Informatics, digital & computational pathology

Telepathology

Intraoperative consultation telepathology


Editor-in-Chief: Debra L. Zynger, M.D.
Robin L. Dietz, M.D.
Liron Pantanowitz, M.D.

Topic Completed: 25 November 2020

Minor changes: 3 March 2021

Copyright: 2020-2021, PathologyOutlines.com, Inc.

PubMed Search: Telepathology intraoperative consultation

Robin L. Dietz, M.D.
Liron Pantanowitz, M.D.
Page views in 2020: 186
Page views in 2021 to date: 152
Cite this page: Dietz RL, Pantanowitz L. Intraoperative consultation telepathology. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/informaticsintraoperativeconsult.html. Accessed October 23rd, 2021.
Definition / general
  • Also known as frozen section via telepathology
  • Transmission of images to a remotely located pathologist during intraoperative consultation / frozen section
  • Broadly classified into static, dynamic, robotic, whole slide imaging and hybrid (J Pathol Inform 2014;5:39, J Pathol Inform 2016;7:26)
Terminology
  • Static image telepathology with still photographs (snapshots)
    • Advantages: low bandwidth requirement and quick image transmission with small image files, digital cameras (including cell phones) widely available, low cost and no complex software needed (Hum Pathol 2007;38:1330)
    • Disadvantages: skilled person is required onsite to take photos, image quality depends on the experience of the photographer and only limited portion of tissue / slide examined (Anal Cell Pathol 2000;21:201)
  • Dynamic telepathology with transmission of a video stream
    • Advantages: low bandwidth requirement, remote pathologist can view more regions of a slide, overcomes focus issues and relatively low cost (Hum Pathol 2008;39:56)
    • Disadvantages: skilled person is required onsite to examine (drive) slide, may have lag in video transmission and video files infrequently archived
  • Robotic telepathology with remote pathologist controlling a remote microscope
    • Advantages: no dependence on a person with microscopy skills to drive a stage, no delayed scan time, lower bandwidth requirements, access to freely navigate the entire slide, ability to select different magnification, real time control of focus
    • Disadvantages: someone still needs to load a slide on the device, high cost, more complex software and IT setup
  • Whole slide imaging (WSI) involves scanning a glass slide to generate a digital (whole slide) image (J Pathol Inform 2015;6:49)
    • Advantages: high resolution image, access to the entire slide and WSI can be archived (Hum Pathol 2009;40:1070)
    • Disadvantages: someone still needs to load a slide on the device to be scanned, relatively more expensive, larger footprint of device, high bandwidth requirements, longer time to scan whole slide and transmit large files, small tissue fragments or individual cells may fail to scan, inability to focus in Z axis (unless Z stack scanned) and proprietary file formats may need dedicated image viewers
  • Hybrid (multimodal) uses a combination of the other techniques (e.g. WSI and robotic live microscopy) (J Pathol Inform 2016;7:26)
  • Panoramic imaging uses a digital camera to stitch together a whole slide image in real time while a user examines slides on a conventional microscope
  • Gross telepathology for transmitting images of intraoperatively removed specimens (macroscopy)
Images

Contributed by Liron Pantanowitz, M.D.

Hybrid WSI / robotic scanner

Frozen section suite

Diagrams / tables

Images hosted on other servers:

Network topology
for interinstitutional
frozen section
telepathology

Applications
  • Telepathology during intraoperative consultation (remote frozen section reads), especially for access to expert subspecialists (e.g. neuropathologists) and during nonbusiness hours (e.g. on call at night and weekends) with comparable accuracy to glass slides (J Pathol Inform 2015;6:55, Am J Clin Pathol 2020;153:198)
  • Teleconsultation for a second opinion among pathologists
  • Nonclinical use cases (e.g. education, proficiency testing, quality assurance, archiving)
Advantages
Potential limitations
Implementation
  • System selection to match telepathology system with clinical need and available resources
  • Deployment with appropriate IT infrastructure (sufficient network bandwidth, HIPAA security)
  • Validation according to CAP guidelines (e.g. 60 cases for glass versus digital with 2 week washout)
  • Downtime policy and procedure
  • Documentation (e.g. state that telepathology was performed in the pathology report)
  • Maintenance (regular IT checks that the system is online and operational)
  • Quality assurance program (monitor frozen final discrepancy and deferral rates)
  • Business operations (hospital privileges, malpractice coverage, avoid Stark law antikickback violations)
Board review style question #1
What is the telepathology modality where a remote pathologist can control the microscope stage and objectives at the location where a frozen section slide was prepared?

  1. Dynamic
  2. Panoramic
  3. Robotic
  4. Static
  5. Whole slide imaging
Board review style answer #1
C. Robotic telepathology. The ability to remotely control the microscopic stage and objectives is a feature of robotic telepathology systems.

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Reference: Intraoperative consultation telepathology
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