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

No distance too great

November 4, 2008

Feature

Uncategorised

In Depth

Tele-pathology has promised lots and delivered very little over the last few years. Historically, people have cited technical boundaries and some do not like the idea of remote diagnosis, but a multi-disciplinary team in the UK has seen through these concerns

MULTI-DISCIPLINARY teams (MDTs) have become the basis for providing consistent care to patients with diseases such as cancer. This does mean however, that MDT meetings must take place regularly and can involve a reasonable amount of travel and disruption to workloads. Furthermore, case reviews and second opinions are conducted between team members even more regularly and often involve the movement of slides and supporting documentation between different sites. This inefficient process does mean that patient's files are at risk of being lost or damaged. However, this needn't be the case anymore, since modern communications infrastructures coupled with advanced instrumentation allow the electronic transfer of highly complex data whilst enabling live discussion. Leading this field, Olympus has developed two systems to enable all members of an MDT to review and discuss the same case slides at the same time without the need to travel anywhere.

Olympus intraScope enables direct 1-2-1 control of a microscope from a remote site. This means a slide that needs to be reviewed for second opinion or remote consultation can be loaded at its source site and the microscope fully controlled by a user at a second site. The reviewer can manipulate the slide and microscope as if they were in the room. If questions arise regarding a crucial evaluation, other colleagues can then be consulted concerning the live image immediately and opinions can be exchanged regardless of where the two parties are located.

The concept is based on standard internet communications protocols, which ensures smooth operation, even with variable connection/data transfer speeds. As opposed to most highly exclusive tele-microscopy products, intraScope uses existing network structures and requires no expensive special hardware. Furthermore, the range of functions offered by intraScope is tailored to the needs of the users. For example an electronic address book is used to manage the list of available network remote stations and for optimal performance, images can be compressed before transmission.

The system is designed to operate either the upright BX61, or inverted IX81 automated light microscopes from Olympus. Remote users have control of all motorised components such as the nosepiece (to change the objectives), the shutter, as well as any contrast components (and even filter cubes if fitted). In addition, the software autofocus and all controllable camera settings can be adjusted. What is more, the remote user can also control motorised stages, enabling high-resolution overview images to be acquired automatically, since the intraScope acquires the component images and automatically moves the stage to the next respective position. The component images are stitched together to form the high-resolution overview image.

A discussion mode synchronises the images shown on the client and server computers. For example, both users can have their own respective mouse pointers shown on-screen in order to tag specific areas of interest. They can conduct measurements directly on-screen. Furthermore, they can transfer sheets and diagrams, saved images or any other documents located on their hard drives without the usual restrictions presented by standard e-mail software.

The dotSlide system takes this whole process several steps further forward by scanning entire slides at high resolution and fidelity into a virtual slide file. These files are accessible and fully navigable anywhere on the globe by any number of simultaneous users. The virtual slide can be examined as if it were the original on a microscope, since users can move around the sample and focus in on areas of interest with great ease. This instant electronic access enables quicker second opinions and remote consultations, as well as enabling consistent training and discussion. This clarity of the virtual files also means that the original glass slides can be stored off-site rather than kept at the hospital, greatly improving space utilisation.

"slides can be scanned in one location and reviewed almost instantaneously in another, by users anywhere on the globe via a web browser"

The system works with the same microscopes as the intraScope, combining this with precise and reliable automation, and very advanced software control. These enable the system to provide the exact level of information required by all users.

The dotSlide workstation and server system enable fully controllable remote access, whatever the requirements. Data and associated meta-data are saved in a data management system meaning that slides can be scanned in one location and reviewed almost instantaneously in another, by users anywhere on the globe via a web browser. The dotSlide system features a robotic arm that places the slides onto the stage holder and an integrated barcode scanner that ensures any bar-coded meta-data are automatically loaded and linked with the resultant virtual image.

Users are guided through the virtual slide acquisition process step-by-step by a

Diagnostic images can be shared the world over with tele-pathology systems

scan wizard. This graphical user interface features large control icons and allows even inexperienced users to produce the image results they require in just a few steps with minimal training.

dotSlide can scan multiple large specimens in up to 15 Z-planes. Virtual Z allows the reviewer to simply focus through the specimen, as well as examining regions of interest in different dimensions. This enables better observation for remote consultations, as well as consistent training for students and pathologists. The autofocus function offers improved autofocus capabilities, even when the Z-distance from the specimen's focal plane is much larger, as frequently occurs in specimens with strong topography. The user can also set focus points manually to achieve superior results for difficult samples, leading to improved reliability for the whole virtual slide acquisition process. In addition a sharpness filter for the dotSlide camera results in improved contrast.

A label scan feature enables the label to be scanned in along with the overview image allowing users to get an impression of the complete slide, not just the area that contains the specimen. In addition, mistakes from typing in data manually can be avoided as the label is secure proof of the identity of the slide.
The integrated net image server (NIS) SQL offers a client server database that allows users to manage any kind of image in a simple and convenient way. This powerful tool enables scanned images to be automatically uploaded to the database making them readily available for immediate remote access and multiple keyword queries. Customised database fields and user-defined database structure offer flexibility, and NIS SQL also supports multiple file repository systems to allow secure networking between different scanning units within one database.

Used together, the direct 1-2-1 control of the intraScope and the multiple access capabilities of the dotSlide virtual microscopy system, offer multi-disciplinary teams top-of-the-range microscopy capabilities and peerless tele-pathology facilities. By using the same microscopes and existing communications infrastructure, the systems are easily implemented and enable pathologists to diagnose and provide secondary consultations as if there were working directly with the sample. MDT meetings now no longer need to take place at one site, instead each specialist can remain in their office, greatly reducing travel costs and time delays. Moreover meetings and discussions are not postponed if a team member is away from their office, since the server based system enables global access. Tele-pathology can now start delivering on its promises and provide a step forward in the diagnosis and disease management process that will benefit the patient as well as the healthcare team.