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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 571-572
Ophthalmic telepathology: Concept and practice


1 Larsen & Toubro Ocular pathology Department, Vision Research Foundation, Sankara Nethralaya, 18, College Road, Chennai - 600 006, India
2 Department of Ocular pathology, Sri Sankaradeva Nethralaya, Beltola, Guwahati - 28, Assam, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Biswas J, Das D, Vaijayanthi P. Ophthalmic telepathology: Concept and practice. Indian J Pathol Microbiol 2010;53:571-2

How to cite this URL:
Biswas J, Das D, Vaijayanthi P. Ophthalmic telepathology: Concept and practice. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Aug 25];53:571-2. Available from: http://www.ijpmonline.org/text.asp?2010/53/3/571/68245


Sir,

Telecommunication technologies offer new ways of delivering health care to individuals in remote communities, and the usefulness of telemedicine (TM) is increasingly being studied for variety of medical conditions. [1],[2] Telemedicine technologies are applicable in ophthalmology, because standard ophthalmic instruments can be modified to capture and store images that can be digitalized and transmitted for expert evaluation. Telemedicine can also be used to examine live patients using sophisticated video conferencing devices to transmit real-time images. They can be used in diabetic retinopathy, HIV-related retinopathies, glaucoma, cataract, ocular surface disorders, various retinal and uveitic diseases etc. Telemedicine is thus a modern day technology that aims at taking the dream of 'healthcare for all' closer to reality. In this 21st century with great advancement, especially the information and communication technologies, the healthcare delivery to distant areas can be channelized effectively through TM. [1],[2]

Telepathology is defined as the practice of interactive diagnostic pathology performed at remote location by viewing images on a visual display unit instead of direct visualization on bright field light microscope. [2]

The concept of using video microscopy to provide diagnostic services to remote locations was first described in Boston, USA in 1968, when monochrome images had been captured and archived in a digital format and made available for access from remote location. [2]

India is not far behind in the field of telepathology. The first idea was way back in 2001 in the 50 th Annual Conference of the Indian Association of Pathologist and Microbiologist (IAPM) in Mumbai, where concept paper on Telepathology was presented. [2],[3],[4] Since then, a number of symposia and workshop s have been held in different parts of the country to popularize telepathology. Thereafter, 'telepathology quizzes' at telepathology.org. with images caught the attention of pathologists of India. [5]

We at Sankara Nethralaya, Chennai, India, along with Sri Sankaradeva Nethralaya, Guwahati, Assam, India are pursuing through a static telepathology project. Our complete telepathology unit consists of a suitable laboratory, high speed internet connection, a full computer system, a digital camera (Zeiss Axio Cam MRc, Germany) connected to a microscope (Axioskop 40, Germany) to capture images from the microscope, suitable software for image processing and image transfer by internet. An extra camera is connected for gross pathology in Leica S6 D dissection microscope.

The benefits expected by introduction of this telepathology unit were, better medical service, more distributed specialization, conservation of time, money and increased knowledge sharing. These units had also provided its services to local pathologist and research centers.

Over a two-month period, 20 cases were discussed. Besides the highly specialized scientific value of discussing the cases and exchanging of information, we saved a lot of time and money and offered our patients a better medical service. The time required for diagnosis range 4-6 min. Telepathology observation and diagnosis by the image viewer were all correct and informative.

On an average, each case comprised of five images (range 4-6) with total dimension of 300 kilobytes (190-320 kb). The mean time needed for acquisition of images for each case was an average 3 min, and 5 min for transmission resulting in an overall 8 min. However, maximum transmission time could be upto half an hour if there are network problems. Only for one case, the telepathology consultant had required to see the slides directly before giving the report.

