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The National Academies
500 5th St NW - KWS 502
Washington, DC 20001
Tel: (202) 334-2800
Fax: (202) 334-2139
Phase 3 (2007 Deadline)
Establishment of an Integrated Telepathology, Pathology Imaging, and
Immunohistochemistry Facility in Pakistan
David C. Wilbur and Yukako Yagi, The Massachusetts General Hospital, Boston
Imtiaz Ahmad Qureshi, Holy Family Hospital, Rawalpindi
Pakistani Funding (MoST): $143,000 (not yet paid)
US Funding (State): $164,500
Project Dates on US Side: July 1, 2008 - June 30, 2012
This project seeks to establish a modern digital pathology facility at Holy Family Hospital (HFH) in Rawalpindi, a major Pakistani tertiary care and teaching center. The facility will consist of three main components: (1) pathology imaging, including automated, high-speed, high-resolution digitization of pathology slides; (2) telepathology, including sophisticated pathology training and reporting tools, image analysis, and the near real-time sharing of pathology cases and consultations; and (3) immunohistochemistry, a mainstream molecular tool for histological diagnosis in the West that is not readily available in Pakistani public-sector teaching hospitals. This facility will be linked through its telepathology and imaging components to the Massachusetts General Hospital (MGH). Through these components, MGH staff will be able to provide a high degree of near real-time technical support and training for the facility itself, sophisticated pathology training materials to trainees, and physician-to-physician consultation between the two hospitals.
- Provided technical training in digital pathology and pathology practice to a Pakistani physician
- Established linkages between pathologists in HFH and MGH, including weekly teleconference consultations
- Donated whole slide image scanner and accessories to HFH to facilitate telepathology efforts
A joint paper on the challenges of establishing a digital pathology facility in Pakistan was presented at the 11th European Congress on Telepathology and 5th International Congress on Virtual Microscopy in Venice, Italy, June 6-9, 2012. Another paper on the project has been submitted to the International Academy of Pathology for presentation at its October 2012 conference in South Africa. Although the project was completed as of June 30, the participants remain in regular contact for joint case consultations, which will be enhanced once the new whole slide image scanner recently shipped to Pakistan is installed by the vendor in September 2012. In addition to continuing the collaboration with MGH, Dr. Qureshi plans to introduce this low-cost and easy-to-operate system to other pathologists at HFH and other Pakistani healthcare institutions.
Progress Report Summaries
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2012 Download final report
2011Show summary || Hide summary|| Download full report
The new project PI at HFH, Dr. Imtiaz Ahmad Qureshi, was scheduled to visit MGH in July 2011 for training on using the pathology imaging system to be provided to his hospital. Due to visa delays, however, that visit had to be postponed until November 8-19, 2011. During his stay in Boston, Dr. Qureshi attended some training lectures with his hosts, Dr. Wilbur and co-PI Dr. Yukako Yagi, and they also familiarized him with the operation of the new imaging scanner to be provided to HFH. Dr. Wilbur worked with him on the use of scanner in making diagnoses via telepathology so that Dr. Qureshi will be comfortable with using the system once it is installed. He will also be provided with a laptop and wireless router to be used in setting up a wireless network in his department at HFH. During the visit, Dr. Qureshi also partially attended the 33rd Annual Course Current Concepts in Surgical Pathology organized by Massachusetts General Hospital and Harvard Medical School in Boston. The visit laid the foundation for an ongoing consultative relationship between pathologists at MGH and their colleagues in Pakistan. After Dr. Qureshi returned to Pakitstan, the team has been having telepathology session regularly on Tuesdays, starting in December 2011. So far they have had four telepathology consultation session in which Dr. Wilbur has reviewed 34 cases.
The team will keep having telepathology sessions regularly and extend the number of attendees in 2012. The U.S. team will donate the Whole Slide Imaging Scanner to the Pakistani side if the scanner can be purchased with the current budget. Meanwhile, an abstract of a conference paper will be submitted to European Telepathology Virtual Microscopy Conference, to be held in June, Italy. Because of the failure of MoST to provide any funds on the Pakistani side, the project plan had to be revised to eliminate the creation of the immunohistochemistry facility, but Dr. Yagi now feels confident that progress can be made on the pathology imaging and telepathology components now that Dr. Qureshi is involved. The project has received a no-cost extension through June 2012.
