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Claims  |
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I claim:
1. A telepathology diagnostic system which allows a pathologist located at
a diagnostic center to render pathology diagnostic opinions in connection
with specimens located at a site which is remote from the diagnostic
center, which system comprises:
a microscope located at the remote site and including robotic means for
adjusting the relative position of a specimen to the objective lens, the
magnification of the specimen, and the focus of the specimen;
video camera means for collecting video signals form the microscope;
bidirectional communication means for communicating signals between the
remote site and the diagnostic center; and
a pathologist workstation located at the diagnostic center and comprising a
monitor for viewing the video signals collected by the video camera means
which signals are sent over the bidirectional communication means, and
further comprising microscope control means by which the pathologist
generates control signals which are sent over the bidirectional
communication means to the robotic means of the microscope so that he
pathologist can thereby remotely adjust the relative position of the
specimen to the objective lens, the magnification of the specimen, and the
focus of the specimen;
whereby the system provides the pathologist located at the diagnostic
center with the ability to remotely adjust the relative position of the
specimen to the objective lens, the magnification of the specimen, and the
focus of the specimen to thereby make observations of the specimen
necessary for rendering a pathology diagnostic opinion.
2. The system of claim 1 further comprising means associated with the
microscope for generating location signals whereby the X, Y, and Z
coordinates of microscopic fields being viewed are sent over the
bidirectional communication means to the pathologist workstation.
3. The system of claim 2 wherein the microscopic fields X and Y coordinates
are displayed on a second monitor.
4. The system of claim 2 further comprising a first microprocessor at the
pathologist workstation which is electronically connected to the
bidirectional means and to the microscope control means for processing the
control signals to be sent over the bidirectional communication means and
for processing the location signals received.
5. The system of claim 4 further comprising a second microprocessor at the
remote site which is electronically connected to the bidirectional means
and to the robotic means of the microscope for processing the location
signals to be sent over the bidirectional communication means and for
processing the control signals received.
6. The system of claim 1 wherein identification information relative to the
specimen being viewed is displayed on the monitor.
7. The system of claim 1 wherein the pathologist workstation further
comprises a second monitor for displaying identification information about
the specimen being viewed.
8. The system of claim 7 wherein the second monitor also displays
microscope function parameters including the X and Y coordinates of a
microscopic field being viewed and the level of magnification.
9. The system of claim 1 wherein the pathologist workstation further
comprises means for generation and graphically displaying a map which is a
representation of the shape of the specimen and displaying the relative
position of a field being viewed on the map.
10. The system of claim 9 wherein the means for generating and graphically
displaying comprises a video camera mean located at the remote site which
camera means is adapted to produce a video signal of the entire specimen,
which video signal is converted t a digitized signal by a microprocessor,
which digitized signal is sent over the bidirectional communication means
to the workstation and displayed on a second monitor as a map of the
specimen.
11. The system of claim 10 further comprising means for generating control
signals which cause the specimen to be returned to microscopic fields of
interest previously selected by the pathologist.
12. The system of claim 9 wherein the means for generating and graphically
displaying comprises a digital computer programmed to generate mapping
control signals which cause the entire specimen to be scanned, to
interpret the video signals received so as to determine the X and Y
coordinates of the periphery of the specimen to thereby generate said map,
to display on said map the location of the field currently being viewed,
and to store X and Y coordinates at points of interest selected by the
pathologist.
13. The system of claim 12 wherein the digital computer is further
programmed to generate return control signals which cause the specimen to
be returned to said points of interest.
14. The system of claim 13 wherein the digital computer is further
programmed to generate magnification return control signals which cause
the magnification of the microscope to be returned to that which was being
used when said points of interest were selected.
15. The system of claim 1 wherein the pathologist workstation further
comprises means for electronically storing and photographically
reproducing images.
16. The system of claim 1 wherein the bidirectional communication means
comprises a satellite link for relaying the video and control signals.
17. The system of claim 1 further comprising means for transmitting audio
signals between said first and second site.
