Experience with a Hybrid DynamicStatic Telemicroscopy System for Real Time Surgical Pathology Consul

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Experience with a Hybrid Dynamic-Static
Telemicroscopy System for Real Time Surgical
Pathology Consultation at the University of
Pennsylvania Health System

• Michael Feldman, MD, PhD, Robert Zimmerman,
  MD, Franz Fogt, MD and John E. Tomaszewski,
  MDDepartment of Pathology Laboratory
  Medicine, University of Pennsylvania Health
  System, Philadelphia, PA 19104Department of
  Pathology Laboratory Medicine, Presbyterian
  Medical Center, Philadelphia, PA 19104

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Anatomic Pathology in a Distributed Health System
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Distributed Telemicroscopy

• Apollo Hybrid DynamicStatic Telemicroscope
• H323 video 30 fps 500x300 pixel window, full
  robotic control of scope, 1.5 mega pixel static
  image
• Audio and video between two sites during
  conference
• Report database to store text and images
• 100 Mb WAN between sites
• System uses only 0.75 Mbp

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How Is System Used
Real TimeConsultation
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Consult Protocol

• Case is presented by Pathologist at affiliate
  hospital
• Pt demographics and relevant clinical history if
  available
• Slide is placed on remote robotic microscope
• One or Two consultants at University provide real
  time consultation
• Direct control of robot microscope
• Direct communication with consulting pathologist
  to answer relevant pathologic issues and render
  diagnosis or guide ancillary studies
• Capture of key diagnostic fields at high
  resolution for documentation and annotation to
  communicate relevant features
• Currently, all cases receive glass slide review
  later that day for correlation with teleconsult
  diagnosis

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Case Breakdown
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Detailed Results
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Single Case Discrepancy

• Patient with remote history of IBD with colostomy
  presents with irregular red lesion at ostomy
  site
• Three biopsies taken two of them show exuberant
  granulation tissue, one shows intestinal glands
  underneath squamous epithelium interpreted as
  indefinite for dysplasia on teleconsult and glass
  review.
• Consulting Pathologist wanted third opinion,
  worried about dysplasia
• Glass sent for outside review called high grade
  dysplasia
• Who knows who is correct?

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Indefinite versus HGD?
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Deferred to IHC
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Quality Assurance in a Distributed Health System
University

• - Take video feed out of 14 headed conference
  scope
• - Pipe it to affiliate hospitals using video
• conference function of Telepathology System
• Affiliates see image from conference, hear audio
  from conference and can provide diagnostic
  input via audio from affiliate to University
  conference

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Future Plans

• Add third site within health system
  Phoenixville Hospital
• Collaborate with other Institutions using Apollo
  system for educational conferencing and
  consultation
• Study use of Telepathology in subspecialty
  domains in Surgical Pathology as well as
  Telecytopathology