LIVE SHARING OF MULTI-HEADER MICROSCOPE PATHOLOGY EDUCATION SESSIONS BETWEEN METROPOLITAN AND REGIONAL CENTRES

Experiential learning occurs when junior pathologists are grouped around a multi-header microscope viewing and discussing slides with a senior experienced pathologist. The high educational value of such learning sessions in postgraduate pathology has been widely reported.

Attempts have been made to share multi-header slide sessions and the embedded learning experience between geographically distant sites using conventional video-conferencing. This process, however, is beset by problems such as variable bandwidth, limited availability of ports, cost of video conferencing equipment and the fact that hospital video conferencing equipment is generally not co-located with multi-header microscopes. In addition, uploading lag time, pixilation and distortions significantly impact on the visual input required to recognise morphological features pathognomonic of disease entities.

We aimed to bypass conventional video conferencing by streaming moving microscope images and the associated discussion to a computer and then utilising a cloud based screen sharing system. In order to achieve this we connected an Infinity HD camera to the Olympus BX43 microscope and multi-header system used for teaching. However, the InfinityHD camera produces live video stream in the HDMI output from the camera and is suitable for TV, not computer connection. We therefore connected an Elgato game capture HD device to convert the HDMI signal and transmit video to a desktop computer (with the required power to drive the camera). Using this system with H.264 encoding we can capture excellent HD quality while keeping the file size low. Supported resolution is 1080p (simultaneous 60 fps pass-through and 30 fps capture). The operating pathologist can view the slide both down the microscope and on the computer monitor. Screen sharing via GoToMeeting, WebEx, or similar makes it possible to transmit education sessions to participating sites. In order to maximise the visual signal we separated audio from the moving images and transmitted the sound via a telephone connection. This low cost system enabled both viewing of high resolution lag free images and clear synchronous sound in diverse locations.

Discussions about slide features are immediate and as interactive as the facilitator and participants desire. The ability to share cursor control with linked individuals supports legitimate participation. Entire sessions can be recorded for asynchronous viewing and for archive purposes. File sizes are significantly smaller than those generated using virtual microscopy and have the benefit of directed commentary. This system has proved to be robust and has expanded teaching collaborations between different pathologists and locations. The potential for diagnostic work and second opinions is being explored.