay is short. There was no evidence to favor either the keypad or trackball when the time delay was longer. Inexperienced participants benefitted by allowing them to move long distances over the microscope slide by dragging the field-of-view indicator on the touchscreen control panel. The experiment suggests that changes could be made to the trackball interface which would improve its performance. PMID:1482878

Current experiences with internet telepathology and possible evolution in the next generation of Internet services.

PubMed

Della Mea, V; Beltrami, C A

2000-01-01

The last five years experience has definitely demonstrated the possible applications of the Internet for telepathology. They may be listed as follows: (a) teleconsultation via multimedia e-mail; (b) teleconsultation via web-based tools; (c) distant education by means of World Wide Web; (d) virtual microscope management through Web and Java interfaces; (e) real-time consultations through Internet-based videoconferencing. Such applications have led to the recognition of some important limits of the Internet, when dealing with telemedicine: (i) no guarantees on the quality of service (QoS); (ii) inadequate security and privacy; (iii) for some countries, low bandwidth and thus low responsiveness for real-time applications. Currently, there are several innovations in the world of the Internet. Different initiatives have been aimed at an amelioration of the Internet protocols, in order to have quality of service, multimedia support, security and other advanced services, together with greater bandwidth. The forthcoming Internet improvements, although induced by electronic commerce, video on demand, and other commercial needs, are of real interest also for telemedicine, because they solve the limits currently slowing down the use of Internet. When such new services will be available, telepathology applications may switch from research to daily practice in a fast way.

Current Experiences with Internet Telepathology and Possible Evolution in the Next Generation of Internet Services

PubMed Central

Della Mea, V.; Beltrami, C. A.

2000-01-01

The last five years experience has definitely demonstrated the possible applications of the Internet for telepathology. They may be listed as follows: (a) teleconsultation via multimedia e‐mail; (b) teleconsultation via web‐based tools; (c) distant education by means of World Wide Web; (d) virtual microscope management through Web and Java interfaces; (e) real‐time consultations through Internet‐based videoconferencing. Such applications have led to the recognition of some important limits of the Internet, when dealing with telemedicine: (i) no guarantees on the quality of service (QoS); (ii) inadequate security and privacy; (iii) for some countries, low bandwidth and thus low responsiveness for real‐time applications. Currently, there are several innovations in the world of the Internet. Different initiatives have been aimed at an amelioration of the Internet protocols, in order to have quality of service, multimedia support, security and other advanced services, together with greater bandwidth. The forthcoming Internet improvements, although induced by electronic commerce, video on demand, and other commercial needs, are of real interest also for telemedicine, because they solve the limits currently slowing down the use of Internet. When such new services will be available, telepathology applications may switch from research to daily practice in a fast way. PMID:11339559

[The future of telepathology. An Internet "distributed system" with "open standards"].

PubMed

Brauchli, K; Helfrich, M; Christen, H; Jundt, G; Haroske, G; Mihatsch, M; Oberli, H; Oberholzer, M

2002-05-01

With the availability of Internet, the interest in the possibilities of telepathology has increased considerably. In the foreground is thereby the need of the non-expert to bring in the opinions of experts on morphological findings by means of a fast and simple procedure. The new telepathology system iPath is in compliance with these needs. The system is based on small, but when possible independently working modules. This concept allows a simple adaptation of the system to the individual environment of the user (e.g. for different cameras, frame-grabbers, microscope steering tables etc.) and for individual needs. iPath has been in use for 6 months with various working groups. In telepathology a distinction is made between "passive" and "active" consultations but for both forms a non-expert brings in the opinion of an expert. In an active consultation both are in direct connection with each other (orally or via a chat-function), this is however not the case with a passive consultation. An active consultation can include the interactive discussion of the expert with the non-expert on images in an image database or the direct interpretation of images from a microscope by the expert. Four software modules are available for a free and as fast as possible application: (1) the module "Microscope control", (2) the module "Connector" (insertion of images directly from the microscope without a motorized microscope), (3) the module "Client-application" via the web-browser and (4) the module "Server" with a database. The server is placed in the internet and not behind a firewall. The server permanently receives information from the periphery and returns the information to the periphery on request. The only thing which the expert, the non-expert and the microscope have to know is how contact can made with the server.

Digital slides: present status of a tool for consultation, teaching, and quality control in pathology.

PubMed

Rocha, Rafael; Vassallo, José; Soares, Fernando; Miller, Keith; Gobbi, Helenice

2009-01-01

In the last few years, telepathology has benefited from the progress in the technology of image digitalization and transmission through the world web. The applications of telepathology and virtual imaging are more current in research and morphology teaching. In surgical pathology daily practice, this technology still has limits and is more often used for case consultation. In the present review, we intend to discuss its applications and challenges for pathologists and scientists. Much of the limitations of virtual imaging for the surgical pathologist reside in the capacity of storage of images, which so far has hindered the more widespread use of this technology. Overcoming this major drawback may revolutionize the surgical pathologist's activity and slide storing.

Automated complete slide digitization: a medium for simultaneous viewing by multiple pathologists.

PubMed

Leong, F J; McGee, J O

2001-11-01

Developments in telepathology robotic systems have evolved the concept of a 'virtual microscope' handling 'digital slides'. Slide digitization is a method of archiving salient histological features in numerical (digital) form. The value and potential of this have begun to be recognized by several international centres. Automated complete slide digitization has application at all levels of clinical practice and will benefit undergraduate, postgraduate, and continuing education. Unfortunately, as the volume of potential data on a histological slide represents a significant problem in terms of digitization, storage, and subsequent manipulation, the reality of virtual microscopy to date has comprised limited views at inadequate resolution. This paper outlines a system refined in the authors' laboratory, which employs a combination of enhanced hardware, image capture, and processing techniques designed for telepathology. The system is able to scan an entire slide at high magnification and create a library of such slides that may exist on an internet server or be distributed on removable media (such as CD-ROM or DVD). A digital slide allows image data manipulation at a level not possible with conventional light microscopy. Combinations of multiple users, multiple magnifications, annotations, and addition of ancillary textual and visual data are now possible. This demonstrates that with increased sophistication, the applications of telepathology technology need not be confined to second opinion, but can be extended on a wider front. Copyright 2001 John Wiley & Sons, Ltd.

Combining dynamic and static robotic telepathology: a report on 184 consecutive cases of frozen sections, histology and cytology.

PubMed

Della Mea, V; Cataldi, P; Pertoldi, B; Beltrami, C A

2000-01-01

The aim of this paper is to describe the experiments carried out to evaluate the diagnostic efficacy of a dynamic-robotic telepathology system for the delivery of pathology services to distant hospitals. The system provides static/dynamic features and the remote control of a robotized microscope over 4 ISDN lines. For evaluation purposes, 184 consecutive cases of frozen sections (60), gastrointestinal pathology (64), and urinary cytology (60) have been diagnosed at a distance using the system, and the telediagnosis obtained in this way has been compared with the traditional microscopic diagnosis. Diagnostic agreement ranged from 90% in urinary cytology to 100% in frozen sections. The results obtained suggest that such a system can be considered a useful tool for supporting the pathology practice in isolated hospitals.

A pilot study for the integration of cytometry reports in digital cytology telemedicine applications.

PubMed

Giansanti, Daniele; Cerroni, Fabio; Amodeo, Rachele; Filoni, Marco; Giovagnoli, Maria Rosaria

2010-01-01

Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.

Serendipia: Castilla-La Mancha telepathology network

PubMed Central

Peces, Carlos; García-Rojo, Marcial; Sacristán, José; Gallardo, Antonio José; Rodríguez, Ambrosio

2008-01-01

Nowadays, there is no standard solution for acquiring, archiving and communication of Pathology digital images. In addition, there does not exist any commercial Pathology Information System (LIS) that can manage the relationship between the reports generated by the pathologist and their corresponding images. Due to this situation, the Healthcare Service of Castilla-La Mancha decided to create a completely digital Pathology Department, the project is called SERENDIPIA. SERENDIPIA project provides all the necessary image acquiring devices needed to cover all kind of images that can be generated in a Pathology Department. In addition, in the SERENDIPIA project an Information System was developed that allows, on the one hand, it to cover the daily workflow of a Pathology Department (including the storage and the manage of the reports and its images), and, on the other hand, the Information System provides a WEB telepathology portal with collaborative tools like second opinion. PMID:18673519

[Web-ring of sites for pathologists in the internet: a computer-mediated communication environment].

PubMed

Khramtsov, A I; Isianov, N N; Khorzhevskiĭ, V A

2009-01-01

The recently developed Web-ring of pathology-related Web-sites has transformed computer-mediated communications for Russian-speaking pathologists. Though the pathologists may be geographically dispersed, the network provides a complex of asynchronous and synchronous conferences for the purposes of diagnosis, consultations, education, communication, and collaboration in the field of pathology. This paper describes approaches to be used by participants of the pathology-related Web-ring. The approaches are analogous to the tools employed in telepathology and digital microscopy. One of the novel methodologies is the use of Web-based conferencing systems, in which the whole slide digital images of tissue microarrays were jointly reviewed online by pathologists at distant locations. By using ImageScope (Aperio Technologies) and WebEx connect desktop management technology, they shared presentations and images and communicated in realtime. In this manner, the Web-based forums and conferences will be a powerful addition to a telepathology.

[Present and prospects of telepathology].

PubMed

Takahashi, M; Mernyei, M; Shibuya, C; Toshima, S

1999-01-01

Nearly ten years have passed since telepathology was introduced and real-time pathology consultations were conducted. Long distance consultations in pathology, cytology, computed tomography and magnetic resonance imaging, which are referred to as telemedicine, clearly enhance the level of medical care in remote hospitals where no full-time specialists are employed. To transmit intraoperative frozen section images, we developed a unique hybrid system "Hi-SPEED". The imaging view through the CCD camera is controlled by a camera controller that provides NTSC composite video output for low resolution motion pictures and high resolution digital output for final interpretation on computer display. The results of intraoperative frozen section diagnosis between the Gihoku General Hospital 410 km from SRL showed a sensitivity of 97.6% for 82 cases of breast carcinoma and a false positive rate of 1.2%. This system can be used for second opinions as well as for consultations between cytologists and cytotechnologists.

Augmented Reality Technology Using Microsoft HoloLens in Anatomic Pathology.

PubMed

Hanna, Matthew G; Ahmed, Ishtiaque; Nine, Jeffrey; Prajapati, Shyam; Pantanowitz, Liron

2018-05-01

Context Augmented reality (AR) devices such as the Microsoft HoloLens have not been well used in the medical field. Objective To test the HoloLens for clinical and nonclinical applications in pathology. Design A Microsoft HoloLens was tested for virtual annotation during autopsy, viewing 3D gross and microscopic pathology specimens, navigating whole slide images, telepathology, as well as real-time pathology-radiology correlation. Results Pathology residents performing an autopsy wearing the HoloLens were remotely instructed with real-time diagrams, annotations, and voice instruction. 3D-scanned gross pathology specimens could be viewed as holograms and easily manipulated. Telepathology was supported during gross examination and at the time of intraoperative consultation, allowing users to remotely access a pathologist for guidance and to virtually annotate areas of interest on specimens in real-time. The HoloLens permitted radiographs to be coregistered on gross specimens and thereby enhanced locating important pathologic findings. The HoloLens also allowed easy viewing and navigation of whole slide images, using an AR workstation, including multiple coregistered tissue sections facilitating volumetric pathology evaluation. Conclusions The HoloLens is a novel AR tool with multiple clinical and nonclinical applications in pathology. The device was comfortable to wear, easy to use, provided sufficient computing power, and supported high-resolution imaging. It was useful for autopsy, gross and microscopic examination, and ideally suited for digital pathology. Unique applications include remote supervision and annotation, 3D image viewing and manipulation, telepathology in a mixed-reality environment, and real-time pathology-radiology correlation.

Informatics for practicing anatomical pathologists: marking a new era in pathology practice.

PubMed

Gabril, Manal Y; Yousef, George M

2010-03-01

Informatics can be defined as using highly advanced technologies to improve patient diagnosis or management. Pathology informatics had evolved as a response to the overwhelming amount of information that was available, in an attempt to better use and maintain them. The most commonly used tools of informatics can be classified into digital imaging, telepathology, as well as Internet and electronic data mining. Digital imaging is the storage of anatomical pathology information, either gross pictures or microscopic slides, in an electronic format. These images can be used for education, archival, diagnosis, and consultation. Virtual microscopy is the more advanced form of digital imaging with enhanced efficiency and accessibility. Telepathology is now increasingly becoming a useful tool in anatomical pathology practice. Different types of telepathology communications are available for both diagnostic and consultation services. The spectrum of applications of informatics in the field of anatomical pathology is broad and encompasses medical education, clinical services, and pathology research. Informatics is now settling on solid ground as an important tool for pathology teaching, with digital teaching becoming the standard tool in many institutions. After a slow start, we now witness the transition of informatics from the research bench to bedside. As we are moving into a new era of extensive pathology informatics utilization, several challenges have to be addressed, including the cost of the new technology, legal issues, and resistance of pathologists. It is clear from the current evidence that pathology informatics will continue to grow and have a major role in the future of our specialty. However, it is also clear that it is not going to fully replace the human factor or the regular microscope.

Evaluation of Telepathology Systems and Practices

DTIC Science & Technology

2009-01-01

scaJlIIing >!ideo and pMlin& lhe digitized imogfi on ~ ond uansmining lhem ov..,. compur..,. necWOfU. This proceso perrnilS independmt ’’’’’’’ing of...Roberts, MD, MPP Professor of Medicine, Health Policy and Management and Industrial Engineering Chief, Section of Decision Sciences and Clinical Systems

Use of remote video microscopy (telepathology) as an adjunct to neurosurgical frozen section consultation.

PubMed

Becker, R L; Specht, C S; Jones, R; Rueda-Pedraza, M E; O'Leary, T J

1993-08-01

We investigated the use of remote video microscopy (telepathology) to assist in the diagnosis of 52 neurosurgical frozen section cases. The TelMed system (Discovery Medical Systems, Overland Park, KS), in which the referring pathologist selects appropriate fields for transmission to the consultant, was used for the study. There was a high degree of concordance between the diagnosis rendered on the basis of transmitted video images and that rendered on the basis of direct evaluation of frozen sections; however, in seven cases there was substantial disagreement. Remote evaluation was associated with a more rapid consultation from the standpoint of the consultant, who spent approximately 2 minutes less per case when using remote microscopy; this was achieved at the expense of considerably greater effort on the part of the referring pathologist, who spent approximately 16 minutes per case selecting an average of 4.5 images for transmission to the consultant. The use of remote video microscopy for pathology consultation is associated with a complex series of tradeoffs involving cost, information loss, and timeliness of consultation.

