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Hanna MG, Ardon O, Reuter VE, Sirintrapun SJ, England C, Klimstra DS, Hameed MR. Integrating digital pathology into clinical practice. Mod Pathol 2022; 35:152-164. [PMID: 34599281 DOI: 10.1038/s41379-021-00929-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022]
Abstract
The field of anatomic pathology has been evolving in the last few decades and the advancements have been largely fostered by innovative technology. Immunohistochemistry enabled a paradigm shift in discovery and diagnostic evaluation, followed by booming genomic advancements which allowed for submicroscopic pathologic characterization, and now the field of digital pathology coupled with machine learning and big data acquisition is paving the way to revolutionize the pathology medical domain. Whole slide imaging (WSI) is a disruptive technology where glass slides are digitized to produce on-screen whole slide images. Specifically, in the past decade, there have been significant advances in digital pathology systems that have allowed this technology to promote integration into clinical practice. Whole slide images (WSI), or digital slides, can be viewed and navigated comparable to glass slides on a microscope, as digital files. Whole slide imaging has increased in adoption among pathologists, pathology departments, and scientists for clinical, educational, and research initiatives. Integration of digital pathology systems requires a coordinated effort with numerous stakeholders, not only within the pathology department, but across the entire enterprise. Each pathology department has distinct needs, use cases and blueprints, however the framework components and variables for successful clinical integration can be generalized across any organization seeking to undergo a digital transformation at any scale. This article will review those components and considerations for integrating digital pathology systems into clinical practice.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Henriksen J, Kolognizak T, Houghton T, Cherne S, Zhen D, Cimino PJ, Latimer CS, Scherpelz KP, Yoda RA, Alpers CE, Chhieng DF, Keene CD, Gonzalez-Cuyar LF. Rapid Validation of Telepathology by an Academic Neuropathology Practice During the COVID-19 Pandemic. Arch Pathol Lab Med 2020; 144:1311-1320. [PMID: 32551815 PMCID: PMC10777891 DOI: 10.5858/arpa.2020-0372-sa] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The coronavirus disease 19 (COVID-19) pandemic is placing unparalleled burdens on regional and institutional resources in medical facilities across the globe. This disruption is causing unprecedented downstream effects to traditionally established channels of patient care delivery, including those of essential anatomic pathology services. With Washington state being the initial North American COVID-19 epicenter, the University of Washington in Seattle has been at the forefront of conceptualizing and implementing innovative solutions in order to provide uninterrupted quality patient care amidst this growing crisis. OBJECTIVE.— To conduct a rapid validation study assessing our ability to reliably provide diagnostic neuropathology services via a whole slide imaging (WSI) platform as part of our departmental COVID-19 planning response. DESIGN.— This retrospective study assessed diagnostic concordance of neuropathologic diagnoses rendered via WSI as compared to those originally established via traditional histopathology in a cohort of 30 cases encompassing a broad range of neurosurgical and neuromuscular entities. This study included the digitalization of 93 slide preparations, which were independently examined by groups of board-certified neuropathologists and neuropathology fellows. RESULTS.— There were no major or minor diagnostic discrepancies identified in either the attending neuropathologist or neuropathology trainee groups for either the neurosurgical or neuromuscular case cohorts. CONCLUSIONS.— Our study demonstrates that accuracy of neuropathologic diagnoses and interpretation of ancillary preparations via WSI are not inferior to those generated via traditional microscopy. This study provides a framework for rapid subspecialty validation and deployment of WSI for diagnostic purposes during a pandemic event.
