DIGITAL IMAGERY TELECYTOLOGY - IAC TASK-FORCE SUMMARY/

Optical digital imaging and its related technologies have applications in cytopathology that encompass training and education, image analysi s, diagnosis, report documentation and archiving, and telecommunicatio ns. Telecytology involves the use of telecommunications to transmit cy tology images for the purposes of diagnosis, consultation or education . This working paper provides a mainly informational overview of optic al digital imaging and summarizes current technologic resources and ap lications and some of the ethical and legal implications of the use of these new technologies in cytopathology. Consensus Position Computer hardware standards for optical digital imagery will continue to be dri ven mainly by commercial interests and nonmedical imperatives, but pro fessional organizations can play a valuable role in developing recomme ndations or standards for digital image sampling, documentation, archi ving, authenticity safeguards and teleconsultation protocols; in addre ssing patient confidentiality and ethical, legal and informed consent issues; and in providing suport for quality assurance and standardizat ion of digital image-based testing. There is some evidence that high l evels of accuracy for telepathology diagnosis can be achieved using ex isting dynamic systems, which may also be applicable to telecytology c onsultation. Static systems for both telepathology and telecytology, w hich have the advantage of considerably lower cost, appear to have lo suer levels of accuracy. Laboratories that maintain digital image data bases should adopt practices and protocols that ensure patient confide ntiality Individuals participating in telecommunication of digital ima ges for diagnosis should be properly qualified, meet licensing require ments and use procedures that protect patient confidentiality. Such in dividuals should be cognizant of the limitations of the technology and employ quality assurance practices that ensure the validity and accur acy of each consultation. Even in an informal teleconsultation setting one should define the extent of participation and be mindful of poten tial malpractice liability. Ongoing Issues Digital imagery application s will continue to present ne io opportunities and challenges. Positio n papers such as this ave directed toward assisting the profession to stay informed and in control of these applications in the laboratory. Telecytology is an area in particular need of studies of good quality to provide data on factors affecting accuracy. New technologic approac hes to addressing the issue of selective sampling in static image cons ultation are needed. The use of artificial intelligence software as an adjunct to enhance the accuracy and reproducibility of cytologic diag nosis of digital images in routine and consultation settings deserves to be pursued. Other telecytology-related issues that require clarific ation and the adoption of workable guidelines include interstate licen sure and protocols to define malpractice liability.