Prasse K W, Mahaffey E A, Duncan J R, Burrow M F
Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia, Athens, USA.
Telemed J. 1996 Winter;2(4):259-66. doi: 10.1089/tmj.1.1996.2.259.
To determine the accuracy of interpretation of microscopic images for pathologic study transmitted over Switched-56 lines using a desktop interactive video conferencing system.
In subjective studies, two systems were connected using null-modem cables, which allowed evaluation of different bandwidths from 56 kbps to 384 kbps. Objective studies were done with two systems connected at distant sites via paired Switched-56 lines that produced an effective bandwidth of 112 kbps. A video camera mounted on a microscope was attached to the sending system. The resolution of the video image on the video conferencing system was 352 x 288 lines. Cases for cytology, hematology, and histopathology studies were selected from archives; one pathologist transmitted microscopic images, and a second pathologist made interpretations. The three pathologists were Board certified with similar experience that ranged from 20 to 35 years. Categories of interpretations or observations were predetermined for each study to allow the data on agreement between the direct microscopic interpretation or observation and that recorded by the receiving pathologist to be corrected for agreement attributable to chance alone. The results were analyzed using the kappa statistic.
In the subjective studies, image degradation prevented interpretation while the microscope stage was moved. This problem occurred at all bandwidths tested. Image quality limited microscopic details. Organisms < 1 micron in diameter could not be seen reliably. In objective cytologic studies, overall agreement was recorded on 89 of 99 observations. In the four categories of specimens, observed agreement ranged from 0.778 to 0.958, and kappa was 0.704 to 0.948. For hematology specimens, overall agreement was found on 69 of 80 observations; observed agreement on eight types of nucleated blood cells ranged from 0.5 to 1.0, and kappa was 0.429 to 1.0. Poorer color definition and image quality prevented accurate identification of lymphoblasts and eosinophils in particular. For histologic specimens, overall agreement was obtained on 56 of 66 observations, observed agreement on four categories of histologic change ranged from 0.73 to 0.93, and kappa was 0.47 to 0.9.
The desktop interactive video conferencing system, as configured in this study, was unsuitable for making definitive diagnoses from transmitted microscopic images.
使用桌面交互式视频会议系统，确定通过56K专线传输的病理学研究微观图像的解读准确性。
在主观研究中，两个系统使用零调制解调器电缆连接，可评估从56kbps到384kbps的不同带宽。客观研究则是在远程站点通过成对的56K专线连接两个系统进行，有效带宽为112kbps。一台安装在显微镜上的摄像机连接到发送系统。视频会议系统上视频图像的分辨率为352×288线。从档案中选取细胞学、血液学和组织病理学研究的病例；由一位病理学家传输微观图像，另一位病理学家进行解读。这三位病理学家均获得委员会认证，经验相似，在20至35年之间。为每项研究预先确定解读或观察的类别，以便将直接显微镜解读或观察与接收病理学家记录的结果之间的一致性数据，校正为仅由偶然因素导致的一致性。使用kappa统计量分析结果。
在主观研究中，当移动显微镜载物台时，图像退化妨碍了解读。在所有测试带宽下均出现此问题。图像质量限制了微观细节。直径小于1微米的生物体无法可靠观察到。在客观细胞学研究中，99项观察中有89项记录了总体一致性。在四类标本中，观察到的一致性范围为0.778至0.958，kappa值为0.704至0.948。对于血液学标本，80项观察中有69项发现总体一致性；在八种有核血细胞类型上观察到的一致性范围为0.5至1.0，kappa值为0.429至1.0。较差的颜色清晰度和图像质量尤其妨碍了对成淋巴细胞和嗜酸性粒细胞的准确识别。对于组织学标本，66项观察中有56项获得总体一致性，在四类组织学变化上观察到的一致性范围为0.73至？0.93，kappa值为0.47至？0.9。
本研究中配置的桌面交互式视频会议系统不适用于根据传输的微观图像做出明确诊断。 （注：原文中histologic specimens部分的0.93和0.9处疑似遗漏数字，译文保留原文形式）
