Remote pathology diagnosis enhanced through high-resolution digital photomicrography and Internet e-mail

Heidelberg 19 September 1999In the MedNet telemedicine session chaired by Dr. Greg Mogel, Dr. Della Mea introduced high-resolution digital photomicrography and Internet e-mail as two efficient tools for telepathology consultations. Still histologic images are sent through an asynchronous channel for remote expert diagnosis. After preliminary image sampling, performed by a qualified pathologist, the diagnostic accuracy highly increases. The technology is very suitable for biopsies and transplantation pathology. Various tests have been executed between sites in Udine and Los Angeles with signed and encrypted messages to enhance patient privacy and security. In no less than 93,5% of the cases, the remote diagnosis offered by expert pathologists was correct.

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High-resolution digital photomicrography can solve the problems encountered in telepathology sessions. The current methods of preliminary image sampling present a bias which might cause an incorrect diagnosis of the histologic images. As a result, the pathologist prefers to use all available magnifications, although seen from an a-posteriori point of view, only some fields are really useful to obtain a workable diagnosis. The fact remains that the diagnosis is not easy to perform. A partial solution could be to acquire low magnification fields with very high resolution devices. Operating in this way, it is possible to represent biopsies by just one or two images under the condition that you need devices with a capacity of at least 2000x3000 pixels.

Digital cameras match the severe requirements but they are very expensive. Instead, the cheaper photoscanners constitute an excellent though slower alternative. They can provide a visual representation which resembles that of light microscopy. The aims of the research performed by the team of Dr. Della Mea were threefold. First, the need occurred to verify the diagnostic quality of the photoscanners. The team also had to investigate whether the use of larger images could make the sampling problem less sensible, while the security features demanded a special degree of attention. The ICE-TEL certificate protocol was applied to transmit the privacy-enhanced messages, which had been signed and encrypted previously.

Experiments showed that the image quality potentially turned out to be very good. Only the focusing of the application through a near real time makes it harder to sustain the quality. The trials also learnt that the image selector has to be a pathologist. In those cases where the images were selected by a physician, only 60,7% of the remote diagnoses were made correctly, showing a great contrast with the 93,5% of successful diagnoses, obtained from the images which were pre-selected by a pathologist. This clearly indicates that the diagnostic accuracy increases with the capacity of the image sampler. In any case, research results have proven Internet e-mail and high-resolution digital photomicrography to be useful tools for telepathology consultations. Visual material can be found at the Web site of the University of Udine.


Leslie Versweyveld

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