Introduction to Telepathology

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Introduction to Telepathology

• Bruce E. Dunn, M.D.
• Milwaukee VA Medical Center
• E-mail Bruce.Dunn_at_med.va.gov

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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

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

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Static (Store and Forward) Telepathology

• Static (still) images (photographs) selected by
  referring provider sent to consultant
• Requires skillful image collection by referrer

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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

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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

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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

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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

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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

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