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									Experience with a Hybrid DynamicStatic Telemicroscopy System for Real Time Surgical Pathology Consultation at the University of Pennsylvania Health System
Michael Feldman, MD, PhD*, Robert Zimmerman, MD**, Franz Fogt, MD** and John E. Tomaszewski, MD* *Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, PA 19104

**Department of Pathology & Laboratory Medicine, Presbyterian Medical Center, Philadelphia, PA 19104

Anatomic Pathology in a Distributed Health System

Distributed Telemicroscopy
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Apollo – Hybrid Dynamic:Static Telemicroscope H323 video 30 fps 500x300 pixel window, full robotic control of scope, 1.5 mega pixel static image Audio and video between two sites during conference Report database to store text and images 100 Mb WAN between sites
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System uses only 0.75 Mbp

How Is System Used

Real Time Consultation

Consult Protocol
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Case is presented by Pathologist at affiliate hospital
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Pt demographics and relevant clinical history if available Slide is placed on remote robotic microscope

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One or Two consultants at University provide real time consultation
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Direct control of robot microscope Direct communication with consulting pathologist to answer relevant pathologic issues and render diagnosis or guide ancillary studies Capture of key diagnostic fields at high resolution for documentation and annotation to communicate relevant features

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Currently, all cases receive glass slide review later that day for correlation with teleconsult diagnosis

Case Breakdown
Aorta Bladder Breast 1 2 1

Cervix
Colon

1
1

Endometrium
Lung Nasopharynx Ovary Pancreas Pleura Prostate Skin Soft tissue Vulva

4
3 1 1 2 1 2 7 5 1

Detailed Results
Organ Aorta Bladder Breast Cervix Colon Endometrium Lung 4 2 1 Agree 1 2 1 1 1 Deferred glass review Deferred IHC Disagree major Total Cases by Organ 1 2 1 1 1 4 3

Nasopharynx
Ovary Pancreas Pleura Prostate

1
1 2 1 2

1
1 2 1 2

Skin
Soft tissue Vulva

7
3 1 27 3 2 1 1 1

7
5 1 33

Single Case Discrepancy
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Patient with remote history of IBD with colostomy – presents with irregular red lesion at ostomy site Three biopsies taken – two of them show exuberant granulation tissue, one shows intestinal glands underneath squamous epithelium – interpreted as indefinite for dysplasia on teleconsult and glass review. Consulting Pathologist wanted third opinion, worried about dysplasia Glass sent for outside review called high grade dysplasia Who knows who is correct?

Indefinite versus HGD?

Deferred to IHC

University

Quality Assurance in a Distributed Health System

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Take video feed out of 14 headed conference scope Pipe it to affiliate hospitals using video conference function of Telepathology System Affiliates see image from conference, hear audio from conference and can provide diagnostic input via audio from affiliate to University conference

Future Plans
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Add third site within health system – Phoenixville Hospital Collaborate with other Institutions using Apollo system for educational conferencing and consultation Study use of Telepathology in subspecialty domains in Surgical Pathology as well as Telecytopathology


								
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