Review of Telemicrobiology

Abstract

Context: Microbiology laboratories are continually pursuing means to improve quality, rapidity, and efficiency of specimen analysis in the face of limited resources. One means by which to achieve these improvements is through the remote analysis of digital images. Telemicrobiology enables the remote interpretation of images of microbiology specimens. To date, the practice of clinical telemicrobiology has not been thoroughly reviewed.

Objective: To identify the various methods that can be employed for telemicrobiology, including emerging technologies that may provide value to the clinical laboratory.

Data sources: Peer-reviewed literature, conference proceedings, meeting presentations, and expert opinions pertaining to telemicrobiology have been evaluated.

Conclusions: A number of modalities have been employed for telemicroscopy, including static capture techniques, whole slide imaging, video telemicroscopy, mobile devices, and hybrid systems. Telemicrobiology has been successfully implemented for several applications, including routine primary diagnosis, expert teleconsultation, and proficiency testing. Emerging areas of telemicrobiology include digital plate reading of bacterial cultures, mobile health applications, and computer-augmented analysis of digital images. To date, static image capture techniques have been the most widely used modality for telemicrobiology, despite newer technologies being available that may produce better quality interpretations. Telemicrobiology adds value, quality, and efficiency to the clinical microbiology laboratory, and increased adoption of telemicrobiology is anticipated.

Figure 1

A bronchoalveolar lavage cytospin with toxoplasmosis is shown (Romanofsky stain). Three imaging techniques were used to digitize the glass slide to create this comparative figure including 40x whole slide imaging (WSI) using the Aperio ScanScope XT (top row), 83x oil-immersion WSI using Aperio CS-O (middle row), and a 100x oil-immersion static image captured using an Olympus U-TV0.5XC-3 camera (bottom row). At low magnification (left column) all of the images appear to be of similar quality. However, when viewing a Toxoplasma tachyzoite at higher magnification (right column) there is a marked difference. In the 40x WSI image (top right), the tachyzoite's nucleus is difficult to resolve when maximally zooming in on the image. In the 83x WSI image (middle right), the nucleus is clearly visible, but nuclear details are still not entirely evident. In the 100x static capture image (bottom right), the nucleus is clearly visible, and some nuclear detail is evident. (The 83x images were generously provided by Mohamed E. Salama, MD.)

Figure 2

Copan's WaspLAB software interface for digital plate reading. The software displays a digitally photographed culture plate and provides tools to annotate and analyze the image. Thumbnail images of the Gram stained specimen are visible at the bottom of the browser window, and these slides are meant to be viewed using the same software interface. Image is courtesy of Copan.

Figure 3

The workflow of a telemicrobiology system begins with image acquisition (green) followed by a number of possible analysis pathways (black) and then a final interpretation (red). Typically, image acquisition and novice analysis is performed at the same physical location and does not incorporate the use of telemicrobiology. Telemicrobiology is used when consulting an off-site expert. Currently, computer analysis is not routinely used, but in the future computer analysis is likely to be a valuable resource to enhance the quality and/or speed of digital image analysis that can be performed by on-site novices and off-site experts.