Telepatholgy is the practice of pathology at a distance . there are three types: static image based, dynamic/ real time/dynamic robotic, and virtual or whole slide imaging. uses of telepathology, advantages and problems.

1. Telepathology
Dr. D. ANAMIKA

2. •Telepathology is the practice of pathology at a
distance by visualizing an indirect image on a
video monitor screen rather than viewing a
specimen directly through a microscope.
• It uses telecommunications technology
•Facilitates transfer of image-rich pathology data
between distant locations
•For the purpose of diagnosis, education,
and research

3. •Performance of telepathology depends on
the pathologist who selects the video images
for analysis and the renders the diagnoses.
•Verbal and visual communication can take
place via video conferencing.

4. History
•An academic pathologist, Ronald S. Weinstein
M.D., coined the term “telepathology” in 1986.
• Dr. Weinstein is known to many as the "father
of telepathology".

5. Basic requirements for telepathology
•Microscope
•High resolution camera (750 x 500 resolution is the
minimum, 1K x 750 ideal),
•Image capture board or card in a computer
(Windows or Macintosh)
•Software to manage the images
•Internet access
•Telecommunication system to transmit images.

6. Process in digital imaging

7. Types of telepathology systems
•Telepathology systems are divided into three
major types:
•Static image-based systems,
•Dynamic / Real-time systems,
•Virtual slide systems/ whole slide imaging
(WSI).

8. Static telepathology
•Most reasonably priced and usable systems.
•It is the capture and digitalization of a group of
macroscopic and microscopic images selected
by a pathologist or pathologist assistant
•Transmitted through electronic means to a
telepathologist.

9. •This transmission is usually done by
electronic mail (e-mail) or by a file
transfer protocol (FTP)
•With e-mail, the image files are sent as
attached files in a message containing
the basic information about the case.

10. •The FTP is used to send files directly into a
web server from which the telepathologist
can download them.
• This includes both the images and the
information about the case in a web page
and give simultaneous access to several
pathologists in different parts of the world .

12. •Advantages:
•Simple and inexpensive
•Can be used without any special telecom
equipment other than a standard PC modem and
Internet account.
•Less investment in technology
•Shorter learning curve
•Higher resolution than dynamic real-time
methods, because the real-time requires large
amount of memory.

13. •Disadvantages
•Limited view of field (many pathologist may not be
willing to offer a definite diagnosis)
•Non representative images

14. "Dynamic" telepathology
•Dynamic systems are used to support online,
interactive sessions where images are transmitted
continually as the specimen is moved on the
microscope stage during the process of examination.
•Involves the transmission of microscopic slide images
to recipient in real time via live telecommunication.
•With the implementation of remote robotic
microscope, recipients can completely control the
magnification and slide.
•Robotic - image selection at remote site (robotic
microscope) is controlled by consultant at the hub site

16. Real time robotic microscope
• This robotic system controls
following elements:
• movement of the microscopic
plate,
• changing objectives,
• and focusing and
• light adjustment

17. • A live videophone link is normally provided to allow continuous two-
way communication between the participants.

19. •A modality of dynamic telepathology, in the absence
of a telerobotic system, is to use a telepathologist
assistant who operates the microscope in the remote
location and moves the plate following telephone
instructions from the telepathologist
•This systems provide the telepathologist with an
overview image of the specimen at low resolution
•This is accompanied by images at medium resolution,
which show the constantly changing microscopic
fields according to the movement of the plate.

20. •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.

21. Advantages
•Better field of view
•Real time consultation
•Planes of focus can be addressed

22. Limitations
•Dependence on assistant in case of non-robotic
microscope
•Absence of on-site pathologist
•Requires investment in technology- high-speed network
and better imaging equipment
•Dynamic telepathology has to be accomplished between
centers using the same operating system (software).
• Dynamic telepathology requires more than 128 kbit/s
bandwidth

23. •The cost of the equipment and the computer
programs fluctuate between $20,000 and $90,000
US and they are affordable only by large hospital
and/or academic institutions.
•The actual cost of a good high-resolution digital
camera is between $5,000 and $10,000 US.

24. 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.
•Digital pathology requires high quality scans free of
dust, scratches, and other obstructions.

26. Virtual slide scanner

28. •Real-time and virtual slide systems offer higher
diagnostic accuracy when compared with static-
image telepathology.
•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.

29. Advantages:
•Fidelity of diagnostic material
•Portability
•Ease of sharing
•Archival
•Ability to make use of computer aided diagnostic
tools – image algorithm.
•Simultaneous viewing/teleconferencing
•High resolution images and rapid interpretation
•Automated scanning

30. DRAWBACKS:
•Real-time systems perform best on local area
networks (LANs), but performance may suffer if
employed during periods of high network traffic
•High speed networks
•Expense is an issue with real-time systems and virtual
slide systems .
•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 is difficult.

