Cookie sheets and frozen sections: the high-tech world of telepathology.
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In most tumor cases of neurosurgery, we need to have a rapid section diagnostic of the tumor during the course of surgery. When we have received the results that diagnose the exact dignity of the tumor, we devise the operation strategy for the continuing course of surgery. The tissue sample is sent by taxi to the pathological institute in Heidelberg. It takes approximately 45-60 min until we receive the results by telephone. Many centers are far away from a pathological institute and the patient may need to be re-operated on there. In stereotaxy it is still more important. We need approximately 15-25 specimens during a stereotaxy, so we can be sure we have a sample with some of the tumor tissue present. With direct contact to a pathological institute we could reduce this dramatically. We prepared a methylen blue slide and used a histological microscope with a video camera attached to it and a digitizer interface for digitized pictures. By use of a modem we send the pictures by telephone line to the pathological institute, where they are assessed. We currently have direct contact with a pathologist so they can tell us from which part of the tumor we should send the other histological pictures. The procedure takes about twenty minutes. By using this procedure the distance to the pathological institute is irrelevant. The system costs approximately $10,000, covering the cost mostly of the microscope and the camera (but we already had the microscope) and can be built by anybody with minimal requirements.
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Telemedicine is rather new activity covering various approaches in order to fulfill the main task which can be expressed in more comprehensive words such as "remote medicine" or "medicine on distance". One of definitions of the telemedicine given by the European Commission for Telemedicine says that "telemedicine is fast access to distributed medical expert knowledge using telemedicine and information technologies regardless of actual location of a patient or relevant information". The first connection has been established with Zagreb, Croatia in September by means of PHAROS. In October 1996 the Institute of Pathology with the Radiology and Ophthalmology Clinic of University hospital of Sarajevo has joined the experimental project "SHARED" (a telemedicine initiative to support remote health care structure, proposed by the San Raffaele International Biomedical Science Park with Stato Maggiore della diffesa and European Space Agency). Due to problems in infrastructure and lack of experts, small country like, Bosnia and Herzegovina (B&H) sees telemedicine as a future in its health care organizing.
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Low cost, high-quality consumer-type digital cameras are now available on the market to be used for taking macrophotographs and microphotographs by simply fixing the camera over the eyepiece of a conventional light microscope using an adaptator. The quality of the images obtained is as good as obtained with more expensive materials using Tri CCD cameras. Using the JPEG format for compression, the image file size is approximately 180 Ko. We present a low cost approach we have tested for one year in our pathology department.
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