In 2017, the US Food and Drug Administration (FDA) approved the first whole slide imaging (WSI) system. The FDA endorsement included its use for making diagnoses of surgical specimens. This marks a significant milestone in digital telepathology.
Since this time, advancements in telepathology have spread around the world. Now, areas who do not have a pathologist can access these services. Continue reading to learn more about telepathology.
What Is Telepathology?
Telepathology allows doctors in remote areas to consult with pathologists. This enhances accuracy and decreases the time to make a diagnosis.
This often takes place using telecommunication technology. Tissue specimens, transferred as image-rich pathology data, allow the consultation with a pathologist.
Types of Telepathology
There are four platforms used for telepathology. These include static images, WSI, dynamic nonrobotic telemicroscopy, and dynamic robotic telemicroscopy.
The remote facility sends digital images to the pathologist via email or a shared server. This offers a low cost, low maintenance, simple tech solution to access a pathologist. Yet, there are some downsides to this method.
The pathologist can only review the specimen received. They can’t move around and look at other parts of the tissue. If the image quality is poor, the report may be inaccurate.
WSI uses high-resolution digital images to show the entire tissue section. The sending site digitizes (scans) the glass slides containing the specimens. These images are then transmitted to the remote pathologist.
The WSI systems’ improved imaging enhances the pathologist’s tissue exam. Thus, they can provide primary diagnoses, consultations, and even remote frozen section interpretations.
This equipment is expensive and requires maintenance. It takes time to scan these slides and needs a large internet bandwidth. Storage of these large files may present a problem.
Nonrobotic and Robotic Telemicroscopy
This technology uses a video-calling platform to send real-time images. This nonrobotic method does not give the pathologist control over the image displayed. The robotic technique lets the pathologist move the microscope image and adjust magnification.
The robotic method increases the pathologist’s ability to make an accurate interpretation. The downside is the high cost, maintenance, and high bandwidth requirements.
How to Connect with a Telepathologist?
Specialist Direct has a team of U.S. Board-Certified pathologists. They also employ other subspecialists. These professionals interpret digital pathology specimens within one hour of receipt.
They can also meet STAT needs 24 hours a day, 7 days a week year-round. Specialist Direct also offers second opinions. Consultations can now take place in towns and villages without pathology services.
Diverse Uses of Telepathology
Telepathology’s primary use lies in low-resource areas. It also contributes to education, quality assurance, and diagnoses.
Teaching and Education
In 2014 and 2015, Lagos University Teaching Hospital, Nigeria worked with St. James’s Hospital, Leeds, United Kingdom. Together, they created a telepathology postgraduate teaching program. The focus was on using WSI technology
This program consisted of 12 online sessions. Participants viewed the WSI slides and discussed their findings with course instructors. Offering this style of education was convenient and affordable.
It’s often hard for remote health professionals to leave and pay for education programs. More in-depth programs, like this 12-session course, is often out of reach. Telepathology solves these problems.
External Quality Assurance
A Nigerian pathologist working in the UK developed a telepathology quality assurance program in 2010. A slide-based review process was initially used. With the introduction of WSI in 2016, the program changed.
Quality assurance evaluations began using WSI technology. Bi-annually, the Nigerian and Ghanaian National External Quality Assurance (EQA) views selected slides. Using the Leeds Virtual Pathology server, Nigerian and Ghanaian pathologists and residents collaborate.
With this system, there’s no need to transport glass slides to the learners. Now, this discussion includes 115 participants from different locations. Reviewing the slides and diagnoses increases the attendees’ expertise and improves quality assurance.
When pathologists work alone, this can create stress and even frequent job turn over. Having access to telepathology allows the pathologist to get a second opinion. This can actually serve as a recruiting tool for healthcare organizations.
In this setting, telepathology assists with diagnosis and increases quality assurance. Connecting with other experienced facilities, for example, has improved pathology services in Africa.
Still, the most common use of telepathology is to assist with diagnoses in low resource areas. The Kamauzu Central Hospital in Malawi uses WSI to consult with pathologists in the US.
Both practitioners have equal control over their field of view. They can adjust the level of magnification as needed. This discussion leads to interpretations and diagnoses.
The Department of Pathology at Mulago Hospital in Uganda and Fuerth Hospital in Germany have also worked together. They used robotic telemicroscopy. Slides exams took place via an internet browser-based dynamic imaging system.
The clinicians had access to clinical data, gross tissue descriptions, and the digitized microscopy platform. It only took 30 minutes for pathologists to become comfortable using the equipment. Interpretations of the slides only took between 4 and 25 minutes.
The use of telepathology has greatly decreased the diagnostic turn-around time (TAT). Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, USA and Butaro Cancer Centre of Excellence in Rwanda studied TAT.
In the past, when BWH received blocks and slides, the TAT was 30 days. By using telepathology, the TAT decreased to 14 days.
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