1 EURO-TELEPATH “Telepathology Network in Europe” Proposer: Dr. Marcial García Rojo Pathology Department General Hospital of Ciudad Real Castilla La Mancha

1

EURO-TELEPATHEURO-TELEPATH“Telepathology “Telepathology

Network in Europe”Network in Europe”

Proposer: Dr. Marcial García Rojo Pathology Department General Hospital of Ciudad Real

Castilla La Mancha Health Service (SESCAM) SPAIN,

[email protected]

COST Action IC0604

2

Scope

Adequate technological framework for the management of multimedia electronic healthcare records

Informatics applied to Anatomic Pathology Research on standards to represent, interpret,

browse, retrieve digital medical images World wide search engine Collaborate with Standardisation bodies with

previous research conclusions

3

Background

Telepathology (since 1960s): research, patient data monitoring and management, both patient and healthcare staff education by means of systems which allow a quick and full access to expert counselling and patient data, disregarding the actual location of patients and the demand of its information. Diagnosis and remote consultations Frozen sections (intraoperative studies) Surgical specimens manipulation Fine needle aspiration cytology evaluation Cytology screening Autopsies assistance Molecular pathology guidance

4

Emerging digital pathology

Gross study Digital photography Digital video

Microscopy: Slides Digital photography Virtual microscopy:

whole slide imaging

Molecular Pathology Digital photography

5

From static and dynamic telepathology to Whole Slide ImagingWhole Slide Imaging

Conventional slides are fragile (crystal), They are not permanent, above all in immunofluorescence, joint

crystals, … … In cytology it is not possible to deliver copies 6-11% of static images appear discordant with the original

(conventional) diagnosis (incomplete information)

VIRTUAL SLIDES ADVANTAGES Extraordinary quality in lower magnifications Dynamic map of the slide available High resolution images available transmitting only selected area

(“image streaming”) Record and reproduce the path followed by the pathologist during

slide examination Images storage is permanent and annotation can be performed

over them, and these can also be saved

Tissues are of only 25 x 20 mm

6

Different technologies are integrated in the network

Olympus SIS .slide

Aperio ImageScope Univ. Tampere. Webmicroscope

UCLM. Sepia Project

7

Previous European Research projects

1998: Eureka supported “PathSystem” project (ref. 1456). Prototype of Pathology management system incorporating state-of-the-art telematic principles and techniques

2000: “3D-PATHOLOGY”. A real time system for quantitative diagnostic PATHOLOGY and visualisation in 3D, was funded under 5th FP (Ref: IST-2000-29598).

2001: “E-SCOPE”. Fully Digital Microscopy for routine diagnostics and integration into hospital information workflow (IST-2001-33294 BP)

8

Related COST actions

237: Multimedia Telecommunications Services 275 & 2101: Biometrics (Related to image analysis,

and user identification) 276: Information and Knowledge Management for

Integrated Media Communication 292: Semantic multimodal analysis of digital media

(image analysis) B11: Quantification of magnetic resonance image

texture (image research working groups) B19: Molecular cytogenetics of solid tumours

9

History of the proposal: Standardization activities

IHE Europe: Dr. Christel Le Bozec (INSERM & ADICAP. France): Editor of Pathology Technical Framework, and Project Manager

DICOM in Europe: Dr. Marcial García Rojo, Spain, Secretary of WG26 (Pathology) in Europe activities.

SNOMED CT: Reviewers of Spanish edition CEN TC251: Contacts with standardization bodies

through the Spanish Society of Health Informatics (SEIS) (Board members are included in the Action)

10

Recent references

Boutonnat J, et al. A pilot study in two French medical schools for teaching histology using virtual microscopy. Morphologie 2006 Mar;90(288):21-5. “Teaching program in two French medical schools (Lyon and Grenoble) include virtual slides. Students works faster, on better resources”

Kayser K, et al. [Rom J Morphol Embryol 2006;47(1):21-8 & Diagn Pathol 2006 Jun 10;1:10] Automated tissue-based virtual diagnosis. “The developed system is a fast and reliable procedure to fulfill all requirements for an automated "pre-screening" of virtual slides in tissue-based (eg. lung) diagnosis”.