The COST Action IC0604 "Telepathology Network in Europe" (EURO-TELEPATH).

PubMed

García-Rojo, Marcial; Gonçalves, Luís; Blobel, Bernd

2012-01-01

The COST Action IC0604 "Telepathology Network in Europe" (EURO-TELEPATH) is a European COST Action that has been running from 2007 to 2011. COST Actions are funded by the COST (European Cooperation in the field of Scientific and Technical Research) Agency, supported by the Seventh Framework Programme for Research and Technological Development (FP7), of the European Union. EURO-TELEPATH's main objectives were evaluating and validating the common technological framework and communication standards required to access, transmit and manage digital medical records by pathologists and other medical professionals in a networked environment. The project was organized in four working groups. orking Group 1 "Business modeling in pathology" has designed main pathology processes - Frozen Study, Formalin Fixed Specimen Study, Telepathology, Cytology, and Autopsy -using Business Process Modeling Notation (BPMN). orking Group 2 "Informatics standards in pathology" has been dedicated to promoting the development and application of informatics standards in pathology, collaborating with Integrating the Healthcare Enterprise (IHE), Digital Imaging and Communications in Medicine (DICOM), Health Level Seven (HL7), and other standardization bodies. Working Group 3 "Images: Analysis, Processing, Retrieval and Management" worked on the use of virtual or digital slides that are fostering the use of image processing and analysis in pathology not only for research purposes, but also in daily practice. Working Group 4 "Technology and Automation in Pathology" was focused on studying the adequacy of current existing technical solutions, including, e.g., the quality of images obtained by slide scanners, or the efficiency of image analysis applications. Major outcome of this action are the collaboration with international health informatics standardization bodies to foster the development of standards for digital pathology, offering a new approach for workflow analysis, based in business process modeling. Health terminology standardization research has become a topic of high interest. Future research work should focus on standardization of automatic image analysis and tissue microarrays imaging.

From telepathology to virtual pathology institution: the new world of digital pathology.

PubMed

Kayser, K; Kayser, G; Radziszowski, D; Oehmann, A

Telepathology has left its childhood. Its technical development is mature, and its use for primary (frozen section) and secondary (expert consultation) diagnosis has been expanded to a great amount. This is in contrast to a virtual pathology laboratory, which is still under technical constraints. Similar to telepathology, which can also be used for e-learning and e-training in pathology, as exemplarily is demonstrated on Digital Lung Pathology (Klaus.Kayser@charite.de) at least two kinds of virtual pathology laboratories will be implemented in the near future: a) those with distributed pathologists and distributed (> or = 1) laboratories associated to individual biopsy stations/surgical theatres, and b) distributed pathologists (usually situated in one institution) and a centralized laboratory, which digitizes complete histological slides. Both scenarios are under intensive technical investigations. The features of virtual pathology comprise a virtual pathology institution (mode a) that accepts a complete case with the patient's history, clinical findings, and (pre-selected) images for first diagnosis. The diagnostic responsibility is that of a conventional institution. The Internet serves as platform for information transfer, and an open server such as the iPATH (http://telepath.patho.unibas.ch) for coordination and performance of the diagnostic procedure. The size and number of transferred images have to be limited, and usual different magnifications have to be used. The sender needs to possess experiences in image sampling techniques, which present with the most significant information. A group of pathologists is "on duty", or selects one member for a predefined duty period. The diagnostic statement of the pathologist(s) on duty is retransmitted to the sender with full responsibility. The first experiences of a virtual pathology institution group working with the iPATH server working with a small hospital of the Salomon islands are promising. A centralized virtual pathology institution (mode b) depends upon the digitalization of a complete slide, and the transfer of large sized images to different pathologists working in one institution. The technical performance of complete slide digitalization is still under development. Virtual pathology can be combined with e-learning and e-training, that will serve for a powerful daily-work-integrated pathology system. At present, e-learning systems are "stand-alone" solutions distributed on CD or via Internet. A characteristic example is the Digital Lung Pathology CD, which includes about 60 different rare and common lung diseases with some features of electronic communication. These features include access to scientific library systems (PubMed), distant measurement servers (EuroQuant), automated immunohisto-chemistry measurements, or electronic journals (Elec J Pathol Histol, www.pathology-online.org). It combines e-learning and e-training with some acoustic support. A new and complete database based upon this CD will combine e-learning and e-teaching with the actual workflow in a virtual pathology institution (mode a). The technological problems are solved and do not depend upon technical constraints such as slide scanning systems. At present, telepathology serves as promoter for a complete new landscape in diagnostic pathology, the so-called virtual pathology institution. Industrial and scientific efforts will probably allow an implementation of this technique within the next two years with exciting diagnostic and scientific perspectives.

Development and Demonstration of a Networked Telepathology 3-D Imaging, Databasing, and Communication System

DTIC Science & Technology

1996-10-01

aligned using an octree search algorithm combined with cross correlation analysis . Successive 4x downsampling with optional and specifiable neighborhood...desired and the search engine embedded in the OODBMS will find the requested imagery and que it to the user for further analysis . This application was...obtained during Hoftmann-LaRoche production pathology imaging performed at UMICH. Versant works well and is easy to use; 3) Pathology Image Analysis

Color calibration and fusion of lens-free and mobile-phone microscopy images for high-resolution and accurate color reproduction

NASA Astrophysics Data System (ADS)

Zhang, Yibo; Wu, Yichen; Zhang, Yun; Ozcan, Aydogan

2016-06-01

Lens-free holographic microscopy can achieve wide-field imaging in a cost-effective and field-portable setup, making it a promising technique for point-of-care and telepathology applications. However, due to relatively narrow-band sources used in holographic microscopy, conventional colorization methods that use images reconstructed at discrete wavelengths, corresponding to e.g., red (R), green (G) and blue (B) channels, are subject to color artifacts. Furthermore, these existing RGB colorization methods do not match the chromatic perception of human vision. Here we present a high-color-fidelity and high-resolution imaging method, termed “digital color fusion microscopy” (DCFM), which fuses a holographic image acquired at a single wavelength with a color-calibrated image taken by a low-magnification lens-based microscope using a wavelet transform-based colorization method. We demonstrate accurate color reproduction of DCFM by imaging stained tissue sections. In particular we show that a lens-free holographic microscope in combination with a cost-effective mobile-phone-based microscope can generate color images of specimens, performing very close to a high numerical-aperture (NA) benchtop microscope that is corrected for color distortions and chromatic aberrations, also matching the chromatic response of human vision. This method can be useful for wide-field imaging needs in telepathology applications and in resource-limited settings, where whole-slide scanning microscopy systems are not available.

An initial trial of a prototype telepathology system featuring static imaging with discrete control of the remote microscope.

PubMed

Winokur, T S; McClellan, S; Siegal, G P; Reddy, V; Listinsky, C M; Conner, D; Goldman, J; Grimes, G; Vaughn, G; McDonald, J M

1998-07-01

Routine diagnosis of pathology images transmitted over telecommunications lines remains an elusive goal. Part of the resistance stems from the difficulty of enabling image selection by the remote pathologist. To address this problem, a telepathology microscope system (TelePath, TeleMedicine Solutions, Birmingham, Ala) that has features associated with static and dynamic imaging systems was constructed. Features of the system include near real time image transmission, provision of a tiled overview image, free choice of any fields at any desired optical magnification, and automated tracking of the pathologist's image selection. All commands and images are discrete, avoiding many inherent problems of full motion video and continuous remote control. A set of 64 slides was reviewed by 3 pathologists in a simulated frozen section environment. Each pathologist provided diagnoses for all 64 slides, as well as qualitative information about the system. Thirty-one of 192 diagnoses disagreed with the reference diagnosis that had been reached before the trial began. Qf the 31, 13 were deferrals and 12 were diagnoses of cases that had a deferral as the reference diagnosis. In 6 cases, the diagnosis disagreed with the reference diagnosis yielding an overall accuracy of 96.9%. Confidence levels in the diagnoses were high. This trial suggests that this system provides high-quality anatomic pathology services, including intraoperative diagnoses, over telecommunications lines.

Changes in the job situation due to telemedicine.

PubMed

Aas, I H Monrad

2002-01-01

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.

Evaluation of Android Smartphones for Telepathology

PubMed Central

Ekong, Donald; Liu, Fang; Brown, G. Thomas; Ghosh, Arunima; Fontelo, Paul

2017-01-01

Background: In the year 2014, Android smartphones accounted for one-third of mobile connections globally but are predicted to increase to two-thirds by 2020. In developing countries, where teleconsultations can benefit health-care providers most, the ratio is even higher. This study compared the use of two Android phones, an 8 megapixel (MP) and a 16 MP phone, for capturing microscopic images. Method: The Android phones were used to capture images and videos of a gastrointestinal biopsy teaching set of referred cases from the Armed Forces Institute of Pathology (AFIP). The acquired images and videos were reviewed online by two pathologists for image quality, adequacy for diagnosis, usefulness of video overviews, and confidence in diagnosis, on a 5-point Likert scale. Results: The results show higher means in a 5-point Likert scale for the 8 MP versus the 16 MP phone that were statistically significant in adequacy of images (4.0 vs. 3.75) for rendering diagnosis and for agreement with the reference diagnosis (2.33 vs. 2.07). Although the quality of images was found higher in the 16 MP phone (3.8 vs. 3.65), these were not statistically significant. Adding video images of the entire specimen was found to be useful for evaluating the slides (combined mean, 4.0). Conclusion: For telepathology and other image dependent practices in developing countries, Android phones could be a useful tool for capturing images. PMID:28480119

Color calibration and fusion of lens-free and mobile-phone microscopy images for high-resolution and accurate color reproduction

PubMed Central

Zhang, Yibo; Wu, Yichen; Zhang, Yun; Ozcan, Aydogan

2016-01-01

Lens-free holographic microscopy can achieve wide-field imaging in a cost-effective and field-portable setup, making it a promising technique for point-of-care and telepathology applications. However, due to relatively narrow-band sources used in holographic microscopy, conventional colorization methods that use images reconstructed at discrete wavelengths, corresponding to e.g., red (R), green (G) and blue (B) channels, are subject to color artifacts. Furthermore, these existing RGB colorization methods do not match the chromatic perception of human vision. Here we present a high-color-fidelity and high-resolution imaging method, termed “digital color fusion microscopy” (DCFM), which fuses a holographic image acquired at a single wavelength with a color-calibrated image taken by a low-magnification lens-based microscope using a wavelet transform-based colorization method. We demonstrate accurate color reproduction of DCFM by imaging stained tissue sections. In particular we show that a lens-free holographic microscope in combination with a cost-effective mobile-phone-based microscope can generate color images of specimens, performing very close to a high numerical-aperture (NA) benchtop microscope that is corrected for color distortions and chromatic aberrations, also matching the chromatic response of human vision. This method can be useful for wide-field imaging needs in telepathology applications and in resource-limited settings, where whole-slide scanning microscopy systems are not available. PMID:27283459

Evaluation of Android Smartphones for Telepathology.

PubMed

Ekong, Donald; Liu, Fang; Brown, G Thomas; Ghosh, Arunima; Fontelo, Paul

2017-01-01

In the year 2014, Android smartphones accounted for one-third of mobile connections globally but are predicted to increase to two-thirds by 2020. In developing countries, where teleconsultations can benefit health-care providers most, the ratio is even higher. This study compared the use of two Android phones, an 8 megapixel (MP) and a 16 MP phone, for capturing microscopic images. The Android phones were used to capture images and videos of a gastrointestinal biopsy teaching set of referred cases from the Armed Forces Institute of Pathology (AFIP). The acquired images and videos were reviewed online by two pathologists for image quality, adequacy for diagnosis, usefulness of video overviews, and confidence in diagnosis, on a 5-point Likert scale. The results show higher means in a 5-point Likert scale for the 8 MP versus the 16 MP phone that were statistically significant in adequacy of images (4.0 vs. 3.75) for rendering diagnosis and for agreement with the reference diagnosis (2.33 vs. 2.07). Although the quality of images was found higher in the 16 MP phone (3.8 vs. 3.65), these were not statistically significant. Adding video images of the entire specimen was found to be useful for evaluating the slides (combined mean, 4.0). For telepathology and other image dependent practices in developing countries, Android phones could be a useful tool for capturing images.

Color calibration and fusion of lens-free and mobile-phone microscopy images for high-resolution and accurate color reproduction.

PubMed

Zhang, Yibo; Wu, Yichen; Zhang, Yun; Ozcan, Aydogan

2016-06-10

Lens-free holographic microscopy can achieve wide-field imaging in a cost-effective and field-portable setup, making it a promising technique for point-of-care and telepathology applications. However, due to relatively narrow-band sources used in holographic microscopy, conventional colorization methods that use images reconstructed at discrete wavelengths, corresponding to e.g., red (R), green (G) and blue (B) channels, are subject to color artifacts. Furthermore, these existing RGB colorization methods do not match the chromatic perception of human vision. Here we present a high-color-fidelity and high-resolution imaging method, termed "digital color fusion microscopy" (DCFM), which fuses a holographic image acquired at a single wavelength with a color-calibrated image taken by a low-magnification lens-based microscope using a wavelet transform-based colorization method. We demonstrate accurate color reproduction of DCFM by imaging stained tissue sections. In particular we show that a lens-free holographic microscope in combination with a cost-effective mobile-phone-based microscope can generate color images of specimens, performing very close to a high numerical-aperture (NA) benchtop microscope that is corrected for color distortions and chromatic aberrations, also matching the chromatic response of human vision. This method can be useful for wide-field imaging needs in telepathology applications and in resource-limited settings, where whole-slide scanning microscopy systems are not available.

Strategies for laboratory cost containment and for pathologist shortage: centralised pathology laboratories with microwave-stimulated histoprocessing and telepathology.

PubMed

Leong, Anthony S Y; Leong, F Joel W M

2005-02-01

The imposition of laboratory cost containment, often from external forces, dictates the necessity to develop strategies to meet laboratory cost savings. In addition, the national and worldwide shortage of anatomical pathologists makes it imperative to examine our current practice and laboratory set-ups. Some of the strategies employed in other areas of pathology and laboratory medicine include improvements in staff productivity and the adoption of technological developments that reduce manual intervention. However, such opportunities in anatomical pathology are few and far between. Centralisation has been an effective approach in bringing economies of scale, the adoption of 'best practices' and the consolidation of pathologists, but this has not been possible in anatomical pathology because conventional histoprocessing takes a minimum of 14 hours and clinical turnaround time requirements necessitate that the laboratory and pathologist be in proximity and on site. While centralisation of laboratories for clinical chemistry, haematology and even microbiology has been successful in Australia and other countries, the essential requirements for anatomical pathology laboratories are different. In addition to efficient synchronised courier networks, a method of ultra-rapid tissue processing and some expedient system of returning the prepared tissue sections to the remote laboratory are essential to maintain the turnaround times mandatory for optimal clinical management. The advent of microwave-stimulated tissue processing that can be completed in 30-60 minutes and the immediate availability of compressed digital images of entire tissue sections via telepathology completes the final components of the equation necessary for making centralised anatomical pathology laboratories a reality.

