Telepathology
Encyclopedia
Telepathology is the practice of pathology
at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis
, education
, and research. Performance of telepathology requires that a pathologist selects the video
images for analysis and the rendering diagnoses. The use of “television microscopy
”, the forerunner of telepathology, did not require that a pathologist have physical or virtual “hands-on” involvement in the selection of microscopic fields-of-view for analysis and diagnosis.
An academic pathologist, Ronald S. Weinstein M.D., coined the term “telepathology” in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He and his collaborators published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic
telepathology systems and telepathology diagnostic networks. Dr. Weinstein is known to many as the "father of telepathology". In Norway
, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America
, Europe
, and Asia
.
Telepathology has been successfully used for many applications including the rendering histopathology
tissue diagnoses at a distance, for education, and for research. Although digital pathology
imaging, including virtual microscopy
, is the mode of choice for telepathology services in developed countries, analog
telepathology imaging is still used for patient services in some developing countries.
systems. Static image systems have the benefit of being the most reasonably priced and usable systems. They have the significant drawback in only being able to capture a selected subset of microscopic
fields for off-site evaluation. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety, from a distance. With real-time systems, the consultant actively operates a robotically controlled motorized microscope
located at a distant site—changing focus, illumination, magnification, and field of view—at will. Either an analog video camera or a digital video camera can be used for robotic microscopy. Another form of real-time microscopy involves utilizing a high resolution video camera mounted on a path lab microscope to send live digital video of a slide to a large computer monitor at the pathologist's remote location via encrypted store-and-forward software. An echo-cancelling microphone at each end of the video conference allows the pathologist to communicate with the person moving the slide under the microscope. Virtual slide
systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). This file is stored on a computer server and can be navigated at a distance, over the Internet
, using a browser. Digital imaging
is required for virtual microscopy.
While real-time and virtual slide systems offer higher diagnostic accuracy when compared with static-image telepathology, there are drawbacks to each. Real-time systems perform best on local area networks
(LANs), but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Expense is an issue with real-time systems and virtual slide systems as they can be costly. Virtual slide telepathology is emerging as the technology of choice for telepathology services. However, high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Also, virtual slide digital files are relatively large, often exceeding one gigabyte
in size. Storing and simultaneously retrieving large numbers of telepathology whole-slide image files can be cumbersome, introducing their own workflow challenges in the clinical laboratory.
diagnoses, second opinion
diagnoses, subspecialty pathology expert diagnoses, education, compentency assessment, and research. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a renal pathologist
, a neuropathologist, or a dermatopathologist, for immediate consultations.
is the organization responsible for the implementation of telepathology in Canada
. Canada Health Infoway is a federal non-profit which provides funding for improving digital health infrastructure.
Canada Health Infoway has targeted funding of $1.2 million CAD to the Telepathology Solution for the province of British Columbia
. The system is designed to connect all pathologists within the province. The long-term expectations are improvement to patient care and safety through access to pathology expertise, improved timeliness of results and quality of service.
In Ontario
, the University Health Network
(UHN) hospitals are the primary drivers of the development of telepathology. The three northern Ontario communities of Timmins
, Sault Ste. Marie
and Kapuskasing have several community hospitals virtually linked to UHN pathologists via the Internet 24 hours a day.
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
, education
Medical education
Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor or additional training thereafter ....
, and research. Performance of telepathology requires that a pathologist selects the video
Video
Video is the technology of electronically capturing, recording, processing, storing, transmitting, and reconstructing a sequence of still images representing scenes in motion.- History :...
images for analysis and the rendering diagnoses. The use of “television microscopy
Microscopy
Microscopy is the technical field of using microscopes to view samples and objects that cannot be seen with the unaided eye...
”, the forerunner of telepathology, did not require that a pathologist have physical or virtual “hands-on” involvement in the selection of microscopic fields-of-view for analysis and diagnosis.
