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PubMed1997

Telemedicine and telepathology.

Telepathology is entering a golden era in which both the technology and the rationale for utilizing this technology are evolving. The following decade will see the introduction of national and international telepathology networks, founded on the principle of improving patient care and increasing cost-effectiveness. As telecommunications and imaging technology concurrently advance, newer generations of telepathology platforms will ultimately deliver performance that will be essentially indistinguishable from that of microscope-derived diagnoses.

Humans↗
PubMed1995

Telepathology: frozen section diagnosis at a distance.

Telepathology may be used to provide a frozen section service to hospitals without a department or institute of pathology. We have developed a telepathology system using the commercially available Integrated Services Digital Network (ISDN). The main software and hardware elements of our system are: Apple Macintosh workstations, a program for simultaneous transfer of image, voice and data, and a data bank for storage of patients' data and microscopic images. A picture instrument manager (PIM) makes remote control of microscopes or other instruments possible. The system connects the Department of Pathology of the University of Basel with the Regional Hospital of Samedan, 250 km away, and the Regional Hospital of Burgdorf, 100 km away. During a period of 20 months, frozen sections with the hospitals in Samedan and Burgdorf were performed in 53 patients. Between 54 and 58 s were required for the transfer of a diagnostic 8-bit grey level image containing 341 +/- 26.1 (standard error) kbytes (n = 13) or a diagnostic 24-bit colour image containing 165 +/- 16.9 kbytes (n = 40). Frozen section diagnosis was completed in 20-40 min. True-positive diagnoses of malignant tumours were achieved in 85.7% of cases (sensitivity = 0.857). No false-positive diagnosis was made. In 3 of the 53 cases telepathological diagnosis was not possible for technical reasons.

Frozen Sections↗
PubMed2006

Static telepathology in cancer institute of Tehran university: report of the first academic experience in Iran.

Telepathology is the practice of pathology, which allows quick and timely access to an expert opinion at a distance. We analyzed our new experience in cancer Institute of Tehran University of Medical Sciences with the iPath telepathology server of Basel University. One hundred sixty one cases in a period of 32 months were consulted. These cases received for second evaluation but the definite diagnosis could not be made in this centre. The number of images per case ranged from 3 to 32 (mean: 8). Except one case all cases were evaluated by consultants. Definite final diagnosis was achieved in 88/160 (54.7%). Recommendations for further evaluation were offered in 42/160 cases (26%). Major discrepancies were encountered in 30/160 cases (19%). Thirty-nine of the cases (24.3%) were reported within 1 day. The rate of achieving final diagnosis was higher in histological group rather than cytological ones. Increase in number of H&E images had no significant effect on achieving a definite final diagnosis. The rate of achieving final diagnosis in this study is much lower than other similar studies, which could be due to inappropriate sampling images, a potential cause of misdiagnosis in static telepathology. The other possible reason is that all of the cases in this study were problematic cases that a definite diagnosis could not be made for them even in primary consultation. The mean time for achieving a final diagnosis was also more than other studies, which could be for the reasons mentioned above.

Journal Article↗
PubMed1992

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

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.

Cell Biology↗
PubMed1995

[Telepathology].

Telepathology, introduced in 1986 by Weinstein, was not adopted in Japan because its image could not be transmitted by the National Television Standard Committee (NTSC) transmission. In 1990 a new system of Hi-Vision (HDTV) with 1125 lines, was implemented in Yamagata University and was highly evaluated. This success was followed by new developments both in NTSC and HDTV telepathology systems. Real-time HDTV images are transmitted via optical fiber cables for in-house hospital operations. Static HDTV and NTSC images are transferred via integrated services digital network (64 Kbit/s and 1.5 Mbit/s). Today telepathology networks are extending all over the country.

Computer Communication Networks↗
PubMed1994

Telepathology is available for transplantation-pathology: experience in Japan using an integrated, low-cost, and high-quality system.