Application of content-based image compression to telepathology

NASA Astrophysics Data System (ADS)

Varga, Margaret J.; Ducksbury, Paul G.; Callagy, Grace

2002-05-01

Telepathology is a means of practicing pathology at a distance, viewing images on a computer display rather than directly through a microscope. Without compression, images take too long to transmit to a remote location and are very expensive to store for future examination. However, to date the use of compressed images in pathology remains controversial. This is because commercial image compression algorithms such as JPEG achieve data compression without knowledge of the diagnostic content. Often images are lossily compressed at the expense of corrupting informative content. None of the currently available lossy compression techniques are concerned with what information has been preserved and what data has been discarded. Their sole objective is to compress and transmit the images as fast as possible. By contrast, this paper presents a novel image compression technique, which exploits knowledge of the slide diagnostic content. This 'content based' approach combines visually lossless and lossy compression techniques, judiciously applying each in the appropriate context across an image so as to maintain 'diagnostic' information while still maximising the possible compression. Standard compression algorithms, e.g. wavelets, can still be used, but their use in a context sensitive manner can offer high compression ratios and preservation of diagnostically important information. When compared with lossless compression the novel content-based approach can potentially provide the same degree of information with a smaller amount of data. When compared with lossy compression it can provide more information for a given amount of compression. The precise gain in the compression performance depends on the application (e.g. database archive or second opinion consultation) and the diagnostic content of the images.

History and structures of telecommunication in pathology, focusing on open access platforms.

PubMed

Kayser, Klaus; Borkenfeld, Stephan; Djenouni, Amina; Kayser, Gian

2011-11-07

Telecommunication has matured to a broadly applied tool in diagnostic pathology. Contemporary with the development of fast electronic communication lines (Integrated digital network services (ISDN), broad band connections, and fibre optics, as well as the digital imaging technology (digital camera), telecommunication in tissue--based diagnosis (telepathology) has matured. Open access (internet) and server--based communication have induced the development of specific medical information platforms, such as iPATH, UICC-TPCC (telepathology consultation centre of the Union International against Cancer), or the Armed Forces Institute of Pathology (AFIP) teleconsultation system. They have been closed, and are subject to be replaced by specific open access forums (Medical Electronic Expert Communication System (MECES) with embedded virtual slide (VS) technology). MECES uses php language, data base driven mySqL architecture, X/L-AMPP infrastructure, and browser friendly W3C conform standards. The server--based medical communication systems (AFIP, iPATH, UICC-TPCC) have been reported to be a useful and easy to handle tool for expert consultation. Correct sampling and evaluation of transmitted still images by experts reported revealed no or only minor differences to the original images and good practice of the involved experts. β tests with the new generation medical expert consultation systems (MECES) revealed superior results in terms of performance, still image viewing, and system handling, especially as this is closely related to the use of so--called social forums (facebook, youtube, etc.). In addition to the acknowledged advantages of the former established systems (assistance of pathologists working in developing countries, diagnosis confirmation, international information exchange, etc.), the new generation offers additional benefits such as acoustic information transfer, assistance in image screening, VS technology, and teaching in diagnostic sampling, judgement, and verification.

An Assessment of Pathology Resident Access to and Use of Technology: A Nationwide Survey.

PubMed

Vallangeon, Bethany D; Hawley, Jeffrey S; Sloane, Richard; Bean, Sarah M

2017-03-01

- Current technologies including digital slide scanners and handheld devices can revolutionize clinical practice and pathology graduate medical education (GME). The extent to which these technologies are used in pathology GME is unknown. - To determine the types of technologies used, usage amount, and how they are integrated into pathology residency/fellowship programs nationwide. - A 40-question online survey for residents/fellows was developed and administered via the Research Electronic Data Capture System after institutional review board approval. - Fifty-two program directors (37%) gave permission for participation. One-hundred seventy-one responses were received (18% response rate). Most respondents have access to personal technology (laptop = 78% [134 of 171]), smartphone = 81% [139 of 171], tablet = 49% [84 of 171]), and Web-based digital slide collections (82%, 141 of 171). Few residents are provided electronic devices by their programs (laptop = 22% [38 of 171], smartphone = 0.5% [1 of 171], and tablet = 12% [21 of 171]). Fifty-nine percent have access to digital slide scanners, 33% have access to a program-created database of digitized slides, and 52% use telepathology. Fifteen percent have access to asynchronous learning. Of those with access to video-recorded conferences, 89% review them. Program size was significantly positively correlated with resident access to program-provided laptops (P = .02) and tablets (P < .001), digital slide scanners (P = .01), and telepathology (P = .001). Of all devices, program-provided laptops are used most for professional work (60.5% use this device for more than 5 hours per day). - Most residents report access to multiple types of innovative technology, but incorporation of these tools within pathology training programs is highly variable. Opportunities for incorporating innovative technologies exist and could be further explored.

Fusion of lens-free microscopy and mobile-phone microscopy images for high-color-accuracy and high-resolution pathology imaging

NASA Astrophysics Data System (ADS)

Zhang, Yibo; Wu, Yichen; Zhang, Yun; Ozcan, Aydogan

2017-03-01

Digital pathology and telepathology require imaging tools with high-throughput, high-resolution and accurate color reproduction. Lens-free on-chip microscopy based on digital in-line holography is a promising technique towards these needs, as it offers a wide field of view (FOV >20 mm2) and high resolution with a compact, low-cost and portable setup. Color imaging has been previously demonstrated by combining reconstructed images at three discrete wavelengths in the red, green and blue parts of the visible spectrum, i.e., the RGB combination method. However, this RGB combination method is subject to color distortions. To improve the color performance of lens-free microscopy for pathology imaging, here we present a wavelet-based color fusion imaging framework, termed "digital color fusion microscopy" (DCFM), which digitally fuses together a grayscale lens-free microscope image taken at a single wavelength and a low-resolution and low-magnification color-calibrated image taken by a lens-based microscope, which can simply be a mobile phone based cost-effective microscope. We show that the imaging results of an H&E stained breast cancer tissue slide with the DCFM technique come very close to a color-calibrated microscope using a 40x objective lens with 0.75 NA. Quantitative comparison showed 2-fold reduction in the mean color distance using the DCFM method compared to the RGB combination method, while also preserving the high-resolution features of the lens-free microscope. Due to the cost-effective and field-portable nature of both lens-free and mobile-phone microscopy techniques, their combination through the DCFM framework could be useful for digital pathology and telepathology applications, in low-resource and point-of-care settings.

[Chairman's introductory remarks].

PubMed

Shimo, Masamune

2013-01-01

Remote medicine, as well as the technological development of IT, has been realized in various fields of medical care. Reports have been published of the actual utilization of a system of remote diagnosis by infectious disease surveillance in each region of Nagano Prefecture, a telepathology system in Nagano, operation case of a radiological image remote diagnosis. Situation in the lack of pathologists and radiologists, that changes in the way of working of the physician, or medical information digitized convey how the doctor involved in the diagnosis, any diagnosis based on the information that was received doctor such as whether to perform, various issues have been raised. Soot digitization of information.

The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network.

PubMed

Alami, Hassane; Fortin, Jean-Paul; Gagnon, Marie-Pierre; Pollender, Hugo; Têtu, Bernard; Tanguay, France

2017-09-13

The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Digital pathology: A systematic evaluation of the patent landscape.

PubMed

Cucoranu, Ioan C; Parwani, Anil V; Vepa, Suryanarayana; Weinstein, Ronald S; Pantanowitz, Liron

2014-01-01

Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United States patents and patent applications related to digital pathology. Issued patents and patent applications related to digital pathology published in the United States Patent and Trademark Office (USPTO) database (www.uspto.gov) (through January 2014) were searched using the Google Patents search engine (Google Inc., Mountain View, California, USA). Keywords and phrases related to digital pathology, whole-slide imaging (WSI), image analysis, and telepathology were used to query the USPTO database. Data were downloaded and analyzed using the Papers application (Mekentosj BV, Aalsmeer, Netherlands). A total of 588 United States patents that pertain to digital pathology were identified. In addition, 228 patent applications were identified, including 155 that were pending, 65 abandoned, and eight rejected. Of the 588 patents granted, 348 (59.18%) were specific to pathology, while 240 (40.82%) included more general patents also usable outside of pathology. There were 70 (21.12%) patents specific to pathology and 57 (23.75%) more general patents that had expired. Over 120 unique entities (individual inventors, academic institutions, and private companies) applied for pathology specific patents. Patents dealt largely with telepathology and image analysis. WSI related patents addressed image acquisition (scanning and focus), quality (z-stacks), management (storage, retrieval, and transmission of WSI files), and viewing (graphical user interface (GUI), workflow, slide navigation and remote control). An increasing number of recent patents focused on computer-aided diagnosis (CAD) and digital consultation networks. In the last 2 decades, there have been an increasing number of patents granted and patent applications filed related to digital pathology. The number of these patents quadrupled during the last decade, and this trend is predicted to intensify based on the number of patent applications already published by the USPTO.

Digital pathology: A systematic evaluation of the patent landscape

PubMed Central

Cucoranu, Ioan C.; Parwani, Anil V.; Vepa, Suryanarayana; Weinstein, Ronald S.; Pantanowitz, Liron

2014-01-01

Introduction: Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United States patents and patent applications related to digital pathology. Materials and Methods: Issued patents and patent applications related to digital pathology published in the United States Patent and Trademark Office (USPTO) database (www.uspto.gov) (through January 2014) were searched using the Google Patents search engine (Google Inc., Mountain View, California, USA). Keywords and phrases related to digital pathology, whole-slide imaging (WSI), image analysis, and telepathology were used to query the USPTO database. Data were downloaded and analyzed using the Papers application (Mekentosj BV, Aalsmeer, Netherlands). Results: A total of 588 United States patents that pertain to digital pathology were identified. In addition, 228 patent applications were identified, including 155 that were pending, 65 abandoned, and eight rejected. Of the 588 patents granted, 348 (59.18%) were specific to pathology, while 240 (40.82%) included more general patents also usable outside of pathology. There were 70 (21.12%) patents specific to pathology and 57 (23.75%) more general patents that had expired. Over 120 unique entities (individual inventors, academic institutions, and private companies) applied for pathology specific patents. Patents dealt largely with telepathology and image analysis. WSI related patents addressed image acquisition (scanning and focus), quality (z-stacks), management (storage, retrieval, and transmission of WSI files), and viewing (graphical user interface (GUI), workflow, slide navigation and remote control). An increasing number of recent patents focused on computer-aided diagnosis (CAD) and digital consultation networks. Conclusion: In the last 2 decades, there have been an increasing number of patents granted and patent applications filed related to digital pathology. The number of these patents quadrupled during the last decade, and this trend is predicted to intensify based on the number of patent applications already published by the USPTO. PMID:25057430

Standardization efforts of digital pathology in Europe.

PubMed

Rojo, Marcial García; Daniel, Christel; Schrader, Thomas

2012-01-01

EURO-TELEPATH is a European COST Action IC0604. It started in 2007 and will end in November 2011. Its main objectives are evaluating and validating the common technological framework and communication standards required to access, transmit, and manage digital medical records by pathologists and other medical specialties in a networked environment. Working Group 1, "Business Modelling in Pathology," has designed main pathology processes - Frozen Study, Formalin Fixed Specimen Study, Telepathology, Cytology, and Autopsy - using Business Process Modelling Notation (BPMN). Working Group 2 has been dedicated to promoting the application of informatics standards in pathology, collaborating with Integrating Healthcare Enterprise (IHE), Digital Imaging and Communications in Medicine (DICOM), Health Level Seven (HL7), and other standardization bodies. Health terminology standardization research has become a topic of great interest. Future research work should focus on standardizing automatic image analysis and tissue microarrays imaging.

Supporting telemicroscopy and laboratory medicine activities. The Greek "TELE.INFO.MED.LAB" project.

PubMed

Miaoulis, G; Protopapa, E; Skourlas, C; Delides, G

1995-01-01

In this paper the authors present the basic results of the study for the "TELE.INFO.MED.LAB" project. This study is based on the local experience of the Metaxas Cancer Institute case and on international references. The possibilities rendered by current developments in telemedicine and particularly in telepathology accelerate and facilitate the communication of crucial medical data and creation of "second level" medical services overcoming the geographical particularities of the country. The availability of data transmission (signals, images, texts, etc.) enables the creation of a "uniform market" for various services. This system must take into account the financial realities, geographical aspects transportation problems and technological developments. Organization of this system, the choices of technical standards and the realization of a complete pilot project are described. For this system we also describe the functional and technical aspects, as well as software and hardware components for the different types of units.

Telemedicine in South Africa: success or failure?

PubMed

Gulube, S M; Wynchank, S

2001-01-01

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.

[Hospital and organizational dynamics of the National Institutes of Health. Relationship with high-specialty hospitals].

PubMed

Gabilondo Navarro, Fernando

2011-01-01

In order to primarily encourage medical care, teaching and research activities in high specialty regional hospitals (HSRH), a number of strategies are explored to increase the number of patients cared for, improve the quality and timeliness of care and successfully integrate the function of these hospitals within the care and patient flow model expected by the Federal Government. These strategies include the use of information technology systems as platforms for telemedicine, including tele-imaging, tele-education and telepathology, thus fostering the quality and timeliness of medical care and narrow the relationship between these HSRH with the National Health Institutes. Other strategies such as extra-mural surgery, specific theme workshops, resident rotations, the use of simulators and "Science Weeks" are also explored so as to promote teaching and research. Finally, the reference and counter-reference system and the introduction of pension programs are evaluated as possible strategies supporting resource management.

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process.

PubMed

Wienert, Stephan; Beil, Michael; Saeger, Kai; Hufnagl, Peter; Schrader, Thomas

2009-01-09

The virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen. In this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies. The analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB. WSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis.

