EURO-TELEPATH

1
EURO-TELEPATHTelepathology Network in Europe

• Proposer Dr. Marcial García Rojo
• Pathology Department General Hospital of Ciudad
  Real
• Castilla La Mancha Health Service (SESCAM)
• SPAIN,
• marcial_at_cim.es

COST Action IC0604
2
Scope

• Adequate technological framework for the
  management of multimedia electronic healthcare
  records
• Informatics applied to Anatomic Pathology
• Research on standards to represent, interpret,
  browse, retrieve digital medical images
• World wide search engine
• Collaborate with Standardisation bodies with
  previous research conclusions

3
Background

• Telepathology (since 1960s) research, patient
  data monitoring and management, both patient and
  healthcare staff education by means of systems
  which allow a quick and full access to expert
  counselling and patient data, disregarding the
  actual location of patients and the demand of its
  information.
• Diagnosis and remote consultations
• Frozen sections (intraoperative studies)
• Surgical specimens manipulation
• Fine needle aspiration cytology evaluation
• Cytology screening
• Autopsies assistance
• Molecular pathology guidance

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Emerging digital pathology

• Gross study
• Digital photography
• Digital video
• Microscopy Slides
• Digital photography
• Virtual microscopywhole slide imaging
• Molecular Pathology
• Digital photography

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From static and dynamic telepathology to Whole
Slide Imaging
Tissues are of only 25 x 20 mm

• Conventional slides are fragile (crystal),
• They are not permanent, above all in
  immunofluorescence, joint crystals,
• In cytology it is not possible to deliver copies
• 6-11 of static images appear discordant with the
  original (conventional) diagnosis (incomplete
  information)
• VIRTUAL SLIDES ADVANTAGES
• Extraordinary quality in lower magnifications
• Dynamic map of the slide available
• High resolution images available transmitting
  only selected area (image streaming)
• Record and reproduce the path followed by the
  pathologist during slide examination
• Images storage is permanent and annotation can be
  performed over them, and these can also be saved

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Different technologies are integrated in the
network
Aperio ImageScope
Univ. Tampere. Webmicroscope
Olympus SIS .slide
UCLM. Sepia Project
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Previous European Research projects

• 1998 Eureka supported PathSystem project (ref.
  1456). Prototype of Pathology management system
  incorporating state-of-the-art telematic
  principles and techniques
• 2000 3D-PATHOLOGY. A real time system for
  quantitative diagnostic PATHOLOGY and
  visualisation in 3D, was funded under 5th FP
  (Ref IST-2000-29598).
• 2001 E-SCOPE. Fully Digital Microscopy for
  routine diagnostics and integration into hospital
  information workflow (IST-2001-33294 BP)

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Related COST actions

• 237 Multimedia Telecommunications Services
• 275 2101 Biometrics (Related to image
  analysis, and user identification)
• 276 Information and Knowledge Management for
  Integrated Media Communication
• 292 Semantic multimodal analysis of digital
  media (image analysis)
• B11 Quantification of magnetic resonance image
  texture (image research working groups)
• B19 Molecular cytogenetics of solid tumours

9
History of the proposal Standardization
activities

• IHE Europe Dr. Christel Le Bozec (INSERM
  ADICAP. France) Editor of Pathology Technical
  Framework, and Project Manager
• DICOM in Europe Dr. Marcial García Rojo, Spain,
  Secretary of WG26 (Pathology) in Europe
  activities.
• SNOMED CT Reviewers of Spanish edition
• CEN TC251 Contacts with standardization bodies
  through the Spanish Society of Health Informatics
  (SEIS) (Board members are included in the Action)

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Recent references

• Boutonnat J, et al. A pilot study in two French
  medical schools for teaching histology using
  virtual microscopy. Morphologie 2006
  Mar90(288)21-5. Teaching program in two
  French medical schools (Lyon and Grenoble)
  include virtual slides. Students works faster, on
  better resources
• Kayser K, et al. Rom J Morphol Embryol
  200647(1)21-8 Diagn Pathol 2006 Jun 10110
  Automated tissue-based virtual diagnosis. The
  developed system is a fast and reliable procedure
  to fulfill all requirements for an automated
  "pre-screening" of virtual slides in tissue-based
  (eg. lung) diagnosis.
• Gilbertson JR, et al. Primary histologic
  diagnosis using automated whole slide imaging a
  validation study. BMC Clin Pathol 2006 Apr
  2764. Image information contained in current
  whole slide images is sufficient for pathologists
  to make reliable diagnostic decisions. Further
  validation studies will be needed.

