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UPMC/Air Force Digital Pathology Initiatives



  • Conference Web Casting
  • CoPathPlus PICSPlus Imaging System
  • Digital Gross Imaging
  • Digital Network Camera
  • Digital Slide Imaging
  • Image-Embedded Clinical Reports
  • Remote Microscopy
  • Tele/Video Conferences
  • Web-based Telepathology
  • Webcam - Frozen Section Room

  • 2014 UPMC Telepathology Handout, PDF

    Conference Web Casting

    UPMC Teleconferences (http://teleconference.upmc.edu).  Educational Pathology conferences have been broadcast live over the Internet since 2002 (Yagi, Human Pathology, 2004).  Conference videos are subsequently archived to a searchable web site that includes more than 1285 conferences (as of June 2008).  Many of these conference videos are freely available to the public.  Typically, one conference per day is broadcast and archived.

    Weekly Department of Pathology conferences live/archived on the web. These include:

    • Seminars in Laboratory Medicine/Current Topics in Laboratory Medicine - Selected UPMC AP/CP users - Protected by UPMC network authentication
    • (Selected) AP Didactic Conferences are open to public on the Internet
    • CP Didactic Conference - Selected UPMC AP/CP users - Protected by UPMC network authentication
    • (Selected) Departmental Seminars are open to public on the Internet
    • (Selected) Diagnostic Pathology Conferences are open to public on the Internet
    • All LIVE (Thursdays) sessions are accessible only on UPMC network

    UPMC Pathology users can view them LIVE on Mondays, Wednesdays, and Thursdays at 12:00 Noon, and Tuesdays at 8 AM. They can also view them in archived form (since February 2002) anytime of the day.

    In real time, you may log onto these conferences through our department website and experience the audio and visual components of the lectures. If you miss the talk, the lectures will be archived and can be accessed through the same log on mechanism.

    All conferences can be accessed from anywhere within UPMC network, and many are available outside UPMC, especially in archived form.

    Through web casting, personnel at any of UPMC's twenty domestic hospitals (and international initiatives) can experience UPMC Pathology conferences from the convenience of their desks.

    CoPathPlus PICSPlus Imaging System

    Cerner CoPathPlus Anatomic Pathology system includes an imaging module (PICSPlus) that permits acquisition and association of images with pathology cases. We currently use PICSPlus to store gross images and photomicrographs. These images are useful for a variety of purposes, including documentation of telepathology consultations within UPMC, correlation of gross specimen sampling, image-embedded clinical reporting and conferences. Approximately 3,039 images are captured each month, and utilization is steadily increasing.

    Digital Gross Imaging

    The Sony DFW-SX910 digital camera provide high-resolution digital color images. In early May 07, this gross imaging solution was deployed in Children's Hospital gross pathology laboratory. Digital photography provides a number of advantages over routine 35-mm gross photography, especially with respect to image cataloging, storage, and retrieval integrated to workflow and too date (see recent stats here), gross digital images have been acquired into the CoPathPlus Laboratory Information System.

    Digital Network Camera

    The Nikon DN-100 internet-ready network camera system can deliver live or captured images to a local area network or remote computer anywhere in the world. The DN-100's ability to transfer images over a network or the internet enables medical personnel to easily share digital images of specimens with colleagues, through networking HTTP communication via a web browser. The Nikon DN-100 also allows an operator to remotely control the camera system software and hardware. This application is very useful in provide real-time image sharing.
    Click here for a presentation on the Nikon DN-100 Network Camera.

    Digital Slide Imaging

    Digital Slide Imaging - the ability to digitize an entire histologic slide at high resolution and display the resulting image across a broadband network - is becoming an important technology for telepathology. In this paper, we review the basic components of a whole slide imaging implementation (imaging robot, digital slide, network infrastructure, virtual microscope and laboratory information system interface). We also review the whole slide imaging applications being developed at the University of Pittsburgh, including tele-education, tele-consultation and quality assurance focusing on the importance of whole slide imaging for large, geographically distributed, health systems.

    Aperio T2 is semi-automated, high-throughput device is currently the workhorse for both our clinical evaluation group and for our educational resources.  To date, three clinically-oriented studies have utilized the T2 system: a quality assurance study (Ho, et al. Human Pathology, 2006) ; a primary diagnosis study (Gilbertson, et al. BMC Clinical Pathology, 2006); and an immunohistochemistry validation study (Fine, et al, APIII 2006 abstract).  Further such studies are planned.  Educational resources include several thousand imaged slides including subspecialty teaching sets and unknown educational conference slides.

    Location of Aperio T2 Scanner:

    • UPMC Shadyside (335 Cancer Pavilion)

    For rapid slide scanning, the T2 features a large capacity slide loader and rapid scanning of slides at 0.47 microns per pixel (“20x equivalent”, approximately 6 minutes per slide in our experience).  Viewing options include both stand-alone software and a web based viewer.  Utilizing JPEG 2000 compression, T2-scanned WSI average about 115 megabytes each. Click here for a sample image.

    Trestle/Zeiss Scanners are primarily implemented for telepathology activities, two of our Trestle/Zeiss systems are also outfitted with 50-slide capacity loaders for digital slide imaging.  Although these systems are not as fast as other platforms (approximately 20 minutes per slide), they are deployed at several sites in our health system.  Preliminary investigation is underway to determine suitability of these devices for high-resolution imaging of cytopathology slides.

