Pacific Telepathology at Fiji School of Medicine

1
Pacific Telepathology at Fiji School of Medicine

• Shashidhar VM1, Brauchli K2, Oberholzer M2,
• Pryor J1, Kishore K1, Roy Krishna1.
• 1Fiji School of Medicine Fiji 2University of
  Basel, Switzerland
• Fiji School of Medicine, SUVA Fiji Islands1
• University of Basel, Switzerland2

2
What is Telepathology

• Remote Diagnostics
• Clinician to Pathologist
• Remote Teaching
• Student to Pathologist teacher/institute.
• Remote Discussion/Consultation
• Pathologist to pathologist / clinician to
  pathologist.
• Remote Quality Assurance
• Pathologist to Governing body / advisory

3
Why Telepathology ?

• Limited Pathology resource.
• Geographical distance.
• Efficient use of resource.
• Expert consultation to remote areas.
• Uniformity in quality of service.
• Keeping inline with advancements.

4
How - Telepathology ?

• Patient and primary care at Point A
• Expert Pathologist at point B
• Clinical Details with images of specimen slide
  transmitted in digital form.
• Pathologist reviews at remote Point B.
• Consultation received back digitally.
• Patient improves!
• More Points ? Discussion ? Quality.
• Virtual Global Health Care Institute!

5
How - Telepathology ?
6
Types of Telepathology ?

• Video conferencing.
• High cost, satellite line, expertise.
• Motorised Microscopy
• High tech, costly, bandwidth, Internet speed.
• Full digitized image as movie.
• High tech, costly, large bandwidth, efficient
  connection.
• Selected static images by email/web.
• Low cost, email capability, speed is not
  critical.
• Less accurate, repeat sending may be necessary.

7
1) static images

• some few images selected by non-expert
• Advantage small transfer size.No special
  software needed.
• Disadvantage Selection by non-expert. May miss
  important areas.

8
3) remote microscopy

• motorised microscope with remote control
  software
• Advantage Selection of field of interest by
  expert. very fast.
• Disadvantage complex technology.

9
How to communicate together ?

• Common Network Internet
• Minimum Software Installation Web Application
• Access for all - Access over slow connections
  (email)- Access through Firewalls

10

• Reviewing cases
• email alerts
• web interface
• virtual slide viewer
• remote microscope control (e.g. JAVA applet)

11
The Network
12
The Network
13
At Fiji School of Medicine
14
At Fiji School of Medicine
15
The Real World !
Internet Pathology Suite Telepathology Software
developed at the Department of Pathology,
University of Basel
16
The Real World
Internet Pathology Suite Telepathology Software
developed at the Department of Pathology,
University of Basel

• case discussions
• remote microscope control
• expert groups
• open source
• ...

17
Telepath _at_ FSM

• With support from Kurt Brauchli, University of
  Basel, Switzerland.
• FSM has been given server space.
• Dr. Venkatesh to Coordinate Pacific telepathology
  activities based in FSM.
• www.telepath.patho.unibas.ch

18
Basel Switzerland
Frozen Section (intraoperative)
Tumor board meetings
Second oppinion consultations Discussion
groups Teaching cases for students
Server
Case providers
19
Samedan Frozen Section
20
Thun Tumour Board Meetings
Before
Now
21
Geneva Macropathology course
22
Worldwide Servers
WADN
INHS
Teleteach
Telepath
UNITRA
Telepathology Servers (running on iPath)
23
Case Senders
Case senders
24
Interactions
Non-Experts and Experts
25
Specimen at Solomon Islands
26
AGKT Second Opinions
27
IRIMC IHC planning consultats
28
Spokane Microbiology
29
Cambodia Surgical Consults
30
Ideas for the Future

• Regional Networks global coverage.
• Different Specialties (Radiology, Ophthalmology
  etc.)
• More interactive teaching and CME applications.
• Developing better software and technology.

31
Resources

• Project Home Pagehttp//ipath.sourceforge.net
• Telepathology Serverhttp//telepath.patho.unibas
  .ch

32
2) full digital slide

• The whole slide is scanned automatically
• Advantage no information loss.
• Disadvantage huge amount of information to
  transmit 0.5 - 10 GB/slide

33

• Web Application Server
• Case Database- images- comments/diagnosis
• Web Interface
• Telemicroscopy router
• email-web / web-email

34

• Sending cases
• email

35

• Sending cases
• email
• www

36

• Sending cases
• email
• www
• v-Slide

37

• Sending cases
• email
• www
• v-Slide
• remote control microscope

38

• Reviewing cases
• email alerts

39

• Reviewing cases
• email alerts
• web interface

40

• Reviewing cases
• email alerts
• web interface
• virtual slide viewer

41
Internet 1
Internet 2
42
Hospital Intranet
43
Dial-in clients
44
Dial-in network