We examined the validity and accuracy of telepathology service in the histological diagnosis of biopsy specimens from human transplanted kidney and liver. The still video images of paraffin sections were transmitted via a two-way telephone by use of a digitized telephone network (Integrated Service Digital Networks, 64 kbits/sec). The images were displayed on monitors and diagnosed by an expert pathologist at Tottori University. The quality of transmitted still images was sufficient for the diagnosis, especially at higher magnifications. The average number of transmitted images was 6.2 in the kidney cases and 7.4 in the liver cases. The average time taken for examination of a case was 13 min (range 10 to 16 min). Of 12 biopsy specimens from transplanted kidneys, 10 were adequately diagnosed with the system. Sampling errors caused inadequate diagnosis in a case of cyclosporin tubulopathy, the still images of which were not transmitted. An expert pathologist rendered the diagnosis in a case showing mesangial sclerosis, which was later diagnosed as possible recurrent glomerulonephritis through direct microscopy. Biopsy specimens from 10 liver transplants were also tested using archival materials. Although the etiology of hepatitis could not be determined in one case, diagnoses by telepathology well agreed with the reported diagnoses made through direct microscopy. Telepathology may be an effective way to provide on-line consultations in transplantation pathology, especially for transplant teams lacking expert pathologists.

Adolescent↗
PubMedDate not supplied

Aids of telepathology in intra-operative histomorphological tumor diagnosis and classification.

Visual telecommunication (telepathology) was applied for expert consultation in intra-operative frozen sections and tumor classification of paraffin-embedded, poorly differentiated bronchial carcinoma. The Institute of Pathology, Hospital Baumgartnerhöhe, Vienna and the Department of Pathology, Thoraxklinik, Heidelberg transmitted histological images by use of commercially available computerized modems (VP 2000) and conventional telephone lines. The expert consultation of the frozen sections included the clinical history, macroscopic findings and problems of final judgement of the images. Additional useful information could be obtained in about 35% of cases, and comprised expansion of differential diagnosis, certainty of final diagnosis, and side findings, such as concurrent inflammation, sarcoid-like lesions, etc. The time required for intra-operative diagnosis was 6-10 min. Cases of the Austrian-German quality control study on lung cancer with divergent tumor classification were discussed by use of telepathology. A final congruent tumor diagnosis could be obtained in all divergent cases. The data indicate that telepathology can be successfully used for expert consultation of intra-operative frozen sections and panel discussions of difficult bronchial carcinoma cases.

Humans↗
PubMed2002

Concordance between telepathologic diagnosis and conventional histopathologic diagnosis: a multiobserver store-and-forward study on 20 skin specimens.

OBJECTIVE: To study the validity and feasibility of transferring images of cutaneous biopsy specimens via e-mail to remote physicians active in dermatopathology for teleconsultation. DESIGN: Twenty skin specimens previously diagnosed at the Department of Dermatology, University of Graz, Austria, were subsequently sent for teleconsultation using the store-and-forward method. For each case, 3 or 4 images at different magnifications were sent by e-mail to 16 colleagues (11 dermatopathologists and 5 pathologists) in 15 centers in 6 different countries. Six weeks later each observer received the hematoxylin-eosin-stained specimens to render a conventional diagnosis. SETTING: Dermatopathology and pathology units within institutional and private settings. MATERIAL: Twenty small skin biopsy specimens of cutaneous diseases were selected randomly from a study set of 80. MAIN OUTCOME MEASURE: Concordance between telepathologic diagnoses and conventional histopathologic diagnoses of 20 skin specimens. RESULTS: On average, 78% of the telediagnoses were correct (range, 60%-95%), whereas 85% of the conventional diagnoses were correct (range, 60%-95%). A perfect diagnostic concordance was obtained in 7 (35%) of 20 cases, and a significant difference was identified in only 1 case. CONCLUSIONS: Results suggest that telepathology performed by physicians active in dermatopathology may serve as a reliable technique for the diagnosis of cutaneous diseases when experts in dermatopathology are not available locally. Furthermore, teledermatopathology is attractive because it provides an opportunity to obtain timely consultation on difficult cases.

Adult↗
PubMed2000

Telepathology by the Internet.

