In the era of personalized medicine and targeted therapy, the diagnostic workup of patients with cancer is critical and tissue procurement is of paramount importance. Image guided procedures such fine needle aspiration, needle core biopsy, endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have increased in recent years and on-site evaluations for determining specimen adequacy and diagnosis have increased the demand in cytology involvement. Cytopathologist and cytotechnologist provide the clinician with important feedback on the quality and quantity of material, and the need for additional passes for ancillary studies. ROSE has reduced the number of repeat procedures due to non-diagnostic or insufficient specimens with significant improvement in patient care and reduction in health care costs 1, 2, 3, 4. Expansion of radiology services to off-site locations and acquisition of smaller radiology practices by larger hospital systems has heightened the need for ROSE coverage at these distant sites. Providing this labor-intensive service to multiple health care providers has created logistic challenges for the cytology staff. Moreover, the amount of time commitment by the cytopathologist during ROSE procedure is unpredictable and varies with the complexity of the procedure. A systemic cost-effectiveness study on ROSE found cytopathologists to be insufficiently compensated by current Medicare standards 5. The re-imbursement rate for ROSE procedure based on the current procedural terminology (CPT) code 88172 does not match the amount of time spent by the cytopathologist in these procedures 6. Cytotechnologists cannot bill for ROSE and complex procedures such as EUS, TBNA and EBUS often requires the presence of a cytopathologist.

Advances in telepathology and the application of this technology to perform ROSE have revolutionized the practice of cytopathology 7, 8, 9. Telecytology, as an alternative to in-person ROSE, offers the flexibility of covering procedures that occur at distant sites or when they happen simultaneously in different locations. Several studies confirmed the value of TC especially in big academic centers with satellite hospitals and off-site radiology services 10, 11, 12, 13, 14. There are several options for TC that are available in the market today.