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PubMed2004

[Past, present and future of digital pathology].

The four main aspects of applied medical information technology, which change the traditional systems of the entire health service are signal and data processing, digital modelling and interface optimisation. The information technology serving individual clinical specialties including clinical histopathology is changing at each of the four levels resulting in transformation of the communication paradigms. The object of investigation in histopathology is the digital slide, which is accessible throughout the world with no time or geographical limits. It permits the digital modelling of routine histological and/or cytological slide and it also allows measurements by using image analysis or stereology software packages. The electronic slide can be viewed, examined and diagnosed on a computer connected to a microscope, a new interface in diagnostic histopathology. This study describes the main theoretical and practical aspects, including challenges, of digital pathology and it also discusses the conditions required for successful information management. It reviews the experiences of the last one and half decades gained in the field of pathological information technology in Hungary including its main episodes and milestones of development. Introducing its present state, this paper describes the concept and the mode of investigation of the digital slide. It shows the development and use of a virtual microscope in Hungary. Based on know-how including the British experience this review describes the possible uses of digital slides, which by improving communication could have a positive effect on the entire health care system. It summarises the possible and necessary components of a digital pathology laboratory, which may include the new Slide Archive and Communication System (SACS). Using experimental data it mentions the possibility of generating primary digital pathological sample and producing the so called optical biopsy with no need for removing tissue from the patient.

Analog-Digital Conversion↗
PubMed2004

Specifications and implementation of a new exchange format to support computerized consensus in pathology.

In the pathology domain, consensus sessions around multi-headed microscopes enhance reproducibility and can reduce inter- and intra-observer variability. Computerized tools and Web technology could facilitate the organization of consensus sessions and assist pathologists to agree on features that are relevant to diagnosis. In the context of the IDEM project, whose aim is to achieve a computerized platform to allow pathologists to derive consensual diagnostic during Internet-based collaborative sessions, we propose a new extension of the existing TELESLIDE format. This new extended format enables the storage and the exchange of multi-experts descriptions that will be processed by the IDEM consensus engine to produce consensual descriptions. We describe this new format and its implementation in the IDEM teleconsensus platform.

Consensus↗
PubMed2004

A submission model for use in the indexing, searching, and retrieval of distributed pathology case and tissue specimens.

This paper describes the Shared Pathology Informatics Network (SPIN) submission model for uploading de-identified XML annotations of pathology case and specimen information to a distributed peer-to-peer network architecture. SPIN use cases, architecture, and technologies, as well as pathology information design is described. With the architecture currently in use by six member institutions, SPIN appears to be a viable, secure methodology to submit pathology information for query and specimen retrieval by investigators

Abstracting and Indexing↗
PubMedDate not supplied

[A method of determination of the accuracy of morphological diagnosis of surgical and biopsy material].

The accuracy of morphological diagnosis of 281 surgical samples and biopsy material was analyzed including 253 intrasurgical biopsies on frozen and paraffin sections and 26 television (out of sight) consultations in the "off-line" regime with subsequent control optical microscopy of paraffin sections. The indices of specificity, correspondance and sensitivity allow to have more objective assessment of the quality of life-time morphological diagnosis and can be considered as an obligatory component of annual reports of pathology departments and reports of clinical pathologists at professional certification.

Biopsy, Needle↗
PubMed2004

Web-based health services and clinical decision support.

The purpose of this study was the development of a Web-based e-health service for comprehensive assistance and clinical decision support. The service structure consists of a Web server, a PHP-based Web interface linked to a clinical SQL database, Java applets for interactive manipulation and visualization of signals and a Matlab server linked with signal and data processing algorithms implemented by Matlab programs. The service ensures diagnostic signal- and image analysis-sbased clinical decision support. By using the discussed methodology, a pilot service for pathology specialists for automatic calculation of the proliferation index has been developed. Physicians use a simple Web interface for uploading the pictures under investigation to the server; subsequently a Java applet interface is used for outlining the region of interest and, after processing on the server, the requested proliferation index value is calculated. There is also an "expert corner", where experts can submit their index estimates and comments on particular images, which is especially important for system developers. These expert evaluations are used for optimization and verification of automatic analysis algorithms. Decision support trials have been conducted for ECG and ophthalmology ultrasonic investigations of intraocular tumor differentiation. Data mining algorithms have been applied and decision support trees constructed. These services are under implementation by a Web-based system too. The study has shown that the Web-based structure ensures more effective, flexible and accessible services compared with standalone programs and is very convenient for biomedical engineers and physicians, especially in the development phase.

