Is telepathology a threat?

[tsj]

Been hearing more and more reports that companies are coming out with "ready for primetime" machines that can digitize slides on a mass scale. Some sales reps around here were listing off all these "positives" like "pathologists won't have to be based in hospitals anymore", "you can participate in tumor boards from home", "the computer can give you a more consistent and accurate percentage of postive staining for immunos".

Do you think this will be a good thing or a bad thing for the majority of working pathologists? I suppose ultimately all that should matter is if it's best for patients and healthcare in general. But I think it will result in a lot of outpatient work being sent to the lowest bidder and even overseas (a race to the bottom, so to speak). Also, I don't believe pathology can or should be centralized. It is best for sugeons and clinicians to work closely with their own local pathologists. It is best for the docs and best for the patients.

I guess this is what rads was facing ten years ago. I remember talking to rads residents and med students interested in rads and they were saying about how they would be able to sign cases out from the beach or from home. I don't think they pictured work going to the lowest bidder in Tennessee or deals being set-up with docs from India. Fortunately, we don't have to worry about clinicians wanting to read their own slides they way rads have to worry about surgeons and physicians wanting to produce and read their own imaging.

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[tsj]

I guess the answer is "no" since 30 people have looked at the thread with no responses.

 

[yaah]

Personally I think less of a threat than the outsourcing of radiology. Keep in mind that when someone has a new product they will make it sound like the greatest thing ever, and they will minimize the weaknesses which at this point are all too real. Digitizing a slide requires a huge amount of memory and is probably more costly (in terms of getting all the memory, etc) than just doing normal H&E. And yes, the quality is good but it is still not at the same level.

I think telepathology is a very real consideration for the future though, it's just hard to know how much and when.

It will be very difficult to convince many people that outsourcing biopsies on slides via computer is a viable and appropriate alternative, I think. Some clinicians may see the $ in the bottom line but most would be very hesitant.

 

[Cabbage Head]

Personally I think less of a threat than the outsourcing of radiology. Keep in mind that when someone has a new product they will make it sound like the greatest thing ever, and they will minimize the weaknesses which at this point are all too real. Digitizing a slide requires a huge amount of memory and is probably more costly (in terms of getting all the memory, etc) than just doing normal H&E. And yes, the quality is good but it is still not at the same level.

I think telepathology is a very real consideration for the future though, it's just hard to know how much and when.

It will be very difficult to convince many people that outsourcing biopsies on slides via computer is a viable and appropriate alternative, I think. Some clinicians may see the $ in the bottom line but most would be very hesitant.

I only have limited experience with telepathology, but from what I've seen, it has very limited applications. There are 2 ways to do it. First, you can digitize the image and then look at it on a computer monitor. Second, you can put the slide in a robotic scope and actually scan the slide in real time. With the digitizing way, it requires massive amounts of memory, and there are still limitations. For example, when you use the 40x objective, you need to be able to focus in and out a little bit, as there are depth of field considerations. This makes your memory requirements much higher. Maybe you could just scan things at 20x, and for some cases you could probably get away with that. I think as far as outsourcing, you are really talking about digitizing. With the digital robot way, it's very slow going, and you have to have someone with the slide to change slides out, etc. It's can be ok for frozen sections or something limited like that.

I don't really see glass slides being replaced any time soon.

One thing digitizing could be useful for is being able to detect multiple antibodies on the same slide in immunohistochemistry. That's pretty neat.