Information needed from other modalities, for example flow cytometry or cytogenetics is, well, in another modality. When it’s time to begin an interpretation, the necessary information required to read out a case isn’t exactly at the pathologist’s fingertips. To complicate matters, if a case requires a specialty pathologist, or a pathologist is needed to serve a remote facility, all of this information, including the glass slide, must be sent to the requisite pathologist, or the pathologist must travel to have physical access to the case information.

Healthcare organizations now have a better option: digital pathology. Digital pathology is a computerized, image-based environment that enables pathologists to manage and interpret information generated from a digitized glass slide, with image quality comparable to a microscope.

Virtual microscopy—the practice of converting entire glass microscope slides to high-resolution whole-slide digital images that can be viewed, managed and analyzed—is the key technology that enables digital pathology. The digital slide is a complete representation of the glass microscope slide and can be viewed at any magnification, transforming a computer monitor into a virtual microscope.

Digital slides and other information can be viewed instantly, and the images can be shared with anyone in the world immediately.

Digitized slides are easily archived, replicated, accessed over networks, and integrated with laboratory information systems to support the viewing and consolidation of information that’s required for pathologists to do their work more efficiently and more productively.

Digital slides are multi-gigabyte images that correspond to the cellular details available on a microscope slide. State-of-the-art digital pathology systems comprise ultra-fast linear-array-based scanners integrated with digital slide viewing, management and analysis capabilities on the back-end. Using line-scanning technology, a digital image of an entire microscope slide can be created at giga-pixel resolution and in 24-bit true color in less than two minutes per slide, with superior image quality.

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Once a glass slide has been digitized, specialized server software provides access to digital slide images via the Internet for display on a computer monitor.

One of the deliverables of digital pathology is telepathology which will be the main subject of this first installment of information and presentations.

Telepathology is basically the viewing of pathological specimens on monitor and is successful in alleviating the maldistribution of pathology throughout the United States.

The first telepathology system was developed in the 1960’s at the Massachusetts General Hospital. However, wider adoption and use was not beginning to be fully realized until the mid to late 1980s and 1990s.

There are three main types of telepathology; static, dynamic and whole slide.

In static telepathology pathologists select images, store them on a computer, and upload the image to other pathologists. Although this may seem practical, there are two main downsides to static telepathology. For one, only a small number of images can be transmitted, and two, the consulting telepathologist is unable to select the images he/she wants transmitted. Image quality is often an eminent problem, and often times, it is hard for pathologists to make diagnosis due to the poor quality of the image.

With dynamic telepathology, or “real-time” telepathology, a microscope is used along with a personal computer to send images. This method is very beneficial because it is almost as the same as the usual technique of pathologic examinations. This requires a microscope equipped with a robotic stage and sufficient Internet access and bandwidth to transmit images in a secure and timely manner.

With whole slide imaging, the entire slide is archived and multiple fields and magnifications can be viewed from anywhere.

In today’s health care system, there are many uses of telepathology. One is to provide urgent services at sites either without a pathologist or with a pathologist requiring back-up. Secondly, telepathology can provide immediate access to subspecialty pathology consultants. For example, if a primary care physician in a rural area needs a pathologist to diagnose a disease, and the nearest pathologist is over an hour away, telemedicine can be an excellent alternative. Thirdly, and probably the one most often used, is to facilitate second opinions.

Often times, physicians are not sure if their diagnosis is correct and in order to confirm their decision, they can contact another pathologist via telemedicine.

Additionally, it can, assist pathologists in completing or refining a differential diagnosis. And finally, telepathology can be used for continuing medical education, proficiency testing, and re-certification of pathologists as well as other laboratory personnel.

Telepathology has become an important aspect of telemedicine in the past few years and it will even more in the years to come.

The files associated with this summary provide references and illustration to the role of digital pathology and telepathology.

Subsequent additions to this presentation will focus on other issued related to digital pathology such as image analysis, educational tools, research and business models for clinical laboratories to enhance their practices.

Read the Report

"Modern Pathology"

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links to other presentations on this or related topics

• Dr. Martin Dawes - Pharmacogenomics