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Affiliation(s)
| | | | - Tracy Houghton
- From the Department of Pathology, University of Washington, Seattle
| | - Steve Cherne
- From the Department of Pathology, University of Washington, Seattle
| | - Daisy Zhen
- From the Department of Pathology, University of Washington, Seattle
| | - Patrick J Cimino
- From the Department of Pathology, University of Washington, Seattle
| | | | | | - Rebecca A Yoda
- From the Department of Pathology, University of Washington, Seattle
| | - Charles E Alpers
- From the Department of Pathology, University of Washington, Seattle
| | - David F Chhieng
- From the Department of Pathology, University of Washington, Seattle
| | - C Dirk Keene
- From the Department of Pathology, University of Washington, Seattle
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Chen Y, Janowczyk A, Madabhushi A. Quantitative Assessment of the Effects of Compression on Deep Learning in Digital Pathology Image Analysis. JCO Clin Cancer Inform 2020; 4:221-233. [PMID: 32155093 PMCID: PMC7113072 DOI: 10.1200/cci.19.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Deep learning (DL), a class of approaches involving self-learned discriminative features, is increasingly being applied to digital pathology (DP) images for tasks such as disease identification and segmentation of tissue primitives (eg, nuclei, glands, lymphocytes). One application of DP is in telepathology, which involves digitally transmitting DP slides over the Internet for secondary diagnosis by an expert at a remote location. Unfortunately, the places benefiting most from telepathology often have poor Internet quality, resulting in prohibitive transmission times of DP images. Image compression may help, but the degree to which image compression affects performance of DL algorithms has been largely unexplored. METHODS We investigated the effects of image compression on the performance of DL strategies in the context of 3 representative use cases involving segmentation of nuclei (n = 137), segmentation of lymph node metastasis (n = 380), and lymphocyte detection (n = 100). For each use case, test images at various levels of compression (JPEG compression quality score ranging from 1-100 and JPEG2000 compression peak signal-to-noise ratio ranging from 18-100 dB) were evaluated by a DL classifier. Performance metrics including F1 score and area under the receiver operating characteristic curve were computed at the various compression levels. RESULTS Our results suggest that DP images can be compressed by 85% while still maintaining the performance of the DL algorithms at 95% of what is achievable without any compression. Interestingly, the maximum compression level sustainable by DL algorithms is similar to where pathologists also reported difficulties in providing accurate interpretations. CONCLUSION Our findings seem to suggest that in low-resource settings, DP images can be significantly compressed before transmission for DL-based telepathology applications.
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Affiliation(s)
| | - Andrew Janowczyk
- Case Western Reserve University, Cleveland, OH
- Precision Oncology Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Anant Madabhushi
- Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland Veterans Affair Medical Center, Cleveland, OH
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Weinstein RS, Holcomb MJ, Krupinski EA. Invention and Early History of Telepathology (1985-2000). J Pathol Inform 2019; 10:1. [PMID: 30783545 PMCID: PMC6369631 DOI: 10.4103/jpi.jpi_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/19/2018] [Indexed: 11/11/2022] Open
Abstract
This narrative-based paper provides a first-person account of the early history of telepathology (1985–2000) by the field's inventor, Ronald S. Weinstein, M. D. During the 1980s, Dr. Weinstein, a Massachusetts General Hospital-trained pathologist, was director of the Central Pathology Laboratory (CPL) for the National Cancer Institute-funded National Bladder Cancer Project, located at Rush Medical College in Chicago, IL. The CPL did post therapy revalidations of surgical pathology and cytopathology diagnoses before outcomes of the completed clinical trials were published. The CPL reported that interobserver variability was invalidating inclusion of dozens of treated bladder cancer patients in published reports on treatment outcomes. This problem seemed ripe for a technology-assisted solution. In an effort to solve the interobserver variability problem, Dr. Weinstein devised a novel solution, dynamic-robotic telepathology, that would potentially enable CPL uropathologists to consult on distant uropathology cases in real-time before their assignment to urinary bladder cancer, tumor stage, and grade-specific clinical trials. During the same period, universities were ramping up their support for faculty entrepreneurism and creating in-house technology transfer organizations. Dr. Weinstein recognized telepathology as a potential growth industry. He and his sister, Beth Newburger, were a successful brother–sister entrepreneur team. Their PC-based education software business, OWLCAT™, had just been acquired by Digital Research Inc., a leading software company, located in California. With funding from the COMSAT Corporation, a publically traded satellite communications company, the Weinstein-Newburger team brought the earliest dynamic-robotic telepathology systems to market. Dynamic-robotic telepathology became a dominant telepathology technology in the late 1990s. Dr. Weinstein, a serial entrepreneur, continued to innovate and, with a team of optical scientists at The University of Arizona's College of Optical Sciences, developed the first sub-1-min whole-slide imaging system, the DMetrix DX-40 scanner, in the early 2000s.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael J Holcomb
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
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Ghosh A, Brown GT, Fontelo P. Telepathology at the Armed Forces Institute of Pathology: A Retrospective Review of Consultations From 1996 to 1997. Arch Pathol Lab Med 2017; 142:248-252. [DOI: 10.5858/arpa.2017-0055-oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Telepathology is the practice of pathology at a distance, transmitting images using telecommunication methods for second opinion and/or diagnostic assistance, or for educational purposes. It may be the only means of consultation for some pathologists.
Objective.—
To retrospectively review and evaluate a subset of telepathology consultations from June 1996 to March 1997, and to determine the concordance between the telepathology diagnosis of the contributor and pathologists at the Armed Forces Institute of Pathology (AFIP), Washington, District of Columbia, as well as the concordance between the telepathology diagnosis and the glass slide diagnosis, when available.
