The Implementation of Cloud-Based Telemedical Applications for External Quality Control Purposes in the Field of Cytopathology

Background

Proficiency testing (PT) is a well-recognized method for evaluating actual laboratory performance, usually, by means of interlaboratory comparisons (Cramer et al., 1991; Woodhouse et al., 1999). Proficiency testing results can be used as an independent indication of a laboratory’s diagnostic competence and can be integrated in the ordinary process of the laboratory’s assessment and accreditation (Cramer et al., 1991; Woodhouse et al., 1999). According to ISO 15189:2007, all accredited laboratories must conduct proficiency tests in accordance with their regular patient testing and reporting procedures (Pantanowitz et al., 2009). A recent revision of ISO 15189, published in 2012 proposes the additional use of alternative methods for the evaluation of laboratories technical competence, where accredited PT schemes are not available. The practice of diagnostic cytopathology performed on digital images is a process by which remote laboratories can obtain expert opinions on difficult cases (telecytology) (Archondakis et al., 2009). Telecytological diagnosis can be achieved either with the use of cytological images viewed in real time from the microscope (dynamic telecytological systems), or with the use of cytological pictures that are first captured in a digital format and then transmitted to distant observers (static telecytological systems) (Archondakis et al., 2009; Stamataki et al., 2008) or combinatorially (Della Mea et al., 2000) . Hybrid systems have also been developed. However, the majority of relevant articles have focused on the possible use of telecytology for diagnostic and consultation purposes (Archondakis et al., 2009).