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At least 19 recordsLinked to original sources

PubMed1997

Dynamic-robotic telepathology: Department of Veterans Affairs feasibility study.

In this retrospective study, we assess the accuracy, confidence levels, and viewing times of two generalist pathologists using both dynamic-robotic telepathology and conventional light microscopy (LM) to render diagnoses on a test set of 100 consecutive routine surgical pathology cases. The objective is to determine whether telepathology will allow a pathology group practice at a diagnostic hub to provide routine diagnostic services to a remote hospital without an on-site pathologist. For TP, glass slides were placed on the motorized stage of the robotic microscope of a telepathology system by a senior laboratory technologist in Iron Mountain, MI. Real-time control of the motorized microscope was then transferred to a pathologist in Milwaukee, WI, who viewed images of the glass slides on a video monitor. The telepathologists deferred rendering a diagnosis in 1.5% of cases. Clinically important concordance between the individual diagnoses rendered by telepathology and the "truth" diagnoses established by rereview of glass slides was 98.5%. In the telepathology mode, there were five incorrect diagnoses out of a total of 197 diagnoses. In four cases in which the telepathology diagnosis was incorrect, the pathologist's diagnosis by LM was identical to that rendered by telepathology. These represent errors of interpretation and cannot be ascribed to telepathology. The certainty of the pathologists with respect to their diagnoses was evaluated over time. Results for the first 50 cases served as baseline data. For the second 50 cases, confidence in rendering a diagnosis in the telepathology mode was essentially identical to that of making a diagnosis in the LM viewing mode. Viewing times in the telepathology mode also improved with more experience using the telepathology system. These results support the concept that an off-site pathologist using dynamic-robotic telepathology can substitute for an on-site pathologist as a service provider.

Feasibility Studies↗

PubMed1995

A national telepathology trial in Sweden feasibility and assessment.

The telepathology trial in Sweden was designed to study several parameters, eg, the specific need, practical handling, image quality and acceptance of a static imaging system for consultations between pathologists. From September 1992 until December 1993, six telepathology systems were leased and temporarily installed for 8 to 10 weeks in 29 pathology departments in Swedish hospitals. Three telepathology systems were purchased by the university hospitals in Gothenburg, Linkôping and Uppsala and served as permanent nodes. To assess the project, pre and post field-test questionnaire (focusing on attitudes/expectations and experience/wishes for the future, respectively) were sent to all participating pathologists and cytologists. Although other assessment methods were included in the project, this paper concentrates on the study of questionnaire results. The study shows that the major medical requirements for telepathology in Sweden involve diagnostic questions concerning: cancers in general, grade of malignancy, malignancy of soft tissue, haematopoetic system, skeletal system, breast, uro-genital systems and applications in the field of dermatology, inflammations and transplantations. Telepathology will enhance diagnostic accuracy according to 37% of the responding physicians in the pre field-test study and 31% in the post field-test study, a drop which may reflect excessively high expectations or less than optimal test conditions. A static-image transfer telepathology system was used but the assessment clearly shows that pathologists and cytologists prefer a dynamic imaging telepathology system for the future. Image resolution is crucial and was not adequate for all applications in the study. Half of the respondents preferred having a telepathology system in their own departments.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗

PubMed1997

Diagnostic accuracy of an international static-imaging telepathology consultation service.

Static-image and dynamic- (real-time) image telepathology are competing technologies. Although some studies suggest that the diagnostic accuracy of the dynamic-image telepathology approaches the accuracy of light microscopy, few reports have documented the diagnostic accuracy of static-image telepathology as used in the setting of an actual surgical pathology consultation practice. We report the results of an analysis of 171 telepathology consultation cases submitted to the Arizona-International Telemedicine Network (AITN). Digital images were submitted by pathologists from six participating institutions in Arizona, Mexico, and China. Telepathologists could render a telepathology diagnosis (TP) or defer rendering a diagnosis to obtain additional video images, glass slides for detailed analysis, or to obtain tissue blocks for special studies such as immunohistochemistry. The telepathologists rendered diagnoses for 144 cases and deferred 27 cases. Two pathologists retrospectively evaluated-glass slides from each case and rendered a consensus glass slide (GS) "truth" diagnosis. There was 88.2% concordance between TP and GS diagnoses (127 of 144 diagnoses). Concordance of 96.5% was achieved for clinically important diagnoses (139 of 144 diagnoses). Telepathologists deferred making a diagnosis to obtain glass slides for conventional light microscopy in 14 cases (8.1%) and for results of immunohistochemistry studies in 13 cases (7.6%). Thus, correct diagnoses were rendered by static-image telepathology in 127 of 171 cases (74.3%) at the time of telepathology diagnostic sessions. Inappropriate field selection and sampling biases of referring pathologists, as well as a tendency of static-image telepathologists to underestimate the complexity of some cases, may reduce the value of consultations based on the viewing of static images.

