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Teleconferencing for Pathologists

Teleconferencing for Pathologists. Adam Landman Heathcare Information Systems February 24, 1999. Outline. Introduction to Pathology Introduction to Telepathology Major Software Vendors Requirements Evaluation Recommendation. Introduction to Pathology.

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Teleconferencing for Pathologists

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  1. Teleconferencing for Pathologists Adam Landman Heathcare Information Systems February 24, 1999

  2. Outline • Introduction to Pathology • Introduction to Telepathology • Major Software Vendors • Requirements • Evaluation • Recommendation

  3. Introduction to Pathology

  4. Diagnosis ~ 5 - 7 min, Turnaround < 15 min Large universities and hospitals provide this service on demand Frozen Section - small sections of tissue removed from a patient during surgery requiring diagnosis Surgical Pathology • What about smaller or outlying hospitals?

  5. What about smaller/outlying hospitals? • “Travelling Salesman” -- rely on periodic visits from pathologists • Surgeries must be scheduled to coincide with visit • What if pathologist is not present? • Glass slides express mailed to remote laboratory • Patient may have to undergo second surgery after diagnosis is available • Neither solution is very efficient!

  6. Introduction to Telepathology • Telepathology - practice of pathology from a distance • viewing images on a video monitor rather than light microscope • Images acquired by video camera mounted on light microscope • Images transmitted over a telecommunications link to remote workstation for analysis by telepathologist Referring Pathologist Telepathologist

  7. Microscope Control Slave Master Static Images Dynamic Telepathology System Types • What kinds of images are displayed? • Who has control over selection of images? FTP Video Conferencing Dynamic Robotic

  8. Source: Weinstein, R.S., K.J. Bloom, and L.S. Rozek. 1990. “Static and Dynamic Imaging in Pathology,” in: Mun, S.K., Greberman, M., Hendee, W.R., and Shannon, R. (eds.), Image Management and Communications in Patient Care: Implementation and Impact. Los Alamitos, CA: IEEE Computer Soc. Press, pp. 77-85. Static vs. Dynamic Systems

  9. Telepathology Issue • Static image analysis not normal • Control of microscope • Sequence of images can affect outcome • Omissions are unacceptable • Can video images be used by pathologists to render primary diagnostic opinions or second opinions?

  10. Telepathology Issues (cont.) • Static Imaging -- overall diagnostic accuracy fails to meet accuracy standards (Ito, et al) • Video Microscopy -- validated for diagnostic pathology by Weinstein et al • 15” Sony Trinitron 950-line monitor • 11” Sony 300-line monitor • Dynamic-Robotic -- achieved overall diagnostic accuracy equal to that of light microscopy (Shimosato et al) • So what??

  11. Telepathology Issues (cont.) • Static imaging is unacceptable for diagnosis • Dynamic-robotic is best, but expensive and difficult to setup and operate We will consider COTS Video Conferencing products (dynamic, slave)

  12. Microsoft NetMeeting 2.0 Microsoft Corporation One Microsoft Way Redmond, WA 98052 800-426-9400 http://www.microsoft.com/netmeeting/ White Pine Enhanced CU-SeeMe White Pine Software, Inc.542 Amherst StreetNashua, New Hampshire 03063 800-241-PINE http://www.wpine.com/ Major Vendors

  13. Requirements • Developed requirements based on background and consultation with two experienced UPMC anatomic pathologists • Compatibility • Performance • Product Features • Standards • Ease of Use • Administrative

  14. Compatibility Requirement • Compatibility with Existing Environment • Teleconferencing software must be compatible with hardware and software environment Note: Compatibility is not pertinent to ultimate product comparison

  15. Typical Technical Environment

  16. Performance Requirements Performance --> Image Quality, Compression, Frame Rate • Image Quality • Difficult to standardize • 1,024x768 pixels, 16-bit resolution not currently possible with video conferencing • Current capability: • 128x96 pixels, Sub Quarter Common Intermediate Format (SQCIF) • 176x140 pixels, Quarter Common Intermediate Format (QCIF) • 352x288 pixels, Common Intermediate Format (CIF)

