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Hu D, Wang C, Zheng S, Cui X. Investigating the genealogy of the literature on digital pathology: a two-dimensional bibliometric approach. Scientometrics 2022. [DOI: 10.1007/s11192-021-04224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Archondakis S, Roma M, Kaladelfou E. Implementation of pre-captured videos for remote diagnosis of cervical cytology specimens. Cytopathology 2020; 32:338-343. [PMID: 33368677 DOI: 10.1111/cyt.12948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/08/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. METHODS The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated. RESULTS Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91. CONCLUSIONS Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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Evaluation of Accuracy and Repeatability of Static Telepathology Diagnosis in Assessing the Severity of Dysplasia in Cervical Samples. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00444-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Archondakis S, Roma M, Kaladelfou E. The Implementation of Static Telecytology for Teleconsultation Purposes During Preoperative Evaluation of Thyroid Fine-Needle Aspiration Specimens. Telemed J E Health 2020; 27:207-212. [PMID: 32379546 DOI: 10.1089/tmj.2020.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: The objective of this study was to investigate the impact of applying static telecytology for teleconsultation purposes during preoperative evaluation of challenging thyroid fine-needle aspiration specimens. Materials and Methods: The study was performed on 141 cytologically challenging specimens of 125 patients referred to Alpha Prolipsis Cytopathology Department. All cases were finally confirmed histologically. During the study, 10 characteristic images from each case were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists, with documented experience in the field of thyroid cytology. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered based on digitized images and conventional slides. Telecytology is a prompt and valid method for acquisition of a second opinion diagnosis in challenging cases and can be integrated into daily workflow. The use of telecytology for teleconsultation purposes in the laboratory's daily workflow will further ensure the accuracy of preoperative cytological diagnoses and will contribute to cytopathologists continuous education and better understanding of the criteria applied in thyroid gland lesions cytomorphological diagnosis. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered based on digitized images among contributing cytopathologists. The overall interobserver agreement was very good with κ values of 0.73-0.88. Conclusions: The widespread availability of imaging technology and telecommunication enables instant access to global expert cytopathologists. Static telecytology can be used as an efficient method for acquisition of second opinion in challenging thyroid fine-needle aspiration specimens. It can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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5
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Archondakis S, Roma M, Kaladelfou E. The Use of Static Telecytology for Quality Assessment Purposes in the Evaluation of Cervical Smears Prepared by Means of Liquid-Based Cytology. Telemed J E Health 2020; 26:1522-1525. [PMID: 32167860 DOI: 10.1089/tmj.2019.0303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. Materials and Methods: The study was performed on representative digital cytological images from a total of 808 cervical smears (benign, 270; atypical squamous cells of undetermined significance, 184; low-grade squamous intraepithelial lesion, 124; high-grade squamous intraepithelial lesion, 174; squamous cell carcinoma, 52; and adenocarcinoma, 4) that were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. Their reports were recorded and classified. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of digitized images and conventional slides. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97. Conclusions: Static telecytology can be used as an alternative method for the cytological diagnosis of cervical smears, particularly in quality assurance programs. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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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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Voelker HU, Stauch G, Strehl A, Azima Y, Mueller-Hermelink HK. Diagnostic validity of static telepathology supporting hospitals without local pathologists in low-income countries. J Telemed Telecare 2018; 26:261-270. [PMID: 30595076 DOI: 10.1177/1357633x18818745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Static telepathology (TP) was used to support a hospital in Tanzania that cannot employ a resident pathologist but has a basic laboratory. Histological slides were prepared by the local technical staff and digital images were uploaded into an Internet-based system; consultant pathologists in Germany could give their opinion. The aim of the study was to examine the diagnostic validity of this project without local pathologists. METHODS The set-up period for special training of local technical assistants was 10 weeks. Diagnoses of the first 545 cases that were processed via TP were compared with the results of a second opinion on the basis of routine slides created from the corresponding paraffin blocks, which were sent to Germany. RESULTS Of all cases, 384 (70%) TP diagnoses were completely confirmed by the second opinion. Minor deviations (e.g. divergent subtypes of tumours or other aetiology of non-specific reactive processes) were documented in 76 cases (14%), so that overall, 84% of diagnoses were useful in the setting of the available therapeutic possibilities. The results were better in some subgroups of diseases (90-100% useful diagnoses) and suboptimal (minimum 63%) in a few subgroups with rare diseases. Thirty (5%) malignant diseases were primarily misinterpreted as being benign and 12 (2%) benign diseases as malignant. Forty-three (8%) cases were insufficient for diagnosis using TP and could not be provided with a primary assessment. DISCUSSION Static TP can help support medical services in low-income countries in the absence of local pathologists with a potentially high diagnostic validity, especially for selected groups of diseases. The procedure can significantly improve the diagnostic procedures before commencement of therapy - a substantial contribution within a globalised world.
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Affiliation(s)
- Hans-Ullrich Voelker
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Gerhard Stauch
- Retired Pathologist, Consultant in Telepathology, Aurich, Germany
| | - Annette Strehl
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Yasmin Azima
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
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Montgomery ND, Tomoka T, Krysiak R, Powers E, Mulenga M, Kampani C, Chimzimu F, Owino MK, Dhungel BM, Gopal S, Fedoriw Y. Practical Successes in Telepathology Experiences in Africa. Clin Lab Med 2018; 38:141-150. [PMID: 29412878 PMCID: PMC5996143 DOI: 10.1016/j.cll.2017.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Across much of Africa, there is a critical shortage of pathology services necessary for clinical care. Even in settings where specialty-level clinical care, such as medical oncology, is available, access to anatomic pathology services has often lagged behind. Pathology laboratories in the region are challenging to establish and maintain. This article describes the successful implementation of telepathology services in Malawi and reviews other successful programs developed to support diagnostic pathology in resource-limited settings.