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process

PubMed Central

Wienert, Stephan; Beil, Michael; Saeger, Kai; Hufnagl, Peter; Schrader, Thomas

2009-01-01

Background The virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen. Methods In this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies. Results The analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB. Discussion WSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis. PMID:19134181

Digital imagery/telecytology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

PubMed

O'Brien, M J; Takahashi, M; Brugal, G; Christen, H; Gahm, T; Goodell, R M; Karakitsos, P; Knesel, E A; Kobler, T; Kyrkou, K A; Labbe, S; Long, E L; Mango, L J; McGoogan, E; Oberholzer, M; Reith, A; Winkler, C

1998-01-01

Optical digital imaging and its related technologies have applications in cytopathology that encompass training and education, image analysis, diagnosis, report documentation and archiving, and telecommunications. Telecytology involves the use of telecommunications to transmit cytology images for the purposes of diagnosis, consultation or education. This working paper provides a mainly informational overview of optical digital imaging and summarizes current technologic resources and applications and some of the ethical and legal implications of the use of these new technologies in cytopathology. Computer hardware standards for optical digital imagery will continue to be driven mainly by commercial interests and nonmedical imperatives, but professional organizations can play a valuable role in developing recommendations or standards for digital image sampling, documentation, archiving, authenticity safeguards and teleconsultation protocols; in addressing patient confidentiality and ethical, legal and informed consent issues; and in providing support for quality assurance and standardization of digital image-based testing. There is some evidence that high levels of accuracy for telepathology diagnosis can be achieved using existing dynamic systems, which may also be applicable to telecytology consultation. Static systems for both telepathology and telecytology, which have the advantage of considerably lower cost, appear to have lower levels of accuracy. Laboratories that maintain digital image databases should adopt practices and protocols that ensure patient confidentiality. Individuals participating in telecommunication of digital images for diagnosis should be properly qualified, meet licensing requirements and use procedures that protect patient confidentiality. Such individuals should be cognizant of the limitations of the technology and employ quality assurance practices that ensure the validity and accuracy of each consultation. Even in an informal teleconsultation setting one should define the extent of participation and be mindful of potential malpractice liability. Digital imagery applications will continue to present new opportunities and challenges. Position papers such as this are directed toward assisting the profession to stay informed and in control of these applications in the laboratory. Telecytology is an area in particular need of studies of good quality to provide data on factors affecting accuracy. New technologic approaches to addressing the issue of selective sampling in static image consultation are needed. The use of artificial intelligence software as an adjunct to enhance the accuracy and reproducibility of cytologic diagnosis of digital images in routine and consultation settings deserves to be pursued. Other telecytology-related issues that require clarification and the adoption of workable guidelines include interstate licensure and protocols to define malpractice liability.

Virtual slide telepathology workstation of the future: lessons learned from teleradiology.

PubMed

Krupinski, Elizabeth A

2009-08-01

The clinical reading environment for the 21st century pathologist looks very different than it did even a few short years ago. Glass slides are quickly being replaced by digital "virtual slides," and the traditional light microscope is being replaced by the computer display. There are numerous questions that arise however when deciding exactly what this new digital display viewing environment will be like. Choosing a workstation for daily use in the interpretation of digital pathology images can be a very daunting task. Radiology went digital nearly 20 years ago and faced many of the same challenges so there are lessons to be learned from these experiences. One major lesson is that there is no "one size fits all" workstation so users must consider a variety of factors when choosing a workstation. In this article, we summarize some of the potentially critical elements in a pathology workstation and the characteristics one should be aware of and look for in the selection of one. Issues pertaining to both hardware and software aspects of medical workstations will be reviewed particularly as they may impact the interpretation process.

Emerging Themes in Image Informatics and Molecular Analysis for Digital Pathology.

PubMed

Bhargava, Rohit; Madabhushi, Anant

2016-07-11

Pathology is essential for research in disease and development, as well as for clinical decision making. For more than 100 years, pathology practice has involved analyzing images of stained, thin tissue sections by a trained human using an optical microscope. Technological advances are now driving major changes in this paradigm toward digital pathology (DP). The digital transformation of pathology goes beyond recording, archiving, and retrieving images, providing new computational tools to inform better decision making for precision medicine. First, we discuss some emerging innovations in both computational image analytics and imaging instrumentation in DP. Second, we discuss molecular contrast in pathology. Molecular DP has traditionally been an extension of pathology with molecularly specific dyes. Label-free, spectroscopic images are rapidly emerging as another important information source, and we describe the benefits and potential of this evolution. Third, we describe multimodal DP, which is enabled by computational algorithms and combines the best characteristics of structural and molecular pathology. Finally, we provide examples of application areas in telepathology, education, and precision medicine. We conclude by discussing challenges and emerging opportunities in this area.

Emerging Themes in Image Informatics and Molecular Analysis for Digital Pathology

PubMed Central

Bhargava, Rohit; Madabhushi, Anant

2017-01-01

Pathology is essential for research in disease and development, as well as for clinical decision making. For more than 100 years, pathology practice has involved analyzing images of stained, thin tissue sections by a trained human using an optical microscope. Technological advances are now driving major changes in this paradigm toward digital pathology (DP). The digital transformation of pathology goes beyond recording, archiving, and retrieving images, providing new computational tools to inform better decision making for precision medicine. First, we discuss some emerging innovations in both computational image analytics and imaging instrumentation in DP. Second, we discuss molecular contrast in pathology. Molecular DP has traditionally been an extension of pathology with molecularly specific dyes. Label-free, spectroscopic images are rapidly emerging as another important information source, and we describe the benefits and potential of this evolution. Third, we describe multimodal DP, which is enabled by computational algorithms and combines the best characteristics of structural and molecular pathology. Finally, we provide examples of application areas in telepathology, education, and precision medicine. We conclude by discussing challenges and emerging opportunities in this area. PMID:27420575

Telemedicine in wound healing.

PubMed

Jones, Sophie M; Banwell, Paul E; Shakespeare, Peter G

2004-12-01

Better care for patients and improved health care depends on the availability of good information which is accessible when and where it is needed. The development of technology, more specifically the Internet, has expanded the means whereby information can be acquired and transmitted over large distances enabling the concept of telemedicine to become a reality. Telemedicine, defined as the practise of medicine at a distance, encompasses diagnosis, education and treatment. It is a technology that many thought would expand rapidly and change the face of medicine. However, this has not happened and during the last decade although certain telemedicine applications, such as video-consulting and teleradiology, have matured to become essential health care services in some countries, others, such as telepathology, remain the subject of intensive research effort. Telemedicine can be used in almost any medical specialty although the specialties best suited are those with a high visual component. Wound healing and wound management is thus a prime candidate for telemedicine. Development of a suitable telemedical system in this field could have a significant effect on wound care in the community, tertiary referral patterns and hospital admission rates.

[Audiovisual telecommunication by multimedia technology in HNO medicine. ISDN--internet--ATM].

PubMed

Plinkert, P K; Plinkert, B; Kurek, R; Zenner, H P

2000-11-01

Telemedicine includes all medical activities in diagnosis, therapeutics, or social medicine undertaken by means of an electronic transfer medium, enabling the transmission of visual and acoustic information over long distances to doctors not personally present at the place of the requested consultation. Most experience with telemedicine applications has been gained in the field of diagnosis (teleconsultation, teleradiology, telepathology) and is expanding to quality control and quality assurance. Decisive for each form of application is its availability, practicability, cost, safety, and especially quality of audiovisual transmission. For telesurgical applications, particularly the use of minimally invasive techniques in otorhinolaryngology, head, and neck surgery, the high quality transmission of audiovisual data in real time is necessary. Rapid expansion and further developments in transmission technologies and networks in the last decade have created several technologies with increased quality and costs. In this paper, we tested different transmission media for audiovisual telecommunication--integrated services digital network (ISDN), Internet, and asynchronous transfer mode (ATM)--using real time video transmission of typical operations in otorhinolaryngology. Their applications, costs, and future perspectives are discussed.

Virtual microscopy in virtual tumor banking.

PubMed

Isabelle, M; Teodorovic, I; Oosterhuis, J W; Riegman, P H J; Passioukov, A; Lejeune, S; Therasse, P; Dinjens, W N M; Lam, K H; Oomen, M H A; Spatz, A; Ratcliffe, C; Knox, K; Mager, R; Kerr, D; Pezzella, F; Van Damme, B; Van de Vijver, M; Van Boven, H; Morente, M M; Alonso, S; Kerjaschki, D; Pammer, J; López-Guerrero, J A; Llombart-Bosch, A; Carbone, A; Gloghini, A; Van Veen, E B

2006-01-01

Many systems have already been designed and successfully used for sharing histology images over large distances, without transfer of the original glass slides. Rapid evolution was seen when digital images could be transferred over the Internet. Nowadays, sophisticated virtual microscope systems can be acquired, with the capability to quickly scan large batches of glass slides at high magnification and compress and store the large images on disc, which subsequently can be consulted through the Internet. The images are stored on an image server, which can give simple, easy to transfer pictures to the user specifying a certain magnification on any position in the scan. This offers new opportunities in histology review, overcoming the necessity of the dynamic telepathology systems to have compatible software systems and microscopes and in addition, an adequate connection of sufficient bandwidth. Consulting the images now only requires an Internet connection and a computer with a high quality monitor. A system of complete pathology review supporting biorepositories is described, based on the implementation of this technique in the European Human Frozen Tumor Tissue Bank (TuBaFrost).

TuBaFrost 6: virtual microscopy in virtual tumour banking.

PubMed

Teodorovic, I; Isabelle, M; Carbone, A; Passioukov, A; Lejeune, S; Jaminé, D; Therasse, P; Gloghini, A; Dinjens, W N M; Lam, K H; Oomen, M H A; Spatz, A; Ratcliffe, C; Knox, K; Mager, R; Kerr, D; Pezzella, F; van Damme, B; van de Vijver, M; van Boven, H; Morente, M M; Alonso, S; Kerjaschki, D; Pammer, J; Lopez-Guerrero, J A; Llombart Bosch, A; van Veen, E-B; Oosterhuis, J W; Riegman, P H J

2006-12-01

Many systems have already been designed and successfully used for sharing histology images over large distances, without transfer of the original glass slides. Rapid evolution was seen when digital images could be transferred over the Internet. Nowadays, sophisticated Virtual Microscope systems can be acquired, with the capability to quickly scan large batches of glass slides at high magnification and compress and store the large images on disc, which subsequently can be consulted through the Internet. The images are stored on an image server, which can give simple, easy to transfer pictures to the user specifying a certain magnification on any position in the scan. This offers new opportunities in histology review, overcoming the necessity of the dynamic telepathology systems to have compatible software systems and microscopes and in addition, an adequate connection of sufficient bandwidth. Consulting the images now only requires an Internet connection and a computer with a high quality monitor. A system of complete pathology review supporting bio-repositories is described, based on the implementation of this technique in the European Human Frozen Tumor Tissue Bank (TuBaFrost).

Global manipulation of digital images can lead to variation in cytological diagnosis

PubMed Central

Prasad, H; Wanjari, Sangeeta; Parwani, Rajkumar

2011-01-01

Background: With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations. Aim: To analyse the impact of manipulating digital images on their diagnosis. Design: Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted κ statistics was used to measure and assess the levels of agreement between observers. Results: Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade. Conclusion: Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible. PMID:21572507

Virtual slide telepathology workstation of the future: lessons learned from teleradiology☆

PubMed Central

Krupinski, Elizabeth A.

2013-01-01

Summary The clinical reading environment for the 21st century pathologist looks very different than it did even a few short years ago. Glass slides are quickly being replaced by digital “virtual slides,” and the traditional light microscope is being replaced by the computer display. There are numerous questions that arise however when deciding exactly what this new digital display viewing environment will be like. Choosing a workstation for daily use in the interpretation of digital pathology images can be a very daunting task. Radiology went digital nearly 20 years ago and faced many of the same challenges so there are lessons to be learned from these experiences. One major lesson is that there is no “one size fits all” workstation so users must consider a variety of factors when choosing a workstation. In this article, we summarize some of the potentially critical elements in a pathology workstation and the characteristics one should be aware of and look for in the selection of one. Issues pertaining to both hardware and software aspects of medical workstations will be reviewed particularly as they may impact the interpretation process. PMID:19552939

Manual stage acquisition and interactive display of digital slides in histopathology.

PubMed

Gherardi, Alessandro; Bevilacqua, Alessandro

2014-07-01

More powerful PC architectures, high-resolution cameras working at increasing frame rates, and more and more accurate motorized microscopes have boosted new applications in the field of biomedicine and medical imaging. In histopathology, the use of digital slides (DSs) imaging through dedicated hardware for digital pathology is increasing for several reasons: digital annotation of suspicious lesions, recorded clinical history, and telepathology as a collaborative environment. In this paper, we propose the first method known in the literature for real-time whole slide acquisition and displaying conceived for conventional nonautomated microscopes. Differently from DS scanner, our software enables biologists and histopathologists to build and view the DS in real time while inspecting the sample, as they are accustomed to. In addition, since our approach is compliant with existing common microscope positions, provided with camera and PC, this could contribute to disseminate the whole slide technology in the majority of small labs not endowed with DS hardware facilities. Experiments performed with different histologic specimens (referring to tumor tissues of different body parts as well as to tumor cells), acquired under different setup conditions and devices, prove the effectiveness of our approach both in terms of quality and speed performances.

[The impact of technology in Pathological Anatomy and the contribution of this speciality to technological development].

PubMed

Puras-Gil, A M; López-Cousillas, A

1999-01-01

It is obvious that technology has contributed throughout history to the development of the different sciences. In this article, we define the concept of Pathology as a medical speciality, and we explain its influence in a hospital, considering very different fields such as education, research, quality control, hospital information, and patient care. This speciality has undergone a considerable evolution, to which technological innovation has undoubtedly contributed. As a basic discipline, it is of great importance in pre and post-graduate training, in the medical education at the hospital or outside it, and in the fields previously mentioned. Its relation with other disciplines such us Chemistry, (fixation and dyeing), Physics (mechanical devices), Mathematics (algorithms, morphometry, statistics...) and Telecommunications (telepathology, image analysis...) is examined and their contribution to Pathology is evaluated. We are also aware of contributions made by Pathology to technological innovation in the evaluation of different diagnostic methods or in the recent therapeutic technologies based on Radiotherapy, Hyperthermia, laser, prothesis, etc.; where histological examination provides accurate information about the therapeutic capacity or side-effects, or the rejection reactions caused, aiding the research to obtain adequate results.

Global manipulation of digital images can lead to variation in cytological diagnosis.

PubMed

Prasad, H; Wanjari, Sangeeta; Parwani, Rajkumar

2011-03-31

With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations. To analyse the impact of manipulating digital images on their diagnosis. Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted κ statistics was used to measure and assess the levels of agreement between observers. Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade. Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible.