Design.—
Photocopies of de-identified telepathology reports from the AFIP during a 15-month period between June 1996 and March 1997 were reviewed. Contributor versus telepathology diagnosis was graded as 1 (complete agreement), 2 (partial agreement), 3 (disagreement; usually a diagnosis of benign versus malignant), and deferred. Data were analyzed using descriptive statistical methods.
Results.—
Of the 262 cases, 194 (74%) were in complete agreement with the contributor's diagnosis, 34 of 262 (13%) were in minor disagreement, and 21 of 262 (8%) were in major disagreement. Diagnoses were deferred in 5% (13 of 262) of cases.
Conclusions.—
Using commercial off-the-shelf technology and despite telecommunication challenges during that time, the AFIP demonstrated that telepathology could be conducted reliably.
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Sirintrapun SJ, Rudomina D, Mazzella A, Feratovic R, Alago W, Siegelbaum R, Lin O. Robotic Telecytology for Remote Cytologic Evaluation without an On-site Cytotechnologist or Cytopathologist: A Tale of Implementation and Review of Constraints. J Pathol Inform 2017; 8:32. [PMID: 28966832 PMCID: PMC5609359 DOI: 10.4103/jpi.jpi_26_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/01/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The first satellite center to offer interventional radiology procedures at Memorial Sloan Kettering Cancer Center opened in October 2014. Two of the procedures offered, fine needle aspirations and core biopsies, required rapid on-site cytologic evaluation of smears and biopsy touch imprints for cellular content and adequacy. The volume and frequency of such evaluations did not justify hiring on-site cytotechnologists, and therefore, a dynamic robotic telecytology (TC) solution was created. In this technical article, we present a detailed description of our implementation of robotic TC. METHODS Pathology devised the remote robotic TC solution after acknowledging that it would not be cost effective to staff cytotechnologists on-site at the satellite location. Sakura VisionTek was selected as our robotic TC solution. In addition to configuration of the dynamic robotic TC solution, pathology realized integrating the technology solution into operations would require a multidisciplinary effort and reevaluation of existing staffing and workflows. RESULTS Extensively described are the architectural framework and multidisciplinary process re-design, created to navigate the constraints of our technical, cultural, and organizational environment. Also reviewed are the benefits and challenges associated with available desktop sharing solutions, particularly accounting for information security concerns. CONCLUSIONS Dynamic robotic TC is effective for immediate evaluations performed without on-site cytotechnology staff. Our goal is providing an extensive perspective of the implementation process, particularly technical, cultural, and operational constraints. Through this perspective, our template can serve as an extensible blueprint for other centers interested in implementing robotic TC without on-site cytotechnologists.
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Affiliation(s)
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Allix Mazzella
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - William Alago
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Robert Siegelbaum
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
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Sirintrapun SJ, Rudomina D, Mazzella A, Feratovic R, Alago W, Siegelbaum R, Lin O. Robotic Telecytology for Remote Cytologic Evaluation without an On-site Cytotechnologist or Cytopathologist: An Active Quality Assessment and Experience of Over 400 Cases. J Pathol Inform 2017; 8:35. [PMID: 28966835 PMCID: PMC5609392 DOI: 10.4103/jpi.jpi_25_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first satellite center to offer interventional radiology procedures at Memorial Sloan Kettering Cancer Center opened in October 2014. Two of the procedures offered, fine needle aspirations and core biopsies, required a rapid on-site cytologic evaluation of smears and biopsy touch imprints for cellular content and adequacy. The volume and frequency of such evaluations did not justify hiring on-site cytotechnologists, and therefore, a dynamic robotic telecytology (TC) solution was created. In this article, we provide data on our experience with this active implementation. Sakura VisionTek was selected as our robotic TC solution. METHODS A retrospective analysis of all TC evaluations from this satellite site was performed. Information was collected on demographics, lesion location, imaging modality; a comparison of TC-assisted adequacy with final adequacy was also conducted. RESULTS An analysis of 439 cases was performed over a period of 23 months with perfect correlation in 92.7% (407/439) of the cases. An adequacy upgrade (inadequate specimen becomes adequate) in 6.6% (29/439) of the cases. An adequacy downgrade (adequate specimen becomes inadequate), is near zero at 0.7% (3/439) of the cases. CONCLUSIONS Dynamic robotic TC is effective for immediate evaluations performed without on-site cytotechnology staff. The overall intent of this article is to present data and concordance rates as outcome metrics. Thus far, such outcome metrics have exceeded our expectations. Our TC implementation shows high, perfect concordance. Adequacy upgrades are minor but more relevant and impressive is a near zero adequacy downgrade. Our full implementation has been so successful that plans are in place for configurations at future satellite sites.