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Affiliation(s)
- Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Tamiwe Tomoka
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Robert Krysiak
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Eric Powers
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Maurice Mulenga
- Kamuzu Central Hospital, Tidziwe Centre, PO Box 149, Lilongwe, Malawi
| | - Coxcilly Kampani
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Fred Chimzimu
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Michael K Owino
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | | | - Satish Gopal
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, 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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Shah KK, Lehman JS, Gibson LE, Lohse CM, Comfere NI, Wieland CN. Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology. J Am Acad Dermatol 2016; 75:1229-1237. [PMID: 27742174 DOI: 10.1016/j.jaad.2016.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Teledermatopathology has evolved from static images to whole slide imaging (WSI), which allows for remote viewing and manipulation of tissue sections. Previous studies of WSI in teledermatopathology predated College of American Pathologists (CAP) telepathology validation guidelines. OBJECTIVE We conducted a comprehensive retrospective WSI validation study of routine dermatopathology cases, adhering to CAP guidelines. METHOD In all, 181 consecutive cases arranged into 3 categories (inflammatory, melanocytic, nonmelanocytic proliferations) were reviewed by 3 board-certified dermatopathologists via traditional microscopy (TM) and WSI. Intraobserver (TM vs WSI), TM intraobserver and interobserver (TM vs TM), and WSI interobserver (WSI vs WSI) concordance was interpreted using a 3-tier system. RESULTS TM versus WSI intraobserver concordance (86.9%; 95% confidence interval [CI] 83.7-89.6) did not differ from TM versus TM intraobserver concordance (90.3%; 95% CI 86.7-93.1) or interobserver concordance (WSI: 89.9%; 95% CI 87.0-92.2, and TM: 89.5%; 95% CI 86.5-91.9). Melanocytic proliferations had the lowest TM versus WSI intraobserver concordance (75.6%; 95% CI 68.5-81.5), whereas inflammatory lesions had the highest TM versus WSI intraobserver concordance (96.1%; 95% CI 91.8-98.3). Nonmelanocytic proliferations had an intraobserver concordance of 89.1% (95% CI 83.4-93.0). LIMITATIONS Efficiency and other logistical WSI parameters were not evaluated. CONCLUSION Intraobserver and interobserver diagnostic concordance between WSI and TM was equivalent. Therefore, WSI appears to be a reliable diagnostic modality for dermatopathology.
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Affiliation(s)
- Kabeer K Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Carilyn N Wieland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
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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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Mpunga T, Hedt-Gauthier BL, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman DS, Pepoon JR, Shulman LN, Milner DA. Implementation and Validation of Telepathology Triage at Cancer Referral Center in Rural Rwanda. J Glob Oncol 2016; 2:76-82. [PMID: 28717686 PMCID: PMC5495446 DOI: 10.1200/jgo.2015.002162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Connecting a cancer patient to the appropriate treatment requires the correct diagnosis provided in a timely manner. In resource-limited settings, the anatomic pathology bridge to efficient, accurate, and timely cancer care is often challenging. In this study, we present the first phase of an anatomic telepathology triage system, which was implemented and validated at the Butaro District Hospital in northern rural Rwanda. Methods Select cases over a 9-month period in three segments were evaluated by static image telepathology and were independently evaluated by standard glass slide histology. Each case via telepathology was classified as malignant, benign, infectious/inflammatory, or nondiagnostic and was given an exact histologic diagnosis. Results For cases triaged as appropriate for telepathology, correlation with classification and exact diagnosis demonstrated greater than 95% agreement over the study. Cases in which there was disagreement were analyzed for cause, and the triage process was adjusted to avoid future problems. Conclusion Challenges to obtaining a correct and complete diagnosis with telepathology alone included the need for immunohistochemistry, assessment of the quality of images, and the lack of images representing an entire sample. The next phase of the system will assess the effect of telepathology triage on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for evaluation outside of telepathology.
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Affiliation(s)
- Tharcisse Mpunga
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bethany L Hedt-Gauthier
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Irenee Nshimiyimana
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Gaspard Muvugabigwi
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Natalie Pritchett
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lauren Greenberg
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Origene Benewe
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David S Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James R Pepoon
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Danny A Milner
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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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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Schuh F, Biazús JV, Resetkova E, Benfica CZ, Ventura ADF, Uchoa D, Graudenz M, Edelweiss MIA. Histopathological grading of breast ductal carcinoma in situ: validation of a web-based survey through intra-observer reproducibility analysis. Diagn Pathol 2015; 10:93. [PMID: 26159429 PMCID: PMC4702358 DOI: 10.1186/s13000-015-0320-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Histopathological grading diagnosis of ductal carcinoma in situ (DCIS) of the breast may be very difficult even for experts, and it is important for therapeutic decisions. The challenge may be due to the inaccurate and/or subjective application of the diagnosis criteria. The aim of this study was to investigate the intra-observer agreement between a traditional method and a developed web-based questionnaire for scoring breast DCIS. METHODS A cross-sectional study was carried out to evaluate the diagnostic agreement of an electronic questionnaire and its point scoring system with the subjective reading of digital images for 3 different DCIS grading systems: Holland, Van Nuys and modified Black nuclear grade system. Three pathologists analyzed the same set of digitized images from 43 DCIS cases using two different web-based programs. In the first phase, they accessed a website with a newly created questionnaire and scoring system developed to allow the determination of the histological grade of the cases. After at least 6 months, the pathologists read again the same images, but without the help of the questionnaire, indicating subjectively the diagnoses. The intra-observer agreement analysis was employed to validate this innovative web-based survey. RESULTS Overall, diagnostic reproducibility was similar for all histologic grading classification systems, with kappa values of 0.57 ± 0.10, 0.67 ± 0.09 and 0.67 ± 0.09 for Holland, Van Nuys classification and modified Black nuclear grade system respectively. Only two 2-step diagnostic disagreements were found, one for Holland and another for Van Nuys. Both cases were superestimated by the web-based survey. CONCLUSION The diagnostic agreement between the web-based questionnaire and a traditional method, both using digital images, is moderate to good for Holland, Van Nuys and modified Black nuclear grade system. The use of a scoring point system does not appear to pose a major risk of presenting large (2-step) diagnostic disagreements. These findings indicate that the use of this point scoring system in this web-based survey to grade objectively DCIS lesions is a useful diagnostic tool.
