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PubMed2000

Competence on demand in DNA image cytometry.

Quantitation methods in clinical pathology have to be normalized and standardized both from the instrumental and the methodological point of view to guarantee a defined level of precision and accuracy independent of the site where they are applied. The comparability of results obtained in different laboratories is the basis for the application of standardized diagnostic classification systems and therapeutic schemes. Remote quantitation based on standardized evaluation tools could be a way to reach the goals mentioned above. Diagnostic DNA image cytometry, increasingly used as a routine method in clinical pathology, will serve as an example for demonstrating the feasibility and usefulness of a concept of remote quantitation. We report a system for a remote DNA ploidy analysis, based on client server technology, and accessible via Internet or ISDN connections (Quantitation Server EUROQUANT). This system (i) allows the cytometric measurement of the DNA content of cells for diagnostic purposes, (ii) provides the user with comprehensive quality control of such measurements, (iii) helps in trouble-shooting, and (iv) gives assistance in diagnostic interpretation. The system uses the principles of telepathology and Internet technology. To date, more than 40 laboratories from Europe, USA, and Asia have successfully performed analyses on about 3,000 ploidy data sets.

Confidentiality↗
PubMed2000

The impact of information technology on histopathology.

Pathology is one of the most computer intensive areas of medicine and as a result diagnostic pathologists in histopathology have often been at the cutting edge of computer literacy. The majority of laboratories use laboratory information systems to issue and store pathology reports. Many of these systems provide the diagnostician with the ability to retrieve reports and cases using coding systems such as SNOMED, but more advanced computer facilities that might assist the pathologist in the diagnosis or interpretation of a case are often lacking. In recent years advances in computer technology have begun to have a much wider impact on the practice of medicine and newer technologies are beginning to find their way into the reporting room. In this review, I cover some of the recent and emerging advances in IT that have the potential to revolutionize the practice of diagnostic histopathology in the next 5 years. The major area of telepathology has been a subject of several recent reviews and will not be covered here.

Databases, Factual↗
PubMed2001

Characteristics of a telecytology consultation service.

Although numerous reports describe the application of remote video microscopy to pathologic diagnosis (telepathology), only a few address some of the special issues surrounding remote cytologic diagnosis (telecytology). These studies have generally suggested a high correlation between telecytologic diagnoses and those arising from direct examination of the glass slides, but factors affecting the clinical utility of routine cytologic diagnosis have not been examined. In this report, we describe our experience in telecytologic consultation on 99 cases seen at the Armed Forces Institute of Pathology between October 1995 and November 1999. The mean time between receipt of the telecytologic images and the contributor receipt of the faxed report was 9.9 hours (median, 5.13 hours). Using stringent criteria for agreement, we find fair to good (48%) concordance between the contributor's impression and the consultant's opinion. The concordance between the consultant's telecytologic diagnosis and the subsequent glass slide diagnosis is imperfect; in 8 (31%) of 26 cases in which the glass slide was sent after the telecytology consultation, a minor discrepancy between these diagnoses was found. No major discrepancies were found between the consultant's telecytologic and glass slide diagnoses.

Cytodiagnosis↗
PubMed2003

Virtual slides: high-quality demand, physical limitations, and affordability.

Virtual slides (VSs) have been around since the beginning of telepathology. As recently as a couple of years ago, only single small images could be acquired, and their distribution was limited to e-mail at best. Today, whole slides can be acquired, covering an area up to 100,000 times larger than that possible only a few years ago. Moreover, advanced Internet and world-wide web technologies enable delivery of those images to a broad audience. Despite considerable advances in technology, few good examples of VSs for public use can be found on the web. One of the reasons for this is a lack of sophisticated and integrated commercial solutions covering the needs from acquisition to delivery at reasonable cost. This article describes physical and technical limitations of the VS technology to clarify the demands on a VS acquisition system. A new type of web-based VS viewer (vMic; http://alf3.urz.unibas.ch/vmic/) open to public use is introduced, allowing anyone to set up a VS system with high usability at low cost.

Humans↗
PubMed2002

Teledermatology and teledermatopathology.

