McLaughlin W J, Schifman R B, Ryan K J, Manriquez G M, Bhattacharyya A K, Dunn B E, Weinstein R S
Department of Pathology, Arizona Health Services Center, Tucson, USA.
Telemed J. 1998 Spring;4(1):11-7. doi: 10.1089/tmj.1.1998.4.11.
Rural hospitals generally lack staffing with infectious disease specialists or pathologists. Without on-site pathologists, the range of microbiology services offered by clinical laboratories may be limited as well.
To study the feasibility of using static-image telepathology to evaluate Gram stains of microbiologic preparations.
In this retrospective feasibility study, three pathologists evaluated Gram stains of slides from 50 cases by two viewing modalities: static-image telepathology and conventional light microscopy. Digital video images of slides were captured at two magnifications (using 40x and 100x objective lenses) at 1024 x 768 x 24-bit color and transmitted over standard telephone lines at 14,400 kbps. Pathology reports and culture results served as "truth diagnoses." Categories of interpretations were correct, minor discrepancy, or major discrepancy with regard to the implications for patient care.
The diagnostic accuracy of video image readings and conventional light microscopy readings were nearly identical, with no statistically significant differences in the performances of specialty and nonspecialty pathologists (P > 0.05). The mean accuracies of readings of the video images and light microscopy images were 95.3% and 95.4%, respectively. Taking into account the time required by a referring pathologist to capture video digital images, telemicrobiology was somewhat less efficient than conventional light microscopy.
Pathologists can accurately evaluate digital video images of preselected fields on Gram-stained slides. In clinical practice, however, a limiting factor may be the availability of local personnel qualified to select the microscopic fields for evaluation by telepathologists. The adequacy of the video images suggests that telepathology may also be used for remote supervision of quality assurance programs in microbiology laboratories, as well as for remote proficiency training of laboratory personnel.
农村医院通常缺乏传染病专家或病理学家。由于没有现场病理学家，临床实验室提供的微生物学服务范围可能也会受到限制。
研究使用静态图像远程病理学评估微生物制剂革兰氏染色的可行性。
在这项回顾性可行性研究中，三名病理学家通过两种观察方式评估了50例病例玻片的革兰氏染色：静态图像远程病理学和传统光学显微镜检查。玻片的数字视频图像在两种放大倍数下（使用40倍和100倍物镜）以1024×768×24位颜色进行采集，并通过标准电话线以14400 kbps的速度传输。病理报告和培养结果作为“真实诊断”。就对患者护理的影响而言，解释类别分为正确、轻微差异或重大差异。
视频图像读数和传统光学显微镜读数的诊断准确性几乎相同，专科和非专科病理学家的表现无统计学显著差异（P>0.05）。视频图像读数和光学显微镜图像读数的平均准确率分别为95.3%和95.4%。考虑到转诊病理学家采集视频数字图像所需的时间，远程微生物学的效率略低于传统光学显微镜检查。
病理学家可以准确评估革兰氏染色玻片上预选区域的数字视频图像。然而，在临床实践中，一个限制因素可能是缺乏有资格为远程病理学家选择用于评估的显微镜视野的当地人员。视频图像的充分性表明，远程病理学也可用于微生物实验室质量保证计划的远程监督，以及实验室人员的远程能力培训。
