ATA May 2007 FY 05 Telepathology Project

IMITS Telepathology Project

The Integrated Medical Information Technologies Systems (IMITS) Telepathology Project, a U. S. Air Force (USAF) and University of Pittsburgh Medical Center (UPMC) congressional funded initiative, is building the potential to create a USAF enterprise digital pathology network.

USAF and UPMC Modernization Initiative: IMITS TelepathologyLeslie Anthony,1 Drazen Jukic,1 Robert Zalme,2 Larry George,2 Jonhan Ho,1 Aaron Yanuzo1

1University of Pittsburgh Medical Center, Pittsburgh, PA; 2Keesler Air Force Base, Biloxi, MS

IMITS 02 Key Accomplishments

IMITS 04 Key Accomplishments

IMITS 05Projected Accomplishments

WHAT ARE WE LEARNING? USAF adoption of digital pathology tends to mirror that of academic and medical institutions at large.

This work was supported by funding from the U.S. Air Force administered by the U.S. Army Medical Research Acquisition Activity (USAMRAA), 820 Chandler Street, Fort Detrick MD 21702-5014, Contract No. DAMD17-03-2-0017. The content of the information does not necessarily reflect the position or policy of the U.S. Government and no official endorsement should be inferred.

• STATIC IMAGE equipment and DoD certification

• ROBOTIC MICROSCOPESfor Keesler, Eglin and Travis AFBs

• WHOLE SLIDE IMAGING (WSI) SYSTEM at Keesler

• STATIC IMAGE evaluated

• STATIC IMAGE case reviews with USAF and UPMC on USAF website and WebEx

• STATIC IMAGE case reviews with USAF and UPMC on USAF website and WebEx

• STATIC IMAGE repository of cases

• WSI validation studies with results published

• WSI SYSTEMS state-of-the-art assessments

• WSI prototype integration software

• ROBOTIC MICROSCOPY SYSTEM to achieve network security certification (May 2007)

• ROBOTIC MICROSCOPY SYSTEMS to be deployed at six USAF locations (summer 2007)

• WSI SYSTEM to achieve network security certification (fall 2007)

• ROBOTIC AND WSI STUDIES to further demonstrate utility and benefit of digital technologies (Spring 2008)

• USAF Business Case for digital pathology

• Cadre of USAF pathology champions familiar and comfortable with digital pathology systems.

STATIC IMAGE SYSTEMS• First digital imaging system to gain support by pathology community• Systems haves limited applications and built-in constraints:

– Single field, camera-on-microscope systems cannot document the entire slide forcing pathologists to find and capture areas of interest

– Necessitates highly trained individuals on both ends of a consultation

• Deployed at 3 USAF sites but user activity remains minimal• UPMC user activity is also minimal with static images captured in

less than 1% of all cases

Microscope SiteSL-4 Slide Loader System MicroscopeMotorized Stage & FocusDigital CameraControlStandard PCInternet Connection

Diagnosing SiteStandard PCInternet Connection

Java-based viewer for the Internet

DSS Server attached to SAN. Pulls images from SL-4 and serves for local and public.

ROBOTIC MICROSCOPY SYSTEMS• Reasonably successful in promoting digital pathology with tens of

thousands of cases documented since the mid-nineties.• These real-time, remote control systems only require hands-on

involvement of pathologists on the diagnosing side• They do not provide (as part of the core operations) permanent

image storage• UPMC has 8 robotic systems and by summer the USAF will have 7

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Java-based viewer from the Internet through UPMC Citrix

CONCLUSIONCurrent digital pathology systems are capable of providing useful levels of pathology reviews across distributed health systems and they will only get better.

WHOLE SLIDE IMAGING (WSI) SYSTEMS• Hold most promise for advancing digital pathology within the USAF

and elsewhere • Series of technologies to capture a digital image of an entire glass

slide at high resolution, store the image on a server and display the image on demand over a broadband network

• Pathologist has access to the entire histologic section and can “pan and zoom” across the “digital slide” as desired - simulating an exam carried out on the microscope

FY ’04 Validation Studies• Assessed use of WSI in three important areas of clinical practice: 1)

Quality Assurance, 2) Primary Diagnosis, and 3) Immunohistochemistry

• Found that images produced by current WSI devices are sufficient to produce accurate, detailed diagnostic reports, even for difficult and complex cases

• Companies still need to address image management issues such as integration with the LIS, the user’s interface and hospital networks

Status of WSI Industry• UPMC challenged market leaders of automated, high-speed, high-

resolution WSI systems • Overall, the WSI industry is strong with competition and underlying

improvements in optics and electronics driving advances in performance

Trestle DMetrix Zeiss Aperio Bacus