Remote autopsy services: A feasibility study on nine cases

Vodovnik, Aleksandar; Aghdam, Mohammad Reza F.; Espedal, Dan Gøran

doi:10.1177/1357633x17708947

Cited by 10 publications

(9 citation statements)

References 13 publications

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“…Fraggetta et al reported successful validation and adoption of digital pathology, and also described the importance of minimizing human intervention to streamline operations [35]. Vodovnik et al has reported complete digital pathology validation of routine surgical pathology cases, autopsies, cytology, and frozen sections, including using remote signout [36][37][38]. Reporting was primarily performed by a single senior staff pathologist.…”

Section: Discussionmentioning

confidence: 99%

Validation of a digital pathology system including remote review during the COVID-19 pandemic

et al. 2020

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Remote digital pathology allows healthcare systems to maintain pathology operations during public health emergencies. Existing Clinical Laboratory Improvement Amendments regulations require pathologists to electronically verify patient reports from a certified facility. During the 2019 pandemic of COVID-19 disease, caused by the SAR-CoV-2 virus, this requirement potentially exposes pathologists, their colleagues, and household members to the risk of becoming infected. Relaxation of government enforcement of this regulation allows pathologists to review and report pathology specimens from a remote, non-CLIA certified facility. The availability of digital pathology systems can facilitate remote microscopic diagnosis, although formal comprehensive (case-based) validation of remote digital diagnosis has not been reported. All glass slides representing routine clinical signout workload in surgical pathology subspecialties at Memorial Sloan Kettering Cancer Center were scanned on an Aperio GT450 at ×40 equivalent resolution (0.26 µm/pixel). Twelve pathologists from nine surgical pathology subspecialties remotely reviewed and reported complete pathology cases using a digital pathology system from a non-CLIA certified facility through a secure connection. Whole slide images were integrated to and launched within the laboratory information system to a custom vendor-agnostic, whole slide image viewer. Remote signouts utilized consumer-grade computers and monitors (monitor size, 13.3-42 in.; resolution, 1280 × 800-3840 × 2160 pixels) connecting to an institution clinical workstation via secure virtual private network. Pathologists subsequently reviewed all corresponding glass slides using a light microscope within the CLIA-certified department. Intraobserver concordance metrics included reporting elements of top-line diagnosis, margin status, lymphovascular and/or perineural invasion, pathology stage, and ancillary testing. The median whole slide image file size was 1.3 GB; scan time/slide averaged 90 s; and scanned tissue area averaged 612 mm 2. Signout sessions included a total of 108 cases, comprised of 254 individual parts and 1196 slides. Major diagnostic equivalency was 100% between digital and glass slide diagnoses; and overall concordance was 98.8% (251/254). This study reports validation of primary diagnostic review and reporting of complete pathology cases from a remote site during a public health emergency. Our experience shows high (100%) intraobserver digital to glass slide major diagnostic concordance when reporting from a remote site. This randomized, prospective study successfully validated remote use of a digital pathology system including operational feasibility supporting remote review and reporting of pathology specimens, and evaluation of remote access performance and usability for remote signout.

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Section: Discussionmentioning

confidence: 99%

Validation of a digital pathology system including remote review during the COVID-19 pandemic

et al. 2020

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“…We have also shown that remote autopsy services are feasible in the hands of experienced staff, with increased flexibility and interest in autopsy technicians in the service as a result. [ 12 14 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…This study has been previously published. [ 15 ] To complete our routine, remote digital pathology services, and increase flexibility of the autopsy services, nine autopsies were performed remotely involving three senior staff pathologists, one senior autopsy technician, and one junior resident. The autopsies were performed on site by the autopsy technician or resident, supervised by the same, remote pathologist, over Jabber Video (Cisco) on a high-speed broadband connection.…”

Section: Ethodsmentioning

confidence: 99%

“…[ 2 5 7 8 9 ] Apart from better ergonomics, instant access to slides, and remote reporting, the advantages of digital pathology include improved diagnostic quality assurance, shorter turnaround on complex and difficult cases through external consultation services, faster image analysis, streamlining of teaching, and improving working flexibility of pathologists. [ 6 10 11 12 13 14 15 ] Smaller pathology departments like ours are especially vulnerable in terms of slower recruitment of pathologists. Our business plan of digitalization has focused on more efficient pathology services with existing resources in securing their continuity.…”

Section: Introductionmentioning

confidence: 99%

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Complete Routine Remote Digital Pathology Services

