Image sampling in static telepathology for frozen section diagnosis

Background-A frozen section diagnostic service is often not directly availa ble, in small rural or mountain hospitals. In these cases, it could be poss ible to provide frozen section diagnosis through telepathology systems. Tel epathology is based on two main methods: static and dynamic. The former is less expensive, but involves the crucial problem of image sampling. Aims-To characterise the differences in image sampling for static telepatho logy when undertaken by pathologists with different experience. Methods-As a test field, a previously studied telepathology method based on multimedia email was adopted. Using this method, three pathologists with d ifferent levels of experience sampled images from 155 routine frozen sectio ns and sent them to a distant pathology institute, where diagnoses were mad e on digital images. After the telepathology diagnoses, the glass slides of both the frozen sections and the definitive sections were sent to the remo te pathologists for review. Results-Four of 155 transmissions were considered inadequate by the remote pathologist. In the remaining 151 cases, the telepathology diagnosis agreed with: the gold standard in 146 (96.7%). There was no significant divergenc e between the three pathologists in their sampling of the images. Each case comprised five images on average, acquired in four minutes.:The overall ti me for transmission was about 19 minutes. Conclusions-The results suggest that in: routine frozen section diagnosis a n inexperienced pathologist can sample images sufficiently well to permit r emote diagnosis. However, as expected, the internet is too unreliable for s uch a time dependent task. An improvement in the system would involve integ rated real time features, so that there could be interaction between the tw o pathologists.