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Youssef A, Rosenwald A, Rosenfeldt MT. TelePi: an affordable telepathology microscope camera system anyone can build and use. Virchows Arch 2024; 485:115-122. [PMID: 37935902 PMCID: PMC11271423 DOI: 10.1007/s00428-023-03685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
Telepathology facilitates histological diagnoses through sharing expertise between pathologists. However, the associated costs are high and frequently prohibitive, especially in low-resource settings, where telepathology would paradoxically be of paramount importance due to a paucity of pathologists.We have constructed a telepathology system (TelePi) with a budget of < €120 using the small, single-board computer Raspberry Pi Zero and its High-Quality Camera Module in conjunction with a standard microscope and open-source software. The system requires no maintenance costs or service contracts, has a small footprint, can be moved and shared across several microscopes, and is independent from other computer operating systems. TelePi uses a responsive and high-resolution web-based live stream which allows remote consultation between two or more locations. TelePi can serve as a telepathology system for remote diagnostics of frozen sections. Additionally, it can be used as a standard microscope camera for teaching of medical students and for basic research. The quality of the TelePi system compared favorable to a commercially available telepathology system that exceed its cost by more than 125-fold. Additionally, still images are of publication quality equal to that of a whole slide scanner that costs 800 times more.In summary, TelePi is an affordable, versatile, and inexpensive camera system that potentially enables telepathology in low-resource settings without sacrificing image quality.
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Affiliation(s)
- Almoatazbellah Youssef
- Institute of Pathology and Comprehensive Cancer Centre Mainfranken, Julius Maximilian University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Andreas Rosenwald
- Institute of Pathology and Comprehensive Cancer Centre Mainfranken, Julius Maximilian University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Mathias Tillmann Rosenfeldt
- Institute of Pathology and Comprehensive Cancer Centre Mainfranken, Julius Maximilian University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
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El Jiar M, Eliahiai I, Chaib S, Elmorabit K, Mouatakid M, Kharmoum J, Chraibi M. The State of Telepathology in Africa in the Age of Digital Pathology Advancements: A Bibliometric Analysis and Literature Review. Cureus 2024; 16:e63835. [PMID: 39099907 PMCID: PMC11297393 DOI: 10.7759/cureus.63835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Telepathology emerges as a vital tool, offering significant promise for enhancing pathology services in Africa, a region historically challenged by healthcare access and resource limitations. This review explores the development, adoption, and impacts of telepathology in Africa through a comprehensive bibliometric analysis and literature review. A methodical search in PubMed for publications up to 2024 revealed 119 pertinent studies, out of which 47 met the inclusion criteria for a focused review on telepathology's role in African healthcare settings. This research has charted a clear trajectory of growing interest in telepathology, as evidenced by the annual increase in related publications and robust international collaboration. It underscores the expanding utility of telepathology in diagnostics, education, and research within Africa, particularly in domains like dermatopathology, neuropathology, and, notably, oncology. The integration of artificial intelligence into telepathology presents new frontiers for enhancing diagnostic accuracy and efficiency. However, the review also identifies persistent challenges such as infrastructural inadequacies, a shortage of skilled professionals, and regulatory hurdles. The study highlights the indispensable role of international partnerships in advancing telepathology in the region. This review proposes a strategic pivot toward "leapfrogging," an approach that allows Africa to skip traditional developmental hurdles by directly adopting cutting-edge technologies and practices.
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Affiliation(s)
- Mohammed El Jiar
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Imane Eliahiai
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Sanae Chaib
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Khalid Elmorabit
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Mohamed Mouatakid
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Jinane Kharmoum
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Mariame Chraibi
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
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Rizzo PC, Caputo A, Maddalena E, Caldonazzi N, Girolami I, Dei Tos AP, Scarpa A, Sbaraglia M, Brunelli M, Gobbo S, Marletta S, Pantanowitz L, Della Mea V, Eccher A. Digital pathology world tour. Digit Health 2023; 9:20552076231194551. [PMID: 37654717 PMCID: PMC10467307 DOI: 10.1177/20552076231194551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Digital pathology (DP) is currently in the spotlight and is rapidly gaining ground, even though the history of this field spans decades. Despite great technological progress, the adoption of DP for routine clinical diagnostic use remains limited. Methods A systematic search was conducted in the electronic databases Pubmed-MEDLINE and Embase. Inclusion criteria were all published studies that encompassed any application of DP. Results Of 4888 articles retrieved, 4041 were included. Relevant articles were categorized as "diagnostic" (147/4041, 4%) where DP was utilized for routine diagnostic workflow and "non-diagnostic" (3894/4041, 96%) for all other applications. The "non-diagnostic" articles were further categorized according to DP application including "artificial intelligence" (33%), "education" (5%), "narrative" (17%) for reviews and editorials, and "technical" (45%) for pure research publications. Conclusion This manuscript provided temporal and geographical insight into the global adoption of DP by analyzing the published scientific literature.
