An Initial Trial of a Prototype Telepathology System Featuring Static Imaging With Discrete Control of the Remote Microscope

Abstract

A b s t r a c t Routine diagnosis of pathology images transmitted over telecommunications lines remains an elusive goal. Part of the resistance stems from the difficulty of enabling image selection by the remote pathologist. To address this problem, a telepathology microscope system (TelePath, TeleMedicine Solutions, Birmingham, Ala) Increasingly in medicine, electronic images are replacing film-based media. Radiology, remains the one medical specialty that routinely uses electronic images for diagnosis.1-3 The reasons for the disparity between radiology and other medical specialties are varied but of special importance is the requirement for color in pathology, as well as in other clinical specialties. Pathology also requires multiple fields of view and multiple optical magnifications. Telepathology, the use of images transmitted over telecommunications media for diagnosis, has been successfully implemented in a small number of settings, but widespread acceptance has remained elusive. 4-9Two quite different models of telepathology have been developed. The "dynamic model" uses real time transmission of video images along with remote control of the microscope to provide immediate diagnoses using images selected at the home site. The "static model" uses still digital images selected at the remote site and transmitted at a later time for remote diagnosis. [10][11][12] Each of these models has distinct advantages. The dynamic model allows the remote user to select the images for viewing. It is useful for real time intraoperative diagnosis or consultation between pathologists, but it requires high bandwidth, and most of the images transmitted are of modest quality. The static model usually provides images of superior quality, but the number of images is limited. It is usually not feasible to transmit the images in real time, and the selection of images by the remote site requires that 2 pathologists share the interaction. Because bandwidth requirements are low for this system, images can be transmitted over the Internet.

The validity of telepathological frozen section diagnosis with ISDN-mediated remote microscopy

“…Oberholzer et al [20] report a slightly higher sensitivity (85.7%) than was found in our study. Eide and Nordrum [6] and Nordrum and Eide [17] found similar values to ours, with, in particular, a test accuracy of 89.0% (11/100 misclassifications, 1 false-positive, 3 false-negative and 7 deferred diagnoses); Winokour et al [33], a test accuracy of 96.9% (routine diagnoses without frozen section situation); Steffen et al [27] found 89%; Fujita et al [9], 94.9% and Adachi et al [1], 93.2%. Our data are in the range of those reported above and reach a test efficiency of 90%, with deferred diagnoses excluded, and 81% if deferred diagnoses are included.…”

Static Image Telepathology in Routine Surgical Pathology Diagnosis: A Report on the First Experience in the Arab World from Kuwait

“…It is interesting that no false-positive diagnosis of malignancy was rendered by the tele-Francis/Junaid/Dajani pathologist in frozen as well as paraffin sections. Such a telediagnosis of frozen sections has been successfully reported by several experts with a diagnostic accuracy ranging from 89 to 96.9% [8,[17][18][19].…”

Teleneurology in Practice

“…Thus, this mode was abandoned (Weinstein, unpublished observations, 1988) [56,78]. Currently, the designation "dynamic-robotic" is used exclusively in the context of real-time video imaging.…”