Gilbertson JR, et al. Primary histologic diagnosis using automated whole slide imaging: a validation study. BMC Clin Pathol 2006 Apr 27;6:4. “Image information contained in current whole slide images is sufficient for pathologists to make reliable diagnostic decisions. Further validation studies will be needed.”

11

History of the proposal: Research activities Telepathology: Dr. Janina Slodkowska (Institute of Tuberculosis

and Lung Diseases, Warsaw, Poland). Semantic interoperability and HL7: Dr. Bernd Blobel (University of

Regensburg Medical Center, Germany). Pathology Information Systems: Dr. Christel Le Bozec, and Dr.

Marcial García Rojo. Security infrastructure: Dr. Bernd Blobel Web based distance learning: Dr. Izet Masic (University of

Sarajevo, Bosnia & Herzegovina). JPEG, JPEG2000: Ecole Polytechnique Fédérale de Lausanne Image analysis and diagnosis: Prof. Gloria Bueno (University of

Castilla-La Mancha, Spain), and Dr. Janina Slodkowska. Industry research in equipment and software: Tribvn, France.

12

Virtual Slide Congress in Internet (2 editions)

http://www.conganat.org/vsc/







13

History of the proposal: Practical experiences Telemedicine: Dr. Luis Gonçalves (Alentejo region telemedicine,

Portugal), Dr. Ekaterine Kladiashvili (Georgian Telemedicine Union).

Virtual microscopy and virtual slides atlases and seminars: Dr. Jorma Isola (Tampere University, Finland), and Dr Mikael Lundin (University of Helsinki, Finland).

Virtual slides based telepathology: Dr. Marcial García Rojo. Digital Imaging network: Ykonos project (radiology) of

SESCAM (Public Health Service in Castilla La Mancha, Spain). Terminology in pathology networks: ADICAP, Dr. Christel Le

Bozec Software development and integration: SESCAM and Tribvn.

14

DICOM WG26 meeting in Madrid

15

EURO-TELEPATHEURO-TELEPATH“Telepathology Network in “Telepathology Network in

Europe”Europe”COST Action IC0604COST Action IC0604

Objectives and working programme

16

Objectives (1)

General: Evaluate and validate -in a networked environment- the

common technological framework and communication standards required to access, transmit and manage digital medical records by pathologists and other medical specialties.

10 specific objectives:1. Increase the use of automation procedures over 50% in

Anatomic Pathology2. Increase productivity. Reach up to 100 slides digitization per

day3. Norms and compression rules to obtain microscopic images

with full diagnostic quality in minimum possible space (1-2 GB)4. Best viewer design based on standardized (JPEG2000) format

for microscopic pathology images

17

Objectives (& 2)

(cont’d):5. Define a set of standardized DICOM file headings for pathology

microscopic images.6. Definition of new types of messages needed for pathological

image information exchange (CEN, HL7, and other standards)7. Increase the European scientific leadership in the emerging

Pathology Technical Framework (IHE-Pathology)8. Research in Pathology Information Systems and other

hospital information systems to integrate a standardized workflow of pathology images

9. Agree on methodology to establish an open, web-based European teleconsultation service based on virtual slides

10. Design a central metasearch engine containing a +3500 virtual database of pathology images for joint research, teaching and observation purposes

18

Expected benefits: Medical

Allow users (healthcare professionals and specialists) to obtain better and faster diagnosis in all related fields of Medicine (oncology, dermatology, gynaecology, etc.), including Primary Care.

Improve patient care through a better surveillance of treatment response effectiveness.

Resolve drawbacks of irregular “in hand” data handling, allowing pathologists to select his/her collaborating team from previously arranged expert panels, with the capability of obtaining a response in a few hours or even minutes.