A new concept for telemicroscopy has recently been introduced using the Internet and conventional web browser, with Java support for microscope remote control as well as image transfer and discussion (http://amba.charite.de/telemic/). The system has two major components: the telemicroscopy server, which is a computer with Internet access connected to the automatic microscope, and the telemicroscopy client, who remotely operates the microscope. This simplified telemicroscopy system allows any Internet user to become a consultant for telepathology without the acquisition of specialized hardware or software. For the inquirer seeking advice, however, this solution is still very expensive, since it requires a fully automated microscope. The present study describes a system that can be used for conventional microscopes. A video camera mounted on a microscope with a photo tube is connected to the frame grabber of a PC. Java-based telemicroscopy software transforms the computer into an Internet server, which automatically distributes new microscope images, after manual operations, to all connected clients. Any Internet user can access the web page of the server to become a telemicroscopy client. A Chat function allows for the online exchange of written text and a Discuss function enables the mouse button to display an arrow to all connected clients, which highlights distinct structures of the images. The system was optimized for simplicity, while presenting all features that are necessary to show and discuss difficult cases with any expert in the field who has Internet access. It offers new perspectives for telepathology and it is envisaged that many pathologists and scientists will use this facility to connect their personal microscopes to the Internet, forming a network for teleconsultation. To foster this development, the software described in this paper is being made freely available. Hopefully, this development will promote communication between pathologists and may thus increase the quality of diagnosis. Information on inquiry and installation of the software is available at the website mentioned above. Telemicroscopy sessions using the Telemic version for conventional microscopes can be scheduled by contacting the authors by e-mail (iver. petersen@charite.de).

Communication↗
PubMed2003

[Telecommunication and telepathology in orthopedic oncology. Possibilities in diagnosis and therapy of primary malignant bone tumors].

The rareness of primary malignant bone tumors and the difficulty of differential diagnosis make this field a part of oncology in which the consulting physician must rely on consistent histopathological monitoring of highest quality throughout the diagnostic and therapeutic process. In a pilot project of the Department of Bone Pathology of the University of Hamburg and the Orthopedic Department of the University of Heidelberg, 190 cases of suspected primary bone tumor were the subject of interdisciplinary discussion between July 2001 and March 2003 using a telepathology system established for this purpose. Diligent differential diagnoses were made prior to the biopsy; optimal location and further strategy for the biopsy were discussed and determined according to the guidelines of the international bone tumor centers. This also included the decision if intraoperative pathological examination of frozen sections should be performed. In 51 cases such examinations were performed. Those results immediately influenced the surgical procedure. Telepathology performed as described in this article led to a close interdisciplinary cooperation over a large distance and helped significantly to optimize therapy of patients with malignant bone tumors.

Biopsy↗
PubMed1997

Color images in telepathology: how many colors do we need?

It is generally assumed that for telepathology, accurate depiction of microscopic images requires the use of "true color" (ie, 24 bits, eight bits each for red, green, and blue) in the digitized image used for transmission. If such a 24-bit color image file, which provides a palette of 16.7 million colors, could be reduced in size by decreasing the possible numbers of colors displayed in the image to 8 bits (palette of 256 colors), the image files would require less storage space, could be transmitted more rapidly, and would require less telecommunications bandwidth. However, such color reduction must not result in detectable image degradation, especially if the images are to be used for diagnosis. Therefore, we performed a carefully controlled study to determine whether pathologists could detect differences in the quality of microscopic images that were reduced from 24 to 8 bits of color. Thirty pathologists were each asked to view a set of 30 image pairs displayed on a computer monitor. Each image pair consisted of the original 24-bit color version and an 8-bit color-reduced version, derived using an adaptive color reduction algorithm with diffusion dithering. Observers were asked whether they could detect any difference in quality between the image pairs. Then, regardless of their answer, they were asked to choose the better quality image of the pair. Overall, there was not a statistically significant ability to consciously detect differences between the image pairs (P < .750). However, when forced to choose, there was a significant preference for the 8-bit images as being of "better quality" (P < .005). We conclude that telepathology applications may be able to take advantage of adaptive color reduction algorithms to reduce image file size without sacrificing image quality. Additional studies must be performed to determine the minimal image requirements for accurate diagnosis by telepatholgy.

Color↗
PubMed2003

The development and evaluation of the UK national telepathology network.