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Affiliation(s)
- Fernando Schuh
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Breast surgeon, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | | | - Erika Resetkova
- Department of Pathology, MD Anderson Cancer Center, Houston, Texas, USA.
| | | | | | - Diego Uchoa
- Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Márcia Graudenz
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Maria Isabel Albano Edelweiss
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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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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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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Mostafa MG, Dalquen P, Kunze D, Terracciano L. Telecytological diagnosis of space-occupying lesions of the liver. Acta Cytol 2014; 58:174-81. [PMID: 24457208 DOI: 10.1159/000357195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/11/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In this study, the efficiency of telemedical consulting with regard to fine needle aspirates from space-occupying lesions (SOLs) of the liver is investigated for the first time. STUDY DESIGN The study includes fine needle aspirations from 62 patients, 33 with hepatocellular carcinoma (HCC) and 29 with non-hepatic tumors. Using the Internet-based iPath system, the initial pathologist submitted 1-8 images from smears and cell block sections. One consultant assessed the cytological and another one the histological images. Both made their diagnoses independent of each other. A final diagnosis was made by immunochemistry of cell block sections. The cytological images were analyzed retrospectively for the occurrence of the most typical HCC indicators. The number of these indicators was related to the initial diagnoses of the three pathologists, and possible reasons for diagnostic errors were analyzed based on this analysis. RESULTS The accuracy of the preliminary telemedical diagnoses regarding HCC was 82.0% for the cytological images and 87.7% for the histological images. Most of the false diagnoses occurred in tumors with unusual cytological and histological patterns. CONCLUSIONS Telemedical consulting is a valuable tool to obtain a second opinion. However, for improvement of the diagnosis of HCC, supplementary immunochemical tests are necessary.
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Dalquen P, Savic Prince S, Spieler P, Kunze D, Neumann H, Eppenberger-Castori S, Adams H, Glatz K, Bubendorf L. Making cytological diagnoses on digital images using the iPath network. Acta Cytol 2014; 58:453-60. [PMID: 25402774 DOI: 10.1159/000369241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool. AIM To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set. METHOD Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant. RESULTS For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions. CONCLUSION Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.
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Affiliation(s)
- Peter Dalquen
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
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Vega S, Marciscano I, Holcomb M, Erps KA, Major J, Lopez AM, Barker GP, Weinstein RS. Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: the Arizona telemedicine program-US Army-Republic of Panama Initiative. Telemed J E Health 2013; 19:746-53. [PMID: 23931731 DOI: 10.1089/tmj.2013.0025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Many developing countries have shown interest in embracing telemedicine and incorporating it into their healthcare systems. In 2000, the U.S. Army Yuma Proving Ground (YPG) initiated a program to assist the Republic of Panama in establishing a demonstration Panamanian rural telemedicine program. YPG engaged the Arizona Telemedicine Program (ATP) to participate in the development and implementation of the program. MATERIALS AND METHODS The ATP recommended adoption of a "top-down" strategy for creating the program. Early buy-in of the Panamanian Ministry of Health and academic leaders was regarded as critical to the achievement of long-term success. RESULTS High-level meetings with the Minister of Health and the Rectors (i.e., Presidents) of the national universities gained early program support. A telemedicine demonstration project was established on a mountainous Indian reservation 230 miles west of Panama City. Today, three rural telemedicine clinics are linked to a regional Ministry of Health hospital for teleconsultations. Real-time bidirectional videoconferencing utilizes videophones connected over Internet protocol networks at a data rate of 768 kilobits per second to the San Felix Hospital. Telepediatrics, tele-obstetrics, telepulmonology, teledermatology, and tele-emergency medicine services became available. Telemedicine services were provided to the three sites for a total of 1,013 cases, with numbers of cases increasing each year. These three demonstration sites remained in operation after discontinuation of the U.S. involvement in September 2009 and serve as a model program for other telemedicine initiatives in Panama. CONCLUSIONS Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model for establishing telemedicine programs in developing countries.
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Affiliation(s)
- Silvio Vega
- 1 School of Medicine, Latin American University of Science and Technology , Panama City, Panama
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Park S, Parwani AV, Aller RD, Banach L, Becich MJ, Borkenfeld S, Carter AB, Friedman BA, Rojo MG, Georgiou A, Kayser G, Kayser K, Legg M, Naugler C, Sawai T, Weiner H, Winsten D, Pantanowitz L. The history of pathology informatics: A global perspective. J Pathol Inform 2013; 4:7. [PMID: 23869286 PMCID: PMC3714902 DOI: 10.4103/2153-3539.112689] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.
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Affiliation(s)
- Seung Park
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Telemedicine across borders: a systematic review of factors that hinder or support implementation. Int J Med Inform 2012; 81:793-809. [PMID: 22975018 DOI: 10.1016/j.ijmedinf.2012.08.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 08/11/2012] [Accepted: 08/14/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades. METHODS Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence. RESULTS 6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors. CONCLUSIONS National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.
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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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Kldiashvili E, Schrader T. Reproducibility of telecytology diagnosis of cervical smears in a quality assurance program: the Georgian experience. Telemed J E Health 2012; 17:565-8. [PMID: 21851161 DOI: 10.1089/tmj.2011.0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study evaluated the reproducibility of telecytology diagnosis of cervical smears on a randomly selected 50 cases under the conditions of Georgia. MATERIALS AND METHODS Fifty cervical smears (benign, 14; atypical squamous cells of undetermined significance [ASCUS], 14; low-grade squamous intraepithelial lesion [LSIL], 10; high-grade squamous intraepithelial lesion [HSIL], 12) were selected. The digital images were captured at a maximum resolution of 2048 × 1536 pixels and transmitted by electronic mail. Diagnosis of glass slides and digital images was done independently in a double-blind manner by three cytologists, versus the diagnosis of digital images followed by diagnosis of glass slides 3 months later. The procedure was repeated after 3 months. RESULTS Diagnoses were recorded as benign, ASCUS, LSIL, and HSIL. Diagnostic accuracy and interobserver reproducibility were analyzed using an interclass correlation coefficient, which revealed good interobserver agreement for the first (0.82) and second (0.68) glass slide diagnoses and the first (0.80) and second (0.66) digital image diagnoses. The kappa values for interobserver variation between first and second glass slide diagnoses and first and second digital image diagnoses showed good to excellent agreement. CONCLUSIONS Digital images are suitable substitutes for glass slides; telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.
