Telepathology Networks and Modular Infrastructure

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Telepathology Networksand Modular Infrastructure

• Kurt Brauchli, Martin Oberholzer
• Department of Pathology
• University of Basel
• Switzerland

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What is Telepathology

• Remote Diagnostic
• Remote Teaching
• Remote Discussion/Consultation
• Remote Quality Assurance
• ....

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What is Telepathology

• ? A tool to assist a pathologist in daily
  routine.

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What is Telepathology

• ? A tool to assist a pathologist in daily
  routine.
• ? An application of technology in the diagnostic
  and academic work of a pathologist.

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What is Telepathology

• ? A tool to assist a pathologist in daily
  routine.
• ? An application of technology in the diagnostic
  and academic work of a pathologist.
• ? A dialog between expert and non-expert on a
  distance

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What is Telepathology

• ? A tool to assist a pathologist in daily
  routine.
• ? An application of technology in the diagnostic
  and academic work of a pathologist.
• ? A dialog between expert and non-expert on a
  distance
• ? BUT NOT A TECHNOLOGY !

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What is the Technology for ?

• The real specimen and slide is at point A
• The expert who wants to see the slide is at point
  B
• The slide is transmitted in a digital form.
• ? There are many forms to transmit a slide.

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1) static images

• some few images selected by non-expert
• Advantage small transfer size.No special
  software needed.
• Disadvantage Selection by non-expert. May miss
  important areas.

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2) full digital slide

• The whole slide is scanned automatically
• Advantage no information loss.
• Disadvantage huge amount of information to
  transmit 0.5 - 10 GB/slide

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3) remote microscopy

• motorised microscope with remote control
  software
• Advantage Selection of field of interest by
  expert. very fast.
• Disadvantage complex technology.

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How to put everything together ?

• Common Network Internet
• Minimum Software Installation Web Application
• Access for all - Access over slow connections
  (email)- Access through Firewalls

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Modules

• Sending requests

• technical modules
• image capture- single static image- slide
  scanner- remote live camera
• data transfer- email- www, ftp- custom
  protocol

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Modules

• Sending requests
• Reviewing cases

• technical modules
• case viewer- web browser- vSlide viewer
• Storage of Diagnosis and Comments

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Modules

• Sending requests
• Reviewing cases
• Archive

• technical modules
• Storage of case and image data- database

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Modules

• Sending requests
• Reviewing cases
• Archive
• remote instrument control

• technical modules
• remote control- instrument controller- remote
  control- ev. command router (firewall)- remote
  image capture

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Modules

• Sending requests
• Reviewing cases
• Archive
• remote instrument control
• administration and supervision

• technical modules
• Administration- Notification- Scheduling-
  Work load balancing

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Modules

• Sending requests
• Reviewing cases
• Archive
• remote instrument control
• administration and supervision
• Image Analysis ...

• technical modules

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Putting the Modules together

• Finally, how do we build telepathology
  applications from these modules?

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• Web Application Server
• Case Database- images- comments/diagnosis
• Web Interface
• Telemicroscopy router
• email-web / web-email

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• Sending cases
• email

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• Sending cases
• email
• www

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• Sending cases
• email
• www
• v-Slide

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• Sending cases
• email
• www
• v-Slide
• remote control microscope

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• Reviewing cases
• email alerts

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• Reviewing cases
• email alerts
• web interface

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• Reviewing cases
• email alerts
• web interface
• virtual slide viewer

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• Reviewing cases
• email alerts
• web interface
• virtual slide viewer
• remote microscope control (e.g. JAVA applet)

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Future Distributed Network

• Multiple Servers
• Multiple communications links
• Multiple applications

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Internet 1
Internet 2
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Hospital Intranet
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Dial-in clients
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Dial-in network
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The Real World ?
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The Real World !
Internet Pathology Suite Telepathology Software
developed at the Department of Pathology,
University of Basel
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The Real World
Internet Pathology Suite Telepathology Software
developed at the Department of Pathology,
University of Basel

• case discussions
• remote microscope control
• expert groups
• open source
• ...

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Basel Switzerland
Frozen Section (intraoperative)
Tumour board meetings
Second opinion consultations Discussion
groups Teaching cases for students
Server
Case providers
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Frozen Section
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Tumour Board Meetings
Before
Now
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Macropathology course
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Worldwide Servers
WADN
INHS
Teleteach
Telepath
UNITRA
Telepathology Servers (running on iPath)
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Case Senders
Case senders
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Interactions
Non-Experts and Experts
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Solomon Islands Primary Diagnosis
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First Diagnosis from Crete !
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AGKT Second Opinions
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IRIMC IHC planning consultats
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Spokane Microbiology
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Cambodia Surgical Consults
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What is still missing

• Collaboration among network operators
• A standard for exchange of data between systems
• A standard for remote control of dynamic data
  sources.

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Resources

• Project Home Pagehttp//ipath.sourceforge.net
• Telepathology Serverhttp//telepath.patho.unibas.
  ch