Adult↗
PubMed2003

Performance evaluation for screening laboratories of the Asia-Pacific region.

The Centers for Disease Control and Prevention (CDC) has a long history of involvement in quality assurance (QA) activities for support of newborn screening laboratories. Since 1978, CDC's Newborn Screening Quality Assurance Program (NSQAP), has distributed dried-blood spot (DBS) materials for external QA and has maintained related projects to serve newborn screening laboratories. The first DBS materials were distributed for congenital hypothyroidism screening in 1978 and by 2001, NSQAP had expanded to over 30 disorders and performance monitoring for all filter paper production lots from approved commercial sources. In 2001, there were 250 active NSQAP participants, 167 laboratories from 45 countries and 83 laboratories in the United States. Of these laboratories, 31 are from the Asia Pacific Region representing nine countries primarily for two disorders. In 1999, US laboratories had more errors for Performance Evaluation (PE) specimens than other laboratories; but in 2000, US laboratories had fewer errors. International laboratories reported 0.3% false-negative PE clinical assessments for congenital hypothyroidism and 0.5% for phenylketonuria (0.5%) in 2000. Paperless PE data-reporting operation using an Internet website has recently been implemented.

Asia, Southeastern↗
PubMedDate not supplied

Feasibility of screening for high-risk age-related macular degeneration with an Internet-based automated fundus camera.

BACKGROUND AND OBJECTIVE: The objective of this pilot study was to determine whether a new screening system, the DigiScope (EyeTel Imaging, Inc., Columbia, MD), can detect the presence of age-related macular degeneration (AMD) at a level requiring referral to an ophthalmologist for further evaluation and possible treatment. PATIENTS AND METHODS: The DigiScope is an Internet-based semi-automated digital imaging system designed to be in primary care physicians' offices. Forty-two eyes of 21 patients with different categories of AMD were imaged with both the DigiScope and a standard color fundus camera. The imaging capability of the two modalities was compared for identification of lesions associated with AMD and classification into stages. RESULTS: There was good agreement for low-risk lesions and excellent agreement for high-risk lesions. Thirty-five of 36 eyes with intermediate or advanced disease were correctly identified with DigiScope images. Choroidal neovascularization was identified in all cases with the DigiScope due to the presence of subretinal hemorrhage or subretinal fibrosis. The DigiScope was found less capable of detecting subretinal fluid than standard stereo fundus photographs. CONCLUSIONS: This pilot study suggests that the DigiScope may be a useful screening tool for AMD.

Aged↗
PubMed2005

[Accuracy of the cytopathological telediagnosis of palpable limphoadenopathies. A study design simulating the diagnostic support from remote access to health workers in the developing countries].

It has been estimated the accuracy of the cytologic diagnosis, carried out by a cytopathologist, on digital images (DID) of fine needle aspiration lymphonode biopsies (FNAB), in order to validate the telematic support to health workers practising in specialist-lacking remote areas of the developing countries. A blind-cross check simulation design was drawn-up. A non-pathologist practictioner selected the microscopic fields of 39 cases of FNAB, took the pictures with a digital camera, stored them and submitted to a cytopathologist for DID. The DID were compared against the original diagnosis in direct view (DVC). The histologic diagnosis on the surgical biopsies were the golden standard to refer to. The results demonstrate that: 1) DVC and DID have similar and satisfactory sensitivity rates (88.2 e 85.3%) and positive predictive values (96.8 e 90.1%); 2) DID have lower specificity and efficiency rates against DVC (40.0 vs 80.0 and 79.5 vs 79.2%); 3) the negative predictive values are low both in DVC and DID (50.0 e 28.6%), but the data ought to be confirmed in a well-balanced ratio malignancy-benignancy; d) the accuracy of DID could be increased by improving the selection process of the microscopic fields; e) the remote access-assisted cytologic diagnosis of FNAB can be a procedure to carry out easily and cheaply in areas where the histopathology facilities are unavailable. The accuracy is the highest in metastasis, in high-grade non-Hodgkin lymphoma and in lymphocite depletion and mixed cell sub-groups of Hodgkin lymphoma.

Developing Countries↗
PubMed2005

'There is no turning back'--is AFIP facing demise?

