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Introduction to Telepathology

Introduction to Telepathology. Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov. Telepathology. Definition: Provision of diagnostic, support or educational services in anatomic or clinical pathology by viewing gross or microscopic images electronically

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Introduction to Telepathology

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  1. Introduction to Telepathology Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov

  2. Telepathology • Definition: Provision of diagnostic, support or educational services in anatomic or clinical pathology by viewing gross or microscopic images electronically • Rationale: Provide access to a generalist or specialist pathologist (or technologist) not available on-site

  3. Telepathology System Images from www.bildanalys.se/tele.htm

  4. Description of previous slide • In a typical telepathology system, a microscope is connected to a camera through which static or dynamic images are sent via a local or wide area network to a computer where the image is observed by a consultant. • In the previous slide, both sides are equipped with cameras and computers so that each can send images to the other.

  5. Static (Store and Forward) Telepathology • Static (still) images (photographs) selected by referring provider sent to consultant • Requires skillful image collection by referrer

  6. Static (Store and Forward) Telepathology • Advantages • Simple - minimal hardware needs (computer, camera) • Inexpensive - hardware and image transmission (Internet) • Adaptable - many computer systems can be adapted • Disadvantages • Image selection – referrer • Real time interaction - difficult • Not suitable for primary diagnosis by surgical pathologist at a distance • Example:Armed Forces Institute of Pathology consultation service

  7. Dynamic Telepathology • Real-time (television) images selected by referrer as if operating a two-headed microscope Hybrid Dynamic/Store and Forward (HDSF) Telepathology • Combines both store and forward and dynamic telepathology functions

  8. Hybrid Dynamic/Store and Forward Telepathology • Advantages • Dynamic and store and forward imaging functions available • Real time interaction with consultant • Image transmission speed • Disadvantages • More complex than static TP (camera(s), computer system, accessories) • More expensive than static TP - requires broad bandwidth • Image selection - sender • Examples:VISN 12 sites

  9. Robotic Hybrid Dynamic/Store and Forward (HDSF) Telepathology • Hybrid - combines both dynamic and store and forward telepathology functions • Robotic - image selection at remote site (robotic microscope) controlled by consultant at the hub site

  10. Robotic Hybrid Dynamic/Store and Forward Telepathology • Advantages • Robotic control of remote microscope allows distant pathologist to view slides completely • Real time interaction with referrer/PA/clinician • Allows performance of frozen sections • Disadvantages • Most complex telepathology system • Most expensive telepathology system - requires broad bandwidth telecommunications • Examples:Milwaukee-Iron Mountain VAMCs; Richmond-Beckley VAMCs

  11. Dynamic Robotic Telepathology 4 5 WAN Router Router Hub Pathologist examines slides using robotic microscope Slides put onto stage of robotic microscope 3 7 Pathologist dictates report to PA Slides read in Milwaukee 6 2 H & E Sections made Tissue examined/sectioned by remote PA/Hub Pathologist 1 Report reviewed, printed signed, faxed 9 PA enters report into Iron Mtn VistA 8

  12. Conclusions • Multiple telepathology modalities exist • Must balance clinical needs vs cost • Users must be flexible, but do not have to be computer experts • Strong support of telecommunications network is essential

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