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Affiliation(s)
- Paola Chiara Rizzo
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Eddy Maddalena
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Nicolò Caldonazzi
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Marletta
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | | | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Razzano D, Puranam K, Tomoka T, Fedoriw Y. The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa. Front Med (Lausanne) 2022; 9:978245. [PMID: 36325383 PMCID: PMC9618672 DOI: 10.3389/fmed.2022.978245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.
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Affiliation(s)
- Dana Razzano
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Kaushik Puranam
- School of Medicine, Georgetown University, Washington, DC, United States
| | - Tamiwe Tomoka
- Department of Pathology, UNC Project Malawi Cancer Program, Lilongwe, Malawi
| | - Yuri Fedoriw
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Yuri Fedoriw
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Stauch G, Raoufi R, Sediqi A, Dalquen P, Fritz P, Aichmüller C, Aichmüller-Ratnaparkhe M, Hubler M. [Experiences with telepathology in northern Afghanistan : A 10-year success story]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:303-310. [PMID: 35238979 DOI: 10.1007/s00292-022-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Afghanistan is in a military conflict lasting more than 20 years and according to recent political development, in a downhill spiral towards a failed society. This scenario faces the question of the usefulness of international medical aid, especially morphological diagnostics in crisis situations. On the basis of ten years of experience from a telemedicine project, need, feasibility and results in Afghanistan will be discussed. General and country-specific problems and the sustainability of an international partnership are discussed. In summary our experience is: (1) Telemedicine is possible and necessary even in countries with high conflict potential. It is integrated into routine care by local medical care taker, (2) Accompanying video conferences are a significant improvement in telemedical diagnostics, (3) "High level" consultations can bridge the gap between sophisticated western diagnostics and medicine in the partner country in selected cases and (4) Scientific work is possible on the basis of the medical data collected on site and the image material generated.
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Affiliation(s)
- Gerhard Stauch
- iPath Telemedicine Network gGmbH, 26603, Aurich, Deutschland.
- Institut für Pathologie Aurich/Westerstede, Wallinghausener Str. 8-12, 26603, Aurich, Deutschland.
| | - Rokai Raoufi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Atiq Sediqi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Peter Dalquen
- Institut für Pathologie, Universitätsspital Basel, 4031, Basel, Schweiz
| | - Peter Fritz
- Institut für Pathologie, Robert-Bosch-Krankenhaus, 70341, Stuttgart, Deutschland
| | | | | | - Monika Hubler
- Administration iPath Telemedicine Network gGmbH, 79576, Weil am Rhein, Deutschland
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Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review. World J Surg 2022; 46:1855-1869. [PMID: 35428920 PMCID: PMC9012517 DOI: 10.1007/s00268-022-06549-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking. Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes. Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06549-2.
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Mremi A, Bentzer NK, Mchome B, Mlay J, Blaakær J, Rasch V, Schledermann D. The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. PLoS One 2022; 17:e0266649. [PMID: 35421156 PMCID: PMC9009664 DOI: 10.1371/journal.pone.0266649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/25/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction Adequate and timely access to pathology services is a key to scale up cancer control, however, there is an extremely shortage of pathologists in Tanzania. Telepathology (scanned images microscopy) has the potential to increase access to pathology services and it is increasingly being employed for primary diagnosis and consultation services. However, the experience with the use of telepathology in Tanzania is limited. We aimed to investigate the feasibility of using scanned images for primary diagnosis of pre-malignant and malignant cervical lesions by assessing its equivalency to conventional (glass slide) microscopy in Tanzania. Methods In this laboratory-based study, assessment of hematoxylin and eosin stained glass slides of 175 cervical biopsies were initially performed conventionally by three pathologists independently. The slides were scanned at x 40 and one to three months later, the scanned images were reviewed by the pathologists in blinded fashion. The agreement between initial and review diagnoses across participating pathologists was described and measured using Cohen’s kappa coefficient (κ). Results The overall concordance of diagnoses established on conventional microscopy compared to scanned images across three pathologists was 87.7%; κ = 0.54; CI (0.49–0.57).The overall agreement of diagnoses established by local pathologist on conventional microscopy compared to scanned images was 87.4%; κ = 0.73; CI (0.65–0.79). The concordance of diagnoses established by senior pathologist compared to local pathologist on conventional microscopy and scanned images was 96% and 97.7% respectively. The inter-observer agreement (κ) value were 0.93, CI (0.87–1.00) and 0.94, CI (0.88–1.00) for conventional microscopy and scanned images respectively. Conclusions All κ coefficients expressed good intra- and inter-observer agreement, suggesting that telepathology is sufficiently accurate for primary diagnosis in surgical pathology. The discrepancies in interpretation of pre-malignant lesions highlights the importance of p16 immunohistochemistry in definitive diagnosis in these lesions. Sustainability factors including hardware and internet connectivity are essential components to be considered before telepathology may be deemed suitable for widely use in Tanzania.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | | | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joseph Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Tumwine JK. Twenty years of African Health Sciences as infections continue to plague our continent. Afr Health Sci 2020; 20:i-vi. [PMID: 33403000 PMCID: PMC7751560 DOI: 10.4314/ahs.v20i3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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