Teleconferencing for Pathologists

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Teleconferencing for Pathologists

• Adam Landman
• Heathcare Information Systems
• February 24, 1999

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Outline

• Introduction to Pathology
• Introduction to Telepathology
• Major Software Vendors
• Requirements
• Evaluation
• Recommendation

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Introduction to Pathology
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Surgical Pathology

• Frozen Section - small sections of tissue removed
  from a patient during surgery requiring diagnosis

• Diagnosis 5 - 7 min, Turnaround lt 15 min
• Large universities and hospitals provide this
  service on demand

• What about smaller or outlying hospitals?

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What about smaller/outlying hospitals?

• Travelling Salesman -- rely on periodic visits
  from pathologists
• Surgeries must be scheduled to coincide with
  visit
• What if pathologist is not present?
• Glass slides express mailed to remote laboratory
• Patient may have to undergo second surgery after
  diagnosis is available

• Neither solution is very efficient!

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Introduction to Telepathology

• Telepathology - practice of pathology from a
  distance
• viewing images on a video monitor rather than
  light microscope
• Images acquired by video camera mounted on light
  microscope
• Images transmitted over a telecommunications link
  to remote workstation for analysis by
  telepathologist

Referring Pathologist
Telepathologist
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Telepathology System Types

• What kinds of images are displayed?
• Who has control over selection of images?

FTP
Video Conferencing
Dynamic Robotic
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Static vs. Dynamic Systems
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Telepathology Issue

• Static image analysis not normal
• Control of microscope
• Sequence of images can affect outcome
• Omissions are unacceptable
• Can video images be used by pathologists to
  render primary diagnostic opinions or second
  opinions?

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Telepathology Issues (cont.)

• Static Imaging -- overall diagnostic accuracy
  fails to meet accuracy standards (Ito, et al)
• Video Microscopy -- validated for diagnostic
  pathology by Weinstein et al
• 15 Sony Trinitron 950-line monitor
• 11 Sony 300-line monitor
• Dynamic-Robotic -- achieved overall diagnostic
  accuracy equal to that of light microscopy
  (Shimosato et al)

• So what??

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Telepathology Issues (cont.)

• Static imaging is unacceptable for diagnosis
• Dynamic-robotic is best, but expensive and
  difficult to setup and operate

? We will consider COTS Video Conferencing
products (dynamic, slave)
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Major Vendors
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Requirements

• Developed requirements based on background and
  consultation with two experienced UPMC anatomic
  pathologists
• Compatibility
• Performance
• Product Features
• Standards
• Ease of Use
• Administrative

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Compatibility Requirement

• Compatibility with Existing Environment
• Teleconferencing software must be compatible with
  hardware and software environment
• Note Compatibility is not pertinent to ultimate
  product comparison

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Typical Technical Environment
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Performance Requirements
Performance --gt Image Quality, Compression, Frame
Rate

• Image Quality
• Difficult to standardize
• 1,024x768 pixels, 16-bit resolution not currently
  possible with video conferencing
• Current capability
• 128x96 pixels, Sub Quarter Common Intermediate
  Format (SQCIF)
• 176x140 pixels, Quarter Common Intermediate
  Format (QCIF)
• 352x288 pixels, Common Intermediate Format (CIF)

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Performance Requirements

• Compression
• Decrease file size, Increase network performance
• Two standard video codecs
• H.263 - low bandwidth (28.8 Kbps modem)
• H.261 - high bandwidth (LAN and ISDN)

• Frame Rate
• Video 24 fps, Film 30 fps
• Internet frame rate much lower expectations
  (12-15fps)
• Rate using two ranges
• 3-7 fps for low bandwidth
• 7-15 fps for high bandwidth

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Product Feature Requirements

• Multipoint data conferencing - allows users to
  collaborate and share information with one or
  more meeting participants in real-time.
• Audio conferencing - allows pathologist to talk
  in real-time with colleagues.
• Video conferencing - allows pathologist to send
  and receive video images.
• consider how many concurrent video sessions are
  possible
• pathologists facial image
• microscope field view