The U.S. Department of Defense has recommended that Walter Reed Army Medical Center, home of the Armed Forces Institute of Pathology, be relocated and that the AFIP's constituent parts be eliminated or, in the case of its tissue repository, warehoused. CAP past resident Daniel Seckinger, MD, chairman of the board of the American Registry of athology, testified July 7 before the Defense Base Closure and Realignment Commission its public hearing on military base closings. His statement appears here.

Diagnosis↗
PubMedDate not supplied

[Automated MECOS-Ts2 microscopy complex in pathologoanatomic practice].

Computer-aided and information systems of a MECOS-Ts2 microscopy complex designed to transmit a representative image of a specimen along communication lines are considered. The above systems allow the use of the complex: 1) in on-line and off-line modes to provide tele-medical services (cytology, histology, etc.); moreover, the requirements for channel traffic may be decreased over and over again as compared to the routine on-line videomicroscopy mode; 2) for telemedical tests of specialized local automatic procedures of microscopical analysis (analysis of smears of blood and bone-marrow smears, parasitological analysis, etc.); 3) for collection of a representative electronic archive of the "virtual" specimens of rare nosological entities, which have been obtained in different medical institutions, w hich will provide valid statistical assessments of diagnostic decisions; 4) for remote accompaniment of MECOS-Ts2 complexes by the manufacture (update of versions, training, quality control of sample preparation, collection of commission statistics); 5) for training and certification of remote laboratory staff. The functions considered cannot be implemented in analyzers of other types, in flow analyzers, in particular.

Humans↗
PubMed1995

Immunohistochemical correlation of steroid receptors and disease-free interval in 206 consecutive cases of breast cancer: validation of telequantification based on global scene segmentation.

Objective algorithms to evaluate immunocytochemistry in cytology and in histological sections are still under investigation. Clinical value, simplicity, robustness and adaptation to new technologies such as telemedicine and telequantification have to be taken into consideration. The present paper summarizes the experience of the immunoquantification of 206 cases diagnosed from 1990 to 1991, 36 clinical stage I cases, 110 stage II cases and 60 stage III cases. Initial clinical stage IV cases were excluded from the series. Quantification was done on frozen sections incubated with monoclonal estrogen and progesterone receptors (ER, PgR) by the peroxidase antiperoxidase (PAP) technique revealed with DAB. Automatic computerized measurements with a 550-nm filter were based on global scene segmentation, obtaining the parameters of percentage of positive area (pA) and immunoscore (ISC = sum i x pi), being the staining intensity (i) automatically evaluated in 5 grades multiple of the standard deviation (SD) of the control specimen (i x SD) stained with progressive haemathoxyline. Cut point of positive and negative specimens regarding ISC were obtained by semilogarithmic plot with biochemical receptor values (r = 0.73). The whole series showed a significant increase of negative specimens according to clinical stage and a higher number of PgR negative cases (44%) than ER negative cases (32%). The clinical relevance of the quantified parameters were evaluated by free interval disease survival curves being significant in the positive cutting point of ISC = 100 (ER P < 0.06; PgR P < 0.02) and the 40% negative area for the pA (ER P < 0.001; PgR P < 0.004). This quantification technique, which does not require individual cell segmentation, was reproducible at a distance (telequantification through high resolution videophones at 9600 bauds transmission rate; 55 cases). Coefficient of variation (CV) of the parameters in the original and transmitted cases were in the range of 0-5% in specimens with positive areas over 70%; less positive specimens require lower segmentation thresholds to get acceptable coefficients of variation. According to our results, immunohistochemical steroid receptor contents in breast cancer pathology, quantified by the technique of pixel integration, demonstrated the added value of the percentage of positive area in patient follow-up. Those having more than 40% of negative areas have recurrences mainly within the first year.

Adult↗
PubMed1995

Telemedicine: delivering medical expertise across the state and around the world.

Many aspects of medical care can now be delivered at a distance using telemedicine technology. Rapid video and computer-based communication of medical information makes it possible for a physician to "examine" a patient located in another city, to view highly detailed medical images, to consult with distant subspecialists, or to supervise complex medical procedures. This same technology can bring scattered health-care workers together for joint teaching conferences. The Yale Telemedicine Center has initiated a number of such programs ranging from providing consultations in real time to physicians in Saudi Arabia, to interpreting medical images across town or across the state. Telemedicine will become a powerful tool for managed health-care organizations which are responsible for the medical needs of widely distributed patients in a vertically integrated health-care delivery system. This paper reviews the evolution of telemedicine, its technical fundamentals, specific medical applications, and the activities of the Yale Telemedicine Center. Evolving uses for telemedicine in Connecticut are described.

