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2020, Volume 36, Number 3, Page(s) 218-226
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DOI: 10.5146/tjpath.2019.01484 |
Evolution of Telepathology: A Comprehensive Analysis of Global Telepathology Literature Between 1986 and 2017 |
Engin ÞENEL1, Yýlmaz BAÞ2 |
Department of 1Dermatology and 2Pathology, Hitit University Faculty of Medicine, ÇORUM, TURKEY |
Keywords: Telepathology, Telemedicine, Bibliometrics, Scientometrics, Publication trend |
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Objective: Telepathology is an application of telemedicine providing remote evaluation and consultation of digital pathology images and can be
used for educational or experimental purposes. Bibliometrics is a statistical discipline investigating publication patterns and trends in a certain
academic field. Although bibliometric and scientometric studies are becoming increasingly popular, the relevant literature contains only one
limited article related to telepathology. The aim of our study was to perform a holistic bibliometric analysis of the telepathology literature.
Material and Method: Since the first article on telepathology was published in 1986, we included all indexed articles retrieved from Web of
Science databases between 1986 and 2017.
Results: We found that the USA covering 43.01% of all literature was the leading country in the telepathology field and was followed by Germany,
Italy and the UK (n=120, 90 and 83, respectively). The countries with the most contributions were located in the continents of Europe and North
America. The most productive source titles were Human Pathology, Journal of Telemedicine and Telecare, and Modern Pathology. Harvard
University ranked first with 59 articles. The most commonly used keywords of the telepathology literature were “telepathology”, “telemedicine”,
“digital pathology”, “virtual microscopy” and “telecytology”. We noted that all of the ten countries with the most contributions were in the
developed category of UN classification and all twenty of the most productive institutions were from developed countries.
Conclusion: We suggest that researchers from developing and least developed countries should be encouraged to carry out novel studies since
telemedicine is a required and promising technology for rural developing or least developed areas in which access to health care is difficult. |
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Telemedicine is the process of transmitting medical
information and the application of medical services using
communication technologies 1. The World Health
Organization (WHO) defines telemedicine as “..the
delivery of healthcare services, where distance is a critical
factor, by all healthcare professionals using information
and communication technologies for the exchange of valid
information for diagnosis, treatment and prevention of
disease and injuries, research and evaluation, and for the
continuing education of healthcare providers, all in the
interests of advancing the health of individuals and their
communities…” 2. Telepathology is a relatively novel
practice of telemedicine providing remote evaluation of
digital pathology images. Telepathology is defined by the
American Telemedicine Association as “the electronic
multimedia communication across a network of pathologyrelated
information, between two or more locations for use
between pathologists and/or qualified laboratory personnel,
and may include involvement by clinicians and/or patients” 3. Telepathology can be used for educational or
experimental purposes, primary diagnosis and secondary
consultation in all divisions of pathology including histocytopathology,
autopsy, and surgical and anatomical
pathology 4.
Bibliometrics provides holistic data on publication trends
and patterns and is described as “science of science”
5. Although scientometric and bibliometric studies
have been popular recently, only one study relevant to
telepathology has been reported so far to the best of our
knowledge. To fully utilize the advantages of telepathology,
individual feasibility studies are necessary, as data analysis,
organizations, societies and infrastructures 6. Our study
aims to present a comprehensive bibliometric analysis of
the literature of telepathology. |
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Abstract
Introduction
Methods
Results
Disscussion
References
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All data of our study was retrieved from four databases of
Web of Science (WOS, Thomson Reuters, New York, NY,
USA) titled Web of Science Core Collection, Korean Journal Database, SciELO Citation Index and Russian Science
Citation Index. We used the keywords of “telepathology”
and “telecytology” to search the WoS database. All
documents produced between 1986 and 2017 were
included. Since the first article of telepathology literature
was published in 1986, we chose 1986 as the starting year.