18. The system of claim 1 further comprising:
a second robotically controlled microscope located at a second remote site
whereby the pathologist can render pathology diagnostic opinions in
connection with specimens located at multiple remote sites, said second
microscope including second robotic means for adjusting the relative
position of a second specimen to the objective lens, the magnification of
the second specimen, and the focus of the second specimen;
second video camera means for collecting video signals from the second
microscope;
second bidirectional communication means;
wherein said pathologist workstation located at the diagnostic center
further comprises second microscope control means for generating control
signals which are sent over the second bidirectional communication means
to the second robotic means of the second microscope to thereby remotely
adjust the relative position of the second specimen to the objective lens,
the magnification of the second specimen, and the focus of the second
specimen.
19. The system of claim 1 further comprising a second pathologist
workstation locate at a second diagnostic center whereby a second
pathologist can render pathology diagnostic opinions in connection with
specimens located at the remote site, said second pathologist workstation
comprising:
a second monitor for viewing the video signals collected by the video
camera means which signals are sent over a second bidirectional
communication means, and further comprising second microscope control
means for generating control signals which are sent over the second
bidirectional communication means to the robotic means of the microscope
to thereby remotely adjust the relative position of the specimen to the
objective lens, the magnification of the specimen, and the focus of the
specimen.
20. A telepathology diagnostic system which allows a pathologist located at
a diagnostic center to render pathology diagnostic opinions in connection
with specimens located at a site which is remote form the diagnostic
center, which system comprises:
a light microscope located at the remote site and including a robotically
controlled stage for adjusting the relative position of a specimen to the
objective lens, and including means for adjusting the magnification of the
specimen and the focus of the specimen;
means for generating location signals;
a video camera attached to the microscope for collecting video signals from
the microscope;
means for communicating signals between the remote site and the diagnostic
center; and
a pathologist workstation located at the diagnostic center and comprising a
first monitor for viewing the video signals collected by the video camera
which signals are sent over the bidirectional communication means, and
comprising a second monitor for viewing data relative to the specimen and
microscope parameters including the location on the specimen of the
microscopic field of view currently viewed on the first monitor, said
workstation further comprising microscope control means by which the
pathologist generates control signals which are sent over the
bidirectional communication means to the microscope so that the
pathologist can thereby remotely control the stage of the microscope and
to adjust the magnification of the specimen and the focus of the specimen;
whereby the system provides the pathologist located at the diagnostic
center with the ability to remotely adjust the relative position of the
specimen to the objective lens, the magnification of the specimen, and the
focus of the specimen to thereby make observations of the specimen
necessary for rendering a pathology diagnostic opinion.
21. A method for rendering pathology diagnostic opinions at a diagnostic
center in connection with specimens located at a site which is remote for
the diagnostic center comprising the following steps;
obtaining a biological specimen for a patient located at the remote site;
preparing the specimen of microscopic examination;
placing the specimen on a microscope located at the remote site, said
microscope including robotic means for adjusting the relative position of
the specimen to the objective lens, the magnification of the specimen, and
the focus of the specimen;
collecting video signals from the microscope by means of a video camera;
transmitting the video signals collected to a video monitor at the
diagnostic center;
generating control signals at the diagnostic center for adjusting the
relative position of the specimen to the objective lens, the magnification
of the specimen, and the focus of the specimen to thereby facilitate
observations of the specimen necessary for rendering a pathology
diagnostic opinion;
transmitting the control signal from the diagnostic center to robotic means
at the remote site
reporting the pathology diagnostic opinion to the remote site.
22. The method of claim 21 further comprising the step of generating the
graphically displaying a map which is a representation of the shape of the
specimen and displaying the relative position of a filed being viewed on
the map.
23. The method of claim 22 wherein the map is generated and graphically
displayed by video camera means located at the remote site which camera
means is adapted to produce a video signal of the entire specimen, which
video signal is converted to a digitized signal by a microprocessor, which
digitized signal is sent over the bidirectional communication mean to the
workstation and displayed on a second monitor as a map of the specimen. |
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Claims |
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Description |
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BACKGROUND OF THE INVENTION
The present invention relates generally to the field of medicine and
particularly to the field of of pathology. Pathologists are the physicians
responsible for analyzing tissue and liquid specimens by light microscopy.
