With the increasing demand of technology worldwide, Telepathology has been progressing into various ways. From social media images to high definition electronically transmitted images, telepathology is taking a new turn connecting various specialists all around the world.
So, what is telepathology? What are its various types? Is telepathology as good as the conventional microscopic examination by the pathologist itself? What are the drawbacks?
I’ll try to explain all these questions in this blog post. Ronald S Weinstein coined the term telepathology in 1986.
Telepathology is a process in which pathologists provide diagnosis and suggestions by viewing the electronically transmitted images rather than examining the slides under the microscope. Now these images can be transmitted through various sources such as mobiles, high speed digital lines, satellites etc. most commonly and easily used way is through the internet. With availability of high speed internet and various social media options, sending high quality images have been quite easy for getting opinions from different pathologists at the same time.
The Various Steps Involved In Telepathology Are
1. Preparation of the sample for processing.
2. Staining by experienced technicians in the lab.
3. Formation of a high quality digital image by a virtual slide scanner.
4. Sampling the digital image.
5. Image compression according to the requirements and type of system used.
6. Transmission of the image files to various sectors.
7. Displaying the image file for the pathologist via video display.
Telepathology is mainly of three types
1. Dynamic telepathology
2. Static telepathology
3. Virtual telepathology.
Understanding Various Types of Telepathology Systems
In this type of system the pathologists examine the images in real time with the help of a distant robotic microscope. That has a motorized stage and optics as well. This dynamic- robotic telepathology has been mainly used to provide the intraoperative frozen section diagnosis to the various hospitals without the presence of onsite pathologists. The time required for the digital overview of the slides is less than a minute. The virtual controls enable the pathologist to remotely control the movement of the slide for viewing certain sections. Due to this the diagnostic accuracy is quite comparable to the ones observed in conventional light microscopy. Another variation of this dynamic telepathology system is live streaming of the image from a remotely located microscope which may or may not be under robotic control. Now in this type of method the slide manipulation and magnification at various places is controlled by giving instructions to the person who is using the microscope.
The major disadvantage of using dynamic pathology is mainly the time which is consumed during the whole process. The examination of slides under the microscope per se is less time consuming. Another disadvantage is that the pathologist is not involved in the grossing and inspection of the specimen, so it can affect the diagnosis at a certain level. This is because when the pathologist does the inspection and grossing they are aware of the lesion sites and know the orientation of the specimen as well. This onsite presence helps in reaching the diagnosis at a much faster pace making it more convenient for the pathologist and the patient as well. The process of identification, frozen sections and smear preparation as well as communication and relevant history transmission between various doctors and the patients involved, plays a major role in approaching the accurate diagnosis, which definitely lacks in the dynamic telepathology systems. It requires a great deal of planning and training to all the professionals in order to implement telepathology in regular setup.
As the name suggests this includes static images in the form of .jpeg or.tiff files that have been selected by one person accordingly, stored and then forwarded to a pathologist for their opinion. Nowadays, the most common form in this usage is social media images in which a specialist forwards the images showing different sections of the slide to the pathologist they seek opinion from. This type of method is used for receiving a second opinion on difficult cases. In this way the diagnostic accuracy can reach the ones with actual visualization as well.
The major drawback is the image quality which is usually compressed during the transfer. The field selection also plays a very important role in the accuracy of the diagnosis in this type. If the pathologist who is transmitting the file misses any field the pathologist who receives them for second opinion misses it too, ultimately leading to an incorrect diagnosis. Sometimes the nuclear features are also not properly visible in the static telepathology which leads to variation in diagnosis.
Virtual Slide Pathology
The use of virtual telepathology has shown quite a significant clinical utility in various time sensitive situations such as frozen section diagnosis. The main problem in this type of setting is the infrastructure requirements, the time consumed for scanning files, as well as the large file sizes may limit the usefulness in various settings. The image stitching approach has addressed some of these issues.
There is a fourth generation of telepathology system in which a Miniature Microscopic Array (MMA) is used. In this system the output from about 100 miniatures microscopes is captured by 100 individual digital images. This results in the formation of a virtual slide that is produced in minutes.
Pros Of Telepathology
1. Remote consultation can be achieved from various pathologists.
2. Expanded access to various Special studies which are not available at a particular centre.
3. Clinical reviews had been made easier.
4. Archived images can be retrieved for reassessment of any particular case.
5. Patient access can be achieved through this method, but it requires adherence to privacy and security.
6. Quality can be assured in terms of staining.
Cons Of Telepathology
1. More time consuming in certain cases.
2. Quality of images is compromised.
3. Lack of on site inspection, grossing, smear preparation leads to variation in diagnosis.
4. Validation and quality control issues can be there.
5. Lack of trained IT personnel and infrastructure.
6. Expensive and not easily maintained.
7. Can lead to loss of relevant local expertise.
8. Needs a stable and broad band width for telecommunication between the sender and the recipient.
Hence we can see that there are both positive and negative aspects of telepathology.
Hope you found this article helpful in getting a brief idea on the working and types of telepathology.
Take care ☺
Washington Manual Of Surgical Pathology.
Telepatholgy : Guidance From The Royal College Of Pathologists, October 2013. Author- Professor James Lowe, Chair Of Speciality Advisory Committee On Cellular Pathology.