INTERACTIVE

MULTIDISCIPLINARY WEB
CONFERENCING:
The Use of the Aperio and
PolyCom PVX Systems
Ossama Tawfik, MD, PhD
Professor
Director of Anatomic and Surgical Pathology
The University of Kansas Medical Center
Pathology Vision Conf, Oct 2008

OBJECTIVES
1. Why going digital is valuable?
2. What is wrong with the current
system?
3. Can we do better? And why do we
have to?
Why Digital Conferencing?
Problem...
Medicine is changing.
Medical Practice and Teaching is moving away
from the Major Medical Centers into Community
Settings.
Medical Centers are redesigning themselves -
clinics, surgi-centers, nursing homes and
doctors practices.
Great majority of patient care will be outpatient,
located outside the main Campus.

Why Telepathology?
Problem...
The growing physical separation between
Clinician and Pathologist is problematic in
communication...
Traditional Pathology Reports will have
limitations in communication.
How will we communicate with our clients
when they are across town, across the state or
across the world?

Why Telepathology?
Problem...
As medicine becomes distributed, it will become
incumbent upon us as pathologists to find new
ways of communicating for clinical work,
research and education.
The primary mode of communication has always
been the pathology report.
We may now have to rethink the way we report...
Pathologists, radiologists, and surgeons
digital slide/radiology conferencing on a
weekly basis
500 breast needle core biopsies
ERROR REDUCTION!!!!
Evaluation of significant
abnormalities/discrepancies
Correlation with treatment plans for each
patient

INTERACTIVE MULTIDISCIPLINARY
CONFERENCE
Microcalcifications of the breast:
size matters!
A mammographic-histologic correlation study
X Liu, M Inciardi, JP Bradley, F Fan, P Thomas, W Smith, O
Tawfik
Pathologica 2007;99:5-10

Core Needle Biopsy Protocol
Specimen radiography
Calcification
Absent
Calcification
Present
< 100 um > 100 um
Proceed w Dx
Tissue block
radiography
Radiologically
negative
Radiologically
positive
Malignant Dx Benign Dx
Cut deeper in block
Additional
studies are
required!!
Ca Absent Ca Present
Ca SIZE
Medical Error Statistics
Colorado and Utah study
Adverse events (AE) in 2.9% of hospitalizations
8.8% of AEs led to death (about 44K
deaths/annually

New York study
AEs in 3.7% of hospitalizations
13.6% of AEs led to death (98K deaths annually)

Eighth leading cause of death in USA
Dollar Cost of Medical Error
Between $17 to $29 billion/year
Half directly attributable to health care costs
Other half combination of lost productivity, lost
income and disability
Goals of the IOM report
Break cycle of inaction concerning patient
safety and medical error
Enhance knowledge base about medical error
Breakdown legal and cultural barriers which
impede safety improvement
Shift from blaming individuals for past errors to a
focus on preventing future errors by designing
safety into the health care system
Goals of the IOM Report (cont.)
Improve knowledge base about medical
error and safety improvement
Develop tools to improve safety
Cause significant monetary investments to
achieve these goals
Institute of Medicine mandate
Threshold improvement in quality

50% reduction in medical error in five years
ARE WE LISTENING?
OUR PROBLEM
OUR PROBLEM
KU Med Ctr is
Located 3 miles
From Cancer
Center

Man power

Time

Resources

OUR PROBLEM
Aperio ScanScope
System

PolyCom PVX video
conferencing System

OUR SOLUTION
Pathologists, radiologists and surgeons
Develop a web based pre-diagnostic work-
up conference in which the pathology
slides and mammograms could be
analyzed together
Goals:
To insure adequate sampling
To reach a proper diagnosis
To determine the proper surgical/treatment
plans
Aperio/KUMC Pilot Project

Application

Values
Tested

Variables Measured




Confirmation
Reviews with Digital
Conferencing

Quality
Concordance between glass
and digital reads
Image quality
Comfort level with using digital
slides
Ease of use with digital slides

Service and
Efficiency
Pathologist/Radiologist/Surgeon
satisfaction
Comparison of actions taken
based on digital consultations
vs. history of actions for the
same type of discrepancy

Telepathology/Teleradiology
Unit

Server with high speed internet connection
Personal computer w web camera
Digital pathology system (Aperio
ScanScope XT)
Spectrum Plus digital pathology
information management software
Web conferencing system (PolyCom PVX)

Values
Pathology side:
Remote viewing and conferencing
Simultaneous view of multiple digital slides
Archiving and intelligent retrieval capabilities

Radiology side:
Remote viewing and conferencing
Simultaneous view of multiple digital images
Alive radiologic images w radiologist and
pathologist input






Pathology/Radiology:
Audio and Video conferencing while reviewing
images
No need to leave office
No phone calls or typing required

Values
Cases Pathologic Diagnosis
Invasive carcinoma (1 case)
DCIS (1 case)
Fibroadenoma (2 cases)
Fibrocystic changes with microcalcifications (12
cases)
Fat necrosis (1 case)
Fibrosis (3 cases)
Intraductal papilloma (1 case)
Sclerosing adenoma (1 case)
Microcalcifications (11 cases)
Abnormal mammogram, mass (6 cases)
Fibroadenoma (2 cases)
Abnormal ultrasound, mass (2 cases)
Spiculated mass (1 case)
Cases Radiologic Diagnosis
Concordance
No Impact
100%
concordance
Minor
Impact
Major
Impact
13 6 3
Excise lesion (1)
Re-biopsy patient (2)
Follow up
mammograms (2)
X-ray tissue blocks
(4)
Teleconferencing Challenges
Challenges
It requires some training (learning curve)
Psychological barrier!!!!
Limitations in technology (view of small
area of slide, length of transmission of
images, internet connections, etc.)
Image resolution, size of files transmitted

Benefits of telepathology
(telemedicine)

Better medical service
More specialized service
Primary diagnosis for frozen sections
Second opinion and consultations
(dermatopathology, neuropathology,
cytopathology, etc.)
Quality control
Benefits of telepathology
(telemedicine) cont.
Cost saving/Time saving
Exchange of ideas
Improved collaboration with opportunity for
research
E-learning, clinicopathological mtg and
discussion groups


CONCLUSIONS
It can be cost effective solution to the
our university problem.
It negated the need for an on-site
pathologist to staff the biopsy cases
Provided at-your-desk Telepath diagnosis
Digital
photo-
graphs
Tele-
pathology
(remotely
controlled
scopes)
Time
S
c
o
p
e

o
f

U
s
a
g
e

Before digital slides After digital slides
Digital Pathology Applications
Adoption will Occur in Niches
Tumor Board,
Proficiency
Testing, CME
Archival
&
Retrieval
Virtual
IHC
Peer Review,
QA
Image
Analysis
Manual Read
of Digital
Slide
Remote
viewing
Secondary
Consults
Acknowledgments
Marilyn Davis
Dennis Friesen
Mark Redick
Ryan Spaulding
Dennis Schuckman
Sherri Heffner and Aperio Co.
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