For example, tissue specimens removed at surgery are examined under the
microscope by the pathologist who thereafter renders an opinion of the
diagnosis. The patients' physician thereafter makes therapeutic decisions
based upon the pathologists' diagnosis.
Under current practice, specimens removed from a patient must be delivered
to the pathologist who is to examine them. Under the best of
circumstances, the examining pathologist works in a laboratory located at
the hospital where the patient is. In such a case, the turnaround time can
be short enough to allow the pathology diagnostic opinion to be rendered
and the opinion to be acted upon during the same operation in which the
specimen is removed from the patient. Naturally, being able to make and
act on the pathology diagnostic opinion during a single operation is
highly desirable.
Alternatively, when the pathologist is not located at the same hospital,
the specimens can be sent through the mails or other means to a
pathologist working at a diagnostic center at a distant location. This
situation precludes removing the specimen and acting on the pathology
diagnostic opinion during a single surgical procedure. This result not
only adds to the cost of the treatment, but can also lead to adverse
health effects inherent in delaying the therapeutic treatment and by
subjecting the patient to multiple surgical procedures.
A significant trend in the field of medicine generally and the field of
pathology specifically is that of subspecialization. That is, it is more
and more common for individual pathologists to develop high levels of
expertise in diagnosing the diseases occurring in a single organ system,
such as liver or lung. Unfortunately however, most hospitals do not have a
sufficient number of patients with diseases in specific organs to justify
retaining subspecialty pathologists on a full-time basis. Thus, to obtain
opinions from subspecialty pathologists it is required to send the
specimens to the facility at which they are located.
A similar problem has been faced in the field of radiology, that is
inefficiencies and health-threatening delays resulting from a
maldistribution of radiologists and radiology subspecialists. The advent
of teleradiology has, to some extent, provided a solution to this problem.
Teleradiology is the term used to refer to the practice of establishing
networks for telecommunicating the roentgenogram images from the site at
which they are produced to the site of a consulting radiologist.
Naturally, such a system can be used to eliminate critical delays in
providing radiology diagnostic opinions.
Unfortunately, such networking has not been hitherto available in the field
of pathology due to critical differences between the way radiology and
pathology are practiced. The most prominent difference is the fact that
radiologists deal primarily with static black and white images, i.e.
roentgenograms which represent large areas of the body. The information
content of a single image is thus relatively low. Accordingly, the entire
image can be digitized and telecommunicated at an acceptable speed with
existing technology.
In contrast, pathologists work with three dimensional samples which need to
be viewed in full color by panoramic scanning. In making a diagnosis, the
pathologist must be able to view different parts of the sample at
different magnifications, at different intensities of illumination, and in
full color. The pathologist must also be able to focus up and down through
the specimen to view it at different depths. As a result, a network which
simply digitizes and transmits static images would not allow a pathologist
to render diagnostic opinions in an optimal fashion.
SUMMARY OF THE INVENTION
The present invention is directed to a system which allows a pathologist
located at a diagnostic center to render a pathology diagnostic opinion in
connection with specimens located at a remote site. Briefly stated, the
system comprises a microscope located at the remote site which includes
means for robotically adjusting the relative position of a specimen to the
objective lens, the magnification of the specimen, and the focus of the
microscope. A video camera means is provided for collecting video signals
from the microscope. The system also includes a bidirectional
communications link between the diagnostic center and the remote site. A
pathologist workstation is located at the diagnostic center which includes
a monitor for viewing video signals from the video camera means which
signals have been sent over the bidirectional communication means. The
workstation also includes microscope control means for generating control
signals which are sent over the bidirectional communication means to
thereby remotely control the microscope.
In accordance with a preferred embodiment, the system also includes means
associated with the microscope for generating location signals whereby the
X, Y, and Z coordinates of points being viewed are sent over the
bidirectional communication means to the pathologist workstation. In
addition, the preferred embodiment includes a first microprocessor at the
pathologist workstation for processing the control signals to be sent over
the bidirectional communication means and for processing the location
signals received together with a second microprocessor at the remote site
for processing the location signals to be sent over the bidirectional
communication means and the control signals received. This preferred
system also includes means for generating and graphically displaying a map
on a second monitor which map is a representation of the shape of the
specimens and also for displaying the relative position on the map of the
microscopic field currently being viewed.