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Affiliation(s)
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allix Mazzella
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Siegelbaum
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology 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. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. ATA clinical guidelines for telepathology. Telemed J E Health 2016; 20:1049-56. [PMID: 25384254 DOI: 10.1089/tmj.2014.9976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liron Pantanowitz
- 1 Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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Farahani N, Riben M, Evans AJ, Pantanowitz L. International Telepathology: Promises and Pitfalls. Pathobiology 2016; 83:121-6. [PMID: 27101287 DOI: 10.1159/000442390] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Innovative technologies for digital imaging and telecommunications are changing the way we deliver health care. Telepathology collaborations are one example of how delivering remote pathology services to patients can benefit from leveraging this change. Over the years, several academic and commercial teleconsultation networks have been established. Herein, we review the landscape of these international telepathology efforts and highlight key supportive factors and potential barriers to successful cross-border collaborations. Important features of successful international telepathology programs include efficient workflows, dedicated information technology staff, continuous maintenance, financial incentives, ensuring that all involved stakeholders are satisfied, and value-added clinical benefit to patient care. Factors that plague such telepathology operations include legal/regulatory issues, sustainability, and cultural and environmental issues. Pathologists, vendors and laboratory accreditation agencies will need to embrace and capitalize on this new paradigm of international telepathology accordingly.
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Vitkovski T, Bhuiya T, Esposito M. Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms. J Pathol Inform 2015; 6:55. [PMID: 26605120 PMCID: PMC4639948 DOI: 10.4103/2153-3539.168515] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background: Increasingly, as in our institution, operating rooms are located in hospitals and the pathology suite is located at a distant location because of off-site consolidation of pathology services. Telepathology is a technology which bridges the gap between pathologists and offers a means to obtain a consultation remotely. We aimed to evaluate the utility of telepathology as a means to assist the pathologist at the time of intraoperative consultation of lung nodules when a subspecialty pathologist is not available to directly review the slide. Methods: Cases of lung nodules suspicious for a neoplasm were included. Frozen sections were prepared in the usual manner. The pathologists on the intraoperative consultation service at two of our system hospitals notified the thoracic pathologist of each case after rendering a preliminary diagnosis. The consultation was performed utilizing a Nikon™ Digital Sight camera and web-based Remote Medical Technologies™ software with live video streaming directed by the host pathologist. The thoracic pathologist rendered a diagnosis without knowledge of the preliminary interpretation then discussed the interpretation with the frozen section pathologist. The interpretations were compared with the final diagnosis rendered after sign-out. Results: One hundred and three consecutive cases were included. The frozen section pathologist and a thoracic pathologist had concordant diagnoses in 93 cases (90.2%), discordant diagnoses in nine cases (8.7%), and one case in which both deferred. There was an agreement between the thoracic pathologist's diagnosis and the final diagnosis in 98% of total cases including 8/9 (88.9%) of the total discordant cases. In two cases, if the thoracic pathologist had not been consulted, the patient would have been undertreated. Conclusions: We have shown that telepathology is an excellent consultation tool in the frozen section diagnosis of lung nodules.
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Affiliation(s)
- Taisia Vitkovski
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
| | - Tawfiqul Bhuiya
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
| | - Michael Esposito
- Department of Pathology, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, USA
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Abstract
Telepathology is the practice of remote pathology using telecommunication links to enable the electronic transmission of digital pathology images. Telepathology can be used for remotely rendering primary diagnoses, second opinion consultations, quality assurance, education, and research purposes. The use of telepathology for clinical patient care has been limited mostly to large academic institutions. Barriers that have limited its widespread use include prohibitive costs, legal and regulatory issues, technologic drawbacks, resistance from pathologists, and above all a lack of universal standards. This article provides an overview of telepathology technology and applications.
