Telepathology is the practice of

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

at a distance. It uses

telecommunications Telecommunication is the transmission of information by various types of technologies over wire, radio, optical, or other electromagnetic systems. It has its origin in the desire of humans for communication over a distance greater than that fe ...

technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

education Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty ...

, and

research Research is " creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness ...

. Performance of telepathology requires that a pathologist selects the

video Video is an electronic medium for the recording, copying, playback, broadcasting, and display of moving visual media. Video was first developed for mechanical television systems, which were quickly replaced by cathode-ray tube (CRT) syst ...

images for analysis and the rendering of diagnoses. The use of " television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement in the selection of microscopic fields-of-view for analysis and diagnosis. An

academic An academy (Attic Greek: Ἀκαδήμεια; Koine Greek Ἀκαδημία) is an institution of secondary or tertiary higher learning (and generally also research or honorary membership). The name traces back to Plato's school of philosophy, ...

pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In a medical journal editorial, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He and his collaborators published the first scientific paper on robotic telepathology. Weinstein was also granted the first

U.S. The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...

patents for

robotic Robotics is an interdisciplinary branch of computer science and engineering. Robotics involves design, construction, operation, and use of robots. The goal of robotics is to design machines that can help and assist humans. Robotics integrate ...

telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In

Norway Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and the ...

, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989; this is still in operation decades later. A number of clinical telepathology services have benefited many thousands of patients in North America,

Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a subcontinent of Eurasia and it is located entirel ...

, and

Asia Asia (, ) is one of the world's most notable geographical regions, which is either considered a continent in its own right or a subcontinent of Eurasia, which shares the continental landmass of Afro-Eurasia with Africa. Asia covers an are ...

. Telepathology has been successfully used for many applications, including the rendering of histopathology tissue diagnoses at a distance. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries,

analog Analog or analogue may refer to: Computing and electronics * Analog signal, in which information is encoded in a continuous variable ** Analog device, an apparatus that operates on analog signals *** Analog electronics, circuits which use analog ...

telepathology imaging is still used for patient services in some developing countries.

Types of systems

Telepathology systems are divided into three major types: static image-based systems,

real-time systems Real-time computing (RTC) is the computer science term for Computer hardware, hardware and computer software, software systems subject to a "real-time constraint", for example from Event (synchronization primitive), event to Event (computing), ...

, and virtual slide systems. Static image systems have the benefit of being the most reasonably priced and usable systems. They have the significant drawback in only being able to capture a selected subset of

microscopic The microscopic scale () is the scale of objects and events smaller than those that can easily be seen by the naked eye, requiring a lens or microscope to see them clearly. In physics, the microscopic scale is sometimes regarded as the scale be ...

fields for off-site evaluation. Real-time robotic microscopy systems and virtual slides allow a consultant pathologist the opportunity to evaluate histopathology slides in their entirety, from a distance. With real-time systems, the consultant actively operates a robotically controlled motorized

microscope A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisi ...

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. Another form of real-time microscopy involves utilizing a high resolution video camera mounted on a path lab microscope to send live digital video of a slide to a large computer monitor at the pathologist's remote location via encrypted store-and-forward software. An echo-cancelling microphone at each end of the video conference allows the pathologist to communicate with the person moving the slide under the microscope. 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 The Internet (or internet) is the global system of interconnected computer networks that uses the Internet protocol suite (TCP/IP) to communicate between networks and devices. It is a '' network of networks'' that consists of private, pub ...

, using a browser.

Digital imaging Digital imaging or digital image acquisition is the creation of a digital representation of the visual characteristics of an object, such as a physical scene or the interior structure of an object. The term is often assumed to imply or include t ...

is required for virtual microscopy. While real-time and virtual slide systems offer higher diagnostic accuracy when compared with static-image telepathology, there are drawbacks to each. Real-time systems perform best on

local area network A local area network (LAN) is a computer network that interconnects computers within a limited area such as a residence, school, laboratory, university campus or office building. By contrast, a wide area network (WAN) not only covers a larger ...

s (LANs), but performance may suffer if employed during periods of high network traffic or using the Internet proper as a backbone. Expense is an issue with real-time systems and virtual slide systems as they can be costly. 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. 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 can be cumbersome, introducing their own workflow challenges in the clinical laboratory. Types of Telepathology Platform: Telepathology platforms that have adopted whole slide imaging enables remote viewing to aid pathologist in following ways: By remote sharing and secondly by uploading images for expert consultations.

Uses and benefits

Telepathology is currently being used for a wide spectrum of clinical applications including diagnosing of frozen section specimens, primary histopathology diagnoses,

second opinion A second opinion is an opinion on a matter disputed by two or more parties. Law In legal cases, a second opinion which contradicts the opinion of a jointly retained expert may be disregarded as not being impartial. Consumer rights In cas ...

diagnoses, subspecialty pathology expert diagnoses, investigative and regulated preclinical toxicology studies, education, competency assessment, and research. Benefits of telepathology include providing immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a renal pathologist, a neuropathologist, or a dermatopathologist, for immediate consultations.

Services by country

Canada

Canada Health Infoway Canada Health Infoway is an independent, federally funded, not-for-profit organization tasked with accelerating the adoption of digital health solutions, such as electronic health records, across Canada. Infoway is focused on two strategic goals: ...

is the organization responsible for the implementation of telepathology in

Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...

. Canada Health Infoway is a federal non-profit which provides funding for improving digital health infrastructure. Canada Health Infoway has targeted funding of $1.2 million CAD to the Telepathology Solution for the province of

British Columbia British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...

. The system is designed to connect all pathologists within the province. The long-term expectations are improvement to patient care and safety through access to pathology expertise, improved timeliness of results and quality of service. In

Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central C ...

, the

University Health Network University Health Network (UHN) is a public research and teaching hospital network in Toronto, Ontario, Canada. It is the largest health research organization in Canada and ranks first in Canada for total research funding. It was named Canada's ...

(UHN) hospitals are the primary drivers of the development of telepathology. The three northern Ontario communities of

Timmins Timmins ( ) is a city in northeastern Ontario, Canada, located on the Mattagami River. The city is the fourth-largest city in the Northeastern Ontario region with a population of 41,145 (2021). The city's economy is based on natural resource ext ...

, Sault Ste. Marie and

Kapuskasing Kapuskasing is a town on the Kapuskasing River in the Cochrane District of Northern Ontario, Canada, approximately east of Hearst. The town was known as MacPherson until 1917, when the name was changed so as not to conflict with another rail ...

have several community hospitals virtually linked to UHN pathologists via the Internet 24 hours a day.

References

;Bibliography * * * * * * * * * Maiolino P, De Vico G. Telepathology in veterinary diagnostic cytopathology. In: Kumar S, Dunn BE, editors. Telepathology. Berlin, Springer, 2009; 6:63-69. * * * Schroeder JA. Ultrasructural telepathology: remote EM diagnostic via Internet. In: Kumar S, Dunn BE, editors. Telepathology. Berlin, Springer, 2009; 14:179-204. * Sinard JH. Practical pathology informatics. New York, Springer. 2006:265-286. * * * * * *

External links