In accordance with the most preferred embodiment of the invention, the
system includes a plurality of remote sites (e.g. hospitals or clinics
without the services of a pathologist or subspecialist). In this way, the
network can be used to supply pathology diagnostic services to several
remote facilities, thus greatly increasing the efficiencies of the system.
Likewise, the most preferred system includes a plurality of diagnostic
centers, each with a pathologist workstation linked into the diagnostic
network. As a result, the service of pathology subspecialists located
around the world can be pooled, both for initial diagnoses and for further
consultation.
An important feature of the system of the present invention is that the
pathologist at the workstation can not only view the specimen remotely,
but he can also control all the functions of the microscope, i.e. stage
control, focus, magnification, and illumination. Thus, with the system of
the present invention, the pathologist has all the observational faculties
available to him through microscopy at his command that he would have if
the specimen were present when rendering his diagnostic opinion.
The networking of pathology diagnostic services which the system of the
present invention makes possible provides important advantages to the
healthcare field. First, it makes it possible for smaller hospitals,
clinics, and physicians offices which do not have a pathologist on staff
to obtain a pathology diagnostic opinion during a single operation or
other tissue sampling procedures such as fine needle aspiration cytology
biopsies. It also allows hospitals which do have pathologists, but do not
have the pathology subspecialists needed for consultation in a particular
situation, to likewise obtain an expert opinion just as quickly as if the
pathology subspecialist were present at the hospital.
Another advantage provided by the present invention is the fact that thru
the inclusion of more than one diagnostic center in the network, the
pathologist who initially views the specimen can obtain a second opinion
from other pathologists that are located at different centers.
Importantly, this second opinion can be obtained without the delay of
sending the sample to the additional consulting pathologist.
Still another advantage of the present invention is that it can be used to
further the purposes of medical education. In particular, teaching
facilities can be linked to the pathology diagnostic network to thereby
give interns and residents a broader range of diagnostic experience, both
by observing pathologists work at other diagnostic centers, and by
participating in rendering diagnostic opinions themselves. In addition,
previous cases which have been electronically archived by the present
system can be recalled for educational purposes and to review previous
diagnostic practices and diagnostic criteria.
BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will be better understood by way of example and
description when read in connection with the following Figures, wherein:
FIG. 1 is a schematic representation of a diagnostic center linked by
various bidirectional communication means to remote hospitals, a clinic,
and a second diagnostic center;
FIG. 2 is a block diagram illustrating a preferred method of using the
system of the present invention;
FIG. 3 is a schematic representation of the system of a preferred
embodiment the present invention;
FIG. 4 is a schematic representation of the system of an other preferred
embodiment which includes electronic image archiving and electronic
photography reproduction capabilities;
FIG. 5 is a schematic representation of a robotically controlled microscope
according to a preferred embodiment of the present invention;
FIG. 6 is a perspective view of a pathologist workstation arranged
according to a preferred embodiment of the present invention;
FIG. 7 is a perspective view of a combined focus control and marking button
for use at the pathologist workstation depicted in FIG. 6; and
FIG. 8 is a representation of the mapping function of the pathologist
workstation according to the most preferred embodiment of the present
invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to the drawings, FIG. 1 depicts a telepathology network according
to the present invention. The network includes a diagnostic center 11.
Preferably, such an institute will be located at a major tertiary care
hospital which is staffed with a panel of pathology subspecialists.
Alternatively, the diagnostic center may be a smaller facility which is
set up with a single pathologist to render opinions. Accordingly, the term
"diagnostic center" as used in this specification and the appended claims
should be given a rather broad definition, i.e. affacility at which at
least one pathologist can be located to render diagnostic opinions in
connection with specimens at remote sites, via the system of the present
invention.