Humans↗

PubMed1998

[Economic evaluation of telepathology].

Telepathology, defined as the practice of pathology over a distance by viewing images transmitted from a remote site, was previously analyzed mainly with respect to technical equipment and diagnostic accuracy compared with conventional histological diagnosis. In this paper, telepathology is analyzed with regard to economic points of view, demonstrating the background for the cost-saving analysis of telepathology. The acquisition cost and the operating costs of a telepathology system are compared with potential cost-saving and other benefits from telepathology. This analysis may help to decide whether or not telepathology should be established in a hospital.

Cost-Benefit Analysis↗

PubMed1997

Diagnostic accuracy of a rural live video telepathology system.

Accuracy of diagnoses rendered using a live video telepathology network was assessed for permanent sections of surgical pathology specimens. To determine accuracy, telepathology diagnoses were compared with those obtained by directly viewing the glass slide using a standard microscope. A total of 294 cases were read via both telepathology and glass slide by attending pathologists at a tertiary care medical center. Overall accuracy was defined as exact concordance between diagnoses. Clinically insignificant differences in diagnoses were excluded to determine clinically significant accuracy. For the 285 cases with complete data, the overall accuracy for telepathology was 0.912 (95% confidence interval [CI], 0.872-0.941), whereas the overall accuracy for glass slide readings was 0.968 (95% CI, 0.939-0.985). This difference is statistically significant (p = 0.009). When focusing on clinically significant discrepancies, where the difference in diagnosis might affect therapeutic decisions, the video accuracy was only slightly less than the glass slide accuracy (0.965 [95% CI, 0.934-0.982] vs. 0.982 [95% CI, 0.957-0.994], respectively), but this difference is not statistically significant (p = 0.302). Most of the cases with clinically significant differences involved lesions with inherently high interobserver variation. Certainty of diagnosis did not differ between video and glass slide readings (p = 0.911), but there was an association between certainty of diagnosis and diagnostic accuracy for video (p = 0.003 for clinically significant accuracies). Based on these findings, we recommend when using this telepathology system that only preliminary diagnoses should be given in the following situations: for diagnostic areas with known high interobserver variability; when the consultant has any degree of uncertainty about the presence or absence of the lesion in question; and when there is insufficient experience using telepathology as a diagnostic medium.

Crohn Disease↗

PubMed1989

Telepathology. Long-distance diagnosis.

Telepathology is defined as the practice of pathology at a distance, by visualizing an image on a video monitor rather than viewing a specimen directly through a microscope. Components of a telepathology system include the following: (1) a workstation equipped with a high-resolution video camera attached to a remote-controlled light microscope; (2) a pathologist workstation incorporating controls for manipulating the robotic microscope as well as a high-resolution video monitor; and (3) a telecommunications link. Progress has been made in designing and constructing telepathology workstations and fully motorized, computer-controlled light microscopes suitable for telepathology. In addition, components such as video signal digital encoders and decoders that produce remarkably stable, high-color fidelity, and high-resolution images have been incorporated into the workstations. Resolution requirements for the video microscopy component of telepathology have been formally examined in receiver operator characteristic (ROC) curve analyses. Test-of-concept demonstrations have been completed with the use of geostationary satellites as the broadband communication linkages for 750-line resolution video. Potential benefits of telepathology include providing a means of conveniently delivering pathology services in real-time to remote sites or underserviced areas, time-sharing of pathologists' services by multiple institutions, and increasing accessibility to specialty pathologists.

