Absar, Syeda Fatima

Tahir, Mohammad

Wilbur, David

Yagi, Yukako

Analytical Cellular Pathology

Harvard University - DASH 

Whole Slide Imaging BasedDigital Pathology Networkbetween Pakistan and USAThe Harvard community has made thisarticle openly available.  Please share  howthis access benefits you. Your story mattersCitation Absar, Syeda Fatima, Mohammad Tahir, Yukako Yagi, and DavidWilbur. 2014. “Whole Slide Imaging Based Digital PathologyNetwork between Pakistan and USA.” Analytical cellular pathology(Amsterdam) 2014 (1): 136838. doi:10.1155/2014/136838. http://dx.doi.org/10.1155/2014/136838.Published Version doi:10.1155/2014/136838Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:14351355Terms of Use This article was downloaded from Harvard University’s DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAMeeting AbstractWhole Slide Imaging Based Digital PathologyNetwork between Pakistan and USASyeda Fatima Absar,1 Mohammad Tahir,2 Yukako Yagi,3 and David Wilbur31Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA2Department of Pathology, Federal Government Poly Clinic Hospital, Islamabad 44000, Pakistan3Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USACorrespondence should be addressed to David Wilbur; dwilbur@partners.orgReceived 2 September 2014; Accepted 2 September 2014Copyright © 2014 Syeda Fatima Absar et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.BackgroundIn 2007, a modern digital pathology facility was conceived atthe Telemedicine Center of the Holy Family Hospital (HFH),Rawalpindi, Pakistan, in collaboration with the PathologyDepartment of the Massachusetts General Hospital (MGH),Boston, USA [1]. A pathologist from HFH was trained atMGHandwas provided equipmentwith the relevant softwareinstalled. Between December 2011 and August 2012, weeklyhour-long teleconferences were held between the two centers,where static histopathology images were discussed usingPowerPoint.The following month, Pakistan’s first whole slideimaging (WSI) scanner was installed at the TelemedicineCenter at HFH; however, before it could become functional,the pathologist left the country. The aim of the project hadbeen for MGH to provide digital pathology support to HFHand other facilities in the country; however, the untimely exitof the trained pathologist had led to a breach in communica-tion and a hiatus in the activities. In early 2013, we reestab-lished the connection, utilizing the Telemedicine Center butthis time with pathologists from the Federal GovernmentPoly Clinic (FGPC) Hospital, Islamabad. Due to the needs ofteleconsultation in Pakistan, we have changed the protocol toorganize teleconsultation to fit the current situation.MethodTo date, eight histopathology cases have been discussed.These cases were from tissues that ranged from the genitouri-nary system, central nervous system, gastrointestinal system,and soft tissue areas. At present, a consultant histopathologistand his team of four trainee pathologists fromFGPCHospitalare the participants from Pakistan’s side. The pertinent caseslides are sent to HFH three days ahead of time by hand.Theyare scanned using the Panoramic Desk (40x objective lensversion), 3D Histech Ltd., Hungary, as a slide scanner. Eachslide takes approximately thirty minutes to be scanned. Oneto two slides are scanned per case. When slides are ready fordiscussion, a coordinator at MGH is notified via email, whothen arranges a teleconference via “GoToMeeting,” CitrixOnline, CA, USA. During the conference, the screen controlsare handed over to HFH, presenting the case and displayingthe related WSI using the MIRAX viewer. The pathologistfromMGHdiscusses the case and captures screenshots of therelevant areas using his desktop. The Telemedicine Center atHFH has provided a network server IP address to MGH foraccessing the WSI storage database at any time.ResultThe teams conducted their first teleconference in September2013. Subsequently, hourly meetings are held as per therequirement of FGPC, where 3-4 cases are studied. Out ofthe eight cases that have been discussed, the pathologistat MGH was in agreement with the FGPC diagnosis fortwo of the cases. His diagnosis was the same for three ofthe cases but after consultation with other subspecialists atMGH, he suggested a different diagnosis for one case. Fortwo of the cases, he suggested further immunohistochemicalHindawi Publishing CorporationAnalytical Cellular PathologyVolume 2014, Article ID 136838, 2 pageshttp://dx.doi.org/10.1155/2014/1368382 Analytical Cellular Pathologystaining. At the local front, the scanner is being used atthe weekly multidisciplinary meetings at HFH. These areattended by physicians from other facilities, including thesurgical, histopathology, radiology, oncology, and nuclearmedicine departments at HFH, FGPC Hospital, NuclearMedicine Oncology and Radiotherapy Institute (NORI),and the Capital Development Authority (CDA) Hospital,Islamabad.ConclusionAs the groundwork for teleconferencing had already beenlaid, all that was required was to bridge the communicationgap to coordinate the activities between both centers. In thisphase, we are focusing more on utilizing the WSI scanner inboth local and onlinemeetings.These discussions are a learn-ing opportunity for pathologists and trainees at Pakistan’s sideand expose the USA side to rare cases. Although there is nocurrent funding for the project, it has been successful due tothe mutual interest and dedication shown by both sides. Weare now able to establish regular teleconferences using WSIand our aim is to increase their frequency as required.References[1] Y. Yagi, I. Qureshi, A. Malik, and D. C. Wilbur, “Challengesin establishing the WSI based digital pathology facility andtelepathology network between Pakistan and USA,” in Proceed-ings of the 102nd USCAP Annual Meeting, Baltimore, Md, USA,March, 2013.

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