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Affiliation(s)
- Navid Farahani
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Treanor D, Gallas BD, Gavrielides MA, Hewitt SM. Evaluating whole slide imaging: A working group opportunity. J Pathol Inform 2015. [DOI: 10.1016/s2153-3539(22)00459-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. American Telemedicine Association clinical guidelines for telepathology. J Pathol Inform 2014. [PMID: 25379345 DOI: 10.4103/2153–3539.143329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kim Dickinson
- Integrated Oncology, LabCorp and Digital Pathology Association, Irvine, CA, USA
| | - Andrew J Evans
- Department of Pathology, University Health Network Toronto General Hospital, Toronto, Canada
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Walter H Henricks
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jochen K Lennerz
- Department of Pathology, University Ulm, Albert-Einstein-Allee, Ulm, Germany
| | | | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Riben
- Department of Pathology, Anatomic Pathology Informatics, MD Anderson, Houston, TX, USA
| | - Col Daniel Smith
- Department of Pathology, Keesler Medical Center, Biloxi, MS, USA
| | - J Mark Tuthill
- Department of Pathology, Pathology Informatics, Henry Ford Health System, Detroit, MI, USA
| | | | - David C Wilbur
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. American Telemedicine Association clinical guidelines for telepathology. J Pathol Inform 2014; 5:39. [PMID: 25379345 PMCID: PMC4221880 DOI: 10.4103/2153-3539.143329] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kim Dickinson
- Integrated Oncology, LabCorp and Digital Pathology Association, Irvine, CA, USA
| | - Andrew J Evans
- Department of Pathology, University Health Network Toronto General Hospital, Toronto, Canada
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Walter H Henricks
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jochen K Lennerz
- Department of Pathology, University Ulm, Albert-Einstein-Allee, Ulm, Germany
| | | | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Riben
- Department of Pathology, Anatomic Pathology Informatics, MD Anderson, Houston, TX, USA
| | - Col Daniel Smith
- Department of Pathology, Keesler Medical Center, Biloxi, MS, USA
| | - J Mark Tuthill
- Department of Pathology, Pathology Informatics, Henry Ford Health System, Detroit, MI, USA
| | | | - David C Wilbur
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Braunhut BL, Graham AR, Lian F, Webster PD, Krupinski EA, Bhattacharyya AK, Weinstein RS. Subspecialty surgical pathologist's performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study. J Pathol Inform 2014; 5:18. [PMID: 25057432 PMCID: PMC4060405 DOI: 10.4103/2153-3539.133142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/17/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists' decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. MATERIALS AND METHODS Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. RESULTS The 10 participating telepathologists' postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists' area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. CONCLUSIONS Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports.
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Affiliation(s)
- Beth L Braunhut
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Anna R Graham
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA ; Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Fangru Lian
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Phyllis D Webster
- Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA ; Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Ronald S Weinstein
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA ; Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA
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Whole slide imaging diagnostic concordance with light microscopy for breast needle biopsies. Hum Pathol 2014; 45:1713-21. [PMID: 24913758 DOI: 10.1016/j.humpath.2014.04.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/03/2014] [Accepted: 04/09/2014] [Indexed: 11/20/2022]
Abstract
This study investigated the diagnostic accuracy of whole slide imaging (WSI) in breast needle biopsy diagnosis in comparison with standard light microscopy (LM). The study examined the effects of image capture magnification and computer monitor quality on diagnostic concordance of WSI and LM. Four pathologists rendered diagnoses using WSI to examine 85 breast biopsies (92 parts; 786 slides) consisting of benign and malignant cases. Each WSI case was evaluated using images captured at either ×20 or ×40 magnifications and viewed using a Digital Imaging and Communication in Medicine (DICOM) grade, color-calibrated monitor or a standard, desktop liquid-crystal display (LCD) monitor. For each combination, the WSI result was compared with the original, LM diagnosis. The overall concordance rate observed between WSI and LM was 97.1% (95% confidence intervals [CI]: 94.3%-98.5%). After a washout period, all cases were reviewed a second time by each pathologist after using LM, and the second LM diagnosis was compared with the WSI diagnosis rendered by the same pathologist. Intraobserver concordance between WSI and LM was 95.4% (95% CI: 92.2%-97.4%). The second LM diagnoses were also compared with the original LM diagnoses, and the observed interobserver LM concordance rate was 97.3% (95% CI: 93.1%-99.0%). The study data demonstrated that breast needle biopsy diagnoses rendered by WSI were equivalent to diagnoses rendered by LM. No diagnostic differences were detected between the underlying viewing system parameters of monitor quality and image capture resolution. The results of this study demonstrated that WSI can be effectively used in subspecialty diagnostic cases where a minimum amount of tissue is available.