[Expert systems and automatic diagnostic systems in histopathology--a review].

PubMed

Tamai, S

1999-02-01

In this decade, the pathological information system has gradually been settled in many hospitals in Japan. Pathological reports and images are now digitized and managed in the database, and are referred by clinicians at the peripherals. Tele-pathology is also developing; and its users are increasing. However, in many occasions, the problem solving in diagnostic pathology is completely dependent on the solo-pathologist. Considering the need for timely and efficient supports to the solo-pathologist, I reviewed the papers on the knowledge-based interactive expert systems. The interpretations of the histopathological images are dependent on the pathologist, and these expert systems have been evaluated as "educational". With the view of the success in the cytological screening, the development of "image-analysis-based" automatic "histopathological image" classifier has been on ongoing challenges. Our 3 years experience of the development of the pathological image classifier using the artificial neural networks technology is briefly presented. This classifier provides us a "fitting rate" for the individual diagnostic pattern of the breast tumors, such as "fibroadenoma pattern". The diagnosis assisting system with computer technology should provide pathologists, especially solo-pathologists, a useful tool for the quality assurance and improvement of pathological diagnosis.

Development of Whole Slide Imaging on Smartphones and Evaluation With ThinPrep Cytology Test Samples: Follow-Up Study

PubMed Central

Ma, Shuoxin; Yu, Hong; Jin, Yu-Biao; Zheng, Jun

2018-01-01

Background The smartphone-based whole slide imaging (WSI) system represents a low-cost and effective alternative to automatic scanners for telepathology. In a previous study, the development of one such solution, named scalable whole slide imaging (sWSI), was presented and analyzed. A clinical evaluation of its iOS version with 100 frozen section samples verified the diagnosis-readiness of the produced virtual slides. Objective The first aim of this study was to delve into the quantifying issues encountered in the development of an Android version. It should also provide insights into future high-resolution real-time feedback medical imaging apps on Android and invoke the awareness of smartphone manufacturers for collaboration. The second aim of this study was to further verify the clinical value of sWSI with cytology samples. This type is different from the frozen section samples in that they require finer detail on the cellular level. Methods During sWSI development on Android, it was discovered that many models do not support uncompressed camera pixel data with sufficient resolution and full field of view. The proportion of models supporting the optimal format was estimated in a test on 200 mainstream Android models. Other factors, including slower processing speed and camera preview freezing, also led to inferior performance of sWSI on Android compared with the iOS version. The processing speed was mostly determined by the central processing unit frequency in theory, and the relationship was investigated in the 200-model simulation experiment with physical devices. The camera preview freezing was caused by the lag between triggering photo capture and resuming preview. In the clinical evaluation, 100 ThinPrep cytology test samples covering 6 diseases were scanned with sWSI and compared against the ground truth of optical microscopy. Results Among the tested Android models, only 3.0% (6/200) provided an optimal data format, meeting all criteria of quality and efficiency. The image-processing speed demonstrated a positive relationship with the central processing unit frequency but to a smaller degree than expected and was highly model-dependent. The virtual slides produced by sWSI on Android and iOS of ThinPrep cytology test samples achieved similar high quality. Using optical microscopy as the ground truth, pathologists made a correct diagnosis on 87.5% (175/200) of the cases with sWSI virtual slides. Depending on the sWSI version and the pathologist in charge, the kappa value varied between .70 and .82. All participating pathologists considered the quality of the sWSI virtual slides in the experiment to be adequate for routine usage. Conclusions Limited by hardware and operating system support, the performance of sWSI on mainstream Android smartphones did not fully match the iOS version. However, in practice, this difference was not significant, and both were adequate for digitizing most of the sample types for telepathology consultation. PMID:29618454

Telemedicine: barriers and opportunities in the 21st century.

PubMed

Stanberry, B

2000-06-01

This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into 'info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician-patient relationships and against complacency regarding the risks and responsibilities - many of which are as yet unknown - that distant medical intervention, consultation and diagnosis carry.

Web conferencing systems: Skype and MSN in telepathology

PubMed Central

Klock, Clóvis; Gomes, Regina de Paula Xavier

2008-01-01

Virtual pathology is a very important tool that can be used in several ways, including interconsultations with specialists in many areas and for frozen sections. We considered in this work the use of Windows Live Messenger and Skype for image transmission. The conference was made through wide broad internet using Nikon E 200 microscope and Digital Samsung Colour SCC-131 camera. Internet speed for transmission varied from 400 Kb to 2.0 Mb. Both programs allow voice transmission concomitant to image, so the communication between the involved pathologists was possible using microphones and speakers. Alive image could be seen by the receptor pathologist who was able to ask for moving the field or increase/diminish the augmentation. No phone call or typing required. The programs MSN and Skype can be used in many ways and with different operational systems installed in the computer. The capture system is simple and relatively cheap, what proves the viability of the system to be used in developing countries and in cities where do not exist pathologists. With the improvement of software and the improvement of digital image quality, associated to the use of the high speed broad band Internet this will be able to become a new modality in surgical pathology. PMID:18673501

Web conferencing systems: Skype and MSN in telepathology.

PubMed

Klock, Clóvis; Gomes, Regina de Paula Xavier

2008-07-15

Virtual pathology is a very important tool that can be used in several ways, including interconsultations with specialists in many areas and for frozen sections. We considered in this work the use of Windows Live Messenger and Skype for image transmission. The conference was made through wide broad internet using Nikon E 200 microscope and Digital Samsung Colour SCC-131 camera. Internet speed for transmission varied from 400 Kb to 2.0 Mb. Both programs allow voice transmission concomitant to image, so the communication between the involved pathologists was possible using microphones and speakers. A live image could be seen by the receptor pathologist who was able to ask for moving the field or increase/diminish the augmentation. No phone call or typing required. The programs MSN and Skype can be used in many ways and with different operational systems installed in the computer. The capture system is simple and relatively cheap, what proves the viability of the system to be used in developing countries and in cities where do not exist pathologists. With the improvement of software and the improvement of digital image quality, associated to the use of the high speed broad band Internet this will be able to become a new modality in surgical pathology.

Industry-contract research organization pathology interactions: a perspective of contract research organizations in producing the best quality pathology report.

PubMed

Gosselin, Sylvie J; Palate, Bernard; Parker, George A; Engelhardt, Jeffery A; Hardisty, Jerry F; McDorman, Kevin S; Tellier, Pierre A; Silverman, Lee R

2011-02-01

This article provides observations on the features of sponsor-contract research organization communication that will achieve the best quality pathology report based on our collective experience. Information on the test article and any anticipated findings should be provided, and initial slide examination should be done with knowledge of treatment group (but may be followed by blinded review of target tissues to determine no-effect levels). Only a pathologist should write or revise the pathology report or the pathology section of the overall study report. To address concerns related to undue sponsor influence, comments by sponsors should be presented as suggestions rather than directives. Adversity should be defined for each finding by the study pathologist, but the no-observed adverse effect level should not be discussed in the pathology report. Board-certified pathologists are recommended, but are not essential. Sponsors that have a particular format or report preferences should make them known well in advance. Histologic processing "to glass" of protocol-specified tissues from all dosage groups is recommended for rapid evaluation of target tissues. Telepathology is beneficial in certain situations, but it is usually more efficient for the study pathologist and reviewing pathologist to be in the same physical location to review differences of opinion and reach a consensus.

Development of Whole Slide Imaging on Smartphones and Evaluation With ThinPrep Cytology Test Samples: Follow-Up Study.

PubMed

Huang, Yu-Ning; Peng, Xing-Chun; Ma, Shuoxin; Yu, Hong; Jin, Yu-Biao; Zheng, Jun; Fu, Guo-Hui

2018-04-04

The smartphone-based whole slide imaging (WSI) system represents a low-cost and effective alternative to automatic scanners for telepathology. In a previous study, the development of one such solution, named scalable whole slide imaging (sWSI), was presented and analyzed. A clinical evaluation of its iOS version with 100 frozen section samples verified the diagnosis-readiness of the produced virtual slides. The first aim of this study was to delve into the quantifying issues encountered in the development of an Android version. It should also provide insights into future high-resolution real-time feedback medical imaging apps on Android and invoke the awareness of smartphone manufacturers for collaboration. The second aim of this study was to further verify the clinical value of sWSI with cytology samples. This type is different from the frozen section samples in that they require finer detail on the cellular level. During sWSI development on Android, it was discovered that many models do not support uncompressed camera pixel data with sufficient resolution and full field of view. The proportion of models supporting the optimal format was estimated in a test on 200 mainstream Android models. Other factors, including slower processing speed and camera preview freezing, also led to inferior performance of sWSI on Android compared with the iOS version. The processing speed was mostly determined by the central processing unit frequency in theory, and the relationship was investigated in the 200-model simulation experiment with physical devices. The camera preview freezing was caused by the lag between triggering photo capture and resuming preview. In the clinical evaluation, 100 ThinPrep cytology test samples covering 6 diseases were scanned with sWSI and compared against the ground truth of optical microscopy. Among the tested Android models, only 3.0% (6/200) provided an optimal data format, meeting all criteria of quality and efficiency. The image-processing speed demonstrated a positive relationship with the central processing unit frequency but to a smaller degree than expected and was highly model-dependent. The virtual slides produced by sWSI on Android and iOS of ThinPrep cytology test samples achieved similar high quality. Using optical microscopy as the ground truth, pathologists made a correct diagnosis on 87.5% (175/200) of the cases with sWSI virtual slides. Depending on the sWSI version and the pathologist in charge, the kappa value varied between .70 and .82. All participating pathologists considered the quality of the sWSI virtual slides in the experiment to be adequate for routine usage. Limited by hardware and operating system support, the performance of sWSI on mainstream Android smartphones did not fully match the iOS version. However, in practice, this difference was not significant, and both were adequate for digitizing most of the sample types for telepathology consultation. ©Yu-Ning Huang, Xing-Chun Peng, Shuoxin Ma, Hong Yu, Yu-Biao Jin, Jun Zheng, Guo-Hui Fu. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.04.2018.

Clinical and laboratory applications of slide-based cytometry with the LSC, SFM, and the iCYTE imaging cytometer instruments

NASA Astrophysics Data System (ADS)

Bocsi, Jozsef; Luther, Ed; Mittag, Anja; Jensen, Ingo; Sack, Ulrich; Lenz, Dominik; Trezl, Lajos; Varga, Viktor S.; Molnar, Beea; Tarnok, Attila

2004-06-01

Background: Slide based cytometry (SBC) is a technology for the rapid stoichiometric analysis of cells fixed to surfaces. Its applications are highly versatile and ranges from the clinics to high throughput drug discovery. SBC is realized in different instruments such as the Laser Scanning Cytometer (LSC) and Scanning Fluorescent Microscope (SFM) and the novel inverted microscope based iCyte image cytometer (Compucyte Corp.). Methods: Fluorochrome labeled specimens were immobilized on microscopic slides. They were placed on a conventional fluorescence microscope and analyzed by photomultiplayers or digital camera. Data comparable to flow cytometry were generated. In addition, each individual event could be visualized. Applications: The major advantage of instruments is the combination of two features: a) the minimal sample volume needed, and b) the connection of fluorescence data and morphological information. Rare cells were detected, frequency of apoptosis by myricetin formaldehyde and H2O2 mixtures was determined;. Conclusion: LSC, SFM and the novel iCyte have a wide spectrum of applicability in SBC and can be introduced as a standard technology for multiple settings. In addition, the iCyte and SFM instrument is suited for high throughput screening by automation and may be in future adapted to telepathology due to their high quality images. (This study was supported by the IZKF-Leipzig, Germany and T 034245 OTKA, Hungary)

Whole-slide imaging in pathology: the potential impact on PACS

NASA Astrophysics Data System (ADS)

Horii, Steven C.

2007-03-01

Pathology, the medical specialty charged with the evaluation of macroscopic and microscopic aspects of disease, is increasingly turning to digital imaging. While the conventional tissue blocks and glass slides form an "archive" that pathology departments must maintain, digital images acquired from microscopes or digital slide scanners are increasingly used for telepathology, consultation, and intra-facility communication. Since many healthcare facilities are moving to "enterprise PACS" with departments in addition to radiology using the infrastructure of such systems, some understanding of the potential of whole-slide digital images is important. Network and storage designers, in particular, are very likely to be impacted if a significant number of such images are to be moved on, or stored (even temporarily) in, enterprise PACS. As an example, a typical commercial whole-slide imaging system typically generates 15 gigabytes per slide scanned (per focal plane). Many of these whole-slide scanners have a throughput of 1000 slides per day. If that full capacity is used and all the resulting digital data is moved to the enterprise PACS, it amounts to 15 terabytes per day; the amount of data a large radiology department might generate in a year or two. This paper will review both the clinical scenarios of whole-slide imaging as well as the resulting data volumes. The author will emphasize the potential PACS infrastructure impact of such huge data volumes.

Using a visual discrimination model for the detection of compression artifacts in virtual pathology images.

PubMed

Johnson, Jeffrey P; Krupinski, Elizabeth A; Yan, Michelle; Roehrig, Hans; Graham, Anna R; Weinstein, Ronald S

2011-02-01

A major issue in telepathology is the extremely large and growing size of digitized "virtual" slides, which can require several gigabytes of storage and cause significant delays in data transmission for remote image interpretation and interactive visualization by pathologists. Compression can reduce this massive amount of virtual slide data, but reversible (lossless) methods limit data reduction to less than 50%, while lossy compression can degrade image quality and diagnostic accuracy. "Visually lossless" compression offers the potential for using higher compression levels without noticeable artifacts, but requires a rate-control strategy that adapts to image content and loss visibility. We investigated the utility of a visual discrimination model (VDM) and other distortion metrics for predicting JPEG 2000 bit rates corresponding to visually lossless compression of virtual slides for breast biopsy specimens. Threshold bit rates were determined experimentally with human observers for a variety of tissue regions cropped from virtual slides. For test images compressed to their visually lossless thresholds, just-noticeable difference (JND) metrics computed by the VDM were nearly constant at the 95th percentile level or higher, and were significantly less variable than peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) metrics. Our results suggest that VDM metrics could be used to guide the compression of virtual slides to achieve visually lossless compression while providing 5-12 times the data reduction of reversible methods.

New Trends of Emerging Technologies in Digital Pathology.

