Telepathology overview: From concept to implementation

Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience

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.

Telepathology: current status and future prospects in diagnostic histopathology

A system and method for visual image compression and transmission offers significant bandwidth conservation while retaining high resolution imaging capability. Videograpic images are decomposed into detail levels, and images are delivered to a remote site display at a level of detail proportional to the perception level of a viewer. Images are transformed, quantized, coded and queued for transmission in accordance with their level of image detail. Image detail layers are transmitted as an inverse function of image displacement speed and as a direct function of image magnification. Images are constructed vertically with each additional queueing layer providing additional image detail. Higher priority layers are lossy encoded, while the lowest priority layers (highest detail levels) are losslessly encoded.

Compression packaged image transmission for telemicroscopy

Static image analysis of skin specimens: The application of telepathology to frozen section evaluation

Telepathology may be used to provide a frozen section service to hospitals without a department or institute of pathology. We have developed a telepathology system using the commercially available Integrated Services Digital Network (ISDN). The main software and hardware elements of our system are: Apple Macintosh workstations, a program for simultaneous transfer of image, voice and data, and a data bank for storage of patients' data and microscopic images. A picture instrument manager (PIM) makes remote control of microscopes or other instruments possible. The system connects the Department of Pathology of the University of Basel with the Regional Hospital of Samedan, 250 km away, and the Regional Hospital of Burgdorf, 100 km away. During a period of 20 months, frozen sections with the hospitals in Samedan and Burgdorf were performed in 53 patients. Between 54 and 58 s were required for the transfer of a diagnostic 8-bit grey level image containing 341±26.1 (standard error) kbytes (n=13) or a diagnostic 24-bit colour image containing 165±16.9 kbytes (n=40). Frozen section diagnosis was completed in 20–40 min. True-positive diagnoses of malignant tumours were achieved in 85.7% of cases (sensitivity=0.857). No false-positive diagnosis was made. In 3 of the 53 cases telepathological diagnosis was not possible for technical reasons.

Telepathology: frozen section diagnosis at a distance.

DEFINITION Since 1992 we transfer digitalized frozen section images by means of videomicroscope and a personal computer through the public telephone network (ISDN) to the Institut of Pathology at the University Hospital in Basel. The aim of this study is to determine whether the quality of frozen section diagnosis obtained by telepathology is comparable to the conventional one. METHOD The frozen section diagnoses by telepathology from Oct. 1992 to May 1996 (n = 94) are compared to the paraffin sections performed in each case after the primary examination. The result is then compared to the well documented data of conventional frozen section diagnosis in the literature. RESULTS From Oct. 1992 to May 1996 we performed 94 frozen sections. In 84 cases the diagnosis was correct compared to the paraffin section (89%). The sensitivity to detect a malignant tumor was 92%, the specifity 100%. Four examinations were not conclusive and one examination had to be canceled because of technical problems. DISCUSSION In the literature, 92% of malignancy is diagnosed by conventional frozen section [1]. Telepathology gives the same result.

Frozen section diagnosis using telepathology

Schnellschnittuntersuchung mittels Telepathologie

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Telepathology: frozen section diagnosis at a distance.

Frozen section diagnosis using telepathology

Schnellschnittuntersuchung mittels Telepathologie