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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

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introduction to telepathology

Introduction to Telepathology

Bruce E. Dunn, M.D.

Milwaukee VA Medical Center

E-mail: Bruce.Dunn@med.va.gov

telepathology
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
Telepathology System

Images from www.bildanalys.se/tele.htm

description of previous slide
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 (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 telepathology6
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
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
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
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
robotic hybrid dynamic store and forward telepathology
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
dynamic robotic telepathology
Dynamic Robotic Telepathology

4

5

WAN

Router

Router

Hub Pathologist

examines slides using

robotic microscope

Slides put onto stage

of robotic microscope

3

7

Pathologist dictates

report to PA

Slides read in

Milwaukee

6

2

H & E Sections made

Tissue examined/sectioned by

remote PA/Hub Pathologist

1

Report reviewed, printed

signed, faxed

9

PA enters report

into Iron Mtn VistA

8

conclusions
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