Indian Space Research Organisation
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Static telepathology, also known as 'store and forward' or a passive approach to telepathology is the simplest & inexpensive form of telepathology. It involves the capture of still diagnostic images at one site and their electronic transmission and viewing at a remote site (Figures 1-3). The advantages of this system include low cost of the equipment and information transfer, worldwide access, simple and easy handling. The disadvantages are missing interactive handling and discussion abilities, missing control of the received images, and potential sampling errors.
Dynamic telepathology is also known as robotic interactive telepathology (RITP), real time telepathology or active telepathology. It is a more sophisticated technique, which allows the telepathologist to have a complete control over the images he is viewing. The microscope is fitted with a robotic control of the stage movement, focusing and objective lens selection. The advantage of this system is that it is almost similar to using a conventional light microscope, with the sampling error being eliminated. Dynamic telepathology is performed between the two fixed partners viz. larger institutions with smaller hospitals located in remote areas. The disadvantages include the high cost of the equipment, the incompatibility between the systems provided by the different suppliers, the amount of time taken to scan the slide in real-time and the specialized equipment required in the form of a motorized microscope and broad bandwidth communication link required for transmission. 
Hybrid systems combine static and dynamic elements. In such systems, a series of static images are captured and transmitted at the start of the dynamic telepathology session. This helps in the reduction of time used for controlling the robotic microscope.
The minimum requirements needed for telepathology purposes are:
Wider Applications of Telepathology Telepathology has validated applications in few areas of pathology, whereas in certain areas, the applications have yet to be tested. Validated applications
The first and most widely used application of telepathology is intra-operative frozen section services. These have been implemented in many countries like Norway, Switzerland, Germany,Japan and the United States. Robotic telepathology is being used to provide routine surgical pathology services in certain institutions. Telepathology has also been used for expert consultations, second opinions, quality assurance and educational programmes. Provisional applications Telepathology can find application in cytology, fine needle aspiration cytology, haematology, cytogenetics, immunohistochemistry, etc. McLaughlin et aF carried out a feasibility study of telemicrobiology and documented concordance between readings of conventional gram stained slides and video images. Telemicrobiology appeared to be somewhat time consuming as compared to conventional light microscopy. However, there are some unresolved issues in these matters and all relate to the limitations of telepathology services. Future applications Research is now being done to fit telepathology into point-of-care health care delivery strategies, like setting up a telepathology work-station at a breast clinic or in a radiology department to ensure adequacy of flfie-needle aspirates. Ultra rapid turn around time surgical pathology is being developed using automated immunohistochemistry processors and robotic telepathology. Proficiency testing is another interesting potential application of telepathology. Technology options include the use of Internet-based robotic microscopy, galleries of store-and-forward images, and virtual slides. Telepathology can be used to provide round the clock services by taking advantage of different global time zones around the world. "Virtual slides" The recenly published paper by Weinstein et al describes a reinvention of light microscopy,a miniaturized array microscope for ultra rapid virtual slide processing. The ultra rapid virtual slide scanner may be used for the current applications of telepathology, including routine diagnostic surgical pathology,second opinions, expert opinions, education and research. References
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Telepathology can be applied to various aspects of pathology, such as biopsies, surgical specimens, intraoperative frozen sections, cytology etc. Telepathology is not a substitute for glass slide diagnosis. It is a need based service, based on the premise of non-availability of immediate expert help in the vicinity of the primary pathologist's area of work. Traditionally, pathologists are accustomed to viewing high-quality images with their light microscopes. Getting pathologists acclimatized to digital imaging and telepathology is challenging, and requires a change in the pathologist's mind-set. On a positive note, attitudes towards telepathology are also changing, as pathologists gain confidence in this science, largely because of the improvement in the quality of digital imaging and familiarity with digitization and telecommunication technologies.