Informatics, digital & computational pathology
Telepathology
Fundamentals


Topic Completed: 16 October 2018

Revised: 12 August 2019

Copyright: 2018-2019, PathologyOutlines.com, Inc.

PubMed Search: Telepathology [title] "loattrfree full text"[sb]

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Cite this page: Triolo DJ. Telepathology - fundamentals. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/informaticstelepathology.html. Accessed August 19th, 2019.
Definition / general
History
  • Evolved from video microscopy (i.e., television microscopy) research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications
    • Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses
  • Invented, patented and commercialized by Ronald S. Weinstein, MD, University of Arizona professor of pathology and founding director of the Arizona Telemedicine Program
  • Demonstrated in 1986 when a 66 year old breast cancer patient in El Paso, Texas, had her breast biopsy diagnosis verified by a surgical pathologist in Washington, D.C., via satellite communications and telerobotic light microscopy
  • Dr. Weinstein's research team, then in Chicago, published the first telepathology papers in the scientific literature and added the term "telepathology" to the English language
    • Dr. Weinstein frequently is referred to as the father of telepathology and lectures on telepathology around the world
  • Today, telepathology is used in over 32 countries
    • Patients around the world have benefited from often immediate access to pathology subspecialists via telepathology as compared to time consuming physical shipment of pathology specimens
    • This increases diagnostic accuracy and reduces patients' anxiety of waiting weeks for laboratory reports in some countries
    • Subspecialty pathologists are rare in many countries
      • In the field of diagnostic pathology, there are more than 20 subspecialties, including neuropathology, dermatopathology, renal pathology, hematopathology and medical microbiology
      • Pathology subspecialists provide the highest levels of diagnostic accuracy in medicine, render diagnoses on the most complex cases and are experts in advanced molecular testing of tissue specimens
Diagrams / tables

Contributed by Bruce E. Dunn, M.D.

Early telepathology system



Images hosted on other servers:

Innovations in telepathology system designs

Telepathology roadblocks
  • Cost: hybrid of dynamic and static imaging was over $100,00.00 and the viewing workstation was approximately $25,000
  • Communications: the typical telepathology network needed either T-1 lines, which were very expensive or an ISDN network, which was slow and burdensome
  • Image quality: image quality was adequate at best due to several factors:
    • Objectives chosen
    • Network, could cause pixeling
    • Images were through a video teleconferencing module, which in many cases reduced the quality of the images
    • Monitor quality available was not optimum by any standards
    • Color distortion
  • Pathologist availability: pathologists were needed to read the cases
  • Response time: adequate at best due to the communication network chosen to work on
  • Reimbursements: no billable CPT codes existed for telepathology
Early adopters of telepathology
  • Arizona State Telemedicine Network under the direction of Dr. Ron Weinstein
    • Employed a hybrid system that was dynamic ( live) and static (store and forward) imaging combined robotics on the X,Y and Z plane as well as capturing the images in high definition (static) for transmission as well as input into pathology reports
  • Dr. Bruce E. Dunn of the VAMC VISN 12
    • Dr. Dunn employed a hub and spoke model (see telepathology implementation) which employed a fully robotic system along with store and forward systems
    • Applications were for:
      • Surgical pathology
        • Documentation of gross and histopathology
      • Autopsy pathology
        • Documentation of gross and histopathology
      • Clinical pathology
        • Documentation of interesting cases
      • Hematology
        • Documentation of interesting cases
      • Continuing education
Telepathology use cases
  • Initial use cases for telepathology were, by today's standards, very basic
    • Frozen sections
      • Difficult at best due to the nature of image quality
      • Use of wet slides
      • Mandatory for a reading pathologist to be available
    • Second opinions
    • Peer review (rather expensive at the time for this use case)
Telepathology today
  • Telepathology is under the all encompassing umbrella of digital pathology as a use case
    • Digital pathology use cases
      • Telepathology
        • Frozen sections
        • Collaboration
        • Tumor boards
        • Case sharing
        • Second opinions
        • Peer review
      • Digital sign out
        • Primary diagnosis
        • Image analysis
        • Remote sign out
        • Quality control
      • Education
        • Clinical trials
        • Research applications
        • CME
        • Proficiency training
      • Archiving and retrieval
        • Customized reporting
        • Digitization
        • Data mining
Additional references
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