The Digital Microscopy in Organ Transplantation: Ergonomics of the Tele-Pathological Evaluation of Renal, Liver and Pancreatic Grafts
Introduction: The process to build a better safety
culture, methods of error analysis, and preventive measures, starts
with an understanding of the effects when human factors engineering
refer to remote microscopic diagnosis in surgery and specially in
organ transplantation for the remote evaluation of the grafts. It has
been estimated that even in well-organized transplant systems an
average of 8% to 14% of the grafts (G) that arrive at the recipient
hospitals may be considered as diseased, injured, damaged or
improper for transplantation. Digital microscopy adds information on
a microscopic level about the grafts in Organ Transplant (OT), and
may lead to a change in their management. Such a method will
reduce the possibility that a diseased G, will arrive at the recipient
hospital for implantation. Aim: Ergonomics of Digital Microscopy
(DM) based on virtual slides, on Telemedicine Systems (TS) for
Tele-Pathological (TPE) evaluation of the grafts (G) in organ
transplantation (OT). Material and Methods: By experimental
simulation, the ergonomics of DM for microscopic TPE of Renal
Graft (RG), Liver Graft (LG) and Pancreatic Graft (PG) tissues is
analyzed. In fact, this corresponded to the ergonomics of digital
microscopy for TPE in OT by applying Virtual Slide (VS) system for
graft tissue image capture, for remote diagnoses of possible
microscopic inflammatory and/or neoplastic lesions. Experimentation
included: a. Development of an OTE-TS similar Experimental
Telemedicine System (Exp.-TS), b. Simulation of the integration of
TS with the VS based microscopic TPE of RG, LG and PG applying
DM. Simulation of the DM based TPE was performed by 2
specialists on a total of 238 human Renal Graft (RG), 172 Liver Graft
(LG) and 108 Pancreatic Graft (PG) tissues digital microscopic
images for inflammatory and neoplastic lesions on four electronic
spaces of the four used TS. Results: Statistical analysis of specialist‘s
answers about the ability to diagnose accurately the diseased RG, LG
and PG tissues on the electronic space among four TS (A,B,C,D)
showed that DM on TS for TPE in OT is elaborated perfectly on the
ES of a Desktop, followed by the ES of the applied Exp.-TS. Tablet
and Mobile-Phone ES seem significantly risky for the application of
DM in OT (p<.001). Conclusion: To make the largest reduction in errors and adverse events referring to the quality of the grafts, it will
take application of human factors engineering to procurement,
design, audit, and aware ness-raising activities. Consequently, it will
take an investment in new training, people, and other changes to
management activities for DM in OT. The simulating VS based TPE
with DM of RG, LG and PG tissues after retrieval; seem feasible and
reliable and dependable on the size of the electronic space of the
applied TS, for remote prevention of diseased grafts from being
retrieved and/or sent to the recipient hospital and for post-grafting
and pre-transplant planning.
 P. Friend, Organization of organ retrieval-bitter lessons and ambitious
plans, Proceedings of lectures in the Hammersmith Hospital of London,
2010 (Available at: http://vincentbourquin.files.wordpress.com/2010/
11/friend-Hammersmith-11-10-10.pdf, Accessed on 17/07/2012).
 AR Graham, AK Bhattacharyya, KM Scott, F Lian, LL Grasso, LC
Richter, et al. Virtual slide tele-pathology for an academic teaching
hospital surgical pathology quality assurance program. Hum Pathol.,
vol.40, pp.1129-36, Jul. 2009).
 C.S. Mammas, G.P. Economou,N.Arkadopoulos, G. Kostopanagiotou,
G.J. Mandellos, P. Lymberopoulos, V. Smyrniotis, D. Lymberopoulos,
ELMP for TS in the coordination process as a method to optimize
quality in organ transplantations, Proceedings of the 16th Congress of
the Hellenic Society of Organ Transplantation, Thessaloniki, 2011,
 CS Mammas, G. Mandellos, G.-P Economou. and D. Lymberopoulos,
"Structuring Expert-Leaded Medical Protocols for Telemedicine
Systems", in Proc. 23rd Annual International Conference of the IEEE
Engineering in Medicine and Biology, Constantinople, 2001, pp.3529-
 E. Karavatselou, GP. Economou, C. Chassomeris, V. Danelli and D.
Lymperopoulos, OTE-TS: A new value added telematics service for
telemedicine applications, IEEE Transactions on Information
Technology in Biomedicine, vol. 5(3), pp210-224, Sept. 2001.