As will be explained in more detail below, the most preferred embodiment of
the system includes more than one diagnostic center in the network. In
particular, it is most preferable to include as many diagnostic centers as
possible in the network for at least two reasons. First, it is desirable
to provide as many options as possible on where and by whom the specimen
is viewed. Second, it is desirable for the pathologist who initially views
the specimen to be able to obtain a second opinion almost immediately in
difficult or unusual cases.
It is also preferable to include medical teaching facilities as members of
the telepathology network. In this way, physicians in training can be
educated both as passive observers as they watch expert pathologists at
different locations render diagnoses and as actual participants in the
diagnosis process.
The network of the present invention also includes remote sites as depicted
by hospitals 13 and 17 and clinic 15. Typically, the hospitals and clinics
in the network will be those which are too small to retain the services of
a full time pathologist. Also, hospitals which have pathologists but do
not have the pathology subspecialists that may be needed for a particular
diagnosis will also be included in the network. In addition, even large
hospitals which employ several subspecialists may want to be included in
the network for the purpose of obtaining second opinions from pathologists
with similar subspeciality interests at other diagnostic centers. In such
a case, it would be desirable to have both a robotically controlled
microscope and a pathologist workstation at the same site. In fact, once a
pathologist has access to the workstation of the most preferred
embodiment, it is likely that he will prefer to have the workstation
linked to a microscope at the same site. This will provide the expert
pathologist with the capability of performing the specimen mapping
functions, described in detail below, will give the pathologist recall,
archiving, and reproduction powers not otherwise available.
FIG. 1 is also intended to schematically illustrate different bidirectional
telecommunication means by which the remote sites can be linked to the
diagnostic center 11. In general, bidirectional communication means will
include broad band transmission for sending the video signal from the
remote site to the diagnostic center. The communication means will also
require two-way transmission for exchanging data between the two sites.
Preferably, the communication means will also provide for two way audio
transmission.
As shown, the clinic 15 which is relatively close to the diagnostic center
11 is linked via a coaxial cable 23. Hospital 13 which is located at a
greater distance, but not more than about 10 miles, is linked to the
diagnostic center 11 via point to point microwave transmission 21.
Hospitals located great distances from the diagnostic center 11, such as
that shown at 17, can be linked via satellite 19. Indeed, hospitals and
diagnostic centers around the world can be linked in a single network via
satellites. As a suitable example, a COMSAT-SBS satellite with 32 MHz
transponders can be used to relay the necessary signals in both
directions.
The details needed to set up the particular bidirectional communications
links are known in the art. Suffice it to say that it is required that the
bidirectional communications links used in the present invention must be
capable of transmitting full color video signals from the video camera to
the workstation together with the control signals sent to robotically
control the microscope. In addition, the preferred embodiment will also
require that location signals, i.e. feedback on the X, Y, and Z
coordinates of the specimen being viewed, be sent to the workstation as
well.
FIG. 2 illustrates a preferred method by which the system of the present
invention is employed. The dashed rectangles are intended to show the
different sites at which the enclosed steps are performed. The rectangle
25 encloses the steps which are performed at the remote site. Rectangle 27
encloses the steps which are performed at the diagnostic center. Rectangle
29 encloses the step which may or may not be performed at a second
diagnostic center within the diagnostic network.
The first step is the initiation of the plan. In this step, the attending
physician at the remote site decides to obtain a specimen and have that
specimen analyzed through the diagnostic network.
At this point, the diagnostic center is alerted and inquiry is made as to
the availability of a particular pathologist. As stated above, it is
preferable that the attending physician at the remote site have the choice
of multiple diagnostic centers. In this way, the attending physician is
given a broad choice of subspecialists to render the requested opinion.
Also, the attending physician has other options available if the
pathologist selected is unavailable during the requested time.
It should be noted that although the workstation is intended primarily for
use by a physician who has specialized in pathology, it may also be used
by other health care professionals such as cytotechnologists or other
medical technologists. Thus, as used in this specification and the
appended claims, the term "pathologist" is intended to include these other
health care professionals as well.