Better adherence to up-to-date guidelines and protocols in the study of specimens which improves the continuous learning process of pathologists in each participating institution.

Inter-institutional tools in the exchange of medical knowledge would facilitate new research projects of rare diseases, and to achieve a better classification and understanding of diseases.

19

Expected benefits: Technical

Coordination of the existing research efforts in telepathology Quality of electronic medical records to include greater detail in

patient information (reports, images) accessible from different places. Improvement of quality, productivity and efficiency (turnaround time)

in medical diagnosis. Improving specimens’ and patients’ identification procedures. Easier and safer access to key pathology data and images in multiple

areas. Increased use of virtual slides instead of conventional fragile slides. Synergic workflow among specialists/doctors in a collaborative

teamwork (consultation, education, research or quality assurance purposes).

Promote research in 2D and 3D image production and processing, and multispectral image managing, specially in large images.

Benefits for other research areas needing GB images: Computer vision, Astronomy, Geology, Planetary Sciences,

20

Expected benefits: SocioeconomicSocietal benefits Favour patient mobility Reinforce the overall quality and the ubiquity of health care services. Optimise scarce and expensive medical resources. European scale reform of medical data management legislation and consumer

protection standards. Foster continuing medical learning programs, and basic and applied clinical

research opportunities. Improve accessibility and working ergonomics for disabled pathologists-users.Economic benefits Common technological standard for "state-of-the-art" e-health solutions. Digitization centres serving other institutions without scanning facilities. Creation of ubiquitous teleconsultation and digitisation services. Cut down on costs for private and public health actors on licensing for image

visualization software. Contribute to the cost effectiveness of the entire health care system Improve competitiveness of the European medical image industry.

21



Working method, organization, and management (including

working groups)

22

Scientific program: Activities1. Automation procedures in Pathology. Best

technology available and under research.2. Scanning solutions for Pathology

microscopic slides.3. Technological solutions for compression

and storage problems with large image files. 4. Virtual slide standard viewer specifications

which allow efficient reviewing of pathology images.

5. International standards (DICOM, HL7, SNOMED, CEN) and IHE initiative.

6. Model for pathology and other hospital information systems

7. An European-scope telepathology network

8. Collection of interesting and typical samples, and clinico-pathological sessions

23

Use Case 1: referring center owns digitization system

Pathologist Hospital A (sender)

1) Select slides 2) Whole slide digitization (current use of scanners)

3) Images in web server

4) Filling form of consultation case

24

Use case 2: Expert’s role

Expert pathologist in Hospital B (consultant)

1) E-mail notification of new case 2) Review case in Portal

Request additional data

7) Sender (Hospital A) and digitization center (B) are notified that report is available and case is closed

3) Diagnosis and report

25

Use case 3: Intelligent scanners and integrated multifunctional workstations Next step in slide production scanners, consisting in

elaborating intelligent scanners, operating jointly with: integrated analysis, annotation and search & retrieval multifunctional

workstations secured storage and networking management resources.

Objective: to perform advance research targeting the next generations of tools, terminals, networks and standards.

26

Organizational structure of COST Action

Chair / Management Committee / Secretariat

4 Working Groups Scientific Program (item #)

1. Users and working models

Automation / Artificial Intelligence for classification studies (1)Scanning solutions / Clinical eval.(2) Proposal on PIS changes)(6)

2. Standards in PathologyDICOM, HL7, IHE, SNOMED, CEN (5)

3. Technological

Compression & storage / search & retrieval (3)Image viewer / Image analysis (4)Compiling cases (8)

4. Implementation of Telepathology Networks

Telepathology integration guidelines(7)

27

Dissemination plan

Researchers in the EURO-TELEPATH network: website and multimedia tools

Pathologist community: Publications, conferences, expositions, virtual meetings. European Telepathology conference

E-health, IT scientists and standard bodies: Technical documents, attendance to IHE, SNOMED, DICOM, HL7,… meetings, industry meetings, training schools, public web site

Medical-scientific community in general: Journals, COST publication, non-technical reports, workshops and final conference, public web site.

