Investigating Necropsies Using Telemedicine 

Background

Post-mortems, or necropsies, are an effective tool to tell us why something died, and potentially inform management to help prevent it in the future. Veterinarians are trained to perform routine post-mortems, but pathologists are specialized veterinarians and have expertise in the causes of disease and death. However, there are few in Canada and rarely are they located in rural locations and readily available to perform on-site post-mortems. While pathologists are often better able to diagnose a problem when they have access to the whole animal rather than just tissue samples, sending whole bodies to a lab is often impractical and expensive, especially with large livestock like cattle. However, current technology provides an opportunity for telepathology, where pathologists can virtually attend field post-mortems with on-farm veterinarians through a video call. This allows the specialists to see the body on site and work with the veterinarian to harvest the optimal samples based on what they are seeing. The use of telepathology for complex cases or outbreaks makes diagnostics more accessible in rural locations and improves the likelihood of a definitive diagnosis. Having definitive and reliable diagnosis on causes of death whether it be infectious from bacteria or viruses or non-infectious from toxin exposure or trauma, informs cattle producers and vets to help improve herd health, biosecurity, and overall animal and human welfare.

Objectives

• Determine if real-time pathologist assisted field necropsies improve the success of coming to an etiologic diagnosis as compared to non-assisted field necropsies. 
• Determine if pathologist assistance decreases the amount of time and money it takes to come to an etiologic diagnosis from a field necropsy.
• Determine if real-time pathologist assisted field necropsies are a useful and viable service option to be offered to food animal veterinary practitioners by the Diagnostic Services Unit (DSU) at UCVM.

What they did

This team developed a process to use video calling to allow a pathologist at the DSU to virtually attend field post-mortems allowing specialist consultation without having to send a whole body to the lab. They worked with five veterinary clinics to collect a total of 58 necropsies. 32 were collected and submitted normally as unassisted field necropsies while the other 26 were Real-Time Pathologist Assisted Necropsies (RT-PAN). The RT-PAN cases had veterinarians and pathologists connected via video call allowing the pathologist to provide assistance the interpretation of pathology present, collection of samples, and have a visual of the site and animal itself. In both cases, samples were submitted to the DSU for assessment, performing additional tests as needed, to arrive at a definitive diagnosis. Cost and ability to determine the cause of death were recorded for both unassisted and assisted field necropsies.

Following the study, the participating cattle veterinarians and pathologists were asked to comment on if they found the assisted field necropsies useful and whether they would make use of a telepathology service if it were offered by the DSU.

What they Learned

This study helped to answer a few key questions: do assisted necropsies help reach definitive diagnoses more often? Are they cost effective? And did veterinarians find them useful and an effective use of time?

This team learned that pathologist assisted field necropsies reached an definitive diagnosis 98% of the time, compared to unassisted necropsies which only reached an definitive diagnosis 67% of the time. This meant a better use of producer money and veterinary resources; improved satisfaction and relationships for producers, field veterinarians, and pathologists; informed decisions on herd management and treatment; and increased awareness of the value of necropsies.

Through the survey, it was clear that veterinarians would want to use this service and pathologists are willing to deliver it, particularly in challenging cases. In addition to improved diagnostic rate, two other notable features of the service were relationship building between veterinarians and pathologists and continuing education.

However, RT-PANs are not without their challenges. The service’s availability is highly dependent on telecommunications services in the area, and lack thereof may limit use in remote areas. Even in areas with well-developed telecommunication, issues such as adverse weather conditions, poor video, poor audio, and challenges in equipment setup posed challenges for veterinarians and pathologists. A second barrier is the capacity of veterinarians to learn a new skill and train others as time is a limited resource for most large animal vets. Though, the vets who responded to the survey expressed that RT-PANs were a valuable use of time for them.

What this means

Rural vets having access to RT-PANs would support animal disease surveillance in Alberta leading to improved animal health and welfare, food safety, market access, consumer confidence, and public health. Telepathology is particularly relevant in a province as large as Alberta where most farm animals are remote from the lab. RT-PANs could bring diagnostic laboratory expertise to underserved communities and livestock across the province, reaching beyond cattle diagnostics to support all food animals.

Additionally, both the cattle veterinarians and pathologists saw the benefits of pathologist assisted necropsies. Veterinarians indicated they would use the service if it were offered, and the pathologists were willing to provide it. With advancement of telecommunication services, rather than cattle coming to the lab, the lab could be brought to the farm, servicing underserved communities and animals in all corners of the province.

Further, the potential to build relationships and provide continuing education is extremely valuable. Opening up communication to allow for collaboration between producers, veterinarians, and specialists by providing an accurate and reliable service means a better flow of information, better value of producer dollars, and a healthier beef herd. The educational aspect is of particular interest as the service could be extremely valuable in the training of veterinary students, supporting newly graduated veterinarians, guiding veterinary technicians, or providing support to rural veterinarians in remote clinics.