Advantages and Disadvantages of Robotic Telepathology vs Advantages and Disadvantages of Robotic Telepathology vs. Routine Microscopic pathology The Experience Between the Richmond and Beckley VA Medical Centers Department of Pathology and Laboratory Medicine , Richmond, Virginia

Introduction The VISN 6 Veterans Administration hospitals comprise eight hospitals. Three of these hospitals are primary care hospitals where minor surgery takes place. The size of the smaller hospitals does not justify a full time pathologist. Therefore, robotic telepathology was considered as the solution for one of the hospitals, located in Beckley, West Virginia. Beckley VAMC is supported by the larger tertiary-care facility located 250 miles away in Richmond Virginia.

Common Types of Telepathology Dynamic or Robotic Telepathology (image is transmitted instantly, operator can select fields render diagnosis immediately. Digitizing Entire Slide. Static or Capture image digitally and Transmit Forward via electronic lines or other telecommunication media.

Dynamic Robotic Telepathology Operator can view entire slide from a remote site. Operator can select fields for digital image capture. Operator can communicate with transmitter simultaneously to viewing.

Robotic Image Receiving Station at the Richmond VAMC

Transmitting Station at Beckley VAMC

Close-up of Transmitting Station

Telepathology Vs Routine Microscopy Setup Time Telepathology Routine 10-15 Minutes NA AV Time per Slide 2.61 +/- 2.6 SD Minutes 15+/- 11SD Seconds

Strategies Adopted in Our System Because of the length of time required per slide, only small biopsies are analyzed by telepathology. Viewing large sections of tissue by telepathology is impractical and, therefore, performed at the larger facility. All slides are reviewed the next day upon receipt of slides by mail. All major specimens and special stains are processed and viewed by routine microscopy at the larger facility

Costs Associated with Robotic Telepathology Telepathology Hardware $169,344 Purchase cost Maintenance $15,000 Yearly ISDN line cost $8,000 Yearly Slide-Mailing Costs $1,400

Advantages Robotic telepathology is a viable alternative to an on site pathologist. It allows acceptable turnaround time for surgical pathology diagnosis. Meets CAP requirements. It supplies a small hospital with surgical pathology consultation from five pathologists, which would otherwise not be accessible to a small facility.

Disadvantages The system is 12 fold slower to routine microscopy. Screen image is not as optimal as direct view. Repeated line and equipment down-time hinders workflow.

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