TOWARDS THE INTEGRATION OF DIGITAL CYTOLOGY …mitel.dimi.uniud.it/tp2012/presentations/B5-Giansanti.pdf · TOWARDS THE INTEGRATION OF DIGITAL CYTOLOGY IN THE TABLET ... of the potentialities

TOWARDS THE INTEGRATION OF DIGITAL CYTOLOGY IN THE TABLET TECHNOLOGIES

Giansanti D#,Grigioni M#, Pochini M,Giarnieri E, Giovagnoli MR

Facoltà di Medicina e Psicologia, Università “Sapienza” Piazza Aldo Moro -00100 Roma

# Dipartimento di Tecnologie e Salute Istituto Superiore di Sanità Viale Regina Elena, 299 – 00161 Roma

e-mail: [email protected]

Up to 10 years ago tele-pathology was principally based on the design and construction of a few identical and expensive platforms with microscope units and software tools for the display and for the tele-control (zooming, moving cutting of pieces of images). Today thanks to the wonderful development of the information technology, the diffusion of new visualization strategies and the availability of low cost or free visualization proprietary tools the SCENARIO has radically changed. New competitive systems as client-server architectures are today available.

Introduction

Telemedicine applied to cytology is a valid aid to cytologists; in fact it allows the remote exchanging of information about the tissue on glasses and in particular:

-The tele-diagnosis. -The discussion of complex cases. -The minimization of resources (more hospitals could share the same pathologists).

Introduction

Scenario In a typical today’s architecture there is

• One on-site-server with the scanner or alternatively a tele-pathology third-party-server (as a Web service such as the Leeds’ centre at www.virtualpathology.leeds.ac.uk/index.php), for the creation of the virtual glasses and • Low cost (or free) Light-client applications proprietary software tools (PC-client application not asking enough hard disk space, not consuming dynamically PC resources, such as RAM, SWAP ecc., simple and user-friendly) for the navigation on the Digital Slide which can be installed in remote clients.

Ref Giansanti D, Castrichella L, Giovagnoli MR. The design of a health technology assessment system in telepathology. Telemed J E Health. 2008 Aug;14(6):570-5

Scenario: Extranet connection

The WAN Architecture

Scenario: Extranet connection

The associated Workflow

Scenario:intranet connection

The LAN Architecture

Scenario:Intranet connection

The Workflow

Future Directions

-Integration to 3 D Technologies

-Image quality and studies on strategies of navigation

-Health Technology Assessment (HTA)

-Tablet Technologies *

Future Directions

Integration to 3 D Technologies

Different studies have been proposed to approach the introduction of the potentialities of 3D / holographic techniques in cytology vision. However these studies have only dealt with the local diagnosis conducted in stand-alone equipments and have not been conducted over the WAN/LAN in telemedicine applications, apart for cardiovascular purpose (the specific targeted research project Collaborative Holographic Environments for Networked Tasks, COHERENT).

Ref Giansanti D, Grigioni M, D'Avenio G, Morelli S, Maccioni G, Bondi A, Giovagnoli MR. Virtual microscopy and digital cytology: state of the art. Ann Ist Super Sanita. 2010;46(2):115-22

Future Directions

The use of these techniques in consideration to the importance of the stereovision of the cytologist, could be of help both to emulate the stereovision thanks to the use of 3D / holographic techniques and to minimize the data transfer among remote nodes as a partial solution for the area occupancy caused by the Z-stack.


Future Directions


3 D monitor

3 D glasses

Focus Levels ?

Future Directions

Image quality and studies on strategies of navigation

As it is well known the cytologist navigates the standard glass in a particular manner: he or she uses the lateral side of the eye, the same used by the primitive men to avoid animals’ attack. This represents a great differentiation of the way to inspect the glass between the histologist and the cytologist. This means that the new technology based on a monitor and no more on a microscope is expected to change this way to face the glass of the cytologist.

Ref Giansanti D, Grigioni M, D'Avenio G, Morelli S, Maccioni G, Bondi A, Giovagnoli MR. Virtual microscopy and digital cytology: state of the art. Ann Ist Super Sanita. 2010;46(2):115-22

Future Directions

Two are thus the basic questions to investigate:

- The use of technical solutions to record the “dynamics” of image during the navigation (trajectories strategies of navigation)

-The use of automatic tools for the investigation of the image quality during the navigation using the virtual microscope.


Future Directions

One of the tools that could be useful for the investigation of the image quality during the navigation is the virtual quality metric (VQM) . This tool has been successfully investigated in digital-echography from some of the authors. The advantage of the tool is that it is completely objective, but however emulates the subjective perception.


Future Directions

Ref. VQM Wolf S, Pinson M. NTIA Report 02-392 - Video Quality Measurement Techniques. Boulder, Colorado: US Department of Commerce – National Telecommunications and Information Administration; June 2002; available from: www.its.bldrdoc. gov/n3/video/documents.htm; last visited 05/06/2012/.


Virtual Quality Metric

Future Directions


PC for navigating the virtual slide

VQM (Architecture for the investigation)

Future Directions

Image quality and studies on strategies of navigation VQM (Associated Workflow)

Future Directions

Health Technology Assessment

As an important aspect in the introduction of the new technologies in the hospital, specific studies of health technology assessment (HTA) focused on thenew technology for the digital cytology should be performed. The new technologies dedicated to the Digital Cytology, now available on the virtual slides, have radically changed the scenario, increasing the need to develop a specific HTA.