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Jukić DM, Drogowski LM, Martina J, Parwani AV. Clinical examination and validation of primary diagnosis in anatomic pathology using whole slide digital images. Arch Pathol Lab Med 2011; 135:372-8. [PMID: 21366463 DOI: 10.5858/2009-0678-oa.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Novel anatomic pathology technologies allow pathologists to digitally view and diagnose cases. Although digital pathology advocates champion its strengths and move to integrate it into practice and workflow, the capabilities and limitations of digital slides have not been fully investigated. OBJECTIVES To estimate intrapathologist diagnostic discrepancy between glass and digital slides and to determine pathologists' diagnostic certainty when diagnosing with the 2 formats. DESIGN Intrapathologist diagnostic consistency between glass and digital slides was measured. Three pathologists diagnosed 101 cases digitally and with corresponding glass slides. Discrepancies between formats were evaluated, and diagnostic precision and certainty were compared. RESULTS A total of 606 diagnoses were evaluated in pairs (202 per pathologist). Seven cases did not transfer to the database and were eliminated from further study. We report no discrepancies between media in 75%, 87%, and 83% of the cases diagnosed by the 3 pathologists, respectively; significant discrepancies were identified in 3%, 3%, and 7% of cases by each pathologist. In total, we identified significant clinical and therapeutic discrepancies in 13 of 296 cases (4.4%). The certainty values provided by each pathologist were similar between formats. CONCLUSIONS This study did not detect significant differences between diagnoses based on digital and glass slides. We believe that this study further supports the integration of digital slides into pathology workflow, particularly considering the low rate of discrepancy documented here.
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Affiliation(s)
- Drazen M Jukić
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania, 15213, USA.
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Heimann A, Maini G, Hwang S, Shroyer KR, Singh M. Use of telecytology for the immediate assessment of CT guided and endoscopic FNA cytology: Diagnostic accuracy, advantages, and pitfalls. Diagn Cytopathol 2010; 40:575-81. [DOI: 10.1002/dc.21582] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 09/29/2010] [Indexed: 11/05/2022]
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Dunn BE, Choi H, Recla DL, Kerr SE, Wagenman BL. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a twelve year experience. Semin Diagn Pathol 2009; 26:187-93. [DOI: 10.1053/j.semdp.2009.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Archondakis S, Georgoulakis J, Stamataki M, Anninos D, Skagias L, Panayiotides I, Peros G, Karakitsos P. Telecytology: A Tool for Quality Assessment and Improvement in the Evaluation of Thyroid Fine-Needle Aspiration Specimens. Telemed J E Health 2009; 15:713-7. [DOI: 10.1089/tmj.2009.0037] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Lazaros Skagias
- Department of Cytopathology, 401 General Army Hospital, Athens, Greece
| | | | - George Peros
- 4th Department of Surgery, Attikon University Hospital, Athens, Greece
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Dunn BE, Choi H, Recla DL, Kerr SE, Wagenman BL. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience. Hum Pathol 2009; 40:1092-9. [DOI: 10.1016/j.humpath.2009.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
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Medicolegal aspects of telepathology. Hum Pathol 2009; 40:1137-42. [DOI: 10.1016/j.humpath.2009.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 01/14/2009] [Accepted: 01/16/2009] [Indexed: 11/20/2022]
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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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Virtual slide telepathology for an academic teaching hospital surgical pathology quality assurance program. Hum Pathol 2009; 40:1129-36. [PMID: 19540562 DOI: 10.1016/j.humpath.2009.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/09/2009] [Indexed: 11/23/2022]
Abstract
Virtual slide telepathology is an important potential tool for providing re-review of surgical pathology cases as part of a quality assurance program. The University of Arizona pathology faculty has implemented a quality assurance program between 2 university hospitals located 6 miles apart. The flagship hospital, University Medical Center (UMC), in Tucson, AZ, handles approximately 20 000 surgical pathology specimens per year. University Physicians Healthcare Hospital (UPHH) at Kino Campus has one tenth the volume of surgical pathology cases. Whereas UMC is staffed by 10 surgical pathologists, UPHH is staffed daily by a single part-time pathologist on a rotating basis. To provide same-day quality assurance re-reviews of cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc, Tucson, AZ) was installed at the UPHH in 2005. Since then, glass slides of new cases of cancer and other difficult cases have been scanned the same day the slides are produced by the UPHH histology laboratory. The pathologist at UPHH generates a provisional written report based on light microscopic examination of the glass slides. At 2:00 pm each day, completed cases from UPHH are re-reviewed by staff pathologists, pathology residents, and medical students at the UMC using the DMetrix Iris virtual slide viewer. The virtual slides are viewed on a 50-in plasma monitor. Results are communicated with the UPHH laboratory by fax. We have analyzed the results of the first 329 consecutive quality assurance cases. There was complete concordance with the original UPHH diagnosis in 302 (91.8%) cases. There were 5 (1.5%) major discrepancies, which would have resulted in different therapy and/or management, and 10 (3.0%) minor discrepancies. In 6 cases (1.8%), the diagnosis was deferred for examination of the glass slides by the reviewing pathologists at UMC, and the diagnosis of another 6 (1.8%) cases were deferred pending additional testing, usually immunohistochemistry. Thus, the quality assurance program found a small number of significant diagnostic discrepancies. We also found that implementation of a virtual slide telepathology quality assurance service improved the job satisfaction of academic subspecialty pathologists assigned to cover on-site surgical pathology services at a small, affiliated university hospital on a rotating part-time basis. These findings should be applicable to some community hospital group practices as well.
