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PubMed1997

Expert pathology consultation through the Internet: melanoma versus benign melanocytic tumours.

Twenty consecutive cases of melanocytic lesions were chosen from the archives of the archives of the institute of Anatomic Pathology at Santa Chiara Hospital, Trento. Representative images were acquired at a spatial resolution of 512 x 512 pixels, saved in IPEG format and delivered to the remote pathologist by multimedia internet electronic mail. Six cases were diagnosed as benign melanocytic lesions by the local pathologist. Of the 20 cases transmitted, each with an average of 5.3 images, the remote pathologist suggested a diagnosis of malignancy in nine cases while 10 cases were thought to be benign. In one case the images were not considered sufficient for diagnosis. Overall, the diagnostic agreement between local and remote pathologist was 79% (kappa = 0.58, P = 0.002). This preliminary study suggest that telepathology by internet electronic mail can be a valuable tool for remote consultation in dematopathology, as well as for other diagnostic fields where expert consultation is necessary.

Computer Communication Networks↗

PubMed2004

Review on the state of telemedicine and eHealth in Iceland.

This article provides an overview of telemedicine and other eHealth activities in Iceland. Several telemedicine projects, which have been running since 1996, are described. The projects include teleradiology, teleobstetrics, telepsychiatry, maritime telemedicine, telemedicine in surgery, telepathology and a project for the use