 R.H. Morgan. Computer network security for the radiology enterprise
Computer network, Radiology., vol.220, pp.303-09, Aug.2001.
 P.N. Furness, WM Bamford, Tele-pathology. Curr Diag Pathol, vol.7,
pp. 281-291, Dec.2001.
 E. Coiera. Guide to health informatics, CRC, 2015.
 S. Martorell, CG Soares, J. Barnett. Safety, Reliability and Risk
Analysis: Theory, Methods and Applications, CRC, 2014.
 K. Kayser, S. Borkenfeld, J.Görtler, G.Kayser. Image standardization in
tissue - based diagnosis. Diagnostic Pathology, vol.3, pp.17-25,
 KY Jen, JL Olson, S. Brodsky, XJ Zhou, T. Nadasdy, ZG Laszik,,
Reliability of whole slide images as a diagnostic modality for renal
allograft biopsies, Human Pathology, vol.44(5),pp.888-94, 2013.
 E. Krupinski. Human factors and human-computer considerations in
teleradiology and telepathology, Healthcare, vol. 2(1), pp.94-114,
 MY Gabril, GM Yousef. Informatics for practicing anatomical
pathologists: marking a new era in pathology practice. Mod Pathol.,
vol.23, pp.349-358, Jan.2010.
 L. Pantanowitz, K. Dickinson, A. J. Evans, L. A. Hassell, W. H.
Henricks, J. K. Lennerz, et al. ATA Clinical Guidelines for
Telepathology. Telemedicine and e-Health, vol 20(11), pp.1049-70, May
 G. Kayser, J. Görtler, N. Kluge, T. Wiech, M. Werner, K. Kayser.
Standards in virtual microscopy: from tissue processing to image
acquisition and visualization. Diagnostic Pathology, vol.5 (Suppl 1),
 K. Kayser, S. Borkenfeld, T. Goldmann and G. Kayser. Virtual slides in
peer reviewed οpen access medical publication. Diagnostic Pathology,
vol. 6, pp.124-131, Dec.2011.
 L. Pantanowitz, PN Valenstein, AJ Evans, KJ Kaplan, JD Pfeifer, DC
Wilbur et al. Review of the current state of whole slide imaging in
pathology. J Pathol Inform., vol.2, pp.36-45, Aug.2011.
 L. Fónyad1†, T. Krenács†, P. Nagy†, A. Zalatnai†, J. Csomor†, Z. Sápi†
et al. Validation of diagnostic accuracy using digital slides in routine
histopathology Diagnostic Pathology, vol.7, pp.35-41, Mar.2012.
 F. Ghaznavi, A. Evans, A. Madabhushi, M. Feldman. Digital imaging in
pathology: Whole-slide imaging and beyond, Annual Review of
Pathology: Mechanisms of Disease, vol.8: pp.331–59, Nov. 2012.
 G. Romero, L., William C. Andrew L., Eugene T., Jeff M., Anil
Parwani, L. Pantanowitz. Digital Pathology Consultations—a New Era
in Digital Imaging, Challenges and Practical Applications, Journal of
Digital Imaging. vol.26 (4), pp. 667-68, Jan.2013.
 S. Kothari, J. H. Phan, T. H. Stokes, M. D. Wang. Pathology imaging
informatics for quantitative analysis of whole-slide images. Journal of the American Medical Informatics Association, vol.20 (6),pp.1099-
 T. C. Allen. Digital pathology and federalism, Archives of pathology &
laboratory medicine, vol.138 (2): pp.162-165, Feb. 2014.
 Eric F. Glassy. Rebooting the pathology journal: learning in the age of
digital pathology, Archives of Pathology & Laboratory Medicine,
vol.138 (6), pp.728-729, Jun.2014.