AIMS: As technology advances and costs fall, it may be anticipated that soon every histopathologist will expect to be able to exchange electronic images with colleagues. Arguing that the value of a network increases as more people are connected, we sought to install a simple, low-cost telepathology system into any histopathology laboratory which requested it within the UK. METHODS AND RESULTS: We assumed that laboratories had microscopes, computers and internet access. We offered low-cost video cameras, video input cards, software and training to any histopathology department requesting installation, limited only by resources supplied by the UK government. We also established central servers and a website with 'help' files. After 1 year we studied system use and pathologists' opinions by circulating a questionnaire. Installations were completed in 35 laboratories; there are currently 66 registered users of the system, with 16 identified 'experts' covering most organ systems. Serious difficulties were caused by institutional firewalls and reluctance of local information technology (IT) staff to make changes to facilitate the installation or to help resolve subsequent network problems. After installation, many of the telepathology systems remain unused. Concerns were expressed about image quality, though mainly by pathologists who had not used the system for diagnostic work. The system remains available, but the level of use is low. CONCLUSIONS: This project has not achieved its aims. The reasons are complex, but mainly relate to human attitudes. Pathologists with excessive workloads were reluctant to use time to learn new skills which were not directed to reducing workload. IT staff did not perceive the project as part of their routine work. There were also numerous technological problems, but although image quality was cited by many, it was not a complaint of those who actively used the system. These problems have not been encountered by previous projects which involved small groups of committed enthusiasts.

Attitude of Health Personnel↗
PubMed2001

Development and experience with an integrated system for transplantation telepathology.

Rapid and accurate interpretation of allograft biopsies influences the outcome after organ transplantation. Expert histopathologic interpretation can also determine whether a donor organ should be used for transplantation or disposed. These and similar considerations in the field of Transplantation Pathology prompted us to develop a static image, store-and-forward telepathology system capable of rendering accurate, robust, and confidential communication by using readily available equipment and bandwidth capabilities for interactive real-time second opinion consultation. Between July 1999 and October 2000, 102 cases were transmitted, including 78 for second opinion and 1 for primary diagnosis with 6 (5 real-time) frozen sections. Full agreement with the original diagnosis was obtained in 67 of 78 (86%) cases; in 11 (14%) cases, teleconsultation resulted in 8 minor and 3 clinically significant differences of opinion. This led to a change in therapy in 1 case and further evaluation in 2 other cases. We conclude that static image, store-and-forward telepathology can enhance the practice of transplantation pathology, but a multidisciplinary team for ongiong support and development is required. This technology has the potential to promote case sharing, conduct continuing education, build consensus, and standardize readings of biopsies in multicenter trials in which histopathologic findings represent important outcome measures.

Humans↗
PubMedDate not supplied

Ultrastructural telepathology--remote EM-diagnostic via Internet.

New collaboratory opportunities in ultrastructural research and diagnostics are now available on the Internet through the combination of digital image acquisition, remote operation of modern digitally controlled and automated electron microscopes, and the development of software specifically tailored for collaboratory needs. Remote experts can examine samples directly, and unique instruments can be utilized from anywhere. In the case of diagnostic dilemmas, the second-opinion expert is no longer constrained by problems inherent in the interpretation of preselected images. The remote examiner can independently choose the area of interest on the sample as well as select the appropriate magnification for an accurate diagnosis. With these capabilities and together with teleconferencing tools and securely accessible databases on-line, telepathology can provide increased effectiveness and support for diagnostics, research, and teaching in many areas. The authors report their experience with remote electron microscope diagnoses of pathological samples using two different dynamic imaging systems and discuss the main technical issues encountered. It appears that only minor technical issues need to be resolved before ultrastructural telepathology can be promoted for routine use in areas with high-speed Internet access.

Dementia, Multi-Infarct↗
PubMed2002

Practical telepathology using a digital camera and the internet.

Digital camera technology has developed rapidly and a large choice of reasonably priced, user-oriented models are now available. These can be used for both macroscopic and microscopic photography with good resolution. Internet transmission of digital images also makes it possible to consult pathologists anywhere in the world. This study tests a simple, fast, and inexpensive method for practical transmission of images for diagnosis using a digital camera and the Internet. Using a commercial digital camera mounted with a phototube adapter to a light microscope (6 images per case on average), 2210 digital images (310 Mb) from 347 cases of gastrointestinal, lung, and uterus specimens were captured. Each image, stored in medium compression JPEG (Joint Photographers Experts Group) format with 1024 x 768 pixel resolution, required approximately 5 seconds to capture after the case had been reviewed and appropriate fields for imaging selected (30 seconds per case on average). The images were transmitted from Samsung Medical Center, Seoul, to Korea University Hospital, Seoul, and John Hunter Hospital, Newcastle, Australia. Transmission was 100% successful with a total upload time of 3 hours for 310 MB of data (31 seconds per case on average). The images were downloaded in 2 hours and viewed on a 17-inch color monitor with a maximal resolution of 1280 x 1024 pixels. Telepathology diagnoses were made with 95% and 97% concurrence by two pathologists at Korea University Hospital and John Hunter Hospital, respectively. We suggest that the current level of commercial technology yields fast, convenient and economical tools for practical telepathology diagnosis.

