Telepathology is the process of diagnosing pathology at a distance using pictures viewed on a video display rather than directly through a light microscope.” The capture of histological, cytological, and macroscopic pictures for transmission over telecommunication lines for diagnosis, consultation, or continuing medical education is referred to as telepathology.
Methodology of Telepathology
Telepathology is classified into three modes:
- static,
- dynamic (or real time),
- and hybrid (or virtual).
- Static telepathology (or store and forward)
The most basic form of telepathology is static telepathology. The photographs are originally pre-selected, and the sender pathologist performs the digitization of a representative image. These visuals are thereafter sent to a distant telepathology via E-mail or Internet services. One of the appealing aspects of static telepathology is the inexpensive start-up costs, as no special software is necessary to see the pictures, and just a few basic components, such as a microscope, camera, and Internet, are required for setup.
However, there are some related drawbacks with a glass slide, such as the risk of missing a potential diagnostic region, the loss of clarity at low magnification, the lack of focus in static images, and the submitting pathologist’s improper field selection. Despite the fact that this is a less efficient procedure, there have been sporadic instances of concordance between the glass slide and telepathology diagnosis of up to 95%–100%.
- Dynamic telepathology (or real-time)
For frozen-section telepathology and undermanned areas, the dynamic telepathology system is the best option. In this technology, microscopic slide pictures are transmitted to the recipient in real-time via live telecommunication. Recipients can adjust the magnification as well as the slide with the use of a remote robotic microscope.
However, this advanced technology is both costly and difficult to maintain. It has a charge-coupled device video camera, high-resolution video displays, proprietary software, and high-performance hardware (computer). A robust and broad-bandwidth communications link between the sender and the destination is also required. With a concordance rate of 99 percent–100 percent recorded between telepathology and light microscopy diagnosis, dynamic telepathology has transformed the discipline.
- Hybrid telepathology (or virtual)
Hybrid telepathology blends static and dynamic telepathology systems employing nonrobotic real-time telepathology. They have the benefits of both systems. Via this approach, a series of photos are stitched together automatically in software and compressed into a single file.
As soon as the dynamic telepathological session begins, these pictures are transferred, speeding up the recipient’s consultation process by reducing the time spent controlling the robotic microscope. This technique is advantageous in that it allows for rapid consultations and better patient care. It has varying degrees of success.
Clinical Utility of Telepathology:
- Easily delivering critical health care support from distance
Because many residents in rural regions are unable to access even adequate primary medical care, a shortage of pathologists has long been a serious issue in many small pathology departments. Some emergency pathological tests, such as intraoperative frozen section, can be conducted without a pathologist via telepathology. A pathologist examines the gross in a different site after the laboratory technician prepares the specimen locally.
The pathologist will be able to provide the technician with some digital pathology instructions through the monitor. Following that, the pathologist can analyze digital photos and make a diagnosis over the phone. The benefit is that pathologists do not need to travel in order to deliver the service.
- Interoperative pathological analysis
Telepathology can be used to consult with a pathologist who is located in another area. Even without a pathologist, tumor-free margins can be identified during surgery in a tissue-saving way. It is possible to avoid the needless removal of a benign zone of a lesion.
- Conference discussions among distant pathologists
Pathologists are likewise spread unevenly over the world, with half of all trained pathologists living in affluent nations. Telepathology has been utilized to give pathology services to impoverished nations that do not have or have limited access to pathology and specialist pathology. Another significant advantage is easier access to consultations. This is true for pathologists who are isolated and require a second opinion, as well as those who send expert recommendations to subspecialist pathologists.
- Storage
In comparison to the previous technique, digital image storage has a number of advantages. Because the color of stains does not fade with time, digital slides may be preserved for a long period. Glass slides, on the other hand, are prone to breakage, fading, and loss. Aside from that, the costs of setting up and maintaining the old technique would be significantly higher.
Conclusion
In the realm of telepathology, huge technical developments are being made all around the world. Telepathology and digital pathology have evolved from an intriguing concept to a vital tool in clinical and research pathology. Regardless of the methods/instruments utilized, the ultimate objective of pathology practice is a more exact and rapid diagnosis of lesions. As a result, incorporating telepathology and digital pathology into routine diagnostics would transform pathologists’ lives from the microscope to the computer screen.
