Telepathology: An Upcoming Technology in India
Manoj Jaina, R.K. Guptaa, Shalini Kapoora, Sadhna Dhingraa and S.K. Mishrab
Department of Pathologya and Endocrine Surgeryb Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Abstract
With the advent of latest hardware and software technology in computer and imaging and boom in information technology sector, effective and useful telpeathoogy practice is now a reality. India is also keeping pace with latest technology. Potential of telepathology in health care and medical education in being realized in India as well. We present our experience at tertiary care medical centre of India for telepathology over last three years. We conducted regular tele-eduation and tele-consultation sessions with three medical colleges of Orissa, India. The out come was satisfactory in terms of participation, experience and knowledge gains. Key Words: Telepathology, Tele-education, Tele-consultation
for good telepathology is good quality of microscopic preparations.
Material & Methods
With an aim to increase the awareness of telepathology among the pathologist community and to assess the usefulness and difficulties encountered in telpathology practice in India, we conducted first interactive telpathology session in India between PGIMER, Chandigarh and SGPGIMS, Lucknow, in Feb 2001 during Indo-US symposium and slide seminar on endocrine surgical pathology. Live images from microscope were transferred and both way interactive videoconferencing discussions were held. Comments were received from Department of Pathology, PGIMER Chandigarh, on a formatted questionnaire. We also conducted eight static and live tele-eduation and teleconsultation sessions with Deptt. of Pathology, SCB Medical College, Cuttack, during Sep.-Dec., 2001. Seven postgraduate students and faculty members from Cuttack participated in the sessions. The emphasis was on renal and endocrine pathology as such cases are uncommonly seen at Cuttack. Case details of 5- 6 lesions for one session were sent by email beforehand. Interactive live images were transferred and both way discussion was held by videoconferencing. Teleconsultation was done in a similar manner receiving stored and real time microscopic images along with clinical details from Cuttack.
Introduction
Telepathology is defined as performance of pathology at a distance using available telecommunication links. It enables pathologists to render diagnoses and to consult remotely. It can be applied to all areas and activities of a pathologist, but the main role is in anatomic pathology, especially for intraoperative frozen section consultation, in tele-education, and teleconsultation in surgical pathology and cytolopathology. Instruments required for telepathlogy include a good quality CCD or digital camera attached to microscope with appropriate mounts, which is interfaced with a computer having appropriate hardware and software. The computer is linked with remote location having a similar facility, via telecommunication links as Local Area Network or telephone line or ISDN line (128 KBPS speed) or via VSAT (384 KBPS). Greater band width will provide fast and effective data transmission. Offline telepathology (store and forward) is used for sending still images for teaching and consultation. Dynamic telepathology (real time) usually requires both way communication for sending and receiving live images directly from microscope. This can be with or without microscope control at the remote site. The practice of telepathology is limited by the quality of image and its rate of transfer. Real time case discussion is done with audio and video conferencing. An essential prerequisite
Results
According to the filled questionnaire from Department of Pathology, PGIMER Chandigarh, the overall perception of video quality was perceived as good, and sound quality as unsatisfactory by the participants. Telephone line had frequent disconnectivity and slower image frames transfer rate. The course content was interactive and educative and was considered useful by both residents and consultants. The sessions were well appreciated and diagnoses were made in all cases by participants at Cuttack and the lesions were considered excellent and educative by the participants at Cuttack. Image and sound quality was fair and they appreciated live images over still images. In tele-consultation with SCB Medical College, Cuttack, limited opinion could be offered from SGPGI.
Limitations were due to quality of microscopic preparations and inability to see the desired field at desired magnification, due to slower frame transfer rate After our initial experience we started regular telepathology sessions using either stored digital images or transferring real time microscopic images followed by video conferencing for discussion. Sessions were conducted once or twice a month during last two years from Jan 02 to Dec 03 with Pathology Departments of SCB Medical College, Cuttack, MKCG Medical college, Behrampur and VSS Medical college, Burla Orissa. Fully worked up, uncommon cases on particular specialty as nephrology, urology, endocrine surgery, gastrointestinal medicine and surgery, neurology and neurosurgery specialty were shown from our institute to residents and consultants of pathology department of these medical colleges and interactive discussion was done by video conferencing. Cases and discussions were well appreciated. We also received difficult cases for consultation. Limited opinion could be offered. Limitations were suboptimal quality of microscopic images and fewer images per case. Still our opinion helped them in diagnosing and managing the cases.
Conclusions
Telepathology is in a developing phase in our country. It requires awareness among pathologists and needs improvement in the quality of instruments used and in bandwidth of telecommunication links. With the improvement in the quality of digital archiving microscopes and in software and hardware technology in the near future, digital scanning and archiving whole histopathology glass slides at higher resolution and transmitting contents of slide within seconds at higher bandwidth will improve drastically the telepathology consultation. Finally, the quality of microscopic preparations and image optimization always plays a major role in making decisions at the remote end.
Address for Correspondence:
Prof RK Gupta Prof & Head Department of Pathology SGPGIMS, Lucknow, India. PIN 226014 Email: rkgupta@sgpgi.ac.in