Telepathology systems can be divided into dynamic telepathology (DT) and static telepathology (ST). [2] In the DT systems, images are seen interactively on line as they are captured from the microscope. In contrast, ST techniques use static images, which have been captured and archived in a digital format and made available for access from a remote location. First, the acquisition of microscopic and gross images requires use of video cameras or digital static camera. The image sensors of charge-coupled device type, provides sufficient spatial and color resolution, which made great impact in the field of pathology involving wide applications. In composite video, color information is encoded in a single output signal. Transmission of image data requires conversion from continuous (analog) to digital form. The image data are stored and transmitted by computer. Image data can be transmitted and shared between distant sites by using variety of telecommunications technologies for wide area network (WANs). For example, transmission of a full color image that is 640 x 480 pixels at video rates (30 frames per second) would require a bandwidth of 26 Mbits per seconds (Mbps). The cost and availability of these services vary greatly, depending on location and lines used for telepathologic communication. The general trend in the telecommunication industry is increasing availability of high bandwidth services to meet incessant demand for greater capacity by the financial, information services and healthcare industry. At the low end of the bandwidth spectrum, still image files may be transmitted by using the most widely available technology, i.e., the telephone with a modem to convert the data to a form compatible with the analog telephone signal and to compress the data by using a variety of multiplexing schemes such as integrated services digital network (ISDN).

Diagnostic accuracy of telepathology has been found to be 68.8 to 92% for frozen section and 86% to 96.4% for permanent section specimens. [5] Time taken for telepathology diagnosis is an average 4.7 min. The images can be saved in JPEG format. Ideally images should be taken in different magnifications. A gross photographs and microphotographs at 10x, 20x, 40x, 100x should be taken. The number of images can be made based on resolution 800 Χ 600 pixels and at least 500 Χ 300 pixels with digital cameras such as Zeiss, Nikon, Coolpix 4500, 4.0 MEGA pixels, 4Χ zoom, made in Japan. The correct interpretation depends entirely on the image quality that has been transmitted to the center. Along with the photographs, a short history of the patient with all relevant data such as age, sex and site of biopsy and clinical diagnosis has to be sent. Some centers also request to know the challenge or difficulty faced by the referring pathologist regarding the diagnosis of the case.

Therefore, the objectives of telepathology are, to make service accessible and affordable by reducing travel cost and time for the patients to give pathologists at remote places access to specialized opinion from experts, to minimize the delay in diagnosis, to act as an interface between pathologists and help them share their experiences and to help in training and research.

Ophthalmic telepathology has a constructive role in delivering the diagnosis, conversation and teaching at distant areas. Government and private sources are providing adequate funding to establish telemedicine services. Government of India under the National Programme for Control of Blindness (NPCB) has decided to support tele-ophthalmology for the cause eye care across the country and likewise ophthalmic telepathology is sure to follow soon. The telecommunications infrastructure is advancing in ways that will allow rapid and cost-effective transmission of the images. The experience of Desai et al. [4] in using static telepathology consultation between a tertiary cancer center (Tata Memorial Hospital) and a rural cancer hospital (Nargis Dutt Memorial Cancer Hospital) in Barshi, Maharashtra is an eye-opener. [5] Hence, their newer technological advances will transform the eye care scenario in the country into a world-class care for everyone in the near future. Healthcare networks may realize that this subspecialty of ophthalmic telepathology may distribute services and expertise among multiple sites for the betterment of ophthalmic care.

 
   References Top

1.Weinberg DS. How is telepathology being used to improve patient care? Clin Chem 1996;5:831-5.  Back to cited text no. 1      
2.Ongόrό O, Celasun B. Intra hospital use of telepathology system. Pathol Oncol Res 2000;6:197-201.  Back to cited text no. 2      
3.Baruah MK, LaRosa FG. Optimal Imaging in static Telepathology. Indian J Pathol Microbiol 2002;45:367-70.  Back to cited text no. 3  [PUBMED]  Medknow Journal  
4.Desai S, Patil R, Chinoy R, Kothari A, Ghosh TK, Chavan M, et al. Experience with Telepathology at a tertiary cancer centre and a rural cancer hospital. Natl Med J India 2004;17:17-9.  Back to cited text no. 4      
5.Baruah MK. The practice of telepathology in India. J Postgrad Med 2005;51:316-8.  Back to cited text no. 5  [PUBMED]  Medknow Journal  

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Correspondence Address:
Jyotirmay Biswas
Director of Uveitis and HOD - Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68245

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