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Shanmugaratnam K. Happenings in Histopathology – A Post-World War II Perspective. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v36n8p691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
There have been several important developments in the practice of histopathology since World War II; those reviewed in this lecture are grouped under 4 headings: new techniques (cytopathology, electron microscopy, immunohistochemistry and molecular pathology), organisational issues (recruitment, training and certification, subspecialties, quality control and consultations), ethical and legal issues (service costs, and the ownership and uses of biopsy tissues) and globalisation (international associations, standardised classification and nomenclature, and telepathology). Advances in the fields of molecular pathology and telepathology are expected to have the greatest impact on the practice of pathology in the next decade.
Key words: Anatomic pathology, Organisation, Globalisation, Telepathology
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Clarke GM, Zubovits JT, Katic M, Peressotti C, Yaffe MJ. Spatial resolution requirements for acquisition of the virtual screening slide for digital whole-specimen breast histopathology. Hum Pathol 2007; 38:1764-71. [PMID: 17707460 DOI: 10.1016/j.humpath.2007.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/27/2007] [Accepted: 04/05/2007] [Indexed: 10/22/2022]
Abstract
We examined the effect of lateral spatial resolution and reader specialty on the accuracy of detection of breast cancer. The motivation for this pilot study was the need to acquire and display very large data sets in whole-specimen 3D digital breast histopathology imaging. The ultimate goal is to determine the minimum resolution adequate for detection of malignancy. Twenty-three histologic slides were selected from breast pathology cases and digitized at 2 sampling distances (3.2 and 1.9 microm pixels). Images were viewed by 14 pathologists, of whom 5 had breast pathology as their primary specialty. The readers assessed the likelihood of malignancy on a 5-point Likert scale, and provided a provisional diagnosis. For the detection task, sensitivity, specificity, overall accuracy of detection, and area under the receiver-operator curve were calculated. An overall diagnostic score, and scores grouped by malignancy type, were also computed. Outcome measures were examined for significant resolution and specialty effects. Increasing the lateral resolution significantly improved accuracy in diagnosis (P=.004) but no effect was found for detection. Breast specialists achieved significantly higher scores for all outcome measures except specificity. Differences in performance between the 2 groups of readers tended to be greater for the diagnostic task compared to detection, especially at the higher resolution. However, specimen coverage may also be a significant factor. Factors related to the readers may have also affected performance in this study. Based on these results, a more comprehensive study should examine pixel sizes between 0.7 and 1.9 microm.
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Affiliation(s)
- Gina M Clarke
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5.
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Glatz K, Pritt B, Glatz D, Hartmann A, O'Brien MJ, Blaszyk H. A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps. Am J Clin Pathol 2007; 127:938-45. [PMID: 17509991 DOI: 10.1309/nxdb6fmte9x5cd6y] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This Internet-based quiz (http://kathrin.unibas.ch/polyp/) tested the diagnostic variability of 168 pathologists in the diagnosis of 20 colorectal polyps on 3 representative images, including hyperplastic polyps (HPs), traditional serrated adenomas (TSAs), sessile serrated adenomas (SSAs), and tubulovillous adenomas (TVAs). Interobserver variability for each of the 20 lesions was significant and was most pronounced for SSAs. Correct answers were independent of the participant's experience with TVAs, HPs, and TSAs. Participants with gastrointestinal subspecialty training and those who had read a reference article on serrated polyps gave a significantly higher percentage of correct answers for SSAs. The nomenclature used for serrated polyps was generally inconsistent. Our results suggest significant shortcomings in the routine H&E diagnosis of serrated colorectal polyps. A diagnostically unifying concept for lesions of the serrated neoplasia pathway, standardization of nomenclature, training of pathologists, and possibly development of ancillary techniques are of paramount importance for accurate patient management.
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Affiliation(s)
- Katharina Glatz
- Departments of Pathology, University of Basel, Basel, Switzerland
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Teodorovic I, Isabelle M, Carbone A, Passioukov A, Lejeune S, Jaminé D, Therasse P, Gloghini A, Dinjens WNM, Lam KH, Oomen MHA, Spatz A, Ratcliffe C, Knox K, Mager R, Kerr D, Pezzella F, van Damme B, van de Vijver M, van Boven H, Morente MM, Alonso S, Kerjaschki D, Pammer J, Lopez-Guerrero JA, Llombart Bosch A, van Veen EB, Oosterhuis JW, Riegman PHJ. TuBaFrost 6: Virtual microscopy in virtual tumour banking. Eur J Cancer 2006; 42:3110-6. [PMID: 17027253 DOI: 10.1016/j.ejca.2006.04.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 04/04/2006] [Indexed: 11/26/2022]
Abstract
Many systems have already been designed and successfully used for sharing histology images over large distances, without transfer of the original glass slides. Rapid evolution was seen when digital images could be transferred over the Internet. Nowadays, sophisticated Virtual Microscope systems can be acquired, with the capability to quickly scan large batches of glass slides at high magnification and compress and store the large images on disc, which subsequently can be consulted through the Internet. The images are stored on an image server, which can give simple, easy to transfer pictures to the user specifying a certain magnification on any position in the scan. This offers new opportunities in histology review, overcoming the necessity of the dynamic telepathology systems to have compatible software systems and microscopes and in addition, an adequate connection of sufficient bandwidth. Consulting the images now only requires an Internet connection and a computer with a high quality monitor. A system of complete pathology review supporting bio-repositories is described, based on the implementation of this technique in the European Human Frozen Tumor Tissue Bank (TuBaFrost).