In November 2011, Pakistani PI Dr. Qureshi made a two-week visit to the United States, which greatly helped project participants from both sides plan and carry out the first telepathology session. During Dr. Qureshi's stay at the Pathology Imaging and Communication Technology (PICT) Center at MGH, he and Dr. Wilbur participated in simulated telepathology sessions to familiarize Dr. Qureshi with the process so that he would be comfortable operating independently once he returned home to Pakistan. Dr. Qureshi, whose medical specialty is pathology, also attended portions of the 33rd Annual Course on Current Concepts in Surgical Pathology organized by MGH and the Harvard Medical School in Boston. Beginning in December 2011 following Dr. Qureshi's return to Pakistan, the team has been conducting telepathology sessions regularly on Tuesdays. As of early January 2012, they had held four joint consultation sessions in which Dr. Wilbur had reviewed a total of 34 cases. The team will continue holding regular telepathology sessions and will expand the number of participants in 2012. An abstract of a conference paper will be submitted to European Telepathology Virtual Microscopy Conference, to be held in Italy in June 2012. Since the vendor is willing to give a substantial discount on the Whole Slide Imaging (WSI) Scanner, the US team will proceed with the purchasing soon. The equipment will be the first WSI scanner in Pakistan. Dr. Qureshi is willing to introduce the technologies and benefits to other pathologists in Pakistan to improve the healthcare in Pakistan.
2010Show summary || Hide summary || Download full report
A new research fellow, Dr, Sidra Sohail, volunteered full time at the MGH Imaging Lab beginning February 1, 2010. Both fellows were back to Pakistan at the end of May, 2010. A former surgeon at HFH, Dr. Sohail was trained on pathology and informatics. MGH sponsored a J-1 visa invitation for a pathologist from HFH, Dr. Imtiaz Ahmad Qureshi, to come for one to three months of training. During his stay, he worked closely with Dr. Sohail, who served as a liaison in establishing the telepathology effort after Dr. Qureshi returned home. Drs. Wilbur and Yagi supervised them during their stay. Because of the delays encountered, a no-cost extension was authorized through June 2011.
In 2010, the research team established educational site and hosting these functions: a) whole slide imaging case database for educational purposes; b) interactive video conference; and c) Youtube. The team was waiting for a pathologist training in the U.S.. The pathologist was expected to stay at MGH 1 ~ 3 months in 2011 under Drs. Wilbur and Yagi's supervision. However, the visit date was not scheduled yet due to the situation in Pakistan. The team was hoping the Pakistan side could receive their funding in 2011. They would start operation of the systems from U.S. to Pakistan and start actual tele-consultation and tele-education.
2009 Show summary || Hide summary || Download full report
In view of the continuing funding delays on the Pakistani side, MGH has generously decided to donate the necessary telepathology equipment and has identified a means of shipping it to Rawalpindi. Meanwhile, a physician/research fellow at MGH, Dr. Sohail Qayyum, was trained on the installation and operation of the equipment so that could help set it up at HFH and train Pakistani staff members on its use. After visiting HFH in the summer, however, he reported that they would need more help and support, so shipment of the equipment has been postponed until a pathologist could be sent from HFH to Boston for additional training. Meanwhile, the project Web site, which will include educational materials on immunohistochemistry, pathology diagnosis, and digital pathology, as well as a mechanism for teleconsultation, has also been created and will be further developed (http://mirax01.mgh.harvard.edu/mirax/index.php, login and password “guest”). After the donated equipment is received and installed, telepathology diagnostic activities and related training can begin in earnest.
Meanwhile, Dr. Qayyum, Dr. Rice, and Dr. Yagi, made a joint presentation entitled “Optimization of Whole Slide Imaging Parameters for Liquid-Based Cervical Cytology Slides” at the 57th Annual Meeting of the American Society of Cytopathology in Denver in November 2009.
2008 Show summary || Hide summary || Download full report
The partners involved in this project continue to deal with severe challenges because HFH still has not received any of the promised funds from the Pakistani sponsor. This lack of funding on the Pakistani side has created a great deal of difficulty and prevented the hospital from purchasing essential equipment. Nevertheless, the U.S. partners remain in regular contact with their counterparts, including an in-person visit by Dr. Wilbur to HFH in late August 2008 in conjunction with the S&T conference.