This document discusses telepathology, which is the practice of pathology at a distance by visualizing an indirect image on a video monitor rather than viewing a specimen directly through a microscope. The basic requirements for telepathology are a microscope, high-resolution camera, internet access, and a telepathology workstation. There are different approaches to telepathology including dynamic, robotic, and static systems as well as virtual microscopy using whole slide imaging. Applications include primary consultations, second opinions, education, and digital archiving. Advantages include increased access to expertise while limitations include image quality and network dependence.

1. TELEPATHOLOGY
8 June 2013

2. • Definitions and terms
• Brief History
• Approaches in telepathology
• Applications
• Adavantages
• Limitations

3. The basic requirements for telepathology
1. Microscope
2. High-resolution camera
3. Internet access
4. Telepathology workstation

4. • Telepathology
• Pathology at a distance
• 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.
• Digital pathology
• Virtual Microscopy
Weinstein, R.S., “Prospects for Telepathology” (editorial) Human Pathology 17: 433-
434, 1986.

5. History
• Ronald S. Weinstein – father of Telepathology
• Coined the term

6. • 1990- 2000 – Internet era – static image sharing
• Current trend – whole slide imaging (WSI), Virtual
microscopy – high-speed computer networks
DMetrix Digital Eyepiece virtual slide viewer

7. Approaches
• Telepathology systems
• Dynamic
• Dynamic robotic telepathology
• Static
• Virtual microscopy/whole slide imaging

9. Process in digital imaging
Display on a monitor infront of pathologist
Transmission of digital image across telepathology network
Post-processing , compression
Digital image sampling by sensors- camera
Optical image formation by slide scanner
Sample preparation and staining

11. How a digital image is created?
• Analog to digital
• Terminologies
• Image resolution = Width x height
• Pixel = Picture element
• Each pixel can contain only one colour
• Pixel can be 8 bit, 16 bit, 32 bit etc  colour depth
• Its number determines the size of the image not resolution
• DPI or Dots per inch/ pixel per inch = physical printed size
• CCD= Charged couple device = retina of digital camera : An array of
photosensitive elements that produce voltage when exposed to light
• Digital camera resolution = total number of elements in the array

12. • Resolution is usually the size of CCD equivalent to
number of pixels on the chip.
• Size of pixel varies among different types of CCD.
• Pixel size of 6.7 micrometers is thought to be ideal for
microscopy

13. Applications
1. Primary consultation for cytology or histopathology
2. Second opinion in difficult cases
3. Intraoperative consultations e.g. frozen sections.
Dynamic telepathology required. High cost.
4. Retro-consultation
5. Worldwide knowledge database/ Digital archieves

14. 6. Digital slide conferencing
7. Education
• Virtual slide box at www.uscap.org
• Virtual Pathology at the University of Leeds
http://www.virtualpathology.leeds.ac.uk/index.php
• University of Iowa : Virtual slidebox
http://www.path.uiowa.edu/virtualslidebox
8. http://www.slideconsult.com WSI using mScope
software

15. Advantages and Limitations
• Static image telepathology
• Low cost and shorter learning curve
• Less investment in technology
• Limited view of field
• Non-representative images

16. Advantages and Limitations
• Dynamic telepathology
• Better field of view
• Real time consultation
• Planes of focus can be addressed
• 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

17. Advantages and Limitations
• Whole slide imaging/ Virtual microscopy
• Fidelity of diagnostic material
• Portability
• Ease of sharing
• Archival
• Ability to make use of computer aided diagnostic tools –
image algorithm.

18. • Simultaneous viewing/teleconferencing
• High resolution images and rapid interpretation
• Automated scanning
• Storage of digital images
• High speed networks
• Radiology and pathology

19. Telepathology in India
• Static telepathology link between Tata Meomorial
Hospital and Nurgis-Dutt rural cancer hospital in 2000.
• Upto 2004, 299 telepathology consultations
• 98% concordance rate
• 48% cases reported within 8 hrs and 91% in 3 days

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

21. References
1. Weinstein RS. Prospect for telepathology. Hum Pathol 1986;17:443--‐434.
2. Sankaye SB,Kachewar SG. Telepathology for effective healthcare in developing nations. AMJ
2011, 4, 11, 592– 595
3. www.Imagescope.org. Also available from http://aperio.com/pathology--
‐services/imagescope--‐slide--‐ viewing-- software.asp© Copyright 2001 --‐ 2011 Aperio
Technologies, Inc. [Accessed on November 26,2011]
4. Human Pathology (2009) 40, 1057–1069 , Overview of telepathology, virtual microscopy,
and whole slide imaging: prospects for the future
5. Telepathology. In: Handbook on quality assurance in Fine Needle Aspiration Cytology/edited
by Elizabeth K.Abraham.- Thiruvananthapuram: Regional Cancer Centre, 2003. P.62-67 /
Preethi, T.R. (2003)