Vodovnik

Aghdam

2018

Journal of Pathology Informatics

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Background:Validation studies in digital pathology addressed so far diverse aspects of the routine work. We aimed to establish a complete remote digital pathology service.Methods:Altogether 2295 routine cases (8640 slides) were reported in our studies on digital versus microscopic diagnostics, remote reporting, diagnostic time, fine-needle aspiration cytology (FNAC) clinics, frozen sections, and diagnostic sessions with residents. The same senior pathologist was involved in all studies. Slides were scanned by ScanScope AT Turbo (Aperio). Digital images were accessed through the laboratory system (LS) on either 14” laptops or desktop computers with double 23” displays for the remote and on-site digital reporting. Larger displays were used when available for remote reporting. First diagnosis was either microscopic, digital, or remote digital only (6 months washout period). Both diagnoses were recorded separately and compared. Turnaround was measured from the registration to sign off or scanning to diagnosis. A diagnostic time was measured from the point slides were made available to the point of diagnosis or additional investigations were necessary, recorded independently in minutes/session, and compared. Jabber Video (Cisco) and Lync (Microsoft) were interchangeably used for the secure, video supervision of activities. Mobile phone, broadband, broadband over Wi-Fi, and mobile broadband were tested for internet connections. Nine autopsies were performed remotely involving three staff pathologists, one autopsy technician, and one resident over the secure video link. Remote and on-site pathologists independently interpreted and compared gross findings. Diverse benefits and technical aspects were studied using logs or information recorded in LS. Satisfaction surveys on diverse technical and professional aspects of the studies were conducted.Results:The full concordance between digital and light microscopic diagnosis was 99% (594/600 cases). A minor discordance, without clinical implications, was 1% (6/600 cases). The instant upload of digital images was achieved at 20 Mbps. Deference to microscopic slides and rescanning were under 1%. Average turnaround was shorter and percentage of cases reported up to 3 days higher for remote digital reporting. Larger displays improved the most user experience at magnifications over ×20. A digital diagnostic time was shorter than microscopic in 13 sessions. Four sessions with shorter microscopic diagnostic time included more cases requiring extensive use of magnifications over ×20. Independent interpretations of gross findings between remote and on-site pathologists yielded full agreement in the remote autopsies. Delays in reporting of frozen sections and FNAC due to scanning were clinically insignificant. Satisfaction levels with diverse technical and/or professional aspects of all studies were high.Conclusions:Complete routine remote digital pathology services are found feasible in hands of experienced staff. The introduction of digital pathology has improved provisions and organi...

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“…also validated diagnostic concordance between WSI and microscopy for primary diagnosis (retrospective study) and a complete remote DP service including remote reporting, fine-needle aspiration cytology clinics, FSs, diagnostic sessions with residents, and autopsy services. [ 28 42 ]…”

Section: Discussionmentioning

confidence: 99%

Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic

Rao

Kumar

Rajaganesan

et al. 2021

Journal of Pathology Informatics

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Background: The COVID-19 pandemic accelerated the widespread adoption of digital pathology (DP) for primary diagnosis in surgical pathology. This paradigm shift is likely to influence how we function routinely in the postpandemic era. We present learnings from early adoption of DP for a live digital sign-out from home in a risk-mitigated environment. Materials and Methods: We aimed to validate DP for remote reporting from home in a real-time environment and evaluate the parameters influencing the efficiency of a digital workflow. Eighteen pathologists prospectively validated DP for remote use on 567 biopsy cases including 616 individual parts from 7 subspecialties over a duration from March 21, 2020, to June 30, 2020. The slides were digitized using Roche Ventana DP200 whole-slide scanner and reported from respective homes in a risk-mitigated environment. Results: Following re-review of glass slides, there was no major discordance and 1.2% ( n = 7/567) minor discordance. The deferral rate was 4.5%. All pathologists reported from their respective homes from laptops with an average network speed of 20 megabits per second. Conclusion: We successfully validated and adopted a digital workflow for remote reporting with available resources and were able to provide our patients, an undisrupted access to subspecialty expertise during these unprecedented times.

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Remote autopsy services: A feasibility study on nine cases

Cited by 10 publications

References 13 publications

Validation of a digital pathology system including remote review during the COVID-19 pandemic

Validation of a digital pathology system including remote review during the COVID-19 pandemic

Complete Routine Remote Digital Pathology Services

Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic

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