Electronic Journal of Pathology and Histology - Volume 6, issue 3

Authors: Kok, Lambrecht P. | van Drunen, Rudi | Boon, Mathilde E. | Beck, Samuel | van Coevorden, Ruben S.

Article Type: Research Article

Abstract: This paper describes a pilot study in Dutch teledermopathology. Three general practitioners (GPs) were provided with a digital camera by their pathologist at the Leiden Cytology and Pathology Laboratory (LCPL). Following a protocol, they documented the skin lesions of 122 patients before taking biopsies. The digital images were sent by e-mail to the LCPL. The biopsies were sent by conventional mail to the LCPL, and handled according to routine procedures. All images proved informative for the …pathologist. The GPs prediction/expectation of malignancy was compared with the outcome of histology. Nonconcurring diagnoses were analyzed. Among the most common diagnoses, the benign lesion verruca proved difficult for the GPs, whereas basal cell carcinoma proved relatively easy. The documentation of the clinical presentation of skin lesions proved simple and highly successful. In case of referral to hospitals and treatment by specialists comprehensive electronic reports were available and helpful in patient management. The omnipresence of the internet plays an important role in this project. The pilot study revealed positive added value of the digitized images. Show more

Keywords: telepathology, dermatopathology, general practice, internet, digital camera

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 01-01, 2000

Authors: Szymas, Janusz

Article Type: Research Article

Abstract: In September 1996 telepathology in Poland started with the activities undertaken in the TEMPUS Joint European Project. The project activities allowed the development of a telepathology laboratory and to prepare courses of telepathology for students of the Medical Faculty, University of Poznan. Three Workshops on telepathology were held in Poznan with international participation from in 1996 until 1999. A World Wide Web microscope has been established. It uses the Internet to connect pathologists for exchange of …histopathological data. The telemicroscope localized in Poznan allows a worldwide access to the current cases by using a standard Internet browser. At the same time, a histopathological reference case archive has been established for educational purposes. Several neuropathological cases were digitized and sent via e-mail or transmitted via the ftp protocol to neuropathologcal laboratories located in Lodz (Poland) and Udine (Italy) in order to check the usefulness of this method for the remote consultation. Fifteen neurooncological cases were presented for second opinion to experts in Poland and abroad. In an additional trial, we analyzed the diagnostic accuracy of real time transmission of 52 consecutive neurosurgical cases. Telepathology is also a compartment of the "Internet for Physician" program in Poland. The aim of this project is to construct a telepathology system, which will be available for all Pathological Institutes in Poland and match all international standards, necessary to practice telepathology. Together with other local telepathological activities in Lodz, Lublin, Gliwice and Warsaw, and a growing capacity of national and international Internet networks telepathology in Poland is becoming a reality. Show more

Keywords: telepathology, Poland, Tempus project, teleeducation

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 02-02, 2000

Authors: Kayser, Klaus | Kayser, Gian | Zink, Stefan

Article Type: Research Article

Abstract: Background: Telepathology is the work of a pathologist at a distance. It is useful to distinguish two applications, namely on-line and off-line telepathology. Several field tests have been shown that this technology can be successfully applied in frozen section services, remote control measurements, expert consultations, training and education. What is to be expected from this technology in the future? Technology and pathology disciplines: Frozen section service is an interactive end-to-end diagnostic discipline …with contemporary visual and acoustic information transfer. The commercially available systems will probably become integrated into pathology documentation systems, and to be integrated into teaching and training systems. Interdisciplinary connection (for example with radiology or endoscopy) is on the way. These systems will probably remain stationary in contrast to expert consultation and training systems. The trend in expert consultation directs to off-line consultation, mainly by use of the internet. The new generation of cellular phones will provide non-stationary data transfer and will permit a closer integration of expert teleconsultation into the workflow of diagnostic pathology. It will be combined with visual data bases allowing first step diagnosis with integrated image sources. Allocation with other medical fields will construct multi-dimensional image data bases with strict timing in terms of final diagnosis and access to information spread into the internet (electronic publication). Thus, off-line teleconsultation will be one point in a multidimensional telepathology system which can be projected on different scales such as expert consultation, on-the-spot diagnosis, telemeasurements, education, or publication. Teleeducation and training systems will, again, become distributed by the internet and be connected with interactive TV systems which might be located at home or in transportation vehicles (cars, trains, airplanes). Information connection and time schedules: Computer networking is now to be installed between numerous European research centers to be connected by broad band connections. Large university pathology institutions will have access to these lines at reasonable costs in contrast to small institutions which will have to rely on ISDN lines, wireless connections or powerline information transfer. It can be expected that new technologies will increase the gap between large and small institutions giving enormous technical advantages to large institutions. This process has already started in large cities (for example Berlin) although real new pathology applications are still missing. It can be foreseen that within the next five years expert consultation systems will be handled by large institutions to be accessible for diagnostic support by small pathology institutes within Europe. Outlook: Telepathology has already started to become a routine tool in various institutes of pathology. It is no more only a replacement of missing experts or non-available pathologists at locations of surgery. It has already opened a new technology door giving chances for the combination of research, diagnosis, education and publication in pathology, i.e., we will step into a new world of pathology. Show more