Once the attending physician has arranged for the diagnostic center's
participation, the specimen is obtained and prepared. In many cases, the
tissue will be obtained from the patient surgically. Alternatively, it may
be obtained from bodily fluids or cytology preparations. Accordingly, as
used in this specification and the appended claims, the term "specimen" is
intended to have a relatively broad definition which includes samples
obtained from either a human patient or an animal patient as in veterinary
pathology.
Typically, after the tissue is obtained, a frozen section of the specimen
is placed on a glass slide, stained and secured in the specimen stage of
the robotically controlled microscope equipped with a video camera (see
FIG. 5 below). Often, several pieces of tissue are placed on a single
slide.
At this point, control of the microscope and video camera functions are
taken over by the pathologist at the diagnostic center. In particular, the
pathologist will have control over the movement of the stage as well as
the magnification, focus and illumination of the microscope. In this way,
the pathologist has a level of control in viewing the specimen
microscopically comparable to that which he would have if he had the
specimen in his possession.
As described in more detail below, the pathologist views the specimen on a
video monitor. Importantly, the images seen by the pathologist are in full
color, and seen in real time. After viewing the specimen, the pathologist
can decide whether or not to consult with the attending physician before
making his final report. Preferably, this consultation is facilitated by
including means for two-way audio communication as part of the network.
The pathologist can also decide whether to seek consultation with a second
pathologist. Naturally, this can easily be accomplished when the second
pathologist is located at the same diagnostic center. In addition,
pathologists located at different diagnostic centers can be included in
consultation by providing a workstation at the second institute so that
the second pathologist can manipulate and view the specimen on his own and
thus render a second opinion with the same speed as if he were present at
the first institute.
After consultation, if any, the pathologist makes a report of his
diagnostic opinion. This report is communicated to the attending
physician, either orally over the audio communication means, in writing by
electronic mail, or preferably both. The report is also archived at the
diagnostic center for future reference.
FIG. 3 schematically illustrates the primary systems functions of a
preferred system of the invention. The specimen is mounted on the slide 42
which is secured to the stage of the microscope 44. The light source 40 of
the microscope 44 illuminates the specimen on the slide 42. The image of
the specimen is magnified by the lenses of the microscope 44 and picked up
and converted to an electronic video signal by the video camera 46. This
video signal is transmitted over the communication linkage 48 to the
pathologist workstation 52 and viewed by the pathologist on the video
display monitor 56. Control signals are generated at the workstation 52
for remotely controlling the functions of the microscope, including stage
movement, magnification, focus, and illumination control. These control
signals are preferably processed by an inline microprocessor and sent over
a communications linkage 50 to the remote site. As a suitable example, an
IBM XT can be used as the microprocessor at the remote site. Preferably,
the microprocessor is equipped with a modem for transmitting data to and
from the telecommunications uplink.
The control signals preferably pass through an interface box at the remote
site which converts them to the proper signals to which the computerized
microscope will respond. The interface box also preferably converts
location signals generated by the microscope to signals which can be used
by the microprocessor to determine the X and Y, and preferably Z
coordinates of the point of the specimen which is currently being viewed.
The Z coordinate reflects the relative vertical distance between the
objective lens and the specimen, which vertical distance is adjusted by
the focus controls of the microscope.
FIG. 4 shows schematically the system of an other preferred embodiment. The
embodiment depicted here includes an electronic image archiving and
photographic reproduction capability. As in the embodiment shown in FIG.
3, the video camera 62 converts the image produced by the robotically
controlled microscope 64 into a video signal which is sent over the
communications linkage 72 to the pathologist workstation 76 where it is
viewed on the video monitor 74. Control signals are generated at the
workstation 76 and relayed over the communication linkage 72 to
robotically control the functions of the microscope.
In addition, a keyboard 66 is located at the remote site for sending
information about the specimen to the workstation 76. Also, the
workstation includes the capability to electronically store the
information about the sample and the pathologist's report, including the
X, Y, and Z coordinates of the particular microscopic field from the
specimen which are of interest in the pathologist's report, in mass
storage 77 at the diagnostic center (e.g. on the institute's mainframe
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