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Affiliation(s)
- I Teodorovic
- EORTC Data Center, Avenue E. Mounier 83, B-1200 Brussels, Belgium
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Abdirad A, Sarrafpour B, Ghaderi-sohi S. Static telepathology in cancer institute of Tehran university: report of the first academic experience in Iran. Diagn Pathol 2006; 1:33. [PMID: 17018157 PMCID: PMC1594583 DOI: 10.1186/1746-1596-1-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 10/04/2006] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Afshin Abdirad
- Assistant Professor of Pathology, Cancer Institute, Tehran University of Medical Sciences, Cancer Institute, Keshavarz Blvd., Tehran, Iran
| | - Babak Sarrafpour
- Resident of Oral Pathology, School of Dentistry, Tehran University of Medical Sciences, Enghelab St, Tehran, Iran
| | - Siavash Ghaderi-sohi
- Resident of Pathology, Cancer Institute, Tehran University of Medical Sciences, Cancer Institute, Keshavarz Blvd., Tehran, Iran
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Panizzi KTC, Jones KN, Anderson PG. Acquisition and use of digital images for pathology education and practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 563:178-93. [PMID: 16433132 DOI: 10.1007/0-387-32025-3_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Heinzelmann PJ, Williams CM, Lugn NE, Kvedar JC. Clinical outcomes associated with telemedicine/telehealth. Telemed J E Health 2005; 11:329-47. [PMID: 16035930 DOI: 10.1089/tmj.2005.11.329] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This paper is a comprehensive review and synthesis of the literature concerning clinical outcomes associated with various telemedicine applications. It starts out with a brief description of the findings reported by similar literature reviews already published. Subsequently, it proposes a conceptual model for assessing clinical outcomes based on Donabedian's formulation of the Medical Care Process. Accordingly, research findings are reported in terms of the relevant components of the medical care process, namely, diagnosis, clinical management, and clinical outcomes. Specific findings are organized according to the designated clinical and diagnostic application. This is followed by a general report of studies dealing with patient satisfaction.
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Johnston DJ, Costello SP, Dervan PA, O'Shea DG. Development and preliminary evaluation of the VPS ReplaySuite: a virtual double-headed microscope for pathology. BMC Med Inform Decis Mak 2005; 5:10. [PMID: 15845147 PMCID: PMC1087846 DOI: 10.1186/1472-6947-5-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 04/21/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in computing and telecommunications have resulted in the availability of a range of online tools for use in pathology training and quality assurance. The majority focus on either enabling pathologists to examine and diagnose cases, or providing image archives that serve as reference material. Limited emphasis has been placed on analysing the diagnostic process used by pathologists to reach a diagnosis and using this as a resource for improving diagnostic performance. METHODS The ReplaySuite is an online pathology software tool that presents archived virtual slide examinations to pathologists in an accessible video-like format, similar to observing examinations with a double-headed microscope. Delivered through a customized web browser, it utilises PHP (Hypertext PreProcessor) to interact with a remote database and retrieve data describing virtual slide examinations, performed using the Virtual Pathology Slide (VPS). To demonstrate the technology and conduct a preliminary evaluation of pathologists opinions on its potential application in pathology training and quality assurance, 70 pathologists were invited to use the application to review their own and other pathologists examinations of 10 needle-core breast biopsies and complete an electronic survey. 9 pathologists participated, and all subsequently completed an exit survey. RESULTS Of those who replayed an examination by another pathologist, 83.3% (5/6) agreed that replays provided an insight into the examining pathologists diagnosis and 33.3% (2/6) reconsidered their own diagnosis for at least one case. Of those who reconsidered their original diagnosis, all re-classified either concordant with group consensus or original glass slide diagnosis. 77.7% (7/9) of all participants, and all 3 participants who replayed more than 10 examinations stated the ReplaySuite to be of some or great benefit in pathology training and quality assurance. CONCLUSION Participants conclude the ReplaySuite to be of some or of great potential benefit to pathology training and quality assurance and consider the ReplaySuite to be beneficial in evaluating the diagnostic trace of an examination. The ReplaySuite removes temporal and spatial issues that surround the use of double-headed microscopes by allowing examinations to be reviewed at different times and in different locations to the original examination. While the evaluation set was limited and potentially subject to bias, the response of participants was favourable. Further work is planned to determine whether use of the ReplaySuite can result in improved diagnostic ability.
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Affiliation(s)
- Dan J Johnston
- Medical Informatics Group, School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Sean P Costello
- Medical Informatics Group, School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Peter A Dervan
- The Conway Institute of Biomolecular and Biomedical Research, University College Dublin and The Pathology Department, Mater Misericordiae Hospital, Dublin, Ireland
| | - Daniel G O'Shea
- Medical Informatics Group, School of Biotechnology, Dublin City University, Dublin, Ireland
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Dennis T, Start RD, Cross SS. The use of digital imaging, video conferencing, and telepathology in histopathology: a national survey. J Clin Pathol 2005; 58:254-8. [PMID: 15735155 PMCID: PMC1770595 DOI: 10.1136/jcp.2004.022012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2004] [Indexed: 11/03/2022]
Abstract
AIMS To undertake a large scale survey of histopathologists in the UK to determine the current infrastructure, training, and attitudes to digital pathology. METHODS A postal questionnaire was sent to 500 consultant histopathologists randomly selected from the membership of the Royal College of Pathologists in the UK. RESULTS There was a response rate of 47%. Sixty four per cent of respondents had a digital camera mounted on their microscope, but only 12% had any sort of telepathology equipment. Thirty per cent used digital images in electronic presentations at meetings at least once a year and only 24% had ever used telepathology in a diagnostic situation. Fifty nine per cent had received no training in digital imaging. Fifty eight per cent felt that the medicolegal implications of duty of care were a barrier to its use. A large proportion of pathologists (69%) were interested in using video conferencing for remote attendance at multidisciplinary team meetings. CONCLUSIONS There is a reasonable level of equipment and communications infrastructure among histopathologists in the UK but a very low level of training. There is resistance to the use of telepathology in the diagnostic context but enthusiasm for the use of video conferencing in multidisciplinary team meetings.