Computer Communication Networks↗

PubMed1996

Telepathology diagnosis by means of digital still images: an international validation study.

Telepathology affords the means to provide pathological diagnosis and consultation to remote sites. However, before telepathology can become an acceptable medical tool, it will be vital to determine the diagnostic accuracy of this technology. We report the results of a single-blind study of the accuracy of diagnosis performed using computerized still images obtained from a telepathology workstation used in a French telepathology network. Four pathologists, each working alone, reviewed a total of 200 cases of routine surgical pathology (50 cases each), and performed diagnosis based on both computer CD-ROM still images (CD) and conventional glass slides (GS). Concordance between GS and CD diagnosis, as well as accuracy, were determined. Other factors related to performance were also measured, including diagnostic certainty, reasons for uncertainty, and causes of diagnostic error. Overall, there was good agreement between CS and CD diagnosis. There was 87.5% concordance between CS and CD diagnosis, and comparison to consensus (correct) diagnosis showed accuracy of 95.5% and 88.5% for GS and CD diagnosis, respectively. Marked variability in accuracy of CD diagnosis was observed among the four pathologists, and issues related to image selection and/or quality appeared responsible for 60% of the diagnostic errors. The lack of sufficient images and clinical information were frequently cited as reasons for diagnostic uncertainty, as well as feelings of insufficient expertise. It is likely that the opportunity for interaction with the referring pathologist and the use of subspecialty consultants would likely improve the performance of telepathology.

CD-ROM↗

PubMed1995

The validity of intraoperative frozen section diagnosis based on video-microscopy (telepathology).

The validity of intraoperative frozen section diagnosis (IFSD) via telepathology between Hokkaido University School of Medicine (HUSM) and a remote hospital was evaluated. Video-microscopic images of hematoxylin-eosin (HE)-stained frozen sections were transmitted by a cytoscreener via the Pathtran 1,000 system and a telephone line to a color monitor at HUSM (120 km from the submitting hospital) with a resolution of 512 x 480 pixel matrix. The pathologists at HUSM made diagnoses on the received images. Of the 59 cases, there was diagnostic concordance between telepathology and permanent paraffin sections in 19 malignant, 36 benign, and one borderline case. The latter was a case of atypical ductal hyperplasia of the breast. The telepathology diagnostic modality was inconclusive in three cases, two of which were benign and one malignant by paraffin section examination. These results provide evidence for the diagnostic adequacy of video-microscopic images, the interpretation of which compared favorably with that of conventional frozen sections. Although the need for IFSD is increasing, the proportion of hospital pathologists accepting this modality is not. For the appropriate use of telepathology, it is necessary that more pertinent personnel, especially cytoscreeners and pathologists receive a thorough training and become familiar with the system. Telepathology offers pathologists a diagnostic modality that responds to the needs of physicians and serves to enhance the pathologist's position in health care services.

Adult↗

PubMed1997

Telepathologic review: utility, diagnostic accuracy, and interobserver variability on a difficult case consultation service.

The diagnostic accuracy of telepathologic analysis has not been compared to that of conventional light microscopic review on a difficult case consultation service. The anatomic pathology consultation files of the University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepathologic and light microscopic review. The telepathologic and light microscopic crude agreement of five pathologists were compared, with use of the original consultation diagnosis as the "gold standard." Cases were scored as correct, partially correct, or incorrect. After making a video diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope. The pathologists performed significantly better with the light microscope, even after excluding cases in areas of inexpertise (P = .005). The mean percentage of cases that the pathologists wanted to review with the light microscope was 64%, and the major reason for review was diagnostic uncertainty. Cases incorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultation service, pathologists perform significantly better with use of light microscopic than with telepathologic analysis; rarely make an incorrect diagnosis and do not request that case for light microscopic review; and exhibit high telepathologic diagnostic accuracy in areas of expertise.

Adolescent↗

PubMed1994

Current status of telepathology.