An academic pathologist, Ronald S. Weinstein M.D., coined the term “telepathology” in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He and his collaborators published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic
Robotics
Robotics is the branch of technology that deals with the design, construction, operation, structural disposition, manufacture and application of robots...
telepathology systems and telepathology diagnostic networks. Dr. Weinstein is known to many as the "father of telepathology". In Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America
North America
North America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
, Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
, and Asia
Asia
Asia is the world's largest and most populous continent, located primarily in the eastern and northern hemispheres. It covers 8.7% of the Earth's total surface area and with approximately 3.879 billion people, it hosts 60% of the world's current human population...
.
Telepathology has been successfully used for many applications including the rendering histopathology
Histopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
tissue diagnoses at a distance, for education, and for research. Although digital pathology
Digital Pathology
Digital Pathology is an image-based information environment enabled by computer technology that allows for the management of information generated from a digital slide...
imaging, including virtual microscopy
Virtual microscopy
Virtual microscopy is a method of posting microscope images on, and transmitting them over, computer networks. This allows independent viewing of images by large numbers of people in diverse locations. It involves a synthesis of microscopy technologies and digita l technologies...
, is the mode of choice for telepathology services in developed countries, analog
Analog signal
An analog or analogue signal is any continuous signal for which the time varying feature of the signal is a representation of some other time varying quantity, i.e., analogous to another time varying signal. It differs from a digital signal in terms of small fluctuations in the signal which are...
telepathology imaging is still used for patient services in some developing countries.
Types of telepathology systems
Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slideVirtual slide
A virtual slide is created when glass slides are digitally scanned in their entirety to provide a high resolution digital image using a digital scanning system for the purpose of medical digital image analysis...
systems. Static image systems have the benefit of being the most reasonably priced and usable systems. They have the significant drawback in only being able to capture a selected subset of microscopic
Microscopic
The microscopic scale is the scale of size or length used to describe objects smaller than those that can easily be seen by the naked eye and which require a lens or microscope to see them clearly.-History:...
fields for off-site evaluation. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety, from a distance. With real-time systems, the consultant actively operates a robotically controlled motorized microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
located at a distant site—changing focus, illumination, magnification, and field of view—at will. Either an analog video camera or a digital video camera can be used for robotic microscopy. Another form of real-time microscopy involves utilizing a high resolution video camera mounted on a path lab microscope to send live digital video of a slide to a large computer monitor at the pathologist's remote location via encrypted store-and-forward software. An echo-cancelling microphone at each end of the video conference allows the pathologist to communicate with the person moving the slide under the microscope. Virtual slide
Virtual slide
A virtual slide is created when glass slides are digitally scanned in their entirety to provide a high resolution digital image using a digital scanning system for the purpose of medical digital image analysis...
systems utilize automated digital slide scanners that create a digital image file of an entire glass slide (whole slide image). This file is stored on a computer server and can be navigated at a distance, over the Internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
, using a browser. Digital imaging
Digital imaging
Digital imaging or digital image acquisition is the creation of digital images, typically from a physical scene. The term is often assumed to imply or include the processing, compression, storage, printing, and display of such images...
is required for virtual microscopy.
While real-time and virtual slide systems offer higher diagnostic accuracy when compared with static-image telepathology, there are drawbacks to each. Real-time systems perform best on local area networks
Local area network
A local area network is a computer network that interconnects computers in a limited area such as a home, school, computer laboratory, or office building...
(LANs), but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Expense is an issue with real-time systems and virtual slide systems as they can be costly. Virtual slide telepathology is emerging as the technology of choice for telepathology services. However, high throughput virtual slide scanners (those producing one virtual slide or more per minute) are currently expensive. Also, virtual slide digital files are relatively large, often exceeding one gigabyte
Gigabyte
The gigabyte is a multiple of the unit byte for digital information storage. The prefix giga means 109 in the International System of Units , therefore 1 gigabyte is...
in size. Storing and simultaneously retrieving large numbers of telepathology whole-slide image files can be cumbersome, introducing their own workflow challenges in the clinical laboratory.