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Braunhut BL, Graham AR, Richter LC, Webster PD, Krupinski EA, Bhattacharyya AK, Weinstein RS. Fifth generation telepathology systems. Workflow analysis of the robotic dynamic telepathology Component. Diagn Pathol 2013. [PMCID: PMC3849607 DOI: 10.1186/1746-1596-8-s1-s3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gifford AJ, Colebatch AJ, Litkouhi S, Hersch F, Warzecha W, Snook K, Sywak M, Gill AJ. Remote frozen section examination of breast sentinel lymph nodes by telepathology. ANZ J Surg 2012; 82:803-8. [PMID: 22924988 DOI: 10.1111/j.1445-2197.2012.06191.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intraoperative sentinel lymph node (SLN) examination during breast cancer surgery guides the need for immediate axillary clearance. This may be difficult to implement when surgery is performed distant to the centres where pathological examination is undertaken. We aimed to implement and validate a telepathology service for the remote examination of breast SLN by frozen section (FS). METHODS We tested an Internet-based remote microscopy system to report intraoperative FS in real time from two district hospitals without on-site anatomical pathology services. RESULTS FS was performed remotely on 52 patients. Seventeen out of 52 patients had metastases, of which there were six false-negative diagnoses comprising four of micrometastatic disease and two of isolated tumour cells (ITCs). There were no false-negative diagnoses for macrometastatic disease and no false-positive diagnoses. As a control, we audited our experience with 239 consecutive SLN FS examined by on-site pathologists. Sixty out of 239 patients had metastases, of which there were 24 false-negative diagnoses comprising 12 cases of ITC, 5 of micrometastases and 7 of macrometastases. The accuracy of remote FS was equivalent to that of in-house FS (88.2% versus 89.9%). CONCLUSION Remote FS for breast SLN is an accurate procedure ,which is not inferior to FS performed on site.
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Affiliation(s)
- Andrew J Gifford
- Department of Anatomical Pathology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Concordance between whole-slide imaging and light microscopy for routine surgical pathology. Hum Pathol 2012; 43:1739-44. [PMID: 22591912 DOI: 10.1016/j.humpath.2011.12.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/23/2011] [Accepted: 12/28/2011] [Indexed: 11/19/2022]
Abstract
The use of high-resolution digital images of histopathology slides as a routine diagnostic tool for surgical pathology was investigated. The study purpose was to determine the diagnostic concordance between pathologic interpretations using whole-slide imaging and standard light microscopy. Two hundred fifty-one consecutive surgical pathology cases (312 parts, 1085 slides) from a single pathology service were included in the study after cases had been signed out and reports generated. A broad array of diagnostic challenges and tissue sources were represented, including 52 neoplastic cases. All cases were digitized at ×20 and presented to 2 pathologists for diagnosis using whole-slide imaging as the sole diagnostic tool. Diagnoses rendered by the whole-slide imaging pathologists were compared with the original light microscopy diagnoses. Overall concordance between whole-slide imaging and light microscopy as determined by a third pathologist and jury panel was 96.5% (95% confidence interval, 94.8%-98.3%). Concordance between whole-slide imaging pathologists was 97.7% (95% confidence interval, 94.7%-99.2%). Five cases were discordant between the whole-slide imaging diagnosis and the original light microscopy diagnosis, of which 2 were clinically significant. Discordance resulted from interpretive criteria or diagnostic error. The whole-slide imaging modality did not contribute to diagnostic differences. Problems encountered by the whole-slide imaging pathologists primarily involved the inability to clearly visualize nuclear detail or microscopic organisms. Technical difficulties associated with image scanning required at least 1 slide be rescanned in 13% of the cases. Technical and operational issues associated with whole-slide imaging scanning devices used in this study were found to be the most significant obstacle to the use of whole-slide imaging in general surgical pathology.
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Abstract
Digital pathology systems offer pathologists an alternate, emerging mechanism to manage and interpret information. They offer increasingly fast and scalable hardware platforms for slide scanning and software that facilitates remote viewing, slide conferencing, archiving, and image analysis. Deployed initially and validated largely within the research and biopharmaceutical industries, WSI is increasingly being implemented for direct patient care. Improvements in image quality, scan times, and imageviewing browsers will hopefully allow pathologists to more seamlessly convert to digital pathology, much like our radiology colleagues have done before us. However, WSI creates both opportunities and challenges. Although niche applications of WSI technology for clinical, educational, and research purposes are clearly successful, it is evident that several areas still require attention and careful consideration before more widespread clinical adoption of WSI takes place. These include regulatory issues, development of standards of practice and validation guidelines, workflow modifications, as well as defining situations where WSI technology will really improve practice in a cost-effective way. Current progress on these and other issues, along with improving technology, will no doubt pave the way for increased adoption over the next decade, allowing the pathology community as a whole to harness the true potential of WSI for patient care. The digital decade will likely redefine how pathology is practiced and the role of the pathologist.