Teledermatology is in essence an application of clinical telemedicine that deals with the practice of dermatology via the latest communication and information technology. As with other telemedicine applications, the goal is to provide the highest quality of dermatologic care more efficiently by moving patient information rather than the patient. Teledermatopathology, on the other hand, is a nonclinical telemedicine application specifically relating to diagnosis of cutaneous histologic specimens. There are numerous articles evaluating diagnostic concordance of teledermatology. However, because of a lack of a "true" gold standard, most published studies have compared diagnostic capabilities of teledermatology to our traditional face-to-face evaluations. Although the diagnostic correlation varies from study to study, most experts agree that Store and Forward and real-time video teleconferencing teledermatology is as clinically effective as a face-to-face consultation, which is less than 100% accurate. Teledermatopathology is showing similar potential, but because of the limitations on sampling error and the high cost of the alternative, robotic remote telepathology units, its acceptance into our daily practice has been delayed. This article focuses mainly on Store and Forward Teledermatology given its significant advantage and reviews the literature on teledermatology and teledermatopathology's diagnostic concordance and acceptance.

Attitude of Health Personnel↗
PubMed2004

[Health telematics/telemedicine in the republic of Estonia].

The people of Estonia, who until their independence had been systematically deprived of all forms of information, have shown a ready acceptance of the use of information technology in all areas of life. This environment and an excellent IT infrastructure have since the beginning of the new century provided favourable conditions for developing various individual projects in telemedicine. At the core of current telemedical applications in Estonia is the BITNET Project (in neurology, general medicine), built up with Swedish cooperation, and three German-Estonian projects (in telecardiology and telepathology). These projects are accompanied by studies of their cost-effectiveness. They constitute the basis for the plan that routine telemedical services be taken over by the Estonian health insurance. Differing from the situation in the Scandinavian countries, which have had an effective national telemedical service for over ten years, the special feature of telematrics in Estonia is its international networking with foreign centres of excellence. This has its origin in the aim of Estonian health policy to ensure medical services within its own country in all branches of medicine.

Cost-Benefit Analysis↗
PubMed2000

An advanced digital image-capture computer system for gross specimens: a substitute for gross description.

The description of macroscopic appearances of surgically excised specimens together with the sites of specimen sampling form an important component in the documentation of a histopathology specimen. Unfortunately, accuracy of description depends on the vocabulary and descriptive prowess of the pathologist which means that the result can be variable. Transcription of the dictated word also takes time and involves typists. We developed a user-friendly, high-resolution image capture system that will supplement word description of macroscopic specimens and has the potential to replace it completely. It also provides the opportunity of revisiting traditional methods of documenting specimens with words, allowing the production of more relevant and user-friendly reports containing information relevant to clinical management and supplemented by high-resolution digital images. The accompanying Windows-based software has capabilities of generating the entire histopathology report and allows rapid retrospective searches through any one of several common search parameters. The stored images form a powerful database for teaching and research. Connection to remote transmission facilities allows teleconferencing and telepathology consultations.

Databases, Factual↗
PubMed2003

Digital imaging applications in anatomic pathology.

Digital imaging has progressed at a rapid rate and is likely to eventually replace chemical photography in most areas of professional and amateur digital image acquisition. In pathology, digital microscopy has implications beyond that of taking a photograph. The arguments for adopting this new medium are compelling, and given similar developments in other areas of pathology and radiologic imaging, acceptance of the digital medium should be viewed as a component of the technological evolution of the laboratory. A digital image may be stored, replicated, catalogued, employed for educational purposes, transmitted for further interpretation (telepathology), analyzed for salient features (medical vision/image analysis), or form part of a wider digital healthcare strategy. Despite advances in digital camera technology, good image acquisition still requires good microscope optics and the correct calibration of all system components, something which many neglect. The future of digital imaging in pathology is very promising and new applications in the fields of automated quantification and interpretation are likely to have profound long-term influence on the practice of anatomic pathology. This paper discusses the state of the art of digital imaging in anatomic pathology.

Education, Medical↗
PubMed1997

Signal analysis and compression performance evaluation of pathological microscopic images.