Humans↗
PubMed1996

Telemedicine and telepathology at the Armed Forces Institute of Pathology: history and current mission.

The Armed Forces Institute of Pathology uses telepathology and telemedicine programs to support its mission of providing pathology consultation, education, and research. The telepathology service is based on a static imaging or "store-and-forward" approach using both proprietary equipment and open systems through the Internet. Initiated in 1993, the service provides rapid expert consultation to pathologists globally. Diagnoses are provided by pathologists in 22 specialized departments. Educational programs are delivered through the World Wide Web. Category I continuing medical education credits can be obtained through Internet-based courses. Research activities are focused on forensic applications and the creation of image databases.

Computer Communication Networks↗
PubMed1999

"Virtual microscopy" and the internet as telepathology consultation tools: diagnostic accuracy in evaluating melanocytic skin lesions.

The Internet offers a widely available, inexpensive tool for telepathology consultations. It allows the transfer of image and text files through electronic mail (e-mail) or file transfer protocols (FTP), using a variety of microcomputer platforms. We studied the use of the Internet and "virtual microscopy" tools for the diagnosis of 35 skin biopsies, including a variety of benign and malignant melanocytic lesions. Digitized images from these lesions were obtained at 40x and 100x optical magnification, using a high resolution digital camera (Microlumina, Leaf Systems, Southborough, MA), a light microscope with a phototube adapter and a microcomputer with a Pentium 166 MHz microprocessor. Two to four images of each case were arranged on a "canvas" to represent the majority or an entire biopsy level, using Photoshop software (Adobe Systems Inc., San Jose, CA). The images were compressed using Joint Photographers Expert Group (JPEG) format. The images were then viewed on a computer video monitor in a manner that closely resembles light microscopy, including scrolling by using the "hand tool" of Photoshop and changing magnification digitally up to 4 times without visible image degradation. The image files, ranging in size from 700 kilobytes to 2.1 megabytes (average 1.6 megabytes) were attached to e-mail messages that contained clinical information, using standard Multipurpose Internet Mail Extension (MIME) protocols and sent through the Internet, for interpretation by a dermatopathologist. The consultant could open the images from the e-mail message, using Microsoft Outlook Express (Microsoft Corp., Redmond, WA) and Photoshop software, scroll them, change magnification and render a diagnosis in a manner that closely simulates light microscopy. One hundred percent concordance was obtained between the telepathology and traditional hematoxylin and eosin slide diagnoses. The Internet and relatively inexpensive "virtual microscopy" tools offer a novel technology for dermatopathology consultations. Potential applications of this technology to pathology and technical problems posed by the use of an open, widely distributed network to share sensitive medical information are discussed.

Biopsy↗
PubMed2000

Comparison of different telepathology solutions for primary frozen section diagnostic.

In a retrospective study on a set of 125 cases we compared the following three telepathology solutions for primary frozen section diagnosis: ATM-TP (connection via ATM), TPS 1.0 (connection via LAN) and TELEMIC (connection via Internet), which represent different concepts of telepathological procedures. A set of 125 routine frozen sections (breast) was selected from the Charité cases of the year 1999. Four experienced pathologists diagnosed retrospectively all of these cases using the ATM-TP and TPS systems and 53 of them with the TELEMIC system. Using the ATM-TP we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TPS we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TELEMIC we recorded in 53 cases no false positive (0%), no false negative (0%) and 16 deferred (30.2%) cases. The average time of 2.2 minutes per case using ATM-TP is also short enough for routine frozen section diagnostic. This is also true for the TPS system with 7.2 minutes per case.

Breast Neoplasms↗