International Science Index


The Digital Microscopy in Organ Transplantation: Ergonomics of the Tele-Pathological Evaluation of Renal, Liver and Pancreatic Grafts

Abstract:Introduction: The process to build a better safety culture, methods of error analysis, and preventive measures, starts with an understanding of the effects when human factors engineering refer to remote microscopic diagnosis in surgery and specially in organ transplantation for the remote evaluation of the grafts. It has been estimated that even in well-organized transplant systems an average of 8% to 14% of the grafts (G) that arrive at the recipient hospitals may be considered as diseased, injured, damaged or improper for transplantation. Digital microscopy adds information on a microscopic level about the grafts in Organ Transplant (OT), and may lead to a change in their management. Such a method will reduce the possibility that a diseased G, will arrive at the recipient hospital for implantation. Aim: Ergonomics of Digital Microscopy (DM) based on virtual slides, on Telemedicine Systems (TS) for Tele-Pathological (TPE) evaluation of the grafts (G) in organ transplantation (OT). Material and Methods: By experimental simulation, the ergonomics of DM for microscopic TPE of Renal Graft (RG), Liver Graft (LG) and Pancreatic Graft (PG) tissues is analyzed. In fact, this corresponded to the ergonomics of digital microscopy for TPE in OT by applying Virtual Slide (VS) system for graft tissue image capture, for remote diagnoses of possible microscopic inflammatory and/or neoplastic lesions. Experimentation included: a. Development of an OTE-TS similar Experimental Telemedicine System (Exp.-TS), b. Simulation of the integration of TS with the VS based microscopic TPE of RG, LG and PG applying DM. Simulation of the DM based TPE was performed by 2 specialists on a total of 238 human Renal Graft (RG), 172 Liver Graft (LG) and 108 Pancreatic Graft (PG) tissues digital microscopic images for inflammatory and neoplastic lesions on four electronic spaces of the four used TS. Results: Statistical analysis of specialist‘s answers about the ability to diagnose accurately the diseased RG, LG and PG tissues on the electronic space among four TS (A,B,C,D) showed that DM on TS for TPE in OT is elaborated perfectly on the ES of a Desktop, followed by the ES of the applied Exp.-TS. Tablet and Mobile-Phone ES seem significantly risky for the application of DM in OT (p
[1] P. Friend, Organization of organ retrieval-bitter lessons and ambitious plans, Proceedings of lectures in the Hammersmith Hospital of London, 2010 (Available at: 11/friend-Hammersmith-11-10-10.pdf, Accessed on 17/07/2012).
[2] AR Graham, AK Bhattacharyya, KM Scott, F Lian, LL Grasso, LC Richter, et al. Virtual slide tele-pathology for an academic teaching hospital surgical pathology quality assurance program. Hum Pathol., vol.40, pp.1129-36, Jul. 2009).
[3] C.S. Mammas, G.P. Economou,N.Arkadopoulos, G. Kostopanagiotou, G.J. Mandellos, P. Lymberopoulos, V. Smyrniotis, D. Lymberopoulos, ELMP for TS in the coordination process as a method to optimize quality in organ transplantations, Proceedings of the 16th Congress of the Hellenic Society of Organ Transplantation, Thessaloniki, 2011, pp.24.
[4] CS Mammas, G. Mandellos, G.-P Economou. and D. Lymberopoulos, "Structuring Expert-Leaded Medical Protocols for Telemedicine Systems", in Proc. 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology, Constantinople, 2001, pp.3529- 32.
[5] E. Karavatselou, GP. Economou, C. Chassomeris, V. Danelli and D. Lymperopoulos, OTE-TS: A new value added telematics service for telemedicine applications, IEEE Transactions on Information Technology in Biomedicine, vol. 5(3), pp210-224, Sept. 2001.
[6] R.H. Morgan. Computer network security for the radiology enterprise Computer network, Radiology., vol.220, pp.303-09, Aug.2001.
[7] P.N. Furness, WM Bamford, Tele-pathology. Curr Diag Pathol, vol.7, pp. 281-291, Dec.2001.
[8] E. Coiera. Guide to health informatics, CRC, 2015.
[9] S. Martorell, CG Soares, J. Barnett. Safety, Reliability and Risk Analysis: Theory, Methods and Applications, CRC, 2014.
[10] K. Kayser, S. Borkenfeld, J.Görtler, G.Kayser. Image standardization in tissue - based diagnosis. Diagnostic Pathology, vol.3, pp.17-25, Apr.2008.
[11] KY Jen, JL Olson, S. Brodsky, XJ Zhou, T. Nadasdy, ZG Laszik,, Reliability of whole slide images as a diagnostic modality for renal allograft biopsies, Human Pathology, vol.44(5),pp.888-94, 2013.
[12] E. Krupinski. Human factors and human-computer considerations in teleradiology and telepathology, Healthcare, vol. 2(1), pp.94-114, Feb.2014.
[13] MY Gabril, GM Yousef. Informatics for practicing anatomical pathologists: marking a new era in pathology practice. Mod Pathol., vol.23, pp.349-358, Jan.2010.
[14] L. Pantanowitz, K. Dickinson, A. J. Evans, L. A. Hassell, W. H. Henricks, J. K. Lennerz, et al. ATA Clinical Guidelines for Telepathology. Telemedicine and e-Health, vol 20(11), pp.1049-70, May 2014.
[15] G. Kayser, J. Görtler, N. Kluge, T. Wiech, M. Werner, K. Kayser. Standards in virtual microscopy: from tissue processing to image acquisition and visualization. Diagnostic Pathology, vol.5 (Suppl 1), pp.10, 2010
[16] K. Kayser, S. Borkenfeld, T. Goldmann and G. Kayser. Virtual slides in peer reviewed οpen access medical publication. Diagnostic Pathology, vol. 6, pp.124-131, Dec.2011.
[17] L. Pantanowitz, PN Valenstein, AJ Evans, KJ Kaplan, JD Pfeifer, DC Wilbur et al. Review of the current state of whole slide imaging in pathology. J Pathol Inform., vol.2, pp.36-45, Aug.2011.
[18] L. Fónyad1†, T. Krenács†, P. Nagy†, A. Zalatnai†, J. Csomor†, Z. Sápi† et al. Validation of diagnostic accuracy using digital slides in routine histopathology Diagnostic Pathology, vol.7, pp.35-41, Mar.2012.
[19] F. Ghaznavi, A. Evans, A. Madabhushi, M. Feldman. Digital imaging in pathology: Whole-slide imaging and beyond, Annual Review of Pathology: Mechanisms of Disease, vol.8: pp.331–59, Nov. 2012.
[20] G. Romero, L., William C. Andrew L., Eugene T., Jeff M., Anil Parwani, L. Pantanowitz. Digital Pathology Consultations—a New Era in Digital Imaging, Challenges and Practical Applications, Journal of Digital Imaging. vol.26 (4), pp. 667-68, Jan.2013.
[21] S. Kothari, J. H. Phan, T. H. Stokes, M. D. Wang. Pathology imaging informatics for quantitative analysis of whole-slide images. Journal of the American Medical Informatics Association, vol.20 (6),pp.1099- 1108,Nov. 2013.
[22] T. C. Allen. Digital pathology and federalism, Archives of pathology & laboratory medicine, vol.138 (2): pp.162-165, Feb. 2014.
[23] Eric F. Glassy. Rebooting the pathology journal: learning in the age of digital pathology, Archives of Pathology & Laboratory Medicine, vol.138 (6), pp.728-729, Jun.2014.