Telepathology is the practice of

pathology Pathology is the study of disease. 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 the context of modern medical treatme ...

at a distance. It uses

telecommunications Telecommunication, often used in its plural form or abbreviated as telecom, is the transmission of information over a distance using electronic means, typically through cables, radio waves, or other communication technologies. These means of ...

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

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

education Education is the transmission of knowledge and skills and the development of character traits. Formal education occurs within a structured institutional framework, such as public schools, following a curriculum. Non-formal education als ...

, 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 to ...

. Performance of telepathology requires that a pathologist selects the

video Video is an Electronics, electronic medium for the recording, copying, playback, broadcasting, and display of moving picture, moving image, visual Media (communication), media. Video was first developed for mechanical television systems, whi ...

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 tertiary education. The name traces back to Plato's school of philosophy, founded approximately 386 BC at Akademia, a sanctuary of Athena, the go ...

pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In a

medical journal A medical journal is a peer-reviewed scientific journal that communicates medical information to physicians, other health professionals. Journals that cover many medical specialties are sometimes called general medical journals. History The first ...

editorial An editorial, or leading article (UK) or leader (UK), is an article or any other written document, often unsigned, written by the senior editorial people or publisher of a newspaper or magazine, that expresses the publication's opinion about ...

, 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 (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 states and a federal capital district, Washington, D.C. The 48 contiguous ...

patents A patent is a type of intellectual property that gives its owner the legal right to exclude others from making, using, or selling an invention for a limited period of time in exchange for publishing an sufficiency of disclosure, enabling discl ...

for

robotic Robotics is the interdisciplinary study and practice of the design, construction, operation, and use of robots. Within mechanical engineering, robotics is the design and construction of the physical structures of robots, while in computer s ...

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 countries, Nordic country located on the Scandinavian Peninsula in Northern Europe. The remote Arctic island of Jan Mayen and the archipelago of Svalbard also form part of the Kingdom of ...

, 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 North America is a continent in the Northern Hemisphere, Northern and Western Hemisphere, Western hemispheres. North America is bordered to the north by the Arctic Ocean, to the east by the Atlantic Ocean, to the southeast by South Ameri ...

Europe Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west, the Mediterranean Sea to the south, and Asia to the east ...

, and

Asia Asia ( , ) is the largest continent in the world by both land area and population. It covers an area of more than 44 million square kilometres, about 30% of Earth's total land area and 8% of Earth's total surface area. The continent, which ...

. Telepathology has been successfully used for many applications, including the rendering of

histopathology Histopathology (compound of three Greek words: 'tissue', 'suffering', and '' -logia'' 'study of') is the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopatholog ...

tissue diagnoses at a distance. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, 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, 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 betwe ...

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 equipment, 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 ...

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 network, global system of interconnected computer networks that uses the Internet protocol suite (TCP/IP) to communicate between networks and devices. It is a internetworking, network of networks ...

, 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 ...

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, campus, or building, and has its network equipment and interconnects locally managed. LANs facilitate the distribution of da ...

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 The gigabyte () is a multiple of the unit byte for digital information. The SI prefix, prefix ''giga-, giga'' means 109 in the International System of Units (SI). Therefore, one gigabyte is one billion bytes. The unit symbol for the gigabyte i ...

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 The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryosection. The microtome device tha ...

specimens, primary

diagnoses, second opinion 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 Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the cli ...

, 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 An electronic health record (EHR) is the systematized ...

is the organization responsible for the implementation of telepathology in

Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...

. 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 is the westernmost Provinces and territories of Canada, province of Canada. Situated in the Pacific Northwest between the Pacific Ocean and the Rocky Mountains, the province has a diverse geography, with rugged landscapes that ...

. 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 the southernmost Provinces and territories of Canada, province of Canada. Located in Central Canada, Ontario is the Population of Canada by province and territory, country's most populous province. As of the 2021 Canadian census, it ...

, the University Health Network (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 at the 2021 Canadian census and an estimated population of ...

, 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, Ontario, Hearst and northwest of Timmins, Ontario, Timmins. The town was known as MacPherson until 1917. ...

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