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 • Rationale: Provide access to a generalist or specialist pathologist (or technologist) not available on-site Telepathology System Images from www.bildanalys.se/tele.htm 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. Static (Store and Forward) Telepathology • Static (still) images (photographs) selected by referring provider sent to consultant • Requires skillful image collection by referrer 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 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 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 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 • Advantages Robotic Hybrid Dynamic/Store and Forward Telepathology – 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 Dynamic Robotic Telepathology 4 Router 3 Slides put onto stage of robotic microscope WAN Router 5 Hub Pathologist examines slides using robotic microscope 7 Pathologist dictates report to PA Slides read in Milwaukee 2 1 H & E Sections made Tissue examined/sectioned by remote PA/Hub Pathologist 6 9 Report reviewed, printed signed, faxed 8 PA enters report into Iron Mtn VistA 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