Keywords: telepathology, on-line telepathology, off-line telepathology, wireless information transfer, powerline telecommunication

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 03-03, 2000

Authors: Gombas, Peter

Article Type: Research Article

Abstract: AIMS: Although various telepathology techniques have recently been developed globally to enable telecommunication in pathology, pathologists seem to have reservations about implementing cyber age tools in professional practice. Static telepathology (ST) is easy and inexpensive but most of the methods used have been biased due to the low explicit/implicit ratio of transferred information. Our object was to develop a method of ST, which make the technique less biased. METHODS: Digital images of cytological and …histopathological samples were captured with a bright field transmitted light microscope. Static images were stored on a hard disk and transferred to various remote locations via a local network, connected to the Internet. To determine the degree of bias of ST method, ratio of explicit/implicit information /REI/ has been calculated. RESULTS: The degree of bias of transferred digital images strongly depends on both the size of the image and numerical aperture of the objective lenses used to capture the image. Using images with a resolution of 800 x 800 pixels REI of small biopsies was approximately 1:1 when they were captured with an objective lens at a magnification of X10. However, REI of a section with an area typical of that used for pathological diagnosis (approx. 1x1 cm) captured at the same magnification proved to be only 0.01. We found that increasing the magnification of the objective lens used to capture the image, the REI decreased significantly. Although it is possible to increase the resolution of digital images by capturing them with high-resolution cameras or by the use of a slide scanner, this is not always helpful. We recommend, that hierarchic arrangements of digital images captured in the "x, y" and "z" planes and presented in the form of an image pyramid may ameliorate some of the difficulties associated with static digital image transfer. CONCLUSION: Storage and transfer of digital images enable complex information exchange using Internet protocols. ST methods are inexpensive and broadly accessible. The use of the image pyramid system can reduce the degree of bias significantly. It seems to be a useful method for expert discussions, consultations, archiving and education. Show more

Keywords: telepathology, telemedicine, internet, image pyramid, image storage and retrieval

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 04-04, 2000

Authors: Szymas, Janusz | Wolf, Guenther | Papierz, Wielislaw | Danilewicz, Marian | Jarosz, Bozena

Article Type: Research Article

Abstract: We investigated 52 randomly selected tissue specimens from patients undergoing brain surgery in a prospective mode with telepathology equipment. The telepathology system applied TELEMIC and used the Internet as a telecommunication link. All cases were selected from the routine diagnostic workload in the Neurosurgical Pathology Laboratory in Poznan. The diagnostsis was based on telemicroscopy with a remotely operated robotic microscope and a digital camera. The telediagnoses were compared with the conventional diagnoses …of paraffin-embedded section. The accuracy of diagnostic procedure was analyzed by statistical methods. The mean accuracy for the remote diagnosis was calculated to 98%. Pathologists involved in the study assessed the image quality as sufficient for a correct evaluation. The time period for establishing a final diagnosis with the remote microscope was acceptable. Further technical improvements of Internet networks should boost telepathology as an everyday method for remote diagnosis of neurooncological cases. Thus, this level of operation can be used in real-time diagnosis and may be used to transport a specialist's expertise to remote sites including hospitals without a neurooncologist. In addition, this form of telepathology is an ideal tool for education. Show more

Keywords: telepathology, paraffin sections, neurooncology

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 05-05, 2000

Authors: Seiwerth, Sven

Article Type: Research Article

Abstract: The relationship between telepathology and teleradiology is discussed. Although both disciplines have numerous features in common several differences can be noted. The performance of teleradiology is more advanced than that of telepathology: standards have been developed (DICOM 3) and radiologists are trained to judge digital images which include still images (CT scan, MRI) and images sequences (angiographs). The size of radiologic images is small compared to that of histological images of high resolution. The patchwork …technique or store and forward dynamic telepathology are tools to obtain high resolution images in histopathology. They require sophisticated data banks for handling and telepathology use. These databanks need standards for user independent access. The DICOM standard used in radiology is applicable for these purposes. Teleradiology and telepathology meet each other in various medical disciplines, especially in orthopedic oncology and chronic pulmonary diseases. The potential share of telecommunication in radiology and pathology owns a great potential for modern health services. Show more