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History of the proposal Research activities

• Telepathology Dr. Janina Slodkowska (Institute
  of Tuberculosis and Lung Diseases, Warsaw,
  Poland).
• Semantic interoperability and HL7 Dr. Bernd
  Blobel (University of Regensburg Medical Center,
  Germany).
• Pathology Information Systems Dr. Christel Le
  Bozec, and Dr. Marcial García Rojo.
• Security infrastructure Dr. Bernd Blobel
• Web based distance learning Dr. Izet Masic
  (University of Sarajevo, Bosnia Herzegovina).
• JPEG, JPEG2000 Ecole Polytechnique Fédérale de
  Lausanne
• Image analysis and diagnosis Prof. Gloria Bueno
  (University of Castilla-La Mancha, Spain), and
  Dr. Janina Slodkowska.
• Industry research in equipment and software
  Tribvn, France.

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Virtual Slide Congress in Internet (2 editions)
http//www.conganat.org/vsc/
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History of the proposal Practical experiences

• Telemedicine Dr. Luis Gonçalves (Alentejo region
  telemedicine, Portugal), Dr. Ekaterine
  Kladiashvili (Georgian Telemedicine Union).
• Virtual microscopy and virtual slides atlases and
  seminars Dr. Jorma Isola (Tampere University,
  Finland), and Dr Mikael Lundin (University of
  Helsinki, Finland).
• Virtual slides based telepathology Dr. Marcial
  García Rojo.
• Digital Imaging network Ykonos project
  (radiology) of SESCAM (Public Health Service in
  Castilla La Mancha, Spain).
• Terminology in pathology networks ADICAP, Dr.
  Christel Le Bozec
• Software development and integration SESCAM and
  Tribvn.

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DICOM WG26 meeting in Madrid
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EURO-TELEPATHTelepathology Network in
EuropeCOST Action IC0604

• Objectives and working programme

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Objectives (1)

• General
• Evaluate and validate -in a networked
  environment- the common technological framework
  and communication standards required to access,
  transmit and manage digital medical records by
  pathologists and other medical specialties.
• 10 specific objectives
• Increase the use of automation procedures over
  50 in Anatomic Pathology
• Increase productivity. Reach up to 100 slides
  digitization per day
• Norms and compression rules to obtain microscopic
  images with full diagnostic quality in minimum
  possible space (1-2 GB)
• Best viewer design based on standardized
  (JPEG2000) format for microscopic pathology images

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Objectives ( 2)

• (contd)
• Define a set of standardized DICOM file headings
  for pathology microscopic images.
• Definition of new types of messages needed for
  pathological image information exchange (CEN,
  HL7, and other standards)
• Increase the European scientific leadership in
  the emerging Pathology Technical Framework
  (IHE-Pathology)
• Research in Pathology Information Systems and
  other hospital information systems to integrate a
  standardized workflow of pathology images
• Agree on methodology to establish an open,
  web-based European teleconsultation service based
  on virtual slides
• Design a central metasearch engine containing a
  3500 virtual database of pathology images for
  joint research, teaching and observation purposes

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Expected benefits Medical

• Allow users (healthcare professionals and
  specialists) to obtain better and faster
  diagnosis in all related fields of Medicine
  (oncology, dermatology, gynaecology, etc.),
  including Primary Care.
• Improve patient care through a better
  surveillance of treatment response effectiveness.
• Resolve drawbacks of irregular in hand data
  handling, allowing pathologists to select his/her
  collaborating team from previously arranged
  expert panels, with the capability of obtaining a
  response in a few hours or even minutes.
• Better adherence to up-to-date guidelines and
  protocols in the study of specimens which
  improves the continuous learning process of
  pathologists in each participating institution.
• Inter-institutional tools in the exchange of
  medical knowledge would facilitate new research
  projects of rare diseases, and to achieve a
  better classification and understanding of
  diseases.

