Telepathology

Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research.[1][2] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering of diagnoses. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement in the selection of microscopic fields-of-view for analysis and diagnosis.

Not to be confused with the paranormal belief in telepathy.

An academic pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In a medical journal editorial, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services.[3] He and his collaborators published the first scientific paper on robotic telepathology.[4] Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks.[5] Weinstein is known to many as the "father of telepathology".[6] In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989;[7] this is still in operation decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.

Telepathology has been successfully used for many applications, including the rendering of histopathology tissue diagnoses at a distance. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.

Types of systems

Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slide systems.

Static image systems have the benefit of being the most reasonably priced and usable systems. They have the significant drawback in only being able to capture a selected subset of microscopic fields for off-site evaluation.

Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety, from a distance. With real-time systems, the consultant actively operates a robotically controlled motorized microscope located at a distant site—changing focus, illumination, magnification, and field of view—at will. Either an analog video camera or a digital video camera can be used for robotic microscopy. Another form of real-time microscopy involves utilizing a high resolution video camera mounted on a path lab microscope to send live digital video of a slide to a large computer monitor at the pathologist's remote location via encrypted store-and-forward software. An echo-cancelling microphone at each end of the video conference allows the pathologist to communicate with the person moving the slide under the microscope.

Virtual slide systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). This file is stored on a computer server and can be navigated at a distance, over the Internet, using a browser.[8] Digital imaging is required for virtual microscopy.

While real-time and virtual slide systems offer higher diagnostic accuracy when compared with static-image telepathology, there are drawbacks to each. Real-time systems perform best on local area networks (LANs), but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Expense is an issue with real-time systems and virtual slide systems as they can be costly. Virtual slide telepathology is emerging as the technology of choice for telepathology services. However, high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Also, virtual slide digital files are relatively large, often exceeding one gigabyte in size. Storing and simultaneously retrieving large numbers of telepathology whole-slide image files can be cumbersome, introducing their own workflow challenges in the clinical laboratory.

Types of Telepathology Platform: Telepathology platforms that have adopted whole slide imaging enables remote viewing to aid pathologist in following ways: By remote sharing and secondly by uploading images for expert consultations.[9]

Uses and benefits

Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens,[10] primary histopathology diagnoses,[11] second opinion diagnoses,[12] subspecialty pathology expert diagnoses,[13] investigative and regulated preclinical toxicology studies,[14] education,[15] competency assessment,[16] and research. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a renal pathologist, a neuropathologist, or a dermatopathologist, for immediate consultations.

Services by country

Canada

Canada Health Infoway is the organization responsible for the implementation of telepathology in Canada. Canada Health Infoway is a federal non-profit which provides funding for improving digital health infrastructure.

Canada Health Infoway has targeted funding of $1.2 million CAD to the Telepathology Solution for the province of British Columbia.[17] The system is designed to connect all pathologists within the province. The long-term expectations are improvement to patient care and safety through access to pathology expertise, improved timeliness of results and quality of service.

In Ontario, the University Health Network (UHN) hospitals are the primary drivers of the development of telepathology. The three northern Ontario communities of Timmins, Sault Ste. Marie and Kapuskasing have several community hospitals virtually linked to UHN pathologists via the Internet 24 hours a day.[18]

See also

• Anatomical pathology
• Cytopathology
• Digital pathology
• Juan Rosai, a surgical pathology professor working with telepathology
• Medical laboratory
• Microscopy
• Ronald S. Weinstein, an early innovator in telepathology
• Virtual microscope
• Virtual slide