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Affiliation(s)
- T Dennis
- Department of Histopathology, Chesterfield and North Derbyshire Royal Hospital, Calow, Chesterfield S44 5BL, UK
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Weinstein RS, Descour MR, Liang C, Barker G, Scott KM, Richter L, Krupinski EA, Bhattacharyya AK, Davis JR, Graham AR, Rennels M, Russum WC, Goodall JF, Zhou P, Olszak AG, Williams BH, Wyant JC, Bartels PH. An array microscope for ultrarapid virtual slide processing and telepathology. Design, fabrication, and validation study. Hum Pathol 2005; 35:1303-14. [PMID: 15668886 DOI: 10.1016/j.humpath.2004.09.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper describes the design and fabrication of a novel array microscope for the first ultrarapid virtual slide processor (DMetrix DX-40 digital slide scanner). The array microscope optics consists of a stack of three 80-element 10 x 8-lenslet arrays, constituting a "lenslet array ensemble." The lenslet array ensemble is positioned over a glass slide. Uniquely shaped lenses in each of the lenslet arrays, arranged perpendicular to the glass slide constitute a single "miniaturized microscope." A high-pixel-density image sensor is attached to the top of the lenslet array ensemble. In operation, the lenslet array ensemble is transported by a motorized mechanism relative to the long axis of a glass slide. Each of the 80 miniaturized microscopes has a lateral field of view of 250 microns. The microscopes of each row of the array are offset from the microscopes in other rows. Scanning a glass slide with the array microscope produces seamless two-dimensional image data of the entire slide, that is, a virtual slide. The optical system has a numerical aperture of N.A.= 0.65, scans slides at a rate of 3 mm per second, and accrues up to 3,000 images per second from each of the 80 miniaturized microscopes. In the ultrarapid virtual slide processing cycle, the time for image acquisition takes 58 seconds for a 2.25 cm2 tissue section. An automatic slide loader enables the scanner to process up to 40 slides per hour without operator intervention. Slide scanning and image processing are done concurrently so that post-scan processing is eliminated. A virtual slide can be viewed over the Internet immediately after the scanning is complete. A validation study compared the diagnostic accuracy of pathologist case readers using array microscopy (with images viewed as virtual slides) and conventional light microscopy. Four senior pathologists diagnosed 30 breast surgical pathology cases each using both imaging modes, but on separate occasions. Of 120 case reads by array microscopy, there were 3 incorrect diagnoses, all of which were made on difficult cases with equivocal diagnoses by light microscopy. There was a strong correlation between array microscopy vs. "truth" diagnoses based on surgical pathology reports. The kappa statistic for the array microscopy vs. truth was 0.96, which is highly significant (z=10.33, p <0.001). There was no statistically significant difference between rates of agreement with truth between array microscopy and light microscopy (z=0.134, p >0.05). Array microscopy and light microscopy did not differ significantly with respect to the number/percent of correct decisions rendered (t=0.552, p=0.6376) or equivocal decisions rendered (t=2.449, p=0.0917). Pathologists rated 95.8% of array microscopy virtual slide images as good or excellent. None were rated as poor. The mean viewing time for a DMetrix virtual slide was 1.16 minutes. The DMetrix virtual slide processor has been found to reduce the virtual slide processing cycle more than 10 fold, as compared with other virtual slide systems reported to date. The virtual slide images are of high quality and suitable for diagnostic pathology, second opinions, expert opinions, clinical trials, education, and research.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ 85724, USA
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Nordrum I, Johansen M, Amin A, Isaksen V, Ludvigsen JA. Diagnostic accuracy of second-opinion diagnoses based on still images. Hum Pathol 2004; 35:129-35. [PMID: 14745735 DOI: 10.1016/j.humpath.2003.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Second opinion of histological specimens is an important part of the daily routine in anatomic pathology practices. Today, extramural second opinion can be easily obtained by sending still images via an electronic network. The aim of this study was to examine the diagnostic accuracy of second opinion diagnosis based on still images selected from glass slides of 90 archived cases originally referred for extramural second opinion. Two pathologists together diagnosed first the still images (phase 1) and then the glass slides (phase 2). Phase 1 and phase 2 diagnoses were compared with the original second opinion diagnoses (OSODs). The pathologists achieved the same diagnostic results in phase 1 and in phase 2 measured against the OSOD, 67.8% (n = 61) and 68.9% (n = 62) complete agreement, respectively. In 29 cases in phase 1, the diagnoses were discordant with the OSOD. Three cases had incorrect benign diagnoses and 8 cases had incorrect malignant diagnoses. There were 8 false-negative diagnoses regarding malignancy, 6 false-positive diagnoses regarding malignancy, and 4 other discordant diagnoses. Eleven of the 29 discordant diagnoses could have had clinical implications. In interpreting these results, it is important to acknowledge the observer variability in diagnostic histopathology in general. In conclusion, the results support the concept of using still images to obtain second opinion diagnosis.
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Affiliation(s)
- Ivar Nordrum
- Department of Pathology, University Hospital of Northern Norway, Tromsø, Norway
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Williams BH, Hong IS, Mullick FG, Butler DR, Herring RF, O'Leary TJ. Image quality issues in a static image-based telepathology consultation practice. Hum Pathol 2004; 34:1228-34. [PMID: 14691906 DOI: 10.1016/s0046-8177(03)00429-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Field selection and image quality have often been identified as impediments in the successful employment of static-image telepathology. One thousand seven hundred fifty-three electronic consultations using static images were performed at the Department of Telemedicine, Armed Forces Institute of Pathology (AFIP) between November 1994 and September 2001, with 98.3% receiving a telepathology diagnosis. In 47.9% of cases, imagery was considered good by AFIP consultants, 38.5% were considered adequate, and 14.6% of cases were considered to have poor-quality imagery. Deficiencies in image quality were recorded for each case. Cases with imagery rated as good averaged significantly fewer deficiencies per case (0.45, range: 0 to 3) than cases with imagery rated adequate (0.95, range: 0 to 6) or poor (2.4, range: 0 to 7). Deficiencies in focus were most commonly identified in this series of cases (28.1%), followed by improper white balancing of the capture device (14.1%) and inadequate resolution (10%). Cases in which images were of inadequate resolution showed an increased likelihood for discordance between the telepathology diagnosis and the diagnosis rendered on follow-up material ("truth diagnosis"). Inadequate field selection, although only cited in 6.7% of cases overall, was seen with a significantly higher frequency in cases in which there was discordance between the telepathology and truth diagnosis. A review of common image deficiencies in static-image telepathology and possible causes is presented.