Keywords: telepathology, teleradiology, telemedicine, image databases

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 06-06, 2000

Authors: Slodkowska, Janina | Kayser, Klaus | Radomski, Piotr | Papierz, Wielislaw

Article Type: Research Article

Abstract: The authors present their first experience in an international and domestic telepathology consulting service using static image transmission. The study assessed the technical aspects of telepathology performance and examined the consultative accuracy of telepathology in difficult lung pathology and in neuropathology cases. The referring pathologist (RP) used the image analysis system "SAMBA 2005" with Telepath software (Unilog, France), prepared the files of microscopic images, and submitted the images together with scanned HRCT …graphs and e-mail messages (patients information) via Internet to the expert telepathologist (TP). The 3CCD camera was operated at 768 x 576 pixels. A JPEG compression mode was implemented. The number of microscopic images varied from 14 to 21. The files ranged from 1,58 MB to 7,4 MB. The primary diagnoses were included in the transmitted static-image files. Simultaneously the glass slides were mailed to TP to be reviewed by the telepathologist for final diagnoses (RTD). The RP cases included: A/ pilocytic juvenile type astrocytoma, B/ desmoplastic medulloblastoma, C/ pilocytic astrocytoma, D/ pulmonary plasma cell granuloma with LIP (reactive interstitial lymphoid infiltrates), E/ pulmonary chondroides hamartoma with (?) parenchymal foci of smooth muscle proliferation. The e-mail process was successful in all cases. No technical errors occurred. The TP answers were faxed within 24 hrs. There was a high concordance for the important diagnosis made by RT, TP and RTD. The TP and RTD diagnoses extended RP diagnosis in case E by recognition of metastasising uterine benign leiomyoma in the lung. Additional immunostains were proposed for the therapeutic purpose. Our static-image study showed a high degree of the diagnostic accuracy in telepathology expert consultation. This diagnostic accuracy was related to the experience of the telepathologist and referring pathologist. Teleconsultations improved the quality of the diagnoses in the cases pulmonary presented. Show more

Keywords: telepathology, static imaging, diagnostic accuracy, pulmonary pathology

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 07-07, 2000

Authors: Daniel, Dorothea | Schlesner, Judith | Wehrstedt, Kathrin | Hufnagl, Peter | Dietel, Manfred

Article Type: Research Article

Abstract: Image quality is a crucial factor in the diagnostic practice of telepathology. Because of technical and financial limitations there has to be made a compromise between high image quality and fast image transmission. There are no standardized thresholds defining minimal requirements in respect to the image quality during telepathological diagnostics with the purpose to guarantee diagnostic accuracy. Aim of this study is the investigation of the influence of the resolution of digital histological images on subjective …perception. Observers were asked to compare a set of 50 image pairs projected by a slide projector. Each image pair consisted of a reference image of 1800 dpi resolution and a test image of lower resolution. Both were sampled out of an original photographic transparency. According to our results it would be recommendable to use the following resolutions in pixel per micrometer for the purpose of histopathological telediagnosis to meet the claims of viewers with high visual acuity: objective 1x: 0,19 pixel per µm; objective 4x: 0,43 pixel per µm; objective 10x: 1,09 pixel per µm; objective 20x: 2,17 pixel per µm; objective 40x: 4,35 pixel per µm. Show more

Keywords: telepathology, frozen section, image quality, image resolution

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 08-08, 2000

Authors: Wehrstedt, Kathrin | Tennstedt, Corina | Hufnagl, Peter

Article Type: Research Article

Abstract: In recent years the number of described malformations and syndromes has increased rapidly. The diagnosis of fetal malformations requires extensive experience. Since important questions often arise during the autopsy, requiring a second opinion or additional input without interruption of the autopsy, telepathology offers one means of solving this problem. The system employed was TPS Version 1.5, which was developed in a cooperative effort by the Charité and Leica Microsystems. If there is no pathologist available for …a second opinion during the autopsy TPS enables the investigator to save pictures taken during the autopsy so that they can be sent at a later point in time to an expert for a second opinion. In a study comprising 10 cases the image quality and the communication possibilities of TPS were evaluated, with the online communication being compared with respect to suitability, time required and quality. Telepathology can be used in fetal diagnostics. It allows a second opinion to be obtained either during or after the autopsy, under routine conditions where a call for a second opinion is normally not possible. This improves the quality of diagnoses. Show more