Uses and benefits of telepathology
Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens, primary histopathologyHistopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
diagnoses, second opinion
Second opinion
A second opinion is a consultation with an additional physician for an alternative point of view.Second opinion may also refer to:* Second Opinion , an American medical program...
diagnoses, subspecialty pathology expert diagnoses, education, compentency assessment, and research. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a renal pathologist
Renal pathology
Renal pathology is a subspecialty of anatomic pathology that deals with the diagnosis and characterization of medical diseases of the kidneys. In the academic setting, renal pathologists work closely with nephrologists and transplant surgeons, who typically obtain diagnostic specimens via...
, a neuropathologist, or a dermatopathologist, for immediate consultations.
Canada
Canada Health InfowayCanada Health Infoway
Canada Health Infoway is an independent, federally-funded, not-for-profit organization tasked with accelerating the development of electronic health records across Canada. As a strategic investor, they work with Canadian provinces and territories with the goal of creating an electronic health...
is the organization responsible for the implementation of telepathology in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. Canada Health Infoway is a federal non-profit which provides funding for improving digital health infrastructure.
Canada Health Infoway has targeted funding of $1.2 million CAD to the Telepathology Solution for the province of British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
. The system is designed to connect all pathologists within the province. The long-term expectations are improvement to patient care and safety through access to pathology expertise, improved timeliness of results and quality of service.
In Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, the University Health Network
University Health Network
University Health Network is a medical centre that comprises three teaching hospitals affiliated with the University of Toronto Faculty of Medicine....
(UHN) hospitals are the primary drivers of the development of telepathology. The three northern Ontario communities of Timmins
Timmins
Timmins is a city in northeastern Ontario, Canada on the Mattagami River. At the time of the Canada 2006 Census, Timmins' population was 42,997...
, Sault Ste. Marie
Sault Ste. Marie, Ontario
Sault Ste. Marie is a city on the St. Marys River in Algoma District, Ontario, Canada. It is the third largest city in Northern Ontario, after Sudbury and Thunder Bay, with a population of 74,948. The community was founded as a French religious mission: Sault either means "jump" or "rapids" in...
and Kapuskasing have several community hospitals virtually linked to UHN pathologists via the Internet 24 hours a day.
See also
- PathologyPathologyPathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
- Anatomical PathologyAnatomical pathologyAnatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
- CytopathologyCytopathologyCytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
- Digital pathologyDigital PathologyDigital Pathology is an image-based information environment enabled by computer technology that allows for the management of information generated from a digital slide...
- MicroscopyMicroscopyMicroscopy is the technical field of using microscopes to view samples and objects that cannot be seen with the unaided eye...
- Medical laboratoryMedical laboratoryA medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
- Virtual microscopeVirtual microscopeThe Virtual Microscope project is an initiative to make micromorphology and behavior of some small organisms available online. Images are from Antarctica and the Baltic Sea and available at no cost. Images are offered in higher magnification or lower resolution...
- Virtual slideVirtual slideA virtual slide is created when glass slides are digitally scanned in their entirety to provide a high resolution digital image using a digital scanning system for the purpose of medical digital image analysis...
Informative sites or links
- Accelpath - Accelerated Digital Telepathology - Digital Pathology and Telepathology solutions
- APIII (a national pathology informatics meeting's website with archived presentations and contact information for faculty)
- Pathology Visions (a national digital pathology conference)
- Association for Pathology Informatics
- Digital Pathology Association
- Digital Pathology Blog
- American Telemedicine Association
- College of American Pathologists
- United States and Canadian Academy of Pathology
Links to articles
- New Developments in Digital Pathology: from Telepathology to Virtual Pathology Laboratory
- Feeding OWL: Extracting and Representing the Content of Pathology Reports
- Organizing Knowledge in a Semantic Web for Pathology
- Digital medicine in the virtual hospital of the future
Academic digital pathology sites
- Welcome to Digital Pathology at Brown Medical School
- Holycross Cancer Center (Poland, Kielce) Pathomorphology Department virtual slides
- Digital Pathology Imaging Group at University of Pittsburgh Medical Center