Telepathology is moving from the experimental stage to become a regular feature of pathology practice. This has been made possible by technical advances in telecommunications and image processing. Since 1990 the University Hospital of Tromsø has provided local hospitals in northern Norway with a remote frozen section service and with access to video conferences for the review of microscopic findings and for the discussion of major diagnostic issues. Several other hospitals in Norway are now participating in this development and practical relations among pathology laboratories for the purpose of consultation and education will be the next step in the procedure. Similar developments in telepathology have taken place in other countries. Standardization of network and telepathology workstations will be needed before extensive international collaboration can be achieved. Progress in high quality video devices, high capacity telecommunication lines and improved image compression techniques will increase the usage of telepathology services and make them cost-effective. Thus, telepathology will contribute to the development of pathology services in the next century.

False Negative Reactions↗

PubMed1996

Frozen-section services by telepathology: experience of 100 cases in the San-in District, Japan.

The early experience is reported here of the use of intra-operative frozen-section service by telepathology using the integrated Service Digital Network (ISDN), a commercially available system that is being connected between the Department of Pathology of Tottori University and Matsue City Hospital, a distance of 30 km. The transfer rate is currently 64 kbit/s. The frozen-section service was conducted for a total of 117 tissue specimens (organs) from 100 patients between August 1993 and May 1995. The average time taken for examination of each specimen of frozen section was 13 min, ranging between 2 and 42 min. The average number of transmitted images was 6.2. Six cases necessitated more than 11 transmitted images to make a diagnosis, while 13 cases could be diagnosed from two images only. Correct and permissible diagnoses were obtained in 109 (93.2%) out of 117 specimens when comparing the telepathology diagnosis with that of direct microscopy. Improper or misdiagnosis was made for eight cases (specimens), which were misinterpreted as papillary carcinoma in Basedow's disease, adenoma and hyperplasia in two pheochromocytomas, solid-tubular carcinoma in phyllodes tumor, mastopathy in invasive carcinoma, metastatic carcinoma in astrocytoma, follicular lymphoma in reactive hyperplasia, and lymphadenitis in follicular lymphoma. In retrospect, diagnosis of these cases should have been deferred. From the results, it was concluded that the intraoperative frozen-section service by telepathology may be a worthwhile substitute for hospitals with limited accessibility to local pathology service, in spite of pitfalls in some cases. Well prepared, high-quality frozen section, sufficient verbal communication with surgeons, and a rather conservative attitude on the part of a well-trained pathologist seem to be the essential ingredients for reaching an accurate decision when using telepathology.

Computer Communication Networks↗

PubMed1996

[Support by telecommunication of decisions in diagnostic pathology. Experience with the first telepathology system in Hungary].

The term of telepathology can be determined as diagnostic work of the pathologist at distance via an interactive telecommunication connection in which the image of the specimen appears on a monitor instead of viewing it directly through a microscope. Being a part of the telemedicine, the fast development of the telepathology is based on the revolution of the new digital technology. Technical advances of telecommunication and of image procession in the latest 80s have provided the means to transfer huge amount of visual information in narrow communication bandwidth in two direction link. In 1995 multiple live image transmission with simultaneous voice transfer has been performed between the Department of Pathology of MI Central Hospital and 1.st Institute of Pathology and Experimental Cancer Research of Semmelweis Medical University, Budapest. Transfer rate via ISDN channel was 128 kbit/sec. The first live image telemedicine system in CCE/NIS countries has achieved transmission of cytological smears, frozen sections and paraffin embedded slides supplemented with immunohistochemical preparations. Quality of visual information using video-conference software of standard H.320 was suitable for diagnosis. Development of global telepathology services depends on compatibility of different systems and on comprehensive examinations of cost, accessibility and quality for the clients and providers of telemedicine. Recent paper surveys shortly the historical development of the telepathology, analyses the essence of the new consultation technology, summaries the first experiences in Hungary and raises some questions have to be answered in the near future.

Academies and Institutes↗

PubMedDate not supplied

Recent advances in telepathology.

Telepathology is to transform microscopic and gross images of pathological specimen into digital forms and transmit them electronically to remote sites for consultation and collaboration. Many benefits can be derived from telepathology. Although still at its initial developing stage, this technology is beginning to change the way pathological practice is conducted. With the rapid advancement of computer and telecommunication sciences, telepathology is increasingly becoming more feasible and practical for pathologists. This review gives a comprehensive account of the recent development in telepathology, discusses its functionality, applications, limitations and potential, and serves as an introduction to this rapidly evolving field.