Keywords: telepathology, fetal diagnosis, perinatal center, fetal autopsy

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 09-09, 2000

Authors: Hufnagl, Peter | Nguyen-Dobinsky, Trong-Nghia

Article Type: Research Article

Abstract: AIMS: The telepathology system TPS is the result of a joint development of the Institute of Pathology and the Department of Prenatal Diagnostics and Therapy of the Charité Berlin together with Leica Microsystems Wetzlar. This system is implemented on several workstations of pathologists within the institute and in two frozen section labs. We present the general design and the application of the TPS, which is used for second opinions in conventional histology and in frozen sections …as well as for primary diagnostic in frozen sections and for fetal autopsies. MATERIAL AND METHODS: The TPS is strictly case oriented. It may be used for teleconsultation and telediagnostic, because it allows handling of static and dynamic imaging (PAL 762 x 508 x 3 colour resolution, ITU standard H.263, H.264). Pathologists have the possibility to control the remote microscope and to contact the partner using videoconference (ITU standard H.323). Case and image data are archived in an SQL database. The connection between two partners may be realised using LAN or ISDN lines (minimal 2 B channels). We analysed overall accuracy and adaptability to pathologists workflow in the different application fields. RESULTS: The TPS has a case engine for the handling and archiving of the telepathological cases. Every connection between two partners is based on the transmission of a complete case including clinical data, previous findings and macroscopic findings including macroscopic images, overview images and microscopic images with possible annotations. The daily practice showed that these features are necessary for a routine application as well as for legal reasons. CONCLUSIONS Our experiences show that the design of the TPS allows the routine use for a second opinion and frozen section diagnostic. It opens the possibility to integrate telepathology in the ordinary working place of a pathologist. Show more

Keywords: telepathology, frozen section, second opinion, TPS

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 10-10, 2000

Authors: Oberbarnscheidt, Peter | Hufnagl, Peter | Guski, Hans | Hauptmann, Stefen | Dietel, Manfred

Article Type: Research Article

Abstract: AIMS: The routine use of telepathology depends on the exclusion of errors, which are caused by the telepathological technique itself. In this sense telepathology has to be compared with the conventional histological diagnosis. Several studies have been published on this topic. The conditions of these studies are quite different. Our aim is to present a study that especially focuses on error analysis in telepathlogy. MATERIAL AND METHODS: We performed a study on routine frozen sections. Two …different telepathology systems have been used: Broadband video-conferencing based on ATM and the TPS telepathology system. We compared conventional frozen section diagnosis and telepathological diagnosis with the paraffin diagnosis. After a first trial we analysed the error sources and improved the set-up of the systems and the workflow. In a second trial half a year later we investigated how the improvements influenced the performance. RESULTS: For frozen section diagnostic false positive errors are most critical. We had one false positive case using the ATM-system. The error analysis showed that more than a half of the errors could not be attributed to telepathology. Most of the errors were sampling errors. The errors, which could be attributed to telepathology concerned mostly the image quality. While analysing this, we found a few things that could be improved in the workflow and in the set-up of the systems, e.g. microscope set-up (TPS); frame rate (ATM). CONCLUSIONS: Several authors compared telepathology with conventional microscopy. The results are different with respect to various technical solutions, different study designs and standard diagnoses. Unfortunately, the reasons for errors and deferrals are rarely given in detail and have not been analysed sufficiently. The error sources we found in our study are comparable to error sources reported by other authors. The correct sampling on the microscopic level and a guaranteed sufficient image quality are the key for a high quality telepathology solution. By an improvement of the settings of the telepathology systems, the microscope and the workflow, it is possible to avoid some wrong diagnoses and deferrals. As a consequence of study, we suggest to monitor the image quality permanently, to sent always an overview image of the whole specimen and to set up the microscope very carefully. Show more

Keywords: telepathology, frozen section, quality assurance, image quality

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 11-11, 2000

Article Type: Other

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 12-12, 2000

Article Type: Other

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 13-13, 2000

Article Type: Other

Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 14-14, 2000

Authors: Kayser, Klaus

Article Type: Book Review

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Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 15-15, 2000

Authors: Kayser, Klaus

Article Type: Book Review

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Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 16-16, 2000

Authors: Kayser, Klaus

Article Type: Book Review

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Citation: Electronic Journal of Pathology and Histology, vol. 6, no. 3, pp. 17-17, 2000