Ref Giansanti D, Castrichella L, Giovagnoli MR. The design of a health technology assessment system in telepathology. Telemed J E Health. 2008 Aug;14(6):570-5

Future Directions Health Technology Assessment

Different authors have investigated separately some specific aspects relevant to HTA. In the cited Reference some of these authors” have reviewed the previous studies facing the single aspects of HTA and proposed a preliminary methodology to approach HTA in Tele-Pathology. Starting from the outcomes in the previous work there is thus the need to widen the approach of the HTA to the field of digital cytology; considering also:

1) Further issues relevant to studies of HTA, as from specific experience of mondial networks of HTA such as the EUNETHTA (www.eunethta.net/); 2) Integrate specific studies on HTA over the NET, as the focus

is the digital cytology is the communication over the WAN/LAN.

Future Directions

Tablet technologies

The Tablet-technology-ICT-solution is recently widely increased as a user-friendly and effective tool to remotely share image information. Thanks to this technology it is possible to navigate into an image (pan, zoom-in, zoom-out) using only the hand-fingers without typing the keyboard or the software interfaces’ keys. This way of image navigation is going to further improve the application of Telemedicine to Digital Pathology and in particular in Digital-Cytology with particular reference to the remote and/or cooperative decision and diagnosis in cytology.

Tablet Technologies

All the previous considerations on Future Directions are here applicable. Issues relevant to the introduction of the Tablet Technologies in the Digital Cytology are the following:

1) Analysis of the state of art of the tablet technologies.

2) Investigation of HTA solutions to assess the technology (Tablet and applications) both in terms of performances and acceptance for the relevant introduction in Telemedicine.

Tablet Technologies

Analysis of the state of art of the tablet technologies

The analysis with the focus to Digital Cytology returned that the tablet technologies could be grouped into: wearable tablets, portable tablets and not-portable tablets.

The wearable tablets comprehend the Smart-phones i.e the devices that can be embedded in a pocket.

The portable tablets comprehend the A4 A4/2 tablets such as the Apple Ipad i.e the devices that can be embedded in a 24-hours-suitcase.

Tablet Technologies

Analysis of the state of art of the tablet technologies

The not-portable tablets comprehend the very large touch tablets such as the XDesk or Microsoft Surfaces, i.e the devices that cannot be self carried.

Tablet Technologies

Analysis of the state of art of the tablet technologies: The wearable and portable tablets

The first two systems, that are widely used for many different purposes allow to reach everyone in the world, therefore represent a chance for the remote consulting in Digital-Cytology over the LAN or WAN.

Tablet Technologies

Analysis of the state of art of the tablet technologies: The not-portable tablets

The last systems, focusing for example on the Epson XDesk, represent a powerful ICT solution for cooperative analysis and discussion of cases of virtual cytology.

Tablet Technologies


In details, the Epson XDesk is an interactive table; some call it a coffee table because you can put anything on the surface of the table, it works by projections, with the very latest technologies on that. This desk is also compatible with Bluetooth communication protocol and as soon as you put your phone or camera on the surface of the table, the XDesk will be able to see all your files and pictures on the desk. By natural interface pictures on the table can be managed freely and resized, zoomed in and out by finger movements as the iPod touch does, only on a fair larger scale.

Tablet Technologies


The Epson XDesk has a 52-inch screen and a 1024x768 touch screen display. It represents the appropriate high technology solution for cooperative discussions, clinical audit and ultimately the future direction of cooperative virtual microscopy environment. Furthermore it could represent a tool suitable to recover the inheritance of some ICT solutions (such as Pap-Net) for large screening in cytology abandoned because in the first applications the technology was not ready, for computer assisted cervical/vaginal cytology diagnosis.

Tablet Technologies


Tablet Technologies

Investigation of HTA tools to assess the tablet technology :

As a HTA tool we recovered the interactive word based tool we have proposed in the previous work for applications in tele-pathology. This tool had been proposed before the diffusion of the tablet technologies and was thus conceived for the assessment of PC-based-technologies. However the tool is portable, as it is, on tablet based technologies.

Tablet Technologies


Starting from the previously defined flow

Tablet Technologies

Investigation of HTA tools to assess the tablet technology : Starting from the previously defined flow

Section number Section Title Description 1 General Data Contains the general data of the package and of the subject involved in the study 2 Perception of

the subjective quality

Contains a number of questions on the subjective perceived quality with a scoring based on 4 levels. This section also contains specific questions of interest for pathology such as chromatin details, , degree of recognition of cynotype, degree of recognition of nuclear pile

3 Navigation system Contains a number of questions on the navigation with a scoring based on 4 levels. This

section contains specific questions on the translation, zooming system and also a free comment

4 Selection of the details Contains a number of questions on the selections of the basic details with a scoring based on

4 levels. Also open question are available in this section such as the force and weakness points of the package.

5 Requirements of the platform and connection

This section is for the designers of the test. It contains the minimal requirements of the system according to the producers’ datasheets.

6 Final comment

Tablet Technologies


Starting from this tool the investigation will be widened considering also:

- Further issues relevant to studies of HTA, as from specific experience of mondial networks of HTA such as the EUNETHTA ( http://www.eunethta.net/ ) .

- Integration of specific studies on HTA over the NET, as the focus is the D-CYT is the communication over the WAN/LAN.

CONCLUSIONS

Tablet technologies have been reviewed with the focus to the perspectives of the Digital-Cytology. A HTA specific tool has been proposed to assess the performances and acceptance of the applications in Digital-Cytology based on tablet technologies. Possibilities and limitations of the three different tablet technologies will be deeply investigated by means of the proposed HTA methodology on experts and students approaching the new scenario of digital-cytology.

Thank you for your attention

Documents

TOWARDS THE INTEGRATION OF DIGITAL CYTOLOGY …mitel.dimi.uniud.it/tp2012/presentations/B5-Giansanti.pdf · TOWARDS THE INTEGRATION OF DIGITAL CYTOLOGY IN THE TABLET ... of the potentialities