References

1. Weinstein, RS; Graham, AM; Richter, LC; Barker, GP; Krupinski, EA; Lopez, AM; Yagi, Y; Gilbertson, JR; Bhattacharyya, AK; et al. (2009), "Overview of telepathology, virtual microscopy and whole slide imagining: Prospects for the future", Hum Pathol, 40 (8): 1057–1069, doi:10.1016/j.humpath.2009.04.006, PMID 19552937
2. Kumar S (2009), "Telepathology: An Audit", in Kumar S, Dunn BE (eds.), Tele-pathology, Springer-Verlag, pp. 225–229
3. Weinstein, RS (1986), "Prospects for telepathology (Editorial)", Hum Pathol, 17 (5): 433–434, doi:10.1016/s0046-8177(86)80028-4
4. Weinstein, RS; Bloom, KJ; Rozek, LS (1987), "Telepathology and the networking of pathology diagnostic services", Arch Pathol Lab Med, 111 (7): 646–652, PMID 3606341
5. Kayser, K; Szymas, J; Weinstein, RS (1999), Telepathology: Telecommunications, Electronic Education and Publication in Pathology, Springer, pp. 1–186
6. "ReUnion '10 award winners". Archived from the original on 2012-08-05.
7. Nordrum, I; Engum, B; Rinde, E; et al. (1991), "Remote frozen section service: A telepathology project to northern Norway.", Hum Pathol, 1991: 514–518
8. Kayser, K; Molnar, B; Weinstein, RS (2006), "Digital pathology virtual slide technology in tissue-based diagnosis, research and education.", VSV Interdisciplinary Medical Publishing (Berlin): 1–193
9. "Global Telepath Network". 20 February 2019.
10. Evans, AJ; Chetty, R; Clarke, BA; Croul, S; Ghazarian, DM; Kiehl, TR; Ordonez, BP; Ilaalagan, S; Asa, SL (2009), "Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience", Hum Pathol, 40: 1069–1081
11. Dunn, BE; Choi, H; Recla, DL; Kerr, SE; Wagenman, BL (2009), "Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience", Hum Pathol, 40 (8): 1092–1099, doi:10.1016/j.humpath.2009.04.007, PMID 19552935
12. Graham, AR; Bhattacharyya, AK; Scott, KM; Lian, F; Grasso, LL; Richter, LC; Henderson, JT; Carpenter, JB; Lopez, AM; Barker, GP; Weinstein, RS; Weinstein, R. S. (2009), "Virtual slide telepathology for an academic teaching hospital surgical pathology quality assurance program", Hum Pathol, 40 (8): 1129–1136, doi:10.1016/j.humpath.2009.04.008, PMID 19540562
13. Massone, C; Soyer, HP; Lozzi, GP; DiStefani, A; Leinweber, B; Gabler, G; Asgari, M; Boldrini, R; Bugatti, L; Canzonieri, V; Ferrara, G; Kodama, K; Mehregan, D; Rongioletti, F; Janjua, S. A.; Mashayekhi, V; Vassilaki, I; Zelger, B; Zgavec, B; Cerroni, L; Kerl, H; et al. (2007), "Feasibility and diagnostic agreement in teledermatology using a virtual slide system", Hum Pathol, 38 (4): 546–554, doi:10.1016/j.humpath.2006.10.006, PMID 17270240
14. Siegel, Gabriel; Regelman, Dan; Maronpot, Robert; Rosenstock, Moti; Hayashi, Shim-mo; Nyska, Abraham (Oct 2018). "Utilizing novel telepathology system in preclinical studies and peer review". Journal of Toxicologic Pathology. 31 (4): 315–319. doi:10.1293/tox.2018-0032. PMC 6206289. PMID 30393436.
15. Dee, FR (2009), "Virtual microscopy in pathology education", Hum Pathol, 40 (8): 1112–1121, doi:10.1016/j.humpath.2009.04.010, PMID 19540551
16. Bruch, LA; De Young, BR; Kreiter, CD; Haugen, TH; Leaven, TC; Dee, FR (2009), "Competency assessment of residents in surgical pathology using virtual microscopy", Hum Pathol, 40 (8): 1122–1128, doi:10.1016/j.humpath.2009.04.009, PMID 19552936
17. Information Resource Management Plan 2007/08 (PDF), British Columbia Ministry of Health Knowledge Management and Technology Division, retrieved November 23, 2011
18. "UHN establishes first telepathology system in Ontario", News Releases, Canada Health Infoway, archived from the original on August 3, 2010, retrieved November 23, 2011

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External links

• Organizing Knowledge in a Semantic Web for Pathology
• Welcome to Digital Pathology at Brown Medical School
• Holycross Cancer Center (Poland, Kielce) Pathomorphology Department virtual slides
• Digital pathology: DICOM-conform draft, testbed, and first results
• OpenSlide - C library that provides a simple interface to read whole-slide images.