28



Distribution of tasks

29

Current research groups

Action kick-off1. Finland: Tampere University &

University of Helsinki2. France: INSERM & Tribvn3. Germany: University of Regensburg &

Charité Universitätsmedizin Berlin 4. Italy: University of Udine5. Lithuania: National Centre of Pathology

& Kaunas University of Technology6. Poland: Institute of Tuberculosis and

Lung Diseases, Warsaw 7. Portugal: Hospital Espirito Santo8. Serbia: University of Belgrade9. Spain: University of Castilla-La

Mancha, Hospital General deCiudad Real & SESCAM

10. Switzerland: EPF Lausanne11. United Kingdom: University of

Nottingham

Policy: A group of researchers (balance of female & young experts aged less than 35), shall be duly appointed to encourage and coordinate the network’s efforts.

30

Partners’ background

Action kick-off1. Finland: Tampere University &

University of Helsinki2. France: INSERM & Tribvn3. Germany: University of Regensburg &

Charité Universitätsmedizin Berlin 4. Italy: University of Udine5. Lithuania: National Centre of Pathology

& Kaunas University of Technology6. Poland: Institute of Tuberculosis and

Lung Diseases, Warsaw 7. Portugal: Hospital Espirito Santo8. Serbia: University of Belgrade9. Spain: University of Castilla-La

Mancha, Hospital General deCiudad Real & SESCAM

10. Switzerland: EPF Lausanne11. United Kingdom: University of

Nottingham

Clinical Pathology ICT Industry

31

Recruiting new research (university and industry) groups? Non-COST countries?

Other groups:12. England: Univ. Leeds,

Aperio-Europe13. Hungary: 3DHistech &

Semmelweis University,Budapest

14. Ireland: SlidePath, Dublin15. Georgia: G. Telemedicine

Union16. Norway: University

Hospital of Tromsø17. Spain: VICOMTech, San

Sebastián 18. Sweden: University

Hospital, Uppsala

32

Working groups. Distribution of tasks

4 Working Groups: Partners Distribution. Select your choice(s) to participate in Working Group and/or specific tasks

1. Users and working models (6 tasks)

2. Standards in Pathology (5 tasks)

3. Technological (8 tasks)

4. Implementation of Telepathology Networks (5 tasks)(Telepathology integration guidelines)

33

Distribution of tasks. ExampleWG1 Users (working models)

1.1. Review of existing bibliography and research projects of participating groups and other groups in all the aspects related to the Action. Performed by: Hospital General de Ciudad Real. Spain. Tampere University and University Hospital Institute of Medical Technology, Finland.

1.2. Consensus study of existing workflows in pathology departments. Performed by: Hospital General de Ciudad Real. Spain. Biomedical informatics group of the University of Helsinki, Finland. INSERM, France.

1.3. Full study analysis of 10 microscope brands. Performed by: Hospital General de Ciudad Real. Spain. Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.

1.4. Study all visualization performance needs for pathologists. Performed by: Hospital do Espiritu Santo, Evora, Portugal. Tampere University and University Hospital Institute of Medical Technology, Finland. Biomedical informatics group of the University of Helsinki, Finland.

1.5. Image analysis tools study of existing solutions. ISA of the Superior Technical Industrial Engineering School of the University of Castilla La Mancha (UCLM), Spain. Biomedical informatics group of the University of Helsinki, Finland.

1.6. Design of image analysis tools implementation. ISA of the Superior Technical Industrial Engineering School of the University of Castilla La Mancha (UCLM), Spain. Tribvn ICS WF, France. Biomedical informatics group of the University of Helsinki, Finland.

