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| Telepathology : distant interpretation of sections, taken from basic cytology and histopathology biopsys. Sections are transformed into slides using a microscope, then digitised and sent by telecommunication means. The distant expert will ensure interpretation and generate a report, to be sent by eletronic mail as well. |
There is a shortage of pathologists in many parts of the developing world. Furthermore, transport to or from rural sites is slow and expensive. Telepathology can help to alleviate these problems, since it makes it possible to have trained pathologist examinations without having to move either the patient or the pathologist.
Most developing countries have one central hospital - or collaboration with a centre of excellence abroad - with a pathology department, which is well staffed and equipped, whereas smaller rural institutions in the same country may not have equally good access to medical expertise. With regional networks - or international communication - of co-operating institutions, telepathology is good for getting accurate and early diagnoses.
Telenor, the Norwegian telecom operator, has actively pursued telemedicine reseach and development since 1987. Telenor has achieved excellent results in telepathology. Telenor has refined the technology so that a multipart, computer-supported pathology conference with full diagnostic quality can take place over a communication low-speed line, using the same equipment as is used for the diagnostic viewing.
Description of a potential project
In a regional or international network at least two sites will be involved:
1. The primary requesting party. This will be a small rural clinic with telepathology equipment, but without permanent pathologist staffing.
2. An expert medical center with existing facilities for laboratory medicine and well qualified staff, with extensive experience in preparing basic cytology and histopathology biopsys.
The equipment to be used in a potential project will comprise the following:
Communications equipment
The telepathology workstation can communicate via Ethernet LAN, VSAT, ISDN or ATM using TCP/IP in a multihead Microsoft environment. The full application must be capable of running on a 128 kbit/s link, with optimum performance close to 512 kbit/s.
Diagnostic-quality digital images can be transferred at «near real time» rates as the specimen is moved on the microscope stage.
The telepathology workstation
Remote microscope control. It is essential that the pathologist is comfortable with the thought of easily and intuitively controlling the remote microscope in a 1:1 online session. An acceptable level of direct control is provided through motorised x,y,z stepper motors on the remote microscope. It is essential for the workstation that this is closed-loop control, where the local system is continually informed of the position of the remote stage.
Arrangements for the demonstration at WTDC
At the stand on Malta the following type of demonstration will take place:
1. Malta will be acting as the receiver site, reviewing the received cytology or histopathology slides from biopsy material.
2. Connection with the Norwegian Radium Hospital in Oslo for a live telepathology conference, including video and audio connection, and synchronised editing and manipulation of the biopsys.
Contact : Grete S. Thøger
NRH is the largest cancer hospital in Northern Europe. It can accommodate 400 in-patients and has an out-patient clinic and a fairly large unit for experimental work, the Institute for Cancer Research. The institution constitutes a cancer center, offering diagnosis and treatment of cancer with the aid of all modern facilities, as well as advanced cancer research and teaching.
NRH is currently involved in several clinical trials abroad, including a study (20,000 people) in the Peoples Republic of China.
Demonstration liaison at the university hospital is dr. med. Jahn Nesland, Department of Pathology, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway.
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