PubMed

Bueno, Gloria; Fernández-Carrobles, M Milagro; Deniz, Oscar; García-Rojo, Marcial

2016-01-01

The future paradigm of pathology will be digital. Instead of conventional microscopy, a pathologist will perform a diagnosis through interacting with images on computer screens and performing quantitative analysis. The fourth generation of virtual slide telepathology systems, so-called virtual microscopy and whole-slide imaging (WSI), has allowed for the storage and fast dissemination of image data in pathology and other biomedical areas. These novel digital imaging modalities encompass high-resolution scanning of tissue slides and derived technologies, including automatic digitization and computational processing of whole microscopic slides. Moreover, automated image analysis with WSI can extract specific diagnostic features of diseases and quantify individual components of these features to support diagnoses and provide informative clinical measures of disease. Therefore, the challenge is to apply information technology and image analysis methods to exploit the new and emerging digital pathology technologies effectively in order to process and model all the data and information contained in WSI. The final objective is to support the complex workflow from specimen receipt to anatomic pathology report transmission, that is, to improve diagnosis both in terms of pathologists' efficiency and with new information. This article reviews the main concerns about and novel methods of digital pathology discussed at the latest workshop in the field carried out within the European project AIDPATH (Academia and Industry Collaboration for Digital Pathology). © 2016 S. Karger AG, Basel.

The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia.

PubMed

Shiferaw, Fassil; Zolfo, Maria

2012-01-01

Eighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes. This paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources. Ten sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites. Telemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect 'one size fits all' technology and the use of combined interoperable applications, according to the local context, is highly recommended. Telemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts.

A mathematical framework for combining decisions of multiple experts toward accurate and remote diagnosis of malaria using tele-microscopy.

PubMed

Mavandadi, Sam; Feng, Steve; Yu, Frank; Dimitrov, Stoyan; Nielsen-Saines, Karin; Prescott, William R; Ozcan, Aydogan

2012-01-01

We propose a methodology for digitally fusing diagnostic decisions made by multiple medical experts in order to improve accuracy of diagnosis. Toward this goal, we report an experimental study involving nine experts, where each one was given more than 8,000 digital microscopic images of individual human red blood cells and asked to identify malaria infected cells. The results of this experiment reveal that even highly trained medical experts are not always self-consistent in their diagnostic decisions and that there exists a fair level of disagreement among experts, even for binary decisions (i.e., infected vs. uninfected). To tackle this general medical diagnosis problem, we propose a probabilistic algorithm to fuse the decisions made by trained medical experts to robustly achieve higher levels of accuracy when compared to individual experts making such decisions. By modelling the decisions of experts as a three component mixture model and solving for the underlying parameters using the Expectation Maximisation algorithm, we demonstrate the efficacy of our approach which significantly improves the overall diagnostic accuracy of malaria infected cells. Additionally, we present a mathematical framework for performing 'slide-level' diagnosis by using individual 'cell-level' diagnosis data, shedding more light on the statistical rules that should govern the routine practice in examination of e.g., thin blood smear samples. This framework could be generalized for various other tele-pathology needs, and can be used by trained experts within an efficient tele-medicine platform.

[Improving practice in breast pathology: 34-months experience of the regional SENOPATH network and webinars as a tool for diagnosis of difficult lesions of the breast].

PubMed

Quintyn-Ranty, Marie-Laure; Gordien, Karine; Caveriviere, Paul; Mery, Éliane; Jamme-Lallemand, Muriel; Wuithier, Pascal; Palasse, Julien; Reyre, Joelle; Laborie, Vincent; Despax, Brigitte; Rolland, Véronique; Thibaut, Isabelle; Maissongrosse, Véronique; Escourrou, Ghislaine; Duprez-Paumier, Raphaëlle; Bauvin, Éric; Jacob, Michel; Lacroix-Triki, Magali

2015-10-01

Pathologists commonly face breast lesions that are difficult to diagnose. To reduce second opinion delay, erase geographical barrier and provide continuing education, we aimed to develop a telepathology-based regional network of pathologists. With the support of ONCOMIP network, we founded a peer-group named SENOPATH, composed of experienced breast pathologists practising in private laboratories, university hospitals or comprehensive cancer center in the region of Midi-Pyrénées in France. Submitted cases are digitalized at the University Hospital, stored in a shared space with a possible access via Internet prior to the SENOPATH sessions. The group meets monthly, via a synchronized webinar and multihead microscope session. A consensual diagnosis and final pathology report is issued for each case, and sent to the referring clinician via the patient medical file securely hosted by ONCOMIP. Between 2012 and 2014, 142 cases were reviewed, for either diagnostic 'routine' difficulty or rare histological type. The SENOPATH group, also regularly called by oncologists to solve difficult cases, has considerably improved the pathologist network in Southern France. Supported by the webinar tool, its educational impact is prominent, with a considerable progress in the region with regards to standardization of pathology processes, literature review and knowledge sharing. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

An efficient architecture to support digital pathology in standard medical imaging repositories.

PubMed

Marques Godinho, Tiago; Lebre, Rui; Silva, Luís Bastião; Costa, Carlos

2017-07-01

In the past decade, digital pathology and whole-slide imaging (WSI) have been gaining momentum with the proliferation of digital scanners from different manufacturers. The literature reports significant advantages associated with the adoption of digital images in pathology, namely, improvements in diagnostic accuracy and better support for telepathology. Moreover, it also offers new clinical and research applications. However, numerous barriers have been slowing the adoption of WSI, among which the most important are performance issues associated with storage and distribution of huge volumes of data, and lack of interoperability with other hospital information systems, most notably Picture Archive and Communications Systems (PACS) based on the DICOM standard. This article proposes an architecture of a Web Pathology PACS fully compliant with DICOM standard communications and data formats. The solution includes a PACS Archive responsible for storing whole-slide imaging data in DICOM WSI format and offers a communication interface based on the most recent DICOM Web services. The second component is a zero-footprint viewer that runs in any web-browser. It consumes data using the PACS archive standard web services. Moreover, it features a tiling engine especially suited to deal with the WSI image pyramids. These components were designed with special focus on efficiency and usability. The performance of our system was assessed through a comparative analysis of the state-of-the-art solutions. The results demonstrate that it is possible to have a very competitive solution based on standard workflows. Copyright © 2017 Elsevier Inc. All rights reserved.

Telemedicine in Alentejo

PubMed Central

Bayer, Steffen; Gonçalves, Luís; Barlow, James

2014-01-01

Abstract Alentejo covers a third of Portugal, yet it is home to only 5% of the population. Residents of the region are poorer, older, and less educated than the rest of the country. There is a shortage of physicians in several specialties. The low population density, a concentration of specialized services, and a poor public transportation network all create barriers to access. Telemedicine was introduced in 1998 to help address these challenges. In this article, we provide an overview of the program and its current status, focusing on infrastructure, services, and activity volume. We also discuss the impact the program has had from the perspectives of patients and healthcare professionals. From 1998 to 2011, there were 132,546 episodes of service using telemedicine, including real-time teleconsultations, teleradiology, teleultrasound, and telepathology. At present, the network includes 20 primary care units and five hospitals, covering almost 30,000 km2 and 500,000 people. Units have high-resolution videoconferencing equipment, access to patients' clinical records, an image archive, and peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are available in 15 medical specialties and areas, ranging from neurology to pediatric surgery. In 2008, regional health authorities started a tele-education program, and by the end of 2011, 876 healthcare professionals, across 52 locations, had participated in remote learning sessions. More than a decade since telemedicine was introduced in Alentejo, it is now an integral part of everyday service provision. A comprehensive assessment of the costs and consequences of the program is currently underway. PMID:24180419

The history of pathology informatics: A global perspective

PubMed Central

Park, Seung; Parwani, Anil V.; Aller, Raymond D.; Banach, Lech; Becich, Michael J.; Borkenfeld, Stephan; Carter, Alexis B.; Friedman, Bruce A.; Rojo, Marcial Garcia; Georgiou, Andrew; Kayser, Gian; Kayser, Klaus; Legg, Michael; Naugler, Christopher; Sawai, Takashi; Weiner, Hal; Winsten, Dennis; Pantanowitz, Liron

2013-01-01

Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold. PMID:23869286

Dynamic nonrobotic telemicroscopy via skype: A cost effective solution to teleconsultation.

PubMed

Sirintrapun, Sahussapont J; Cimic, Adela

2012-01-01

Skype is a peer to peer software application that has been historically used for voice and video calls, instant messaging, and file transfer over the Internet. Few studies are available using Skype specifically for telepathology. Our aim is to show that dynamic nonrobotic teleconsultation is possible and even effective via means of a standard microscope camera capable of live acquisition, Skype, an established broad band internet connection, and experienced pathologists. Both the consulting "sending" pathologist and consultant "receiving" pathologist are reasonably experienced general surgical pathologists at junior attending level with several years of experience in sign out. Forty-five cases were chosen encompassing a broad range of surgical pathology specimens. The cases were prospectively evaluated with the consultant diagnosis used as a preliminary pathologic impression with the final diagnosis being confirmation. Versions of Skype 5.0 and above were used along with established broadband internet connections, usually between academic medical institutions. Forty of forty-five cases (89%) were essentially concordant. In four of forty-five cases (9%), the consulting impression gave a differential, but favored an entity which did not match the final diagnosis. Only one case (2%) did the consulting impression not match the final diagnosis; a discordant opinion. The image quality via Skype screen sharing option is excellent. Essentially no lag time was seen. We have shown in our small pilot study that Skype is an effective cost-efficient means for teleconsultation, particularly in the setting of entity-related differential diagnoses in surgical pathology and when both the consulting and consultant pathologists are reasonably experienced.

The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia

PubMed Central

Shiferaw, Fassil; Zolfo, Maria

2012-01-01

Background Eighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes. Objective This paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources. Design Ten sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites. Results Telemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect ‘one size fits all’ technology and the use of combined interoperable applications, according to the local context, is highly recommended. Conclusions Telemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts. PMID:22479235

Telecytology: Is it possible with smartphone images?

PubMed

Sahin, Davut; Hacisalihoglu, Uguray Payam; Kirimlioglu, Saime Hale

2018-01-01

This study aimed to discuss smartphone usage in telecytology and determine intraobserver concordance between microscopic cytopathological diagnoses and diagnoses derived via static smartphone images. The study was conducted with 172 cytologic material. A pathologist captured static images of the cytology slides from the ocular lens of a microscope using a smartphone. The images were transferred via WhatsApp® to a cytopathologist working in another center who made all the microscopic cytopathological diagnoses 5-27 months ago. The cytopathologist diagnosed images on a smartphone without knowledge of their previous microscopic diagnoses. The Kappa agreement between microscopic cytopathological diagnoses and smartphone image diagnoses was determined. The average image capturing, transfer, and remote cytopathological diagnostic time for one case was 6.20 minutes. The percentage of cases whose microscopic and smartphone image diagnoses were concordant was 84.30%, and the percentage of those whose diagnoses were discordant was 15.69%. The highest Kappa agreement was observed in endoscopic ultrasound-guided fine needle aspiration (1.000), and the lowest agreement was observed in urine cytology (0.665). Patient management changed with smart phone image diagnoses at 11.04%. This study showed that easy, fast, and high-quality image capturing and transfer is possible from cytology slides using smartphones. The intraobserver Kappa agreement between the microscopic cytopathological diagnoses and remote smartphone image diagnoses was high. It was found that remote diagnosis due to difficulties in telecytology might change patient management. The developments in the smartphone camera technology and transfer software make them efficient telepathology and telecytology tools. © 2017 Wiley Periodicals, Inc.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study.

PubMed

Skandarajah, Arunan; Sunny, Sumsum P; Gurpur, Praveen; Reber, Clay D; D'Ambrosio, Michael V; Raghavan, Nisheena; James, Bonney Lee; Ramanjinappa, Ravindra D; Suresh, Amritha; Kandasarma, Uma; Birur, Praveen; Kumar, Vinay V; Galmeanu, Honorius-Cezar; Itu, Alexandru Mihail; Modiga-Arsu, Mihai; Rausch, Saskia; Sramek, Maria; Kollegal, Manohar; Paladini, Gianluca; Kuriakose, Moni; Ladic, Lance; Koch, Felix; Fletcher, Daniel

2017-01-01

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings.

The evolution of publication hotspots in the field of telemedicine from 1962 to 2015 and differences among six countries.

PubMed

Wang, Yanjun; Zhao, Ye; Zheng, Jianzhong; Zhang, Ailian; Dong, Haiyuan

2018-04-01

Introduction Telemedicine has been implemented in many countries and has captured the attention of many researchers. Herein, we aim to quantify publication hotspots in the field of telemedicine, analyse their evolution, compare them in different countries, and provide visual representations. Methods We used software tools to process PubMed entries for a 54-year period and identified publication hotspots using keyword frequency analysis. We employed a keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and network visualization technology. Results The number of Medical Subject Heading (MeSH) terms increased with time. The most common subcategories of telemedicine between 1962 and 2015 were Remote Consultation, Teleradiology, and Telepathology. The most popular information communication technologies in telemedicine publications were related to the Internet and cell phones. The topics of Patient Satisfaction, Treatment Outcomes, and Home Care Services associated with telemedicine were highlighted after the 1990s. Use frequency of the terms Cell Phones and Self-Care increased drastically in the past six years, and the publication focus in six countries that had the highest output was different. Knowledge network maps and perceptual maps show the relationship between high-frequency MeSH terms. Discussion The telemedicine field has experienced significant growth and expansion in knowledge and innovation in the last 54 years. Publication hotspots for telemedicine lean towards clinical treatment, home care services, and personal care, and countries emphasize publishing in areas related to their national characteristics. This study quantitatively discusses publication hotspots, provides an objective and systematic understanding of this field, and suggests directions for future telemedicine research.

State of the art of teledermatopathology.

PubMed

Massone, Cesare; Brunasso, Alexandra M G; Campbell, Terri M; Soyer, H Peter

2008-10-01

Teledermatopathology may involve real-time transmission of images from distant locations to consulting pathologists by the remote manipulation of a robotic microscope. Alternatively, the static store-and-forward option involves the single-file transmission of subjectively preselected and captured areas of microscopic images by a referring physician. The recent introduction of virtual slide systems (VSS) involves the digitization of whole slides at high resolution thus enabling the user to view any part of the specimen at any magnification. Such technology has surmounted previous restrictions caused by the size of preselected areas and specimen sampling for telepathology. In terms of client access, these VSS may be stored on a virtual slide server, made available on the Web for remote consultation by pathologists via an integrated virtual slide client network. Despite store-and-forward teledermatopathology being the most frequently used and less expensive approach to teledermatopathology, VSS represents the future in this discipline. The recent pilot studies suggest that the use of remote expert consultants in diagnostic dermatopathology can be integrated into daily routine, teleconsultation, and teleteaching. The new technology enables rapid and reproducible diagnoses, but despite its usability, VSS is not completely feasible for teledermatopathology of inflammatory skin diseases as the performance seems to be influenced by the availability of complete clinical data. Improvements in the diagnostic facility will no doubt follow from further development of the VSS, the slide processor, and of course training in the use of virtual microscope. Undoubtedly, as technology becomes even more sophisticated in the future, VSS will overcome the present drawbacks and find its place in all facets of teledermatopathology.

