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Diagnostics Digital and computational pathology, Technology and innovation, Microscopy and imaging, Pathologists’ assistants

Telepathology Heads Up

The revolution in wearable technology has brought a surge of devices to the market, including Google Glass (Figure 1), Microsoft Band, Apple Watch, and gesture-controlled armbands. I’m particularly interested in Google Glass (Glass) having used the technology myself – they are eyeglasses (spectacles) with an optical head-mounted display that allow users to connect directly to the Internet or tether the device wirelessly to a cell phone. 

Figure 1. Google Glass Explorer edition as acquired by the University of Pittsburgh Medical Center.

At a Glance

  • Wearable, digital technology is supporting all areas of healthcare delivery, from pathology to surgery
  • Google Glass is one such device, which is beginning to show potential in clinical settings
  • In preliminary studies it has been shown to support telemedicine, hands-free patient interaction, education and training 
  • There are some downsides, though, and modifications are still needed, including issues such as data protection, before a role in clinical care can be clearly defined and accepted

Glass has a dual-core processor, touchpad control, microphone, camera and prism display. The optical display places a virtual screen in front of the user’s face and glassware (software) installed on the device includes several well-known Google applications (for example, Gmail), as well as novel apps. Multiple users can connect, chat and share videos using Google hangouts too.

Where it all began…

The first “Glass-to-Glass” consultation first took place in 2013, when Dutch surgeon Marlies Schijven successfully communicated with American surgeon Rafael Grossman, live, while performing an operation. Grossman was in a conference center and the consultation was followed live worldwide via a YouTube broadcast. This became the first, proof-of-concept study of the device’s use in a healthcare setting. Several studies have since followed and referred to the great potential of Google Glass in healthcare (1)(2); supporting hands-free patient interactions, remote consultations, and even live virtual training. Preliminary findings indicate that wearing the device in a clinical setting is well-tolerated by doctors and patients; specific examples include streaming of live vital signs and alarms to a surgeon’s Glass device during an operation, or levering real-time access with voice dictation to chart hands-free directly into a patient’s electronic health record. Some practical challenges have, however, been noted including low battery endurance, picture quality, hygiene, limited availability of medical apps, and most importantly, data protection issues (3), causing some to question its current utility in the clinical setting and suggesting its confinement to the classroom. 

But is Glass of any use in pathology? We decided to tackle the question in our department of Pathology at the University of Pittsburgh Medical Center (UPMC) (4); our aim being to use Glass to develop a hands-free imaging modality integrated into gross pathology workflow. We acquired an Explorer edition of Glass, connected it to the Internet using our institution’s secure Wi-Fi system, and we tested it for use in autopsy, gross telepathology and telemicroscopy (Figure 2). And we were pretty impressed. It allowed our pathologists to remotely stream live feeds from our autopsy suite and easily capture hands-free static images of specimens. It was also of value to prosectors who could remotely access pathologists for their assistance while grossing pathology specimens. There were some difficulties encountered in the pathology laboratory, though, including lighting problems, low image resolution, and distracting background noise. But the biggest issue with this technology centers around data security. When streaming data, security is a major concern when it comes to privacy of patient’s personal healthcare information. Clearly, while Glass has much potential in pathology, more studies validating its role in clinical practice are needed.

Figure 2. University of Pittsburgh Medical Center pathologist investigates Google Glass for telepathology.

If the aforementioned key issues get addressed, we would likely use Glass on a regular basis. It offers great applications for real-time sharing. Also, like everything else in pathology informatics, it is hard to keep up with the pace of technological advancements. Not only are there already several competitors to Glass (for example, Recon Jet, GlassUp, Epiphany, Telepathy One), but there is also Oculus Rift from Facebook and HoloLens from Microsoft. Only time will tell if these are just gimmicks or if they have true potential for pathology, and even if that potential is proven, will the laboratory community embrace it or see it as a technological leap too far for today’s practice?

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  1. R Spencer et al., “The use of Google Glass for airway assessment and management”, Paediatr Anesth, 24, 1009–1001 (2014). PMID: 25039494.
  2. MH Schreinemacher et al., “Google Glass in surgery”, Surg Innov, 21, 651–652 (2014). PMID: 25389144.
  3. U-V Albrecht et al., “Google Glass for documentation of medical findings: evaluation in forensic medicine”, J Med Internet Res, 16, e53 (2014). PMID: 24521935.
  4. J Taylor et al., “Google Glass imaging modality for integrated gross pathology workflow”, J Pathol Inform, 6, S2–S3 (2015).

About the Author

Liron Pantanowitz

Professor of Pathology and Biomedical Informatics and Director of Pathology Informatics, University of Pittsburgh Medical Center, Pittsburgh, USA.

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