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Brachtel E, Yagi Y. Digital imaging in pathology--current applications and challenges. JOURNAL OF BIOPHOTONICS 2012; 5:327-335. [PMID: 22213680 DOI: 10.1002/jbio.201100103] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/20/2011] [Accepted: 11/30/2011] [Indexed: 05/31/2023]
Abstract
Conventional histopathology is rapidly shifting towards digital integration. Will microscopes (and pathologists) soon be obsolete? Or are we dealing with just another image modality that leaves the core of tissue diagnosis intact? This article provides an overview of current digital pathology applications and research with emphasis on whole slide imaging (WSI). Static or interactive digital pathology work stations already can be used for many purposes, e.g. telepathology expert consultations, frozen section diagnosis in remote areas, cytology screening, quality assurance, diagnostic validations for clinical trials, quantitation of hormone receptor or HER2 studies in breast cancer, or three-dimensional visualization of anatomical structures, among others. Changes of workflow in histology laboratories are beginning to enable digital image acquisition and WSI in a routine setting. WSI plays an increasing role in pathology education, glass slide boxes in medical schools are being replaced by digital slide collections; digital slide seminars and virtual microscopy are used for postgraduate and continuing medical education in pathology. Research and efforts to validate WSI systems for diagnostic settings are ongoing.
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Affiliation(s)
- Elena Brachtel
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Weinstein RS, Graham AR, Lian F, Braunhut BL, Barker GR, Krupinski EA, Bhattacharyya AK. Reconciliation of diverse telepathology system designs. Historic issues and implications for emerging markets and new applications. APMIS 2012; 120:256-75. [DOI: 10.1111/j.1600-0463.2011.02866.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ronald S. Weinstein
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Anna R. Graham
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Fangru Lian
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Beth L. Braunhut
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Gail R. Barker
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Elizabeth A. Krupinski
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
| | - Achyut K. Bhattacharyya
- Department of Pathology and Arizona Telemedicine Program; College of Medicine; University of Arizona; Tucson; AZ; USA
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Trudel MC, Paré G, Têtu B, Sicotte C. The effects of a regional telepathology project: a study protocol. BMC Health Serv Res 2012; 12:64. [PMID: 22420301 PMCID: PMC3324388 DOI: 10.1186/1472-6963-12-64] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telepathology, which is an emerging form of telemedicine in Canada, is defined as the electronic transmission of pathological images, usually derived from microscopes, from one location to another. There are various applications of telepathology, including case referral for an expert opinion, provision of an emergency service in the absence of a resident pathologist, and education. Until now, there has been relatively little use of telepathology for core diagnostic services in the absence of a local pathologist, but this practice is likely to increase in the future. The Laval University Integrated Health Network is in the process of deploying a telepathology system, primarily to provide an intraoperative frozen section service to small hospitals in sparsely populated areas which are experiencing a severe shortage of on-site pathologists. The telepathology project involves 17 hospitals located in five regions of eastern Quebec, Canada. This paper describes the study protocol that will be used to evaluate the benefits associated with the project. METHODS/DESIGN A panel of experts was first assembled by Canada Health Infoway to agree on a set of benefits indicators that could be applied to all telepathology projects across Canada. Using the set of indicators as an input, we have developed a three-step study protocol. First, a survey questionnaire will be distributed to appraise the way pathologists, pathology technologists and surgeons perceive the telepathology system and its impacts. Second, a series of semi-structured interviews will be conducted with project leaders and telepathology users at sites that are representative of all the hospitals in the Laval University Integrated Health Network. The overall aim is to better understand the expected and unexpected effects of telepathology on health care professionals and patients as well as on the regional organization and delivery of care services. Finally, a pre-post design using secondary data is proposed to evaluate a wide array of tangible benefits to the patients, the health care providers, the hospitals, and the region as a whole. DISCUSSION The Laval University Integrated Health Network's telepathology project is expected to yield positive and significant results that are relevant internationally. Our findings will provide valuable information on the nature and extent of benefits associated with telepathology systems intended to provide an intraoperative frozen section service to remote hospitals experiencing a shortage of specialists.
