Telepathology

Telepathology is defined as the use of communication technology to facilitate the transfer of histological, cytological, and macroscopic images between remote locations for the purposes of diagnosis, consultation, education, and research.

With the growing workforce shortage of certified pathologists evident in the United States, telepathology offers a very good solution. Yet, questions remain regarding how best to use the available technology and overcome the current adoption challenges, thus allowing telepathology to become an integral element of mainstream care delivery.

Although the different applications for telepathology are numerous, the bulk of research has concentrated on its use as a diagnostic tool. Some of the applications include providing urgent services at sites where pathologists are in short supply or in cases were a second opinion is required. This is extremely useful in rural areas where the closest pathologist is several hours away and a primary care physician needs to diagnose a disease. Telepathology has also been used for research applications, distance education, quizzes, and online atlases with great success.

The three main approaches used currently for telepathology are store-and-forward (static), dynamic (real-time), and hybrid (virtual slides). The first is time and place independent, while the second and third operate in real time but bypass geographical boundaries.

All three forms share the limitation of image quality, which often make it difficult for pathologists to make a diagnosis. In store-and-forward telepathology, pathologists select images, store them on a computer, [Page 1651]and forward the image to other pathologists at remote sites. The advantage of this method is that it is inexpensive, and has been shown to have concordance rates as high as 95 to 100 percent between traditional glass slide and telepathology diagnosis. However, limitations include diagnostic errors attributed to the inappropriate field selection by the submitting pathologist. In addition, only a small number of images can be transmitted at one time.

Real-time telepathology involves using a microscope along with a personal computer to send images. This system is very costly, but has revolutionized the field, demonstrating concordance rates of 99 to 100 percent between telepathology and light microscopy diagnosis.

Hybrid systems utilize an automated scanner that takes visual images of the entire slide at a very high resolution, which is forwarded to another location for diagnosis. The biggest advantage of this method is that it can be viewed by multiple pathologists without any loss of resolution. It allows one to see the slide in different magnifications, just like a microscope, without the need of having multiple images.

Because the effectiveness and accuracy of telepathology depends critically on the skill and judgment of the pathologist, both referring and consulting pathologists practicing telepathology should be trained in telepathology. This training includes general telepathology, imaging principles, and its limitations.

Technological advances over the last decade have transformed the internet, digital cameras, and digital imaging applications. These factors present a real opportunity to develop telepathology into an integral part of the healthcare system.