TELEMICROBIOLOGY - FEASIBILITY STUDY

Background: Rural hospitals generally lack staffing with infectious di sease specialists or pathologists. Without on-site pathologists, the r ange of microbiology services offered by clinical laboratories may be limited as well. Objective: To study the feasibility of using static-i mage telepathology to evaluate Gram stains of microbiologic preparatio ns. Materials and Methods: In this retrospective feasibility study, th ree pathologists evaluated Gram stains of slides from 50 cases by two viewing modalities: static-image telepathology and conventional light microscopy. Digital video images of slides were captured at two magnif ications (using 40x and 100x objective lenses) at 1024 x 768 x 24-bit color and transmitted over standard telephone lines at 14,400 kbps. Pa thology reports and culture results served as ''truth diagnoses.'' Cat egories of interpretations were correct, minor discrepancy, or major d iscrepancy with regard to the implications for patient care. Results: The diagnostic accuracy of video image readings and conventional light microscopy readings were nearly identical, with no statistically sign ificant differences in the performances of specialty and nonspecialty pathologists (P > 0.05). The mean accuracies of readings of the video images and light microscopy images were 95.3% and 95.4%, respectively. Taking into account the time required by a referring pathologist to c apture video digital images, telemicrobiology was somewhat less effici ent than conventional light microscopy. Conclusions: Pathologists can accurately evaluate digital video images of preselected fields on Gram -stained slides. In clinical practice, however, a limiting factor may be the availability of local personnel qualified to select the microsc opic fields for evaluation by telepathologists. The adequacy of the vi deo images suggests that telepathology may also be used for remote sup ervision of quality assurance programs in microbiology laboratories, a s well as for remote proficiency training of laboratory personnel.