34



Time-table

35

COST Action Time-table

MC Meetings, WG1 Meetings, WG2 Meetings, WG3 Meetings, WG4 Meetings: 1st and 3rd quarter (2/year)

Workshops: year 1 and year 3 Telepathology Congress: year 2 (Action dissemin.) Final Conference: year 4 (focused on results) STMS (visits): Proposals to COST (eg. year 1 and 4) Reports: yearly Publications: Review status: year 2 & year 4 Training School: year 3 Website

36

Time-table overview

37



Budget

38

Economical dimension

On the basis of the initial 8 countries representatives, the economic dimension of the research activities to be carried out under the Action has been estimated, at an estimate of 16 million euros. (Example: Serendipia Project in Spain 3.5 million Euros)

“A COST Action is implemented through a concerted action, what means that the research is carried out in and financed by the participating countries themselves, while COST provides the means to organize the necessary co-ordination measures.”

“It finances networking of nationally funded activities in supporting meetings, conferences, short term scientific exchanges and outreach activities. COST therefore does NOT fund research itself.”

On average financial support of some € 90.000 p.a. as grant for up to 4 years can be expected.

39

Financing COST Activities

The COST IC0604 Action budget is able to finance the activities of MCs, WGs, which can include the following items: travel expenses and daily allowances for delegates to meetings; workshops/conferences; short term scientific missions (STSMs) - inter-laboratory

exchanges; training schools Action Grants publications and dissemination; high level research conferences organised jointly with ESF; studies, reviews, assessments, strategic activities special provision for research from “near neighbours” countries.

40

Financing meetings. Budget allocation (Management Committee)

Meetings of: MC (2 MC member/country), WG1, WG2, WG3, WG4: 1st and 2nd quarter (2/year each)

Workshops (< 80 participants): years 1 & 3 (balance from the various signatory countries).

Telepathology Congress: year 2 Final Conference: year 4

MC should propose a budget allocationThe contribution should not exceed € 10,000 for a meeting (if

request is up to € 3,000, it will be granted as fixed grant). Printing of proceedings are financed separately from organization

costs

41

Meetings: eligible participants

Management Committee (MC) Working Groups: a “small”(?) number of researchers

(may be MC members or other researchers) selected by the MC.

External experts and invited speakers from non-signatory countries: ≤ 5 per meeting non-COST (“Near Neighbours”) country: up to 4.

For meeting participants, a distinction is made between participants, eligible participants and persons entitled for reimbursement. The participants are all of the people who attend a COST meeting. Among these participants, a certain number will be selected by the Management Committee from the eligible participants (see 2.1.3 - Eligible Participants) and approved by the MC Chair as entitled for reimbursement.

42

Short Term Scientific Mission (STSM) and training school

STMS (young scientists): year 1 and 4 (proposal): Exchange visits (1 wk-3 mo) to an institution or laboratory in another COST member state. The grant should normally cover only travel and

subsistence (up to 2500 €) Training School (young researchers and re-

training): year 3 (dissemination of results) < 5 days and ≤ 30 attendees Financing meeting (see rules) Travel and subsistence for lecturers (see rules) Fixed grants for attendees (<600 €/attendee. Otherwise the

same as for STSMs)

43

Reports and publications

Reports: yearly The COST Office is printing general COST

publications (annual report, domain flyers, booklets, brochures and posters).

Publications: year 2 and year 4

MC will define the contents

Options: External Publisher (choose 2 different publishers) OPOCE (The European Union’s publisher)

44

Action Website

COST Actions Management Committee (MC) may assign up to 2,000 € per annum from within an Action budget to the MC chair as grant holder for the general support of the Action management: Action Website (specific matters and MC

operation), to be hosted on the server of one of the institutions represented on the MC.

45

Action websitehttp://www.conganat.org/eurotelepath/

Documents

1 EURO-TELEPATH “Telepathology Network in Europe” Proposer: Dr. Marcial García Rojo Pathology Department General Hospital of Ciudad Real Castilla La Mancha