Cedars-Sinai Medical Center
Department of Pathology
Los Angeles, California
Alberto M. Marchevsky, MD

S. Lau, A. Marchevsky, C. Felten, W. Yong, C. Lockhart, E. Khanafshar, A. Phan
Department of Pathology and Laboratory Medicine
Cedars-Sinai Medical Center, Los Angeles, California

Background: One of the projected uses of telepathology systems has been in the setting of remote consultation services, particularly in subspecialty areas of pathology. Contemporary web-based teleconferencing techniques allow for the simultaneous transmission of real time video and audio information over the Internet. We explore the use of these methods as a consultation tool for the evaluation of a spectrum of case materials in the areas of transplantation pathology and neuropathology.

Design: Real time video images from 158 cases representing a range of transplantation and neurosurgical pathology (58 endomyocardial biopsies from cardiac transplant recipients, 50 transbronchial biopsies from lung allograft recipients, 50 neuropathology cases) were transmitted through the Internet using a 400 MHz Pentium microcomputer configured with 128 MB of RAM, an 8 MB Matrox Marvel G200 AGP graphics card (Matrox Graphics Inc., Montreal, Canada), Windows 95 Operating System and Windows NetMeeting Version 3.01 (Microsoft Corp., Redmond, WA) software. Images were acquired through a photomicrographic microscope, connected to a Sony 3CCD Model DXC-750 MD video camera (Sony Corp., Tokyo, Japan). Cases were viewed in real time by consultant pathologists on a color video monitor set at 800 x 600 spatial resolution, using a microcomputer equipped with NetMeeting software. Continuous verbal interaction allowed the consultant pathologists to direct field selection, objective settings, and focusing, which were controlled by the referring pathologist. Telepathology diagnoses were recorded and compared with diagnoses rendered by light microscopy.

Results: Complete diagnostic concordance between telepathology and light microscopy diagnoses ranged from 84%-96%. The quality of the transmitted video images was sufficient for most diagnoses. Sound transmission was fairly reliable, with only a minority of consultations disrupted by interruptions in audio communication.

Conclusion: Real time interactive video and audio conferencing through the Internet provides an effective and inexpensive method of remote telepathology consultation, particularly in subspecialty areas of pathology.