Influence of LCD color reproduction accuracy on observer performance using virtual pathology slides

NASA Astrophysics Data System (ADS)

Krupinski, Elizabeth A.; Silverstein, Louis D.; Hashmi, Syed F.; Graham, Anna R.; Weinstein, Ronald S.; Roehrig, Hans

2012-02-01

The use of color LCDs in medical imaging is growing as more clinical specialties use digital images as a resource in diagnosis and treatment decisions. Telemedicine applications such as telepathology, teledermatology and teleophthalmology rely heavily on color images. However, standard methods for calibrating, characterizing and profiling color displays do not exist, resulting in inconsistent presentation. To address this, we developed a calibration, characterization and profiling protocol for color-critical medical imaging applications. Physical characterization of displays calibrated with and without the protocol revealed high color reproduction accuracy with the protocol. The present study assessed the impact of this protocol on observer performance. A set of 250 breast biopsy virtual slide regions of interest (half malignant, half benign) were shown to 6 pathologists, once using the calibration protocol and once using the same display in its "native" off-the-shelf uncalibrated state. Diagnostic accuracy and time to render a decision were measured. In terms of ROC performance, Az (area under the curve) calibrated = 0.8640; uncalibrated = 0.8558. No statistically significant difference (p = 0.2719) was observed. In terms of interpretation speed, mean calibrated = 4.895 sec, mean uncalibrated = 6.304 sec which is statistically significant (p = 0.0460). Early results suggest a slight advantage diagnostically for a properly calibrated and color-managed display and a significant potential advantage in terms of improved workflow. Future work should be conducted using different types of color images that may be more dependent on accurate color rendering and a wider range of LCDs with varying characteristics.

Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.

PubMed

Sayed, Shahin; Cherniak, William; Lawler, Mark; Tan, Soo Yong; El Sadr, Wafaa; Wolf, Nicholas; Silkensen, Shannon; Brand, Nathan; Looi, Lai Meng; Pai, Sanjay A; Wilson, Michael L; Milner, Danny; Flanigan, John; Fleming, Kenneth A

2018-05-12

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan. Copyright © 2018 Elsevier Ltd. All rights reserved.

A comparison of digitized frozen section and smear preparations for intraoperative neurotelepathology.

PubMed

Gould, Peter V; Saikali, Stephan

2012-01-01

Intraoperative consultations in neuropathology are often assessed by smear preparations rather than by frozen sections. Both techniques are standard practice for light microscopic examination on site, but there is little data comparing these techniques in a telepathology setting. Thirty cases of brain tumours submitted for intraoperative consultation at our institution between July and December 2010 were identified in which both frozen section and tissue smear preparations were available for digitization at 20× magnification. Slides were digitized using a Hamamatsu Nanozoomer 2.0 HT whole slide scanner, and resulting digital images were visualized at 1680 × 1050 pixel resolution with NDP. view software. The original intraoperative diagnosis was concordant with the sign out diagnosis in 29/30 cases; one tumeur was initially interpreted as a high grade glioma but proved to be a lymphoma at sign out. Digitized frozen section slides were sufficient for diagnosis at 10× magnification in 27/30 cases. Digitized tissue smears were sufficient for diagnosis at 10× magnification in 28/30 cases. In two cases tumour was present on the tissue smear but not the frozen section (one case of recurrent astrocytoma, one case of meningeal carcinomatosis). In one case of lymphoma, tumour was present on frozen section only. These discrepancies were attributed to tissue sampling rather than image quality. Examination of digitized slides at higher magnfication (20×) permitted confirmation of mitoses and Rosenthal fibers on tissue smear preparations, but did not change the primary diagnosis. Intra-slide variations in tissue thickness on smear preparations led to variable loss of focus in digitized images, but did not affect image quality in thinner areas of the smear or impede diagnosis. Digitized tissue smears are suitable for intraoperative neurotelepathology and provide comparable information to digitized frozen sections at medium power magnification.

The healthcare off-shoring industry in developing economies--institutional and economic foundations: an Indian case.

PubMed

Kshetri, Nir

2011-01-01

Industrialized world-based healthcare providers are increasingly off-shoring low-end healthcare services such as medical transcription, billing and insurance claims. High-skill medical jobs such as tele-imaging and tele-pathology are also being sub-contracted to developing countries. Despite its importance, little theory or research exists to explain what factors affect industry growth. The article's goals, therefore, are to examine economic processes associated with developing economies' shift from low- to high-value information technology enabled healthcare services, and to investigate how these differ in terms of legitimacy from regulative, normative and cognitive institutions in the sending country and how healthcare services differ from other services. This research is conceptual and theory-building. Broadly, its approach can be described as a positivistic epistemology. Anti off-shoring regulative, normative and cognitive pressures in the sending country are likely to be stronger in healthcare than in most business process outsourcing. Moreover, such pressures are likely to be stronger in high-value rather than in low-value healthcare off-shoring. The findings also indicate that off-shoring low-value healthcare services and emergent healthcare industries in a developing economy help accumulate implicit and tacit knowledge required for off-shoring high-value healthcare services. The approach lacks primary data and empirical documentation. The article helps in understanding industry drivers and its possible future direction. The findings help in understanding the lens through which various institutional actors in a sending country view healthcare service off-shoring. The article's value stems from its analytical context, mechanisms and processes associated with developing economies' shift to high-value healthcare off-shoring services.

Mobile teledermatopathology: using a tablet PC as a novel and cost-efficient method to remotely diagnose dermatopathology cases.

PubMed

Speiser, Jodi J; Hughes, Ian; Mehta, Vikas; Wojcik, Eva M; Hutchens, Kelli A

2014-01-01

: Dermatopathology has relatively few studies regarding teledermatopathology and none have addressed the use of new technologies, such as the tablet PC. We hypothesized that the combination of our existing dynamic nonrobotic system with a tablet PC could provide a novel and cost-efficient method to remotely diagnose dermatopathology cases. 93 cases diagnosed by conventional light microscopy at least 5 months earlier by the participating dermatopathologist were retrieved by an electronic pathology database search. A high-resolution video camera (Nikon DS-L2, version 4.4) mounted on a microscope was used to transmit digital video of a slide to an Apple iPAD2 (Apple Inc, Cupertino, CA) at the pathologist's remote location via live streaming at an interval time of 500 ms and a resolution of 1280/960 pixels. Concordance to the original diagnosis and the seconds elapsed to reaching the diagnosis were recorded. 24.7% (23/93) of cases were melanocytic, 70.9% (66/93) were nonmelanocytic, and 4.4% (4/93) were inflammatory. About 92.5% (86/93) of cases were diagnosed on immediate viewing (<5 seconds), with the average time to diagnosis at 40.2 seconds (range: 10-218 seconds). Of the cases diagnosed immediately, 98.8% (85/86) of the telediagnoses were concordant with the original. Telepathology performed via a tablet PC may serve as a reliable and rapid technique for the diagnosis of routine cases with some diagnostic caveats in mind. Our study established a novel and cost-efficient solution for those institutions that may not have the capital to purchase either a dynamic robotic system or a virtual slide system.

Wavelength scanning achieves pixel super-resolution in holographic on-chip microscopy

NASA Astrophysics Data System (ADS)

Luo, Wei; Göröcs, Zoltan; Zhang, Yibo; Feizi, Alborz; Greenbaum, Alon; Ozcan, Aydogan

2016-03-01

Lensfree holographic on-chip imaging is a potent solution for high-resolution and field-portable bright-field imaging over a wide field-of-view. Previous lensfree imaging approaches utilize a pixel super-resolution technique, which relies on sub-pixel lateral displacements between the lensfree diffraction patterns and the image sensor's pixel-array, to achieve sub-micron resolution under unit magnification using state-of-the-art CMOS imager chips, commonly used in e.g., mobile-phones. Here we report, for the first time, a wavelength scanning based pixel super-resolution technique in lensfree holographic imaging. We developed an iterative super-resolution algorithm, which generates high-resolution reconstructions of the specimen from low-resolution (i.e., under-sampled) diffraction patterns recorded at multiple wavelengths within a narrow spectral range (e.g., 10-30 nm). Compared with lateral shift-based pixel super-resolution, this wavelength scanning approach does not require any physical shifts in the imaging setup, and the resolution improvement is uniform in all directions across the sensor-array. Our wavelength scanning super-resolution approach can also be integrated with multi-height and/or multi-angle on-chip imaging techniques to obtain even higher resolution reconstructions. For example, using wavelength scanning together with multi-angle illumination, we achieved a halfpitch resolution of 250 nm, corresponding to a numerical aperture of 1. In addition to pixel super-resolution, the small scanning steps in wavelength also enable us to robustly unwrap phase, revealing the specimen's optical path length in our reconstructed images. We believe that this new wavelength scanning based pixel super-resolution approach can provide competitive microscopy solutions for high-resolution and field-portable imaging needs, potentially impacting tele-pathology applications in resource-limited-settings.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study

PubMed Central

Skandarajah, Arunan; Sunny, Sumsum P.; Gurpur, Praveen; Reber, Clay D.; D’Ambrosio, Michael V.; Raghavan, Nisheena; James, Bonney Lee; Ramanjinappa, Ravindra D.; Suresh, Amritha; Kandasarma, Uma; Birur, Praveen; Kumar, Vinay V.; Galmeanu, Honorius-Cezar; Itu, Alexandru Mihail; Modiga-Arsu, Mihai; Rausch, Saskia; Sramek, Maria; Kollegal, Manohar; Paladini, Gianluca; Kuriakose, Moni; Koch, Felix; Fletcher, Daniel

2017-01-01

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings. PMID:29176904

Dynamic nonrobotic telemicroscopy via skype: A cost effective solution to teleconsultation

PubMed Central

Sirintrapun, Sahussapont J.; Cimic, Adela

2012-01-01

Context: Skype is a peer to peer software application that has been historically used for voice and video calls, instant messaging, and file transfer over the Internet. Few studies are available using Skype specifically for telepathology. Aims: Our aim is to show that dynamic nonrobotic teleconsultation is possible and even effective via means of a standard microscope camera capable of live acquisition, Skype, an established broad band internet connection, and experienced pathologists. Settings and Design: Both the consulting “sending” pathologist and consultant “receiving” pathologist are reasonably experienced general surgical pathologists at junior attending level with several years of experience in sign out. Forty-five cases were chosen encompassing a broad range of surgical pathology specimens. The cases were prospectively evaluated with the consultant diagnosis used as a preliminary pathologic impression with the final diagnosis being confirmation. Materials and Methods: Versions of Skype 5.0 and above were used along with established broadband internet connections, usually between academic medical institutions. Results: Forty of forty-five cases (89%) were essentially concordant. In four of forty-five cases (9%), the consulting impression gave a differential, but favored an entity which did not match the final diagnosis. Only one case (2%) did the consulting impression not match the final diagnosis; a discordant opinion. Conclusions: The image quality via Skype screen sharing option is excellent. Essentially no lag time was seen. We have shown in our small pilot study that Skype is an effective cost-efficient means for teleconsultation, particularly in the setting of entity-related differential diagnoses in surgical pathology and when both the consulting and consultant pathologists are reasonably experienced. PMID:23024887

State of the art in telemedicine - concepts, management, monitoring and evaluation of the telemedicine programme in Alentejo (Portugal).

PubMed

Oliveira, Tiago Cravo; Branquinho, Maria José; Gonçalves, Luís

2012-01-01

Alentejo - one of five Portuguese continental regions - faces major problems impacting the health and social system of the region. Here, the low population density, the low educational and income level as well as an aging population have to be mentioned. Faced with the task of ensuring equal access to healthcare for all its inhabitants, the regional health authorities created the telemedicine program. From 1998 until 2000, the program developed in an experimental fashion, with teleconsultations involving a number of providers: primary health care centers, regional hospitals, and central hospitals. Between 2000 and 2010, there were a total of 135,000 telemedicine acts including teleconsultations, teleradiology (computerised tomography and x-rays), ultrasound telemedicine and telepathology. Presently, the network comprises 20 health centers and 6 hospitals, covering 4 districts. The platform is composed of high resolution videoconferencing equipment, software with patients' clinical records, an image archive, and a number of peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are provided by fifteen medical specialties, across 3 district hospitals, ranging from neurology to pediatric surgery. In 2008, health authorities started the telelearning program, initially using point to point videoconferencing, and by the end of 2010, 848 healthcare professionals, across 52 locations, had participated in remote learning sessions, covering topics from chronic wound treatment, to infection control, to medical error. As of 2011, point to multipoint telelearning is also in operation. This paper provides an overview of the telemedicine program in Alentejo, including both infrastructure and operations. Preliminary results of an ongoing evaluation of the impact of teleconsultations on key indicators of the regional healthcare system are also presented (including current utilization and plans for future expansion). This article builds on the experience acquired throughout a decade of using telemedicine on an everyday basis, in a context of remarkable challenges in the delivery of accessible, equitable and quality healthcare services.

Telemedicine deployments within NATO military forces: a data analysis of current and projected capabilities.

PubMed

Lam, David M; Poropatich, Ronald K

2008-11-01

Since the creation of the NATO Telemedicine Expert Panel (now renamed the TMED Expert Team) in 2000, when few nations had deployed telemedicine systems to support military field operations, this group has been encouraging the nations to deploy telemedicine (TMED) in support of their forces, and to write the use of TMED into NATO doctrine. This has been a relatively successful effort, and TMED is increasingly being used within the military medical structures of some NATO and Partnership for Peace nations to provide medical care to deployed military personnel. We report the results of a multinational survey of current and projected availability of various telemedicine modalities within the NATO medical services that are participating in the work of the TMED expert team (ET). Though only a "snapshot in time," and not representing all NATO nations, this is the first attempt to identify both current and planned TMED utilization within the multinational military medical community. Participating nations report that communication systems now in place at the lowest levels of medical support increasingly enable the routine use of Web-based teleconsultation modalities. Teleradiology is now being seen as the de facto standard for imaging support. While a number of nations report they have deployed capabilities for obtaining clinical consultations at a distance, most responding nations do not have a formal organizational structure to control and manage remote consultation and rely on informal clinical relationships (e.g., requesting consults from the deployed clinician's home hospital or from friends). Military electronic health records are in use by only a minority of nations and fewer still are capable of civilian interface. Less common TMED capabilities (e.g., tele-microbiology, tele-pathology, tele-medical maintenance) are being increasingly used, but are still rarely deployed. As a result of the findings of this survey, specific recommendations for expanding the use of TMED in the NATO multinational medical setting have been made to appropriate NATO bodies.