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Expected benefits Technical

• Coordination of the existing research efforts in
  telepathology
• Quality of electronic medical records to include
  greater detail in patient information (reports,
  images) accessible from different places.
• Improvement of quality, productivity and
  efficiency (turnaround time) in medical
  diagnosis.
• Improving specimens and patients identification
  procedures.
• Easier and safer access to key pathology data and
  images in multiple areas.
• Increased use of virtual slides instead of
  conventional fragile slides.
• Synergic workflow among specialists/doctors in a
  collaborative teamwork (consultation, education,
  research or quality assurance purposes).
• Promote research in 2D and 3D image production
  and processing, and multispectral image managing,
  specially in large images.
• Benefits for other research areas needing GB
  images Computer vision, Astronomy, Geology,
  Planetary Sciences,

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Expected benefits Socioeconomic

• Societal benefits
• Favour patient mobility
• Reinforce the overall quality and the ubiquity of
  health care services.
• Optimise scarce and expensive medical resources.
• European scale reform of medical data management
  legislation and consumer protection standards.
• Foster continuing medical learning programs, and
  basic and applied clinical research
  opportunities.
• Improve accessibility and working ergonomics for
  disabled pathologists-users.
• Economic benefits
• Common technological standard for
  "state-of-the-art" e-health solutions.
• Digitization centres serving other institutions
  without scanning facilities.
• Creation of ubiquitous teleconsultation and
  digitisation services.
• Cut down on costs for private and public health
  actors on licensing for image visualization
  software.
• Contribute to the cost effectiveness of the
  entire health care system
• Improve competitiveness of the European medical
  image industry.

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EURO-TELEPATHTelepathology Network in
EuropeCOST Action IC0604

• Working method, organization, and management
  (including working groups)

22
Scientific program Activities

1. Automation procedures in Pathology. Best
   technology available and under research.
2. Scanning solutions for Pathology microscopic
   slides.
3. Technological solutions for compression and
   storage problems with large image files.
4. Virtual slide standard viewer specifications
   which allow efficient reviewing of pathology
   images.

1. International standards (DICOM, HL7, SNOMED, CEN)
   and IHE initiative.
2. Model for pathology and other hospital
   information systems
3. An European-scope telepathology network
4. Collection of interesting and typical samples,
   and clinico-pathological sessions

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Use Case 1 referring center owns digitization
system

• Pathologist Hospital A (sender)

3) Images in web server
1) Select slides
2) Whole slide digitization (current use of
scanners)
4) Filling form of consultation case
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Use case 2 Experts role

• Expert pathologist in Hospital B (consultant)

1) E-mail notification of new case
3) Diagnosis and report
2) Review case in Portal
7) Sender (Hospital A) and digitization center
(B) are notified that report is available and
case is closed
Request additional data
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Use case 3 Intelligent scanners and integrated
multifunctional workstations

• Next step in slide production scanners,
  consisting in elaborating intelligent scanners,
  operating jointly with
• integrated analysis,
• annotation and search retrieval multifunctional
  workstations
• secured storage and networking management
  resources.
• Objective to perform advance research targeting
  the next generations of tools, terminals,
  networks and standards.

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Organizational structure of COST Action

• Chair / Management Committee / Secretariat

4 Working Groups Scientific Program (item )
1. Users and working models Automation / Artificial Intelligence for classification studies (1) Scanning solutions / Clinical eval.(2) Proposal on PIS changes)(6)
2. Standards in Pathology DICOM, HL7, IHE, SNOMED, CEN (5)
3. Technological Compression storage / search retrieval (3) Image viewer / Image analysis (4) Compiling cases (8)
4. Implementation of Telepathology Networks Telepathology integration guidelines(7)
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Dissemination plan

• Researchers in the EURO-TELEPATH network website
  and multimedia tools
• Pathologist community Publications, conferences,
  expositions, virtual meetings. European
  Telepathology conference
• E-health, IT scientists and standard bodies
  Technical documents, attendance to IHE, SNOMED,
  DICOM, HL7, meetings, industry meetings,
  training schools, public web site
• Medical-scientific community in general
  Journals, COST publication, non-technical
  reports, workshops and final conference, public
  web site.

