Virtual microscopy and the Internet as telepathology consultation tools. A study of gastrointestinal biopsy specimens

Telepathology (TP) is the practice of pathology at a distance using videomicroscopy and telecommunication tools. We explore the use of "virtual microscopy" techniques and the Internet as tools for TP gastrointestinal biopsy consultations. Thirty-five gastrointestinal biopsy specimens were photographed in Los Angeles by using a high-resolution digital camera, a light microscope, and a Pentium 166 microcomputer. Several (2-8) digital photomicrographs were collected at 40x or 100x optical magnification, using 2,700 x 3,400 pixel resolution. The photomicrographs illustrated all the tissue fragments present in 1 of the biopsy levels. They were saved in medium compression JPEG image format. These images can be magnified digitally up to 600% without visible degradation and scrolled at different magnifications on a video monitor, simulating examination under a light microscope. The images files (281 to 3,324 KB) were attached to e-mail messages containing patient information and sent through the Internet to Michigan for interpretation using a Power Macintosh 7100 system. The e-mail process was successful in 100% of instances; 2 files were corrupted owing to user error and had to be resent. Additional photos were requested in 1 case. In 33 of 35 cases, there was diagnostic concordance between the original and the TP diagnoses. The 2 discrepancies were due to diagnostic disagreement. This technology offers pathologists relatively inexpensive and effective tools for gastrointestinal TP consultations.