Digitizing high-quality microscopic images and developing input/output technology for displaying those results is critical to telepathology in which pathological microscopic images are transferred to remote locations where they are diagnosed by specialists. This paper will discuss the results achieved by directly digitizing (nonfilm process) pathological microscopic images at a 2k x 2k resolution, and then using a super-high-definition imaging system to analyze their signals and evaluate compression performance. We will start off by digitizing samples that a pathologist will actually use in making a diagnosis, and then analyze their color distribution and spatial frequencies characteristics by comparing them to general images. This will make it apparent that such pathological images characteristically contain high spatial frequency in their chrominance components. We will also discuss the evaluation results of color differences for L*a*b* space and compression ratios achieved when using JPEG to encode pathological images. We will also present a subjective evaluation of the influence subsampling of chrominance components has on image quality.

Computer Systems↗
PubMed2003

The virtual microscope.

We present the design and implementation of the Virtual Microscope, a software system employing a client/server architecture to provide a realistic emulation of a high power light microscope. The system provides a form of completely digital telepathology, allowing simultaneous access to archived digital slide images by multiple clients. The main problem the system targets is storing and processing the extremely large quantities of data required to represent a collection of slides. The Virtual Microscope client software runs on the end user's PC or workstation, while database software for storing, retrieving and processing the microscope image data runs on a parallel computer or on a set of workstations at one or more potentially remote sites. We have designed and implemented two versions of the data server software. One implementation is a customization of a database system framework that is optimized for a tightly coupled parallel machine with attached local disks. The second implementation is component-based, and has been designed to accommodate access to and processing of data in a distributed, heterogeneous environment. We also have developed caching client software, implemented in Java, to achieve good response time and portability across different computer platforms. The performance results presented show that the Virtual Microscope systems scales well, so that many clients can be adequately serviced by an appropriately configured data server.

Computer Graphics↗
PubMed2006

Visual positioning of previously defined ROIs on microscopic slides.

In microscopy, regions of interest are usually much smaller than the whole slide area. Various microscopy related medical applications, such as telepathology and computer aided diagnosis, are liable to benefit greatly from microscope auto positioning on previously defined regions of interest. In this paper, we present a method for image-based auto positioning on a microscope slide. The method is based on localization of a microscopic query image using a previously acquired slide map. It uses geometric hashing, a highly efficient technique drawn from the object recognition field. The algorithm exhibits high tolerance to possible variations in visual appearance due to slide rotations, scaling and illumination changes. Experimental results indicate high reliability of the algorithm.

Algorithms↗
PubMed2003

Correction of uneven illumination (vignetting) in digital microscopy images.

BACKGROUND: Many digital microscopy images suffer from poor illumination at the peripheries (vignetting), often attributable to factors related to the light path between the camera and the microscope. A commonly used method for correcting this has been to use the illumination of an empty field as a correction filter (white shading correction). AIMS: To develop an alternative shading correction method that does not require this additional image. METHODS: / RESULTS: This report outlines an alternative shading correction method that is based upon the intrinsic properties of the image, which are revealed through Gaussian smoothing. The technique can be implemented within Adobe Photoshop or other graphics editing software and works well with both haematoxylin and eosin and immunohistochemical images. CONCLUSIONS: This technique provides an effective means of optimising digital microscopy image appearances for printing, image analysis, or telepathology.

Computer Graphics↗
PubMed2000

Telediagnosis of transbronchial fine needle aspirations--a feasibility study.

AIM: To analyze the diagnostic accuracy of telediagnostic procedures for transbronchial fine needle aspirations. MATERIAL AND METHODS: A double blind study was performed on cytological slides of 54 randomly selected cases with transbronchial fine needle aspirations. The slides were digitized using a Leica digital camera DC100 mounted on a microscope Leica Laborlux S, and analyzed by an experienced pathologist without knowing the definite diagnosis or any additional clinical data. The diagnoses stated by analyzing the digital images were compared to the final conventional diagnoses. In addition, the duration of the digital diagnosis, used magnifications, and difficulties for correct sampling were documented. RESULTS: The "digital" diagnoses of the 54 cases were all in general agreement with the definite diagnoses. No wrong positive or wrong negative case in respect to malignant/non-malignant (31/23) or to small cell/non-small cell (9/22) occurred. The performance of a digital diagnosis lasted for 115 s at average (15-260 s), and is significantly longer compared to that of conventional fine needle aspiration judgement (20 s). The screening magnification was commonly set to x2.5, that for definite diagnostic analysis x40. Benign diseases (2 tuberculosis and 3 sarcoidosis cases) were correctly classified. CONCLUSIONS: Telepathology systems can probably be used for fine needle aspiration analysis without major diagnostic errors. Their use can improve the endoscopic sampling and avoid second anesthesia when missing the lesion of request during the first examination.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2002

Managing telemedicine: from noble ideas to action.