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EURO-TELEPATHTelepathology Network in
EuropeCOST Action IC0604

• Distribution of tasks

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Current research groups
Policy A group of researchers (balance of female
young experts aged less than 35), shall be duly
appointed to encourage and coordinate the
networks efforts.

• Action kick-off
• Finland Tampere University University of
  Helsinki
• France INSERM Tribvn
• Germany University of Regensburg Charité
  Universitätsmedizin Berlin
• Italy University of Udine
• Lithuania National Centre of Pathology Kaunas
  University of Technology
• Poland Institute of Tuberculosis and Lung
  Diseases, Warsaw
• Portugal Hospital Espirito Santo
• Serbia University of Belgrade
• Spain University of Castilla-La Mancha, Hospital
  General deCiudad Real SESCAM
• Switzerland EPF Lausanne
• United Kingdom University of Nottingham

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Partners background
Clinical
Pathology
ICT
Industry

• Action kick-off
• Finland Tampere University University of
  Helsinki
• France INSERM Tribvn
• Germany University of Regensburg Charité
  Universitätsmedizin Berlin
• Italy University of Udine
• Lithuania National Centre of Pathology Kaunas
  University of Technology
• Poland Institute of Tuberculosis and Lung
  Diseases, Warsaw
• Portugal Hospital Espirito Santo
• Serbia University of Belgrade
• Spain University of Castilla-La Mancha, Hospital
  General deCiudad Real SESCAM
• Switzerland EPF Lausanne
• United Kingdom University of Nottingham

31
Recruiting new research (university and industry)
groups? Non-COST countries?

• Other groups
• England Univ. Leeds, Aperio-Europe
• Hungary 3DHistech Semmelweis
  University,Budapest
• Ireland SlidePath, Dublin
• Georgia G. Telemedicine Union
• Norway University Hospital of Tromsø
• Spain VICOMTech, San Sebastián
• Sweden University Hospital, Uppsala

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Working groups. Distribution of tasks
4 Working Groups Partners Distribution. Select your choice(s) to participate in Working Group and/or specific tasks
1. Users and working models (6 tasks)
2. Standards in Pathology (5 tasks)
3. Technological (8 tasks)
4. Implementation of Telepathology Networks (5 tasks) (Telepathology integration guidelines)
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Distribution of tasks. ExampleWG1 Users (working
models)

• 1.1. Review of existing bibliography and research
  projects of participating groups and other groups
  in all the aspects related to the Action.
  Performed by
• Hospital General de Ciudad Real. Spain.
• Tampere University and University Hospital
  Institute of Medical Technology, Finland.
• 1.2. Consensus study of existing workflows in
  pathology departments. Performed by
• Hospital General de Ciudad Real. Spain.
• Biomedical informatics group of the University of
  Helsinki, Finland.
• INSERM, France.
• 1.3. Full study analysis of 10 microscope brands.
  Performed by
• Hospital General de Ciudad Real. Spain.
• Institute of Tuberculosis and Lung Diseases,
  Warsaw, Poland.
• 1.4. Study all visualization performance needs
  for pathologists. Performed by
• Hospital do Espiritu Santo, Evora, Portugal.
• Tampere University and University Hospital
  Institute of Medical Technology, Finland.
• Biomedical informatics group of the University of
  Helsinki, Finland.
• 1.5. Image analysis tools study of existing
  solutions.
• ISA of the Superior Technical Industrial
  Engineering School of the University of Castilla
  La Mancha (UCLM), Spain.
• Biomedical informatics group of the University of
  Helsinki, Finland.
• 1.6. Design of image analysis tools
  implementation.