We used GunnMap to generate a global productivity map
7. VOSviewer was the freeware tool used for creating
scientometric networks in our study 8. We used the
United Nations (UN) system for country classification 9. |
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Abstract
Introduction
Methods
Results
Disscussion
References
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General Feature of the Literature
Our search yielded 1109 articles in the telepathology
literature between 1986 and 2017. Only 237 documents
(21.37%) were open access. The peak year for number of
publications was 2012 with 83 articles. No pattern was
detected in the progress of the total number of publications
by year. No items were produced in the years of 1988, 1990
and 1992 (Figure 1). English is the main language of the
literature (94.91%) followed by German and French (2.43
and 2.08%, respectively). The most studied research areas
were found to be health care sciences, telecommunications,
pathology, computer science and oncology (68.89, 63.12,
55.45, 42.38 and 39.58%, respectively; Table I). The most
common document types in the literature were original
article, meeting abstract and review (72.77, 28.40 and
18.12%, respectively; Table II).
Click Here to Zoom |
Table I: The most studied research areas of the telepathology
literature between 1986 and 2017. |
Productivity of Countries, Authors, Journals and
Institutions
The USA, covering 43.01% of the literature, was detected
to rank first among countries with 477 articles, followed by
Germany, Italy and the UK (n=120, 90 and 83, respectively; Figure 2). China stood out among developing countries
according to the UN classification with 18 articles (3.07%)
followed by Brazil, India and Colombia (1.44, 1.26 and
0.81%, respectively). From the underdeveloped (least
developed) countries, Benin, Burundi, Congo, Rwanda,
Senegal, Sudan and Zambia produced one article each.
Click Here to Zoom |
Figure 2: Top ten countries publishing telepathology articles between 1986 and 2017. |
The countries contributing the most countries were
located in the continents of Europe and North America
(Figure 3). Weinstein RS was the most prolific author
with 44 papers (3.97%, Table III). The source titles with
the most contributions were Human Pathology, Journal
of Telemedicine and Telecare and Modern Pathology (n=
80, 69 and 56 articles, respectively; Table IV). The most
productive meeting in this field was the 10th European
Congress on Telepathology and the 4th International
Congress on Virtual Microscopy with 20 proceedings
(Table V). Harvard University was the leading institution
with 59 documents followed by the University of Arizona,
Pennsylvania Commonwealth System of Higher Education,
and the University of Pittsburgh (n= 52, 50 and 48 items,
respectively; Table VI).
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Figure 3: Publication density of world countries in the telepathology field. |
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Table III: The 20 most prolific authors of the telepathology
literature between 1986 and 2017. |
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Table IV: The journals with the most contributions to the
telepathology literature. |
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Table V: The meetings or conferences in which the most documents on telepathology were presented. |
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Table VI: The 20 most productive institutions in the telepathology literature between 1986 and 2017. |
Citations, Keywords and Bibliometric Network Analyses
The h-index is a calculated metric value to measure
productivity and citation impact in a certain area. The
h-index of telepathology literature was 52. The total number
of citations was 14,911 (8,997 without self-citations) and
the average number of citations per item were 13.45.
The most cited article was an original article titled
“Telemedicine Technology and Clinical Applications”
published in 1995 by Perednia and Allen (Table VII). This
article did not only focus on telepathology and mentioned
telepathology as an application of store-and-forward
telemedicine 10. The most cited document focusing on
telepathology was an original article titled “Overview of telepathology, virtual microscopy, and whole slide imaging:
prospects for the future” published in 2009 by Weinstein
RS who is the most prolific author of telepathology
literature, and was cited 146 times. The article presented
information relevant to fourth-generation telepathology
systems, so-called virtual slide telepathology systems used
for educational purposes 11.
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Table VII: The most cited articles in telepathology literature by decades. |
The most common keywords of the telepathology literature
were “telepathology”, “telemedicine”, “digital pathology”,
“virtual microscopy” and “telecytology” (Table VIII).
Bibliometric network analysis of the keywords revealed a
“starburst pattern” in which keywords of “telepathology”,
“digital pathology” and “internet” were centered (Figure
4). As we analyzed the co-authorship among countries, it
was found that the most collaborative countries were the
USA with 377 documents and 6286 citations (total link
strength, TLS=127) followed by Italy, the UK and Germany
(TLS=79, 73 and 71, respectively; Figure 5).