The aim of the present study was to elucidate how telemedicine can be used in an integrated and comprehensive manner. Two Swedish telemedicine projects were studied. The technical platform was an ISDN videoconferencing system which could be connected to various items of medical equipment. The first project, general telemedicine, concerned communication between two primary care centres, one county hospital and one university hospital. The specialties involved were dermatology, orthopaedics and otolaryngology. The second project, telepathology, included pathology and cytology at the university hospital, and surgery and gynaecology at a county hospital. The first round of interviews was conducted to reveal the expectations of the physicians regarding the potential benefits and applications of the technology and potential organizational obstacles. Subsequent interview rounds were carried out to reveal what had happened since the previous interview. In total 62 interviews were carried out with 32 respondents. The main conclusions were that the technology's generic features, namely the transmission of pictures and sound, had been translated into appropriate fields of application, which had been diffused and routinized in organizational activities. In order to facilitate this process, there were two crucial issues for managers. First, due to the 'openness' of the technology, actors who had the will to test the limits of the technology had to be identified and engaged. Second, while the use of the new technologies implied that new patterns of action were established, it was necessary to discover and develop routines that could be used as a facilitator for the further use of telemedicine.

Attitude of Health Personnel↗
PubMed2002

Telemedicine and changes in the distribution of tasks between levels of care.

The present investigation, which was part of a larger study, was designed to answer the question 'Has telemedicine produced changes in the distribution of tasks between the general practitioner and specialist, or between the local hospital and university/central hospital?' Qualitative interviews were carried out with 30 persons involved in four telemedicine services in Norway: teledermatology, tele-otolaryngology, telepsychiatry, and a telepathology frozen-section service. The results indicated that telemedicine does not produce large changes in the distribution of tasks. The reported effects were largest and most complex for telepsychiatry, followed by teledermatology. Local variations in how telemedicine is practised may explain the variation in the findings between telemedicine applications.

Dermatology↗
PubMed2001

Telemedicine in South Africa: success or failure?

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.

Female↗
PubMed2004

A pilot study of a combined dermoscopic-pathological approach to the telediagnosis of melanocytic skin neoplasms.

We examined a combined (dermoscopic-pathological) approach to the telediagnosis of melanocytic skin lesions. A store-and-forward teleconsultation was simulated. Dermoscopic and histopathology images from 12 melanocytic lesions were stored in a telepathology workstation. A dermoscopy consultant, a histopathology consultant and an expert in dermoscopic-pathological correlation gave their diagnoses and comments on the images. The consensus diagnosis between two teleconsultants on the original histological slides was regarded as the gold standard. The diagnostic accuracy was 83% (including one false negative diagnosis of malignancy) for teledermoscopy and 100% for teledermatopathology. The combined approach detected one case that showed a much greater atypia on dermoscopy than on histopathology. In this case step-sections of the sample were deemed to be required for definite diagnosis. The combined approach was helpful in detecting macroscopic and microscope sampling errors of melanocytic lesions during teleconsultation.

Adolescent↗
PubMed1997

Telemedicine in northern Norway.

The University Hospital of Tromsø has been involved in a variety of telemedicine activities since the late 1980s, including teleradiology, telepathology, teledermatology, remote endoscopy, remote gastroscopy, teleechocardiography, transmission of electrocardiograms, telepsychiatry, electronic delivery of laboratory results and distance learning for health professionals. Since 1993 the department of telemedicine in Tromsø has been designated the national centre of competence in telemedicine. With a wealth of experience to draw from, a critical number of health-care professionals exposed to and using telemedicine routinely, the support of the Norwegian health authoriues, a national centre guiding telemedicine research, no licensing barriers within the country, nationwide ISDN and reimbursement for telemedicine services, the future of telemedicine in Norway looks promising.

History, 20th Century↗