[Telemedicine in otorhinolaryngology exemplified by a Tübingen-Leipzig video conference].

PubMed

Plinkert, P K; Plinkert, B; Fuchs, M; Zenner, H P

2000-10-01

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability, reliability, costs and quality were determined and compared with other technologies for audiovisual data transfer.

Use of a wiki as an interactive teaching tool in pathology residency education: Experience with a genomics, research, and informatics in pathology course.

PubMed

Park, Seung; Parwani, Anil; Macpherson, Trevor; Pantanowitz, Liron

2012-01-01

The need for informatics and genomics training in pathology is critical, yet limited resources for such training are available. In this study we sought to critically test the hypothesis that the incorporation of a wiki (a collaborative writing and publication tool with roots in "Web 2.0") in a combined informatics and genomics course could both (1) serve as an interactive, collaborative educational resource and reference and (2) actively engage trainees by requiring the creation and sharing of educational materials. A 2-week full-time course at our institution covering genomics, research, and pathology informatics (GRIP) was taught by 36 faculty to 18 second- and third-year pathology residents. The course content included didactic lectures and hands-on demonstrations of technology (e.g., whole-slide scanning, telepathology, and statistics software). Attendees were given pre- and posttests. Residents were trained to use wiki technology (MediaWiki) and requested to construct a wiki about the GRIP course by writing comprehensive online review articles on assigned lectures. To gauge effectiveness, pretest and posttest scores for our course were compared with scores from the previous 7 years from the predecessor course (limited to informatics) given at our institution that did not utilize wikis. Residents constructed 59 peer-reviewed collaborative wiki articles. This group showed a 25% improvement (standard deviation 12%) in test scores, which was greater than the 16% delta recorded in the prior 7 years of our predecessor course (P = 0.006). Our use of wiki technology provided a wiki containing high-quality content that will form the basis of future pathology informatics and genomics courses and proved to be an effective teaching tool, as evidenced by the significant rise in our resident posttest scores. Data from this project provide support for the notion that active participation in content creation is an effective mechanism for mastery of content. Future residents taking this course will continue to build on this wiki, keeping content current, and thereby benefit from this collaborative teaching tool.

Comparing whole slide digital images versus traditional glass slides in the detection of common microscopic features seen in dermatitis

PubMed Central

Vyas, Nikki S.; Markow, Michael; Prieto-Granada, Carlos; Gaudi, Sudeep; Turner, Leslie; Rodriguez-Waitkus, Paul; Messina, Jane L.; Jukic, Drazen M.

2016-01-01

Background: The quality and limitations of digital slides are not fully known. We aimed to estimate intrapathologist discrepancy in detecting specific microscopic features on glass slides and digital slides created by scanning at ×20. Methods: Hematoxylin and eosin and periodic acid–Schiff glass slides were digitized using the Mirax Scan (Carl Zeiss Inc., Germany). Six pathologists assessed 50–71 digital slides. We recorded objective magnification, total time, and detection of the following: Mast cells; eosinophils; plasma cells; pigmented macrophages; melanin in the epidermis; fungal bodies; neutrophils; civatte bodies; parakeratosis; and sebocytes. This process was repeated using the corresponding glass slides after 3 weeks. The diagnosis was not required. Results: The mean time to assess digital slides was 176.77 s and 137.61 s for glass slides (P < 0.001, 99% confidence interval [CI]). The mean objective magnification used to detect features using digital slides was 18.28 and 14.07 for glass slides (P < 0.001, 99.99% CI). Parakeratosis, civatte bodies, pigmented macrophages, melanin in the epidermis, mast cells, eosinophils, plasma cells, and neutrophils, were identified at lower objectives on glass slides (P = 0.023–0.001, 95% CI). Average intraobserver concordance ranged from κ = 0.30 to κ = 0.78. Features with poor to fair average concordance were: Melanin in the epidermis (κ = 0.15–0.58); plasma cells (κ = 0.15–0.49); and neutrophils (κ = 0.12–0.48). Features with moderate average intrapathologist concordance were: parakeratosis (κ = 0.21–0.61); civatte bodies (κ = 0.21–0.71); pigment-laden macrophages (κ = 0.34–0.66); mast cells (κ = 0.29–0.78); and eosinophils (κ = 0.31–0.79). The average intrapathologist concordance was good for sebocytes (κ = 0.51–1.00) and fungal bodies (κ = 0.47–0.76). Conclusions: Telepathology using digital slides scanned at ×20 is sufficient for detection of histopathologic features routinely encountered in dermatitis cases, though less efficient than glass slides. PMID:27563489

Image analysis and machine learning in digital pathology: Challenges and opportunities.

PubMed

Madabhushi, Anant; Lee, George

2016-10-01

With the rise in whole slide scanner technology, large numbers of tissue slides are being scanned and represented and archived digitally. While digital pathology has substantial implications for telepathology, second opinions, and education there are also huge research opportunities in image computing with this new source of "big data". It is well known that there is fundamental prognostic data embedded in pathology images. The ability to mine "sub-visual" image features from digital pathology slide images, features that may not be visually discernible by a pathologist, offers the opportunity for better quantitative modeling of disease appearance and hence possibly improved prediction of disease aggressiveness and patient outcome. However the compelling opportunities in precision medicine offered by big digital pathology data come with their own set of computational challenges. Image analysis and computer assisted detection and diagnosis tools previously developed in the context of radiographic images are woefully inadequate to deal with the data density in high resolution digitized whole slide images. Additionally there has been recent substantial interest in combining and fusing radiologic imaging and proteomics and genomics based measurements with features extracted from digital pathology images for better prognostic prediction of disease aggressiveness and patient outcome. Again there is a paucity of powerful tools for combining disease specific features that manifest across multiple different length scales. The purpose of this review is to discuss developments in computational image analysis tools for predictive modeling of digital pathology images from a detection, segmentation, feature extraction, and tissue classification perspective. We discuss the emergence of new handcrafted feature approaches for improved predictive modeling of tissue appearance and also review the emergence of deep learning schemes for both object detection and tissue classification. We also briefly review some of the state of the art in fusion of radiology and pathology images and also combining digital pathology derived image measurements with molecular "omics" features for better predictive modeling. The review ends with a brief discussion of some of the technical and computational challenges to be overcome and reflects on future opportunities for the quantitation of histopathology. Copyright © 2016 Elsevier B.V. All rights reserved.

Use of a wiki as an interactive teaching tool in pathology residency education: Experience with a genomics, research, and informatics in pathology course

PubMed Central

Park, Seung; Parwani, Anil; MacPherson, Trevor; Pantanowitz, Liron

2012-01-01

Background: The need for informatics and genomics training in pathology is critical, yet limited resources for such training are available. In this study we sought to critically test the hypothesis that the incorporation of a wiki (a collaborative writing and publication tool with roots in “Web 2.0”) in a combined informatics and genomics course could both (1) serve as an interactive, collaborative educational resource and reference and (2) actively engage trainees by requiring the creation and sharing of educational materials. Materials and Methods: A 2-week full-time course at our institution covering genomics, research, and pathology informatics (GRIP) was taught by 36 faculty to 18 second- and third-year pathology residents. The course content included didactic lectures and hands-on demonstrations of technology (e.g., whole-slide scanning, telepathology, and statistics software). Attendees were given pre- and posttests. Residents were trained to use wiki technology (MediaWiki) and requested to construct a wiki about the GRIP course by writing comprehensive online review articles on assigned lectures. To gauge effectiveness, pretest and posttest scores for our course were compared with scores from the previous 7 years from the predecessor course (limited to informatics) given at our institution that did not utilize wikis. Results: Residents constructed 59 peer-reviewed collaborative wiki articles. This group showed a 25% improvement (standard deviation 12%) in test scores, which was greater than the 16% delta recorded in the prior 7 years of our predecessor course (P = 0.006). Conclusions: Our use of wiki technology provided a wiki containing high-quality content that will form the basis of future pathology informatics and genomics courses and proved to be an effective teaching tool, as evidenced by the significant rise in our resident posttest scores. Data from this project provide support for the notion that active participation in content creation is an effective mechanism for mastery of content. Future residents taking this course will continue to build on this wiki, keeping content current, and thereby benefit from this collaborative teaching tool. PMID:23024891

Applications of holographic on-chip microscopy (Conference Presentation)

NASA Astrophysics Data System (ADS)

Ozcan, Aydogan

2017-02-01

My research focuses on the use of computation/algorithms to create new optical microscopy, sensing, and diagnostic techniques, significantly improving existing tools for probing micro- and nano-objects while also simplifying the designs of these analysis tools. In this presentation, I will introduce a set of computational microscopes which use lens-free on-chip imaging to replace traditional lenses with holographic reconstruction algorithms. Basically, 3D images of specimens are reconstructed from their "shadows" providing considerably improved field-of-view (FOV) and depth-of-field, thus enabling large sample volumes to be rapidly imaged, even at nanoscale. These new computational microscopes routinely generate <1-2 billion pixels (giga-pixels), where even single viruses can be detected with a FOV that is <100 fold wider than other techniques. At the heart of this leapfrog performance lie self-assembled liquid nano-lenses that are computationally imaged on a chip. The field-of-view of these computational microscopes is equal to the active-area of the sensor-array, easily reaching, for example, <20 mm^2 or <10 cm^2 by employing state-of-the-art CMOS or CCD imaging chips, respectively. In addition to this remarkable increase in throughput, another major benefit of this technology is that it lends itself to field-portable and cost-effective designs which easily integrate with smartphones to conduct giga-pixel tele-pathology and microscopy even in resource-poor and remote settings where traditional techniques are difficult to implement and sustain, thus opening the door to various telemedicine applications in global health. Through the development of similar computational imagers, I will also report the discovery of new 3D swimming patterns observed in human and animal sperm. One of this newly discovered and extremely rare motion is in the form of "chiral ribbons" where the planar swings of the sperm head occur on an osculating plane creating in some cases a helical ribbon and in some others a twisted ribbon. Shedding light onto the statistics and biophysics of various micro-swimmers' 3D motion, these results provide an important example of how biomedical imaging significantly benefits from emerging computational algorithms/theories, revolutionizing existing tools for observing various micro- and nano-scale phenomena in innovative, high-throughput, and yet cost-effective ways.

Accuracy of a remote quantitative image analysis in the whole slide images.

PubMed

Słodkowska, Janina; Markiewicz, Tomasz; Grala, Bartłomiej; Kozłowski, Wojciech; Papierz, Wielisław; Pleskacz, Katarzyna; Murawski, Piotr

2011-03-30

The rationale for choosing a remote quantitative method supporting a diagnostic decision requires some empirical studies and knowledge on scenarios including valid telepathology standards. The tumours of the central nervous system [CNS] are graded on the base of the morphological features and the Ki-67 labelling Index [Ki-67 LI]. Various methods have been applied for Ki-67 LI estimation. Recently we have introduced the Computerized Analysis of Medical Images [CAMI] software for an automated Ki-67 LI counting in the digital images. Aims of our study was to explore the accuracy and reliability of a remote assessment of Ki-67 LI with CAMI software applied to the whole slide images [WSI]. The WSI representing CNS tumours: 18 meningiomas and 10 oligodendrogliomas were stored on the server of the Warsaw University of Technology. The digital copies of entire glass slides were created automatically by the Aperio ScanScope CS with objective 20x or 40x. Aperio's Image Scope software provided functionality for a remote viewing of WSI. The Ki-67 LI assessment was carried on within 2 out of 20 selected fields of view (objective 40x) representing the highest labelling areas in each WSI. The Ki-67 LI counting was performed by 3 various methods: 1) the manual reading in the light microscope - LM, 2) the automated counting with CAMI software on the digital images - DI , and 3) the remote quantitation on the WSIs - as WSI method. The quality of WSIs and technical efficiency of the on-line system were analysed. The comparative statistical analysis was performed for the results obtained by 3 methods of Ki-67 LI counting. The preliminary analysis showed that in 18% of WSI the results of Ki-67 LI differed from those obtained in other 2 methods of counting when the quality of the glass slides was below the standard range. The results of our investigations indicate that the remote automated Ki-67 LI analysis performed with the CAMI algorithm on the whole slide images of meningiomas and oligodendrogliomas could be successfully used as an alternative method to the manual reading as well as to the digital images quantitation with CAMI software. According to our observation a need of a remote supervision/consultation and training for the effective use of remote quantitative analysis of WSI is necessary.

The role of technology in the clinical laboratory of the future.

PubMed

Wilkinson, D S

1997-01-01

Advances in automation and informatics will drive the implementation of new technology as we enter the 21st century. Five technologies which will have the greatest impact on the practice of laboratory medicine during the next decade include molecular diagnostics, near patient testing, image analysis, robotics, and information management. The list of molecular pathology tests with potential clinical utility expands daily. Some, such as tests for human immune deficiency virus (HIV) and hepatitis C virus, already are available as commercial kits. Quality assessment and proficiency testing programs still are evolving. DNA tests in oncology, such as T- and B-cell gene rearrangements and t(9;22) translocation, have proven useful in detecting small numbers of tumor cells and have demonstrated clinical utility in some circumstances. Tests for monogenetic diseases, such as sickle cell disease, are useful in planning antenatal management of mothers at risk. Screening tests for the genetic predisposition for certain forms of colon and breast cancer and Alzheimer's Disease are now possible. This suggests the potential for large scale screening of populations at risk. Continued improvements in biosensor technology and miniaturization will increase the ability to test for many analytes at or near the patient. The generally increased cost per test must be reconciled with the potential to decrease the overall cost of care by improved turnaround time. Computerized image analysis will radically change, and in some cases eliminate, manual clinical microscopy in urinalysis, hematology, immunohistochemistry, and cytology. Robotics will greatly decrease personnel requirements for repetitive tasks, such as specimen transport, processing, and aliquoting. We will process many specimens from start to finish without human intervention. Image management systems will allow archiving of diagnostic gross and microscopic images along with the traditional text descriptions and diagnosis. Telepathology will link smaller centers with expert consultants in tertiary centers. Voice recognition systems will obviate the need for transcriptionists. Modern database architectures will allow the clinical laboratory to measure performance effectiveness and clinical outcomes and will place laboratorians at the forefront of outcomes research. Hand-held devices will allow physicians to conveniently order laboratory tests and retrieve results, further decreasing the functional turnaround time for laboratory testing. All of these technologies will be expensive to implement, but well-planned deployment will both decrease cost and improve the quality of medical care.