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EURO-TELEPATHTelepathology Network in
EuropeCOST Action IC0604

• Time-table

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COST Action Time-table

• MC Meetings, WG1 Meetings, WG2 Meetings, WG3
  Meetings, WG4 Meetings 1st and 3rd quarter
  (2/year)
• Workshops year 1 and year 3
• Telepathology Congress year 2 (Action dissemin.)
• Final Conference year 4 (focused on results)
• STMS (visits) Proposals to COST (eg. year 1 and
  4)
• Reports yearly
• Publications Review status year 2 year 4
• Training School year 3
• Website

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Time-table overview
37
EURO-TELEPATHTelepathology Network in
EuropeCOST Action IC0604

• Budget

38
Economical dimension

• On the basis of the initial 8 countries
  representatives, the economic dimension of the
  research activities to be carried out under the
  Action has been estimated, at an estimate of 16
  million euros. (Example Serendipia Project in
  Spain ? 3.5 million Euros)
• A COST Action is implemented through a concerted
  action, what means that the research is carried
  out in and financed by the participating
  countries themselves, while COST provides the
  means to organize the necessary co-ordination
  measures.
• It finances networking of nationally funded
  activities in supporting meetings, conferences,
  short term scientific exchanges and outreach
  activities. COST therefore does NOT fund research
  itself.
• On average financial support of some 90.000
  p.a. as grant for up to 4 years can be expected.

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Financing COST Activities

• The COST IC0604 Action budget is able to finance
  the activities of MCs, WGs, which can include the
  following items
• travel expenses and daily allowances for
  delegates to meetings
• workshops/conferences
• short term scientific missions (STSMs) -
  inter-laboratory exchanges
• training schools
• Action Grants
• publications and dissemination
• high level research conferences organised jointly
  with ESF
• studies, reviews, assessments, strategic
  activities
• special provision for research from near
  neighbours countries.

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Financing meetings. Budget allocation (Management
Committee)

• Meetings of MC (2 MC member/country), WG1, WG2,
  WG3, WG4 1st and 2nd quarter (2/year each)
• Workshops (lt 80 participants) years 1 3
  (balance from the various signatory countries).
• Telepathology Congress year 2
• Final Conference year 4
• MC should propose a budget allocation
• The contribution should not exceed 10,000 for a
  meeting (if request is up to 3,000, it will be
  granted as fixed grant).
• Printing of proceedings are financed separately
  from organization costs

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Meetings eligible participants

• Management Committee (MC)
• Working Groups a small(?) number of
  researchers (may be MC members or other
  researchers) selected by the MC.
• External experts and invited speakers
• from non-signatory countries 5 per meeting
• non-COST (Near Neighbours) country up to 4.
• For meeting participants, a distinction is made
  between participants, eligible participants and
  persons entitled for reimbursement. The
  participants are all of the people who attend a
  COST meeting. Among these participants, a certain
  number will be selected by the Management
  Committee from the eligible participants (see
  2.1.3 - Eligible Participants) and approved by
  the MC Chair as entitled for reimbursement.

42
Short Term Scientific Mission (STSM) and training
school

• STMS (young scientists) year 1 and 4 (proposal)
  Exchange visits (1 wk-3 mo) to an institution or
  laboratory in another COST member state.
• The grant should normally cover only travel and
  subsistence (up to 2500 )
• Training School (young researchers and
  re-training) year 3 (dissemination of results)
• lt 5 days and 30 attendees
• Financing meeting (see rules)
• Travel and subsistence for lecturers (see rules)
• Fixed grants for attendees (lt600 /attendee.
  Otherwise the same as for STSMs)

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Reports and publications

• Reports yearly
• The COST Office is printing general COST
  publications (annual report, domain flyers,
  booklets, brochures and posters).
• Publications year 2 and year 4
• MC will define the contents
• Options
• External Publisher (choose 2 different
  publishers)
• OPOCE (The European Unions publisher)

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Action Website

• COST Actions Management Committee (MC) may assign
  up to 2,000 per annum from within an Action
  budget to the MC chair as grant holder for the
  general support of the Action management
• Action Website (specific matters and MC
  operation), to be hosted on the server of one of
  the institutions represented on the MC.

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Action website
http//www.conganat.org/eurotelepath/