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Product Feature Requirements

• Whiteboard allows users to share pictures, draw
  diagrams, and graphically update information in
  real time.
• Application Sharing lets users share Windows
  application with other participants in a meeting.
• might be useful for application to control
  robotic microscope
• Chat text-based chat application.
• Binary File Transfer enables files to be sent
  to participants during a meeting.
• natural integration of standard static
  telepathology

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Standards Requirements

• Standards - ensure users can call, connect, and
  communicate with people using compatible
  conferencing products
• International Telecommunications Union (ITU)
  Standards
• T.120 - standard for multipoint data conferencing
• H.323 - standard for audio and video conferencing
• Broad industry support with gt 120 vendors
  participating

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Ease of Use Requirements

• Easy to Use is imperative for Pathologists
• Difficult to evaluate without using software
• Proxies
• Installation Wizard
• Graphical User Interface
• On-line Help

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Administrative Requirements

• Miscellaneous software attributes
• Cost
• particularly important in hospitals and labs with
  budget constraints (everywhere!)
• Product support
• Upgradeability
• Cross-platform support

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Evaluation

• Developed priority weights in collaboration with
  two experienced UPMC anatomic pathologists

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Evaluation
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Evaluation
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Recommendation

• Microsoft NetMeeting 2.0
• Cost-effective solution that delivers a complete,
  integrated Internet conferencing solution suited
  to meet the needs of the practicing pathologist
• Sensitivity Analysis of weights
• Formal methodology may have been overkill
• CU-SeeMe major revision due March 1999

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Recommendation (Limitations)

• Not generalizable to larger user community
• Needs more complete analysis
• hands-on usage of products
• General telepathology issues need consideration
• Medical-legal
• Diagnostic accuracy
• Patient confidentiality

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Acknowledgements/References
Special thanks to Ms. Yukako Yagi, Dr. John
Gilbertson, and Dr. Bob Dawson for their
assistance and insightful comments.

• Vaughn, G.L., Tendencies of pathologists in
  observing frozen sections, feasibility study,
  UAB Center for Telecommunications Education
  Research, 1994.
• Weinstein, R.S., K.J. Bloom, and L.S. Rozek.
  1990. Static and Dynamic Imaging in Pathology,
  in Mun, S.K., Greberman, M., Hendee, W.R., and
  Shannon, R. (eds.), Image Management and
  Communications in Patient Care Implementation
  and Impact. Los Alamitos, CA IEEE Computer Soc.
  Press, pp. 77-85.
• Ito, H., H. Adachi, K. Taniyama, Y. Fukuda, and
  K. Dohi. 1994. Telepathology Is Available for
  Transplantation-Pathology Experience in Japan
  Using an Integrated, Low-Cost, and High-Quality
  System, Modern Pathology, 17 801-05.
• Oberholzer, M., H-R Fischer, H. Christen, S.
  Gerber, M. Bruhlmann, M. Mihatsch, M. Famos, C.
  Winkler, P.Fehr, L. Bachthold, and K. Kayser.
  1993. Telepathology with an Integrated Services
  Digital Network A New Tool for Image Transfer
  in Surgical Pathology, A Preliminary Report.
  Human Pathology, 24 1078-85.
• Eide, T.J., and I. Nordrum. 1992. Frozen Section
  Service via the Telenetwork in Northern Norway,
  Zentralblatt Pathologie, 138 409-12.
• Bloom, K.J., L.S. Rozek, and R.S. Weinstein.
  1987. ROC Curve Analysis of Super High
  Resolution Video for Histopathology, SPIE Proc
  Visual Image Process, 845 408-12.
• http//www.zdnet.com/pccomp/features/fea0297/sub5.
  html/
• http//www.microsoft.com/netmeeting
• http//www.wpine.com/

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Questions