  17. Performance Requirements • Compression • Decrease file size, Increase network performance • Two standard video codecs: • H.263 - low bandwidth (28.8 Kbps modem) • H.261 - high bandwidth (LAN and ISDN) • Frame Rate • Video 24 fps, Film 30 fps • Internet frame rate much lower expectations (12-15fps) • Rate using two ranges: • 3-7 fps for low bandwidth • 7-15 fps for high bandwidth

  18. Product Feature Requirements • Multipoint data conferencing - allows users to collaborate and share information with one or more meeting participants in real-time. • Audio conferencing - allows pathologist to talk in real-time with colleagues. • Video conferencing - allows pathologist to send and receive video images. • consider how many concurrent video sessions are possible • pathologist’s facial image • microscope field view

  19. Product Feature Requirements • Whiteboard – allows users to share pictures, draw diagrams, and graphically update information in real time. • Application Sharing – lets users share Windows application with other participants in a meeting. • might be useful for application to control robotic microscope • Chat – text-based chat application. • Binary File Transfer – enables files to be sent to participants during a meeting. • natural integration of standard static telepathology

  20. Standards Requirements • Standards - ensure users can call, connect, and communicate with people using compatible conferencing products • International Telecommunications Union (ITU) Standards • T.120 - standard for multipoint data conferencing • H.323 - standard for audio and video conferencing • Broad industry support with > 120 vendors participating

  21. Ease of Use Requirements • “Easy to Use” is imperative for Pathologists • Difficult to evaluate without using software • Proxies • Installation Wizard • Graphical User Interface • On-line Help

  22. Administrative Requirements • Miscellaneous software attributes: • Cost • particularly important in hospitals and labs with budget constraints (everywhere!) • Product support • Upgradeability • Cross-platform support

  23. Evaluation • Developed priority weights in collaboration with two experienced UPMC anatomic pathologists

  24. Evaluation

  25. Evaluation

  26. Recommendation • Microsoft NetMeeting 2.0 • Cost-effective solution that delivers a complete, integrated Internet conferencing solution suited to meet the needs of the practicing pathologist • Sensitivity Analysis of weights • Formal methodology may have been overkill • CU-SeeMe major revision due March 1999

  27. Recommendation (Limitations) • Not generalizable to larger user community • Needs more complete analysis • hands-on usage of products • General telepathology issues need consideration • Medical-legal • Diagnostic accuracy • Patient confidentiality

  28. Acknowledgements/References Special thanks to Ms. Yukako Yagi, Dr. John Gilbertson, and Dr. Bob Dawson for their assistance and insightful comments. • Vaughn, G.L., “Tendencies of pathologists in observing frozen sections,” feasibility study, UAB Center for Telecommunications Education & Research, 1994. • Weinstein, R.S., K.J. Bloom, and L.S. Rozek. 1990. “Static and Dynamic Imaging in Pathology,” in: Mun, S.K., Greberman, M., Hendee, W.R., and Shannon, R. (eds.), Image Management and Communications in Patient Care: Implementation and Impact. Los Alamitos, CA: IEEE Computer Soc. Press, pp. 77-85. • Ito, H., H. Adachi, K. Taniyama, Y. Fukuda, and K. Dohi. 1994. “Telepathology Is Available for Transplantation-Pathology: Experience in Japan Using an Integrated, Low-Cost, and High-Quality System,” Modern Pathology, 17: 801-05. • Oberholzer, M., H-R Fischer, H. Christen, S. Gerber, M. Bruhlmann, M. Mihatsch, M. Famos, C. Winkler, P.Fehr, L. Bachthold, and K. Kayser. 1993. “Telepathology with an Integrated Services Digital Network – A New Tool for Image Transfer in Surgical Pathology, A Preliminary Report.” Human Pathology, 24: 1078-85. • Eide, T.J., and I. Nordrum. 1992. “Frozen Section Service via the Telenetwork in Northern Norway,” Zentralblatt Pathologie, 138: 409-12. • Bloom, K.J., L.S. Rozek, and R.S. Weinstein. 1987. “ROC Curve Analysis of Super High Resolution Video for Histopathology,” SPIE Proc Visual Image Process, 845: 408-12. • http://www.zdnet.com/pccomp/features/fea0297/sub5.html/ • http://www.microsoft.com/netmeeting • http://www.wpine.com/

  29. Questions

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