    Locations of Trestle/Zeiss Scanners:

    • UPMC Shadyside (Pathology Frozen Section)
    • Children's Hospital of Pittsburgh (6915 CHP)
    • UPMC Presbyterian (Pathology Frozen Section)
    • Magee Womens Hospital of UPMC (3684 MWH)
    • VA Pittsburgh Health System (2NE126, Surgical Pathology Lab)

    Image-Embedded Clinical Reports

    Due to departmental workflow restrictions (network color printer and manual report distribution) this service is available on a limited basis in the Department of Pathology.

    Remote Microscopy

    UPMC has eight of MedMicro Internet Microscope systems deployed at six of our hospitals, including “UPMC Italy" in Palermo and our digital pathology laboratory.  The MedMicro system is a remote-controlled microscope that permits high quality, real-time interpretation of glass microscope slides via the internet.  To facilitate utilization of these MedMicro systems, formal training is required for all UPMC pathologists.

    UPMC has been successfully using the Coolscope for tele-neuropathology consultations since 2003 (Fine, et al; APIII 2006 abstract).  The Coolscope system is a remote-controlled microscope that permits high quality, real-time interpretation of glass microscope slides via the internet.  Slides may be viewed using a web-based viewer that requires no installation; just a link that can be sent via email.  The software supports acquisition of digital photomicrographs, which are then imported into our APLIS for the purpose of documenting intra-operative consultations.

    Tele/Video Conferences

    UPMC (Pathology) currently has andberg equipment installed at each of its academic hospitals.  We are currently in the process of modernizing this equipment to support teleconferences involving three or more locations simultaneously, including video microscopy and PowerPoint for weekly:

    • Every Tue - Consult Slide Conference/Resident's Slide Conference - between PUH/SCF-SHY-MWH
    • Every Wed – Pancreas/Liver Conference - between Cancer Pavilion-MUH-Passavant (Donor Hall)
    • Every Thu - CytoPath Slide conference or Journal club - between PUH-SHY-MWH
    • Every Fri - Telepathology Special Interest Group Meeting - between Cancer Pavilion-MWH
    • Every Month - AP Supervisors Meeting - between SCF(Totten Room)-SHY
    • There have been a lot of unscheduled meetings between PUH-SHY-SCF-MWH that have used TANDBERGs

    and other types of Conferences.  In addition, the upgraded systems will feature higher video resolution and better data compression to permit better visual quality.

    Current Pathology video conference sites (on National ISDN and UPMC IP network):

    • UPMC Cancer Pavilion (201 Cytology Conference room) – TANDBERG (IP)
    • UPMC Shadyside (Pathology Sign-out room) – TANDBERG (IP)
    • UPMC Presbyterian (Pathology Conference room) - TANDBERG (ISDN and IP)
    • Scaife Hall (Totten Room) - TANDBERG (IP)
    • UPMC Montifiore (Transplant Pathology Conference room) – TANDBERG (ISDN and IP)
    • Magee Womens Hospital of UPMC - (Pathology Sign-out room) - TANDBERG (IP)
    • Children’s Hospital of Pittsburgh of UPMC – TANDBERG (IP)
    • UPMC St. Margaret – (Dr. Jagjit Singh office) – POLYCOM PVX (IP)
    • UPMC Passavant - (Donor Hall) - Polycom HDX9004 (ISDN and IP)
    • UPMC Bedford Memorial - (Video Conference room) - Polycom HDX9004 (ISDN and IP)
    • UPMC Horizon-Greenville - (Video Conference room) - Polycom HDX9004 (ISDN and IP)
    • UPMC Horizon- Shenango - (Video Conference room) - Polycom HDX9004 (ISDN and IP)

    TV Conferencing is a flexible tool, allowing video communication between campuses. At UPMC, travel time can be thirty minutes between teaching campuses, making video conferencing an important productivity tool. The system supports moderated conference control, as well as shared applications, digital whiteboard, file transfer and text chat.

    Microscope based video (and especially high resolution digital) feeds are used to support Telepathology across UPMC campuses.

    Microscopic real time video feeds combined with large, high resolution monitors allow "overflow" attendance at multi-headed scopes and allow pathologist to present finding at tumor boards and specialty conferences.

    Web-based Telepathology

    Traditionally, telepathology has been implemented using custom software and high-speed private data networks. Internet2 and the World Wide Web offer a flexible, ubiquitous, user-friendly, and intrinsically multimedia environment ideally suited for telepathology applications. At the University of Pittsburgh Medical Center, we are actively investigating web-based telepathology. Yukako Yagi, Adam Landman, APIII 1998.

    Web-based teleconsultation:

    UPMC Digital Pathology Consultation Service

    • Connect with our team of internationally recognized leaders in pathology when you need a second set of eyes and subspecialty expertise.
    • Our pathologists, who are physicians at UPMC and faculty of the University of Pittsburgh, deliver their expertise and high-quality consultation directly to your practice, hospital, or lab. The UPMC Digital Pathology Consultation Portal.
    • Now it's easier than ever to send your slides electronically via a secure internet connection through the UPMC Digital Pathology Consultation Portal. Receive rapid consultations with no mail, courier, or inconvenience required.
    • The digital portal gives you a valuable second opinion necessary to be accurate and efficient in both diagnosis and treatment.

    In Web-based teleconsultation, a Web-browser displaying text and static images gives pathologists the ability to submit and review cases. Case arrival and analysis events occur in separate time intervals, with notification ability via pager and/or e-mail.

    Webcam - Frozen Section Room

    In order to provide optimal service to the Shadyside Hospital neurosurgery group, and to optimize tumor tissue banking, a webcam was installed in the Shadyside frozen section room so that the Presbyterian–University Hospital neuropathologists can view gross specimen remotely from their location. The Neuropathologists now have the ability to see the gross of intraoperative specimens prior to their being prepared for the MedMicro Internet Microscope System.

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