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Ramey J, Fung KM, Hassell LA. Use of mobile high-resolution device for remote frozen section evaluation of whole slide images. J Pathol Inform 2011; 2:41. [PMID: 21969922 PMCID: PMC3169922 DOI: 10.4103/2153-3539.84276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/25/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction: With recent advances, it is now possible to view whole slide images (WSI) on mobile, high-resolution, viewing devices (MVD). This creates a new paradigm in which MVDs may be used for consultation and/or diagnosis. Validation of the results with devices is important for practitioners and regulators. We evaluated the use of MVDs in frozen section (FS) interpretation. Methods: A series of 72 consecutive FS cases were selected for potential inclusion in the study. A 67 case subset of these were successfully scanned at 20x magnification. Scan times were recorded. A sample of WSI FS cases, with gross and clinical information, was presented to six pathologists on an iPad MVD using the Interpath application. Times to diagnosis were recorded. Results were compared with the original reported and final diagnosis. Participants also completed a survey assessing image quality, interface, and diagnostic comfort level. Results: Scan times averaged two minutes and 46 seconds per slide, (standard deviation [SD] 2 minutes 46 seconds). Evaluation times averaged 4 minutes and 59 seconds per case, range to 13 minutes and 50 seconds, SD 3 minutes 48 seconds. Concordance between initial FS diagnosis and rendered through the MVD was 89%. Minor discrepancies made up 8% and major disagreements 3%. The kappa statistic for this series is 0.85. Participants rated the experience at 5 on a 10-point scale, range 3 to 7. Two-thirds found the image quality to be adequate, half were satisfied with image resolution, and 33% would be willing to make a diagnosis on the iPad, plus one only for special cases. Five of six respondents (83%) found the navigation with the study software difficult. Conclusion: Image fidelity and resolution makes the iPad potentially suitable for WSI evaluation of FS. Acceptable accuracy is attainable for FS interpretation. But, although possible to obtain acceptable results, use of the iPad with Interpath to view WSI is not easy and meets user resistance. The obstacle of slide navigation at high magnification could introduce frustrations, delays, or errors.
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Affiliation(s)
- Joel Ramey
- Oklahoma University College of Medicine, Oklahoma City, OK
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Bibliography: Current world literature. Female urology. Curr Opin Urol 2010; 20:343-6. [PMID: 20531093 DOI: 10.1097/mou.0b013e32833bd73a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The vast advancements in telecommunications and converting medical information to a digital format have increased the number of applications within telemedicine. Telepathology, in simplest terms, is the practice of formally rendering a pathologic diagnosis based upon examination of an image rather than of a glass slide through traditional microscopy. The use of telepathology for clinical patient care has so far been limited to relatively few large academic institutions. Although a number of challenges remain, there is increasing demand for the use of information technology in pathology as a whole owing to the expansion of health care networks and the opportunity to enhance the quality of service delivered to patients. The software used to acquire, display, and manage digital images for clinical patient care may be subject to national and federal regulations just as is any other electronic information system. Despite the barriers, telepathology systems possess the capability to help manage pathology cases on a global scale, improve laboratory workload distribution, increase standardization of practice and enable new classes of ancillary studies to facilitate diagnosis and education even in the most remote parts of the earth.
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Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Hum Pathol 2009; 40:1057-69. [PMID: 19552937 DOI: 10.1016/j.humpath.2009.04.006] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/09/2009] [Indexed: 11/23/2022]
Abstract
Telepathology, the practice of pathology at a long distance, has advanced continuously since 1986. Today, fourth-generation telepathology systems, so-called virtual slide telepathology systems, are being used for education applications. Both conventional and innovative surgical pathology diagnostic services are being designed and implemented as well. The technology has been commercialized by more than 30 companies in Asia, the United States, and Europe. Early adopters of telepathology have been laboratories with special challenges in providing anatomic pathology services, ranging from the need to provide anatomic pathology services at great distances to the use of the technology to increase efficiency of services between hospitals less than a mile apart. As to what often happens in medicine, early adopters of new technologies are professionals who create model programs that are successful and then stimulate the creation of infrastructure (ie, reimbursement, telecommunications, information technologies, and so on) that forms the platforms for entry of later, mainstream, adopters. The trend at medical schools, in the United States, is to go entirely digital for their pathology courses, discarding their student light microscopes, and building virtual slide laboratories. This may create a generation of pathology trainees who prefer digital pathology imaging over the traditional hands-on light microscopy. The creation of standards for virtual slide telepathology is early in its development but accelerating. The field of telepathology has now reached a tipping point at which major corporations now investing in the technology will insist that standards be created for pathology digital imaging as a value added business proposition. A key to success in teleradiology, already a growth industry, has been the implementation of standards for digital radiology imaging. Telepathology is already the enabling technology for new, innovative laboratory services. Examples include STAT QA surgical pathology second opinions at a distance and a telehealth-enabled rapid breast care service. The innovative bundling of telemammography, telepathology, and teleoncology services may represent a new paradigm in breast care that helps address the serious issue of fragmentation of breast cancer care in the United States and elsewhere. Legal and regulatory issues in telepathology are being addressed and are regarded as a potential catalyst for the next wave of telepathology advances, applications, and implementations.
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