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Affiliation(s)
- Bruce H Williams
- Department of Telepathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Aoki N, Dunn K, Johnson-Throop KA, Turley JP. Outcomes and Methods in Telemedicine Evaluation. Telemed J E Health 2003; 9:393-401. [PMID: 14980098 DOI: 10.1089/153056203772744734] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.
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Affiliation(s)
- Noriaki Aoki
- School of Health Information Sciences, University of Texas Health Science Center-Houston, Houston, Texas, USA.
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Costello SSP, Johnston DJ, Dervan PA, O'Shea DG. Development and evaluation of the virtual pathology slide: a new tool in telepathology. J Med Internet Res 2003; 5:e11. [PMID: 12857667 PMCID: PMC1550558 DOI: 10.2196/jmir.5.2.e11] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Accepted: 04/30/2003] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Virtual Pathology Slide is an interactive microscope emulator that presents, via the Internet or CD-ROM, a complete 15.53 mm x 11.61 mm digitalized tissue section. The Virtual Pathology Slide mimics the use of a microscope in both the stepwise increase in magnification (from 16x up to 2000x) and in lateral motion in the X and Y Cartesian directions. This permits a pathologist to navigate to any area on a slide, at any magnification, similar to a conventional microscope. OBJECTIVE The aim of this study was to assess the diagnostic accuracy and acceptability of the Virtual Pathology Slide. METHODS Ten breast needle core biopsies were randomly selected and presented to 17 pathologists or trainee pathologists with at least 2 years experience in pathology practice. Participants were required to examine each case online and provide a diagnostic classification using online feedback forms. The recorded data permitted examination of interobserver variability and user satisfaction. RESULTS Agreement between original glass-slide diagnosis and consensus diagnosis using the Virtual Pathology Slide was reached in 9 out of 10 slides. Percentage concordance for slides lay in the range of 35.3% to 100% with an average percentage concordance between slides of 66.5%. The average Kappa statistics for interobserver agreement was 0.75 while average percentage concordance amongst participants was 66.5%. Participants looked at an average of 22 fields of view while examining each slide. Confidence: 81.25% of the participants indicated confidence using the Virtual Pathology Slide to make a diagnostic decision, with 56.25% describing themselves as "reasonably confident," 18.75% as "confident," and 6.25% as "very confident." Ease of use: 68.75% reported the system as "easy" or "very easy" to use. Satisfaction: 87.5% of participants expressed satisfaction with image quality, with 43.75% describing the image quality as "adequate," 25% describing it as "good," and 18.75% describing the image quality as "excellent." Pathologists with a working bandwidth greater than 20 kilobits per second found the download speed of the Virtual Pathology Slide "adequate" or better. CONCLUSIONS Results from this study show that the Virtual Pathology Slide can be used to make a correct diagnostic decision, and that the system is a realistic alternative to dynamic telepathology.
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Affiliation(s)
- Sean SP Costello
- School of BiotechnologyMedical Informatics GroupDublin City UniversityDublinIreland
| | - Daniel J Johnston
- School of BiotechnologyMedical Informatics GroupDublin City UniversityDublinIreland
| | - Peter A Dervan
- Mater Misericordiae HospitalThe Conway Institute of Biomolecular and Biomedical ResearchUniversity College DublinThe Pathology DepartmentDublinIreland
| | - Daniel G O'Shea
- School of BiotechnologyMedical Informatics GroupDublin City UniversityDublinIreland
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Settakorn J, Kuakpaetoon T, Leong FJWM, Thamprasert K, Ichijima K. Store-and-forward diagnostic telepathology of small biopsies by e-mail attachment: a feasibility pilot study with a view for future application in Thailand diagnostic pathology services. Telemed J E Health 2003; 8:333-41. [PMID: 12419027 DOI: 10.1089/15305620260353225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diagnostic telepathology by electronic mail (e-mail) attachment is relatively simple and incurs minimal cost. We assessed its accuracy and practical aspects in routine diagnostic pathology. Using 100 small biopsy specimens, a total of 1,488 images were digitized by one pathologist and sent as e-mail attachments from Nara Medical University, Japan, to a pathologist at Rajavithi Hospital, Thailand. His diagnoses were compared with his conventional light microscopy interpretation at a later date. The average total turnaround time spent on each case was 215 minutes, far less than the several days required by conventional post. There were two clinically significant errors. One was a diagnostically difficult case of colonic dysplasia, which was called carcinoma with telepathology. The other was a signet ring cell carcinoma of the stomach which was undetected with telepathology. Microscopy objective magnification and digital image quality may have played a role in impairing interpretation in both cases. Store-and-forward telepathology provides acceptable efficacy, a comparatively faster turnaround time than post and could be applied in routine work within Thai pathology services.
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Affiliation(s)
- J Settakorn
- Chiang Mai University, Department of Pathology, Faculty of Medicine, Chiang Mai 50200, Thailand
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Cross SS, Dennis T, Start RD. Telepathology: current status and future prospects in diagnostic histopathology. Histopathology 2002; 41:91-109. [PMID: 12147086 DOI: 10.1046/j.1365-2559.2002.01423.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Telepathology is the process of diagnostic histopathology performed on digital images viewed on a display screen rather than by conventional glass slide light microscopy. The technology of telepathology has radically improved over the past 5 years so that it is no longer the limiting factor in the diagnostic process. This review looks at the resources needed for dynamic and static telepathology, including image quality, computers and software interfaces, means of transmission and human resources. It critically analyses 32 published trials of telepathology, including some large prospective studies, in all areas of diagnostic histopathology including intraoperative frozen sections, routine and referral cases. New developments, including internet solutions and virtual microscopy, are described and there is analysis of the economics of telepathology within health care systems. The review concludes that all the necessary technology for telepathology is available, there is strong published evidence for a diagnostic accuracy comparable with glass slide diagnosis, in many contexts there is a clear-cut economic argument in favour of telepathology, and that the technique should now be integrated into mainstream diagnostic histopathology.
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Affiliation(s)
- S S Cross
- Digital Pathology Research Group, Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Bioscience, University of Sheffield, South Yorkshire, UK.
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