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Figure 4: Bibliometric network of the most used keywords in the telepathology literature. |
Click Here to Zoom |
Figure 5: The most collaborative countries in the telepathology literature. |
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Abstract
Introduction
Methods
Results
Disscussion
References
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The earliest telemedicine applications date back to the
eighteenth and nineteenth centuries. In these centuries,
patients wrote detailed letters containing medical histories and symptoms and sent them to specialist doctors by
couriers, and doctors responded with the diagnosis,
treatment plan and prescription 12. Willem Einthoven
(1860-1927), a Dutch doctor and physiologist who invented
the first electrocardiogram (ECG) transmitted ECGs of
the patients from the hospital to an off-site laboratory by
means of telegraph 13. The first remote assessment of
medical images, reported in 1950, was performed between
the Chester County Hospital and Philadelphia over a
distance of twenty-eight miles via commercial telephone
wires or radio and described as “telognosis” 14. In the late
1950s, National Aeronautics and Space Administration
(NASA) initiated the Space Technology Applied to Rural
Papago Advanced Health Care (STARPAHC) Project
for telemedical consultation of people living in remote
locations of Arizona’s Papago Indian Reservation with little
or no medical services. In 1964, a closed circuit television system was introduced between the Nebraska Psychiatric
Institute and the Norfolk State Hospital 112 miles away to
use telemedicine for neurologic and psychiatric evaluation
of the patients 15.
The first recorded telepathology procedure was performed
in the late 1960s between Massachusetts General Hospital
and Logan Airport Medical Station in Boston via a realtime
“television microscopy” service 16. Since this onset,
the research area of telepathology has been growing into
subfields. The first paper in the telepathology field was
an editorial published in 1986 and titled “Prospects for
Telepathology” by Ronald Weinstein. The author defined
telepathology as “the practice of pathology by visualizing
an indirect image on a television screen rather than
viewing a specimen directly through a microscope…”.
Interestingly, there was no study on telepathology in the medical literature prior to this definition. Weinstein
predicted the future of computer technology perfectly
and defined the level of development of telepathology at
that time as “an embryonic stage of development” 16.
Over the last 30 years, the generation of telepathology
systems has improved rapidly with the evolution of digital
microscopy: video-microscopy, robotic microscopy and the
upgrade to virtual slide processing systems. This change is
a revolution in the traditional pathology practice in today’s
computer age 17. Increased workload, case complexity,
financial constraints, and staffing shortages justify wider
implementations of digital pathology 6. The possibility to
consult expert colleagues using telepathology, particularly
for cases not requiring molecular investigations in external
laboratories, may also permit significant financial savings,
reduce the turnaround time, facilitate the international
change of information, and support the sharing of even
more cases 18.
Bibliometrics is a popular statistical application providing
quantitative and qualitative analysis of a certain academic
field 19. The term was coined by Alan Pritchard in the
late 1960s as ‘‘an application of mathematics and statistical
methods to books and other media of communication”
although Siyali Ramamrita Ranganathana, who was a
librarian and mathematician from India, created the
principal ideas behind bibliometrics and scientometrics
in the 1940s 19,20. Bibliometric studies have become
increasingly popular in the academic literature in the last
decades, and a total of 8806 reports have been published in
the time period of our study according to the WoS databases.
Although the term of telepathology has been included in
MeSH terminology since 1996, the scientific literature
contained only one bibliometric study of telepathology.
Della Mea reported the first and only bibliometric study in
the telepathology literature in 2011 21. The data of this
study was extracted from PubMed and only 967 papers published in 344 different journals from 34 countries were
detected between 1986 and 2010. The USA was found to be
the leading country as noted in our study with 310 articles
(32.06%) followed by Germany, Italy, UK and Japan (n= 81,
46, 40 and 27 documents, respectively). The major journals
in the telepathology field were Journal of Telemedicine and
Telecare, Human Pathology and the Telemedicine Journal
(n= 71, 65 and 27 items, respectively) 21.
In conclusion, we found that all ten of the most contributing
countries were in developed category of UN classification
although telemedicine is a required and promising
technology for rural developing or least developed areas in
which access to health care is difficult. Also, all twenty most
productive institutions were from developed countries.
We suggest that researchers from developing and least
developed countries should be encouraged to carry out
novel studies.
CONFLICT of INTEREST
The authors declare no conflict of interest. |
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Abstract
Introduction
Methods
Results
Discussion
References
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Abstract
Introduction
Methods
Results
Discussion
References
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Copyright © 2020 The Author(s). This is an open-access article published by the Federation of Turkish Pathology Societies under the terms of the Creative Commons Attribution License that permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited. No use, distribution, or reproduction is permitted that does not comply with these terms. |
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