Connecticut↗
PubMed1995

[Telemedicine and medical responsibility].

Dealing with telemedicine including telediagnosis and teleassistance, we have to assess the legal and ethical components of medical liability. With medical telediagnosis, the dispersion of medical liabilities is the main risk: how can we ensure a clear identification of the medical liabilities involved in case of damage? From a legal point of view, the dispersion of the liabilities is not authorized and the use of telediagnosis must ensure a total transparence. As we cannot presently establish a separate amount for a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient is a contract similar to the usual contract between laboratories which implies that the liability belongs to the practitioner who has received the sample. In the future, other legal obligations may appear when telediagnosis develops. Indeed, the increase in reliability due to telediagnosis could be normally required as a part of the medical obligation to use the latest technology. On the opposite, the excessive use of teleassistance, when there is neither emergency nor medical isolation, is dangerous because it affects the integrity and the quality of the medical act. A medical practice without any clinical examination of the patient is contrary to medical ethics.

Computer Communication Networks↗
PubMed1995

[Reliability of the anatomopathological diagnosis by static image transfer].

50 hepatic biopsies and 50 prostatic biopsies were submitted for diagnostic to an expert by the mean of static images previously digitalized by a consulting pathologist. Accuracy of diagnosis was obtained in 2 minutes with 4 images in 86% of cases. Additional data such as new images, several power fields, permitted accuracy of diagnosis in 98% of the cases. The experiences showed clearly that the quality of the transferred static images is sufficient to allow diagnoses. It pointed out the importance of the different actors involved in the consultation. It illustrates the possible use of this system as a training tool.

Female↗
PubMed1995

[Telecytoconsultation: application of the TRANSPATH system to the cervicovaginal pathology].

Telediagnosis in Cytology is possible and useful. As for histology it requires education to use this new tool and a new method to make a diagnosis, but also a rigorous behaviour. But for cytology, technical restrictions are more important: selection of adequate fields, magnification (a 60 x objective is necessary), illumination (specially for little round cells, in fact spheric ones), and a good knowledge of cytology of both partners to be used with accuracy. This method offers no real access to smear's background and false negatives are impossible to exclude. Moreover it is difficult to differentiate between endocervical and endometrial cells and competence in cytology is much more necessary than for histology. A more detailed evaluation is therefore required.

Databases, Factual↗
PubMed1995

A contribution to the quantitative analysis of transmitted images.

The scope of this paper is to contribute to the analysis of the problem of connecting two, relatively distinct, mostly technological, aspects of modern pathology. The authors analyze the differences between the values of morphometric and other parameters, such as: area, density, perimeter, etc. obtained on the same set of images before and after transmission. The results obtained prove that the differences due to the compression-transmission-decompression module, which is inherent to the image transmission process, are negligible.

Croatia↗
PubMed1995

The design and use of a computer-based digital image acquisition, management, and communications system for conferencing in pathology.

The Roche ImageManager is a PC computer-based system, running under Windows 3.1. This system allows the storage, viewing, printing, and transmission of, and conferencing on large sets of high resolution, color images from various sources. Images may be acquired at resolutions up to 3072 x 2320 pixels under software control, and transmitted for conferencing or stored in the database using JPEG compression. Each image is stored with associated information, text notes, annotations, and a "thumbnail" image. The stored information may be searched for matching images, for example representative images of a particular disease for training, or images to be reviewed for a particular patient. Images may be transmitted with all associated information between sites which have telephone service, worldwide. Support is being added for LAN use with a multi-user database, ISDN and Switch56 communications, and remote microscope control. Interactive conferencing allows rapid transmission of low resolution images for specimen scanning, viewing of multiple high resolution still images, and real-time interactive pointers for detailed discussions of image features. The ImageManager is being used and evaluated for conferencing and training purposes. A study was performed by Roche Biomedical Laboratories to compare the ability of pathologists to make a diagnosis on complex cases using transmitted images vs. routine microscopic examination. The effectiveness of the system in providing images of a sufficient quality to allow diagnosis in a private practice setting will be presented.

Computer Communication Networks↗