Computer Communication Networks↗

PubMed1987

Telepathology and the networking of pathology diagnostic services.

Telepathology is the practice of pathology over a long distance. Components of a telepathology system include the following: a remote-controlled light microscope attached to a high-resolution video camera; a pathologist workstation incorporating controls for manipulating the microscope and a high-resolution video monitor; and a telecommunications linkage. An immediate challenge is to establish the specifications for a telepathology system. Breast tissue has served as a model. Receiver operator characteristic curve studies show that the pathologist's ability to discriminate benign from malignant breast tumors is similar using either a conventional light microscope or a video monitor with approximately 1000 lines of resolution. The percentage of cases for which pathologists render an "equivocal" diagnosis is the same for the two modalities. Telepathology may be an effective way to provide on-line consultations in difficult cases and to provide hospitals in remote areas with immediate access to anatomic pathology services.

Computer Communication Networks↗

PubMed1997

Telepathology diagnosis of prostrate needle biopsies.

We conducted a prospective analysis of the diagnostic accuracy of a static-image telepathology system (Roche RIAS, Elon College, NC) in the interpretation of needle biopsies of the prostate (NBx). Two hundred consecutive cases received in consultation were included. Each case was examined by one of the researchers (MHW), and images were captured either according to the areas of concern designated by the referring pathologist (set A; 100 cases) or according to the judgment of MHW (set B; 100 cases). The other researcher (JIE) daily rendered diagnoses first on the video images and then by direct microscopy. Accuracy of video diagnosis was categorized as 0 (correct), 1 (minor error), 2 (major error), or 3 (deferred). An average of 5.49 images were captured per case in set A, and 5.28 for set B. Seventy-seven, 9, 9, and 5 cases were categorized as 0, 1, 2, and 3, respectively, for set A, and 78, 17, 1, and 4 cases, respectively, for set B. Video versus direct diagnoses for the type 2 errors were five carcinoma versus markedly atypical, two carcinoma versus atypical, one carcinoma versus nonspecific granulomatous prostatitis, and two benign versus atypical. In these difficult NBx, telepathology allowed an essentially correct diagnosis in almost all of the cases. The number of images required was reasonable, and the images were of excellent quality. However, the accuracy varied from set A to set B, with the fractions of nondeferred cases that were given an essentially correct video diagnosis totaling 91% and 99%, respectively (P < .01). Accuracy of telepathology diagnosis using static images may depend on the person capturing the images, even in the case of small biopsies.

Biopsy, Needle↗

PubMed1996

Field test to evaluate telepathology in telemedicine.

Telepathology is currently performed only on prototype systems. The application of telepathology consultations differs from the conventional procedure because of the technical and cost restrictions. This paper outlines technical concepts and the principal hardware and software modules necessary for telemicroscopy equipment. A field test to gather information concerning the user needs and to evaluate parameters of telepathology consultation sessions is reported.

Computer Communication Networks↗

PubMed1998

Pathologists' attitudes to implementing telepathology.

If pathologists will benefit so much from using telepathology, why is it taking so long to be introduced? This question has been discussed between experts, but the potential users are rarely asked for their opinions. A questionnaire was sent to the 256 members of the Austrian Society of Pathology; this addressed general aspects of telemedicine, telepathology in frozen-section services and expert consultation, videoconferencing technologies, teleteaching and teletraining. The response rate was 46%. In general, the pathologists thought that telemedicine could become valuable in their daily routine. However, pathologists were most afraid of sampling errors in remote diagnosis and would not readily accept an alternative to the conventional method of looking at a sample. This is only possible using realtime, remotely controlled microscopes. Telepathology systems providing only still images would not be acceptable to most respondents. There was interest in the use of videoconferencing for clinicopathological conferences. Teleteaching and teletraining were seen as welcome additional techniques, but were nevertheless judged unable to replace classical methods of teaching and training.

Attitude of Health Personnel↗

PubMedDate not supplied

Telepathology applications of the Internet multimedia electronic mail.

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.

Evaluation Studies as Topic↗