The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects.

INTRODUCTION: Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS: A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS: The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.

Microscopic Image Photography Techniques of the Past, Present, and Future.

CONTEXT: The field of pathology is driven by microscopic images. Educational activities for trainees and practicing pathologists alike are conducted through exposure to images of a variety of pathologic entities in textbooks, publications, online tutorials, national and international conferences, and interdepartmental conferences. During the past century and a half, photographic technology has progressed from primitive and bulky, glass-lantern projector slides to static and/or whole slide digital-image formats that can now be transferred around the world in a matter of moments via the Internet. OBJECTIVE: To provide a historic and technologic overview of the evolution of microscopic-image photographic tools and techniques. DATA SOURCES: Primary historic methods of microscopic image capture were delineated through interviews conducted with senior staff members in the Emory University Department of Pathology. Searches for the historic image-capturing methods were conducted using the Google search engine. Google Scholar and PubMed databases were used to research methods of digital photography, whole slide scanning, and smart phone cameras for microscopic image capture in a pathology practice setting. CONCLUSIONS: Although film-based cameras dominated for much of the time, the rise of digital cameras outside of pathology generated a shift toward digital-image capturing methods, including mounted digital cameras and whole slide digital-slide scanning. Digital image capture techniques have ushered in new applications for slide sharing and second-opinion consultations of unusual or difficult cases in pathology. With their recent surge in popularity, we suspect that smart phone cameras are poised to become a widespread, cost-effective method for pathology image acquisition.

History and structures of telecommunication in pathology, focusing on open access platforms.

BACKGROUND: Telecommunication has matured to a broadly applied tool in diagnostic pathology. TECHNOLOGY AND SYSTEMS: Contemporary with the development of fast electronic communication lines (Integrated digital network services (ISDN), broad band connections, and fibre optics, as well as the digital imaging technology (digital camera), telecommunication in tissue--based diagnosis (telepathology) has matured. Open access (internet) and server--based communication have induced the development of specific medical information platforms, such as iPATH, UICC-TPCC (telepathology consultation centre of the Union International against Cancer), or the Armed Forces Institute of Pathology (AFIP) teleconsultation system. They have been closed, and are subject to be replaced by specific open access forums (Medical Electronic Expert Communication System (MECES) with embedded virtual slide (VS) technology). MECES uses php language, data base driven mySqL architecture, X/L-AMPP infrastructure, and browser friendly W3C conform standards. EXPERIENCES: The server--based medical communication systems (AFIP, iPATH, UICC-TPCC) have been reported to be a useful and easy to handle tool for expert consultation. Correct sampling and evaluation of transmitted still images by experts reported revealed no or only minor differences to the original images and good practice of the involved experts. ß tests with the new generation medical expert consultation systems (MECES) revealed superior results in terms of performance, still image viewing, and system handling, especially as this is closely related to the use of so--called social forums (facebook, youtube, etc.). BENEFITS AND EXPECTATIONS: In addition to the acknowledged advantages of the former established systems (assistance of pathologists working in developing countries, diagnosis confirmation, international information exchange, etc.), the new generation offers additional benefits such as acoustic information transfer, assistance in image screening, VS technology, and teaching in diagnostic sampling, judgement, and verification.

25 years of telepathology research: a bibliometric analysis.

BACKGROUND: The first appearance of the word "telepathology" in a scientific paper can be tracked down to 1986, in a famous editorial of Ronald Weinstein. Since that paper, research in telepathology grew up developing different subfields, including static and dynamic telepathology and more recently virtual microscopy. The present work attempts an analysis of research in telepathology, starting from the tools provided by bibliometrics. METHODS: A query has been developed to extract papers related to telepathology and virtual microscopy, and it has been then submitted to Pubmed by means of Entrez Utilities functions. Results obtained in XML have been processed through ad-hoc developed PHP scripts, in order to extract data on Authors, countries, and keywords. RESULTS: On PubMed, 967 papers related to telepathology and virtual microscopy have been retrieved, which involved 2904 Authors; corresponding authors were from 37 countries. Of those authors, 2213 co-authored just one paper. Papers were published on 344 different journals, of which only 52 from the Pathology field. An analysis of papers per year has been also attempted, that demonstrates variable research output in time. CONCLUSIONS: From the proposed analysis, telepathology seems to have been consistently studied, in time, by about 400 researchers, with occasional participation of many other people. Telepathology research seems also to have varied in time, although some peaks in paper publishing are certainly related to the proceedings of the European congress on telepathology series, when they have been published on journals. However, some clear sign appears that suggests research in traditional telepathology, after a peak in 2000, showed some decline until virtual microscopy became mainstream, topic that currently pushes research again. The low number of clinical trials calls for more randomized studies in telepathology, to enable evidence-based application.

Telemedicine in northern Norway.

The University Hospital of Tromsø has been involved in a variety of telemedicine activities since the late 1980s, including teleradiology, telepathology, teledermatology, remote endoscopy, remote gastroscopy, teleechocardiography, transmission of electrocardiograms, telepsychiatry, electronic delivery of laboratory results and distance learning for health professionals. Since 1993 the department of telemedicine in Tromsø has been designated the national centre of competence in telemedicine. With a wealth of experience to draw from, a critical number of health-care professionals exposed to and using telemedicine routinely, the support of the Norwegian health authoriues, a national centre guiding telemedicine research, no licensing barriers within the country, nationwide ISDN and reimbursement for telemedicine services, the future of telemedicine in Norway looks promising.