31. Uses of telepathology
•Primary consultation for cytology or histopathology
•Second opinion in difficult cases
•Intraoperative consultations e.g. for rapid frozen
section diagnosis  Dynamic telepathology
required, but high cost. Retro-consultation
•Worldwide knowledge database/ Digital archieves
•Digital slide conferencing
•Education, eg : virtual slide box
•Competency assessment
•Research

32. •Another benefit can be gaining direct access to
subspecialty pathologists such as a renal
pathologist, a neuropathologist, or
a dermatopathologist, for immediate consultations.
•Time consumption, labor and cost intensive
exchanges of specimens by post or other means of
transportation can be avoided

33. Teleradiology Vs Telepathology
S.NO TELEPATHOLOGY TELERADIOLOGY
1. Original specimen is usually a glass
slide; image must be digitised before
transmission
Images produced in radiology are
already digitised
2. Original quality of images may be lost
as a result of digitisation of images
None of the original diagnostic
information has been lost or
degraded
3. Criteria still being established Well-established international
standards in radiology for image
acquisition, storage and transfer
4. No comparable requirement for training
and assessment in digital imaging
techniques in histopathology
Radiologists trained to understand
factors that influence digital image
quality
5. Histopathology selected areas viewed
at a very wide range of magnifications;
larger number of data files
Images viewed at a relatively
limited range of
magnification;fewer data files

34. Advantages of telepathology
•Telepathology can help pathologists in India who
commonly practice in smaller labs dealing with routine
histopathology or in smaller hospitals when they come
across unconventional cases.
•Without handing over blocks, a real-time consultation
with discussion can take place with telepathology,
between two pathologists
•This is better than a conventional consultation as the
local pathologist observes and understands the
diagnostic approach taken by the expert.

35. •Viewing images cuts out on the money and travel
time of a pathologist
•Telepathology can have a crucial role in education
and training in the following ways:
•Online cases and images are excellent tools of
education, supplementing standard books.
•Video clips from case conferences can be a part of
routine training.

36. •The virtual slide technology can reduce the number
of microscopes in a class.

37. Problems in Telepathology
•If used for routine workload (telemicroscopy), the
problem arises if the centre lacks a pathologist who
can use the facility well or is ill trained to read
digital images.
•Acceptance of responsibility by the local
pathologist for the final telepathology report that
goes out is a point to be considered.

38. •Technical standards for image capture, storage and
transfer need to be well set.
•While viewing distant virtual slides, the factor of
time lag has to be considered which does not
happen in a light microscope set up.
•Image resolutions may be inadequate for assessing
nuclear chromatin pattern or glomerular
pathology.
•If a lab solely relies on telepathology, there can be
damaging loss of local expertise.

39. •Training of new pathologists can become a problem
because they need to see and examine all kinds of
actual specimen.
•Telepathology may prove difficult in cases of large
complex specimens that need to be grossed well
and dissected in person.

40. Hybrid Telepathology
Simultaneous transmission of both real-time microscopy and static
images
• 2 major components located at the 1) remote site and 2) service
provider site (receiving site) The best choice is a "hybrid system"
 motorized microscopes,
 remote control,
 a scanner for slide digitization,
This achieve the best characteristics from each system without
respective disadvantages.
This choice has been applied to Rovigo province health structures, and
Trecenta hospital,USA

41. Telepathology in India
• Static telepathology link between Tata Meomorial Hospital and
Nurgis-Dutt rural cancer hospital in 2000
• India was not lagging far behind in the field of telepathology. The first
taste of telepathology in India was provided at a symposium
organized in the 50th Annual Conference of the Indian Association of
Pathologists and Microbiologists in Mumbai in 2001 aptly named
Telepathology: Today and Tomorrow
• A telepathology quiz page was opened in the popular pathoindia.com
e-group
• Upto 2004, 299 telepathology consultations
• 98% concordance rate
• 48% cases reported within 8 hrs and 91% in 3 days

42. Future perspectives
• High-speed scanning : 15x15 mm tissue area at 40x
in <1 min
•Technology for Scanning fluorescent slides
•Storage costs remain a limiting factor for digital
archiving

43. References
• 1)Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA,
Lopez AM, et al. Overview of telepathology, virtual microscopy, and
whole slide imaging: Prospects for the future. Hum Pathol
2009;40:1057-69.
• 2)Organizational model for a telepathology system Diagnostic
Pathology 2008, 3(Suppl 1):S7
• 3)Weinstein RS, Descour MR, Liang C, Bhattacharyya AK, Graham AR,
Davis JR, et al. Telepathology overview: From concept to
implementation. Hum Pathol 2001;32:1283-99.
• 4)Weinstein RS, Bhattacharyya AK, Graham AR, Davis JR.
Telepathology: A ten-year progress report. Hum Pathol 1997;28:1-7.
• 5)Introduction to telepathology:chapter 1;Sajeesh kumar
• Various internet sources.

44. Thank you