Introduction to Telepathology

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13 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

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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



Rationale:

Provide access to a generalist or
specialist pathologist (or technologist) not
available on
-
site

Telepathology System

Images from www.bildanalys.se/tele.htm

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 (still) images (photographs) selected by
referring provider sent to consultant



Requires skillful image collection by referrer


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


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


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


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


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

1

Tissue examined/sectioned by

remote PA/Hub Pathologist

2

3

5

4

6

7

8

9

H & E Sections made

Slides put onto stage

of robotic microscope

WAN

Hub Pathologist

examines slides using

robotic microscope

Slides read in

Milwaukee

Pathologist dictates

report to PA

PA enters report

into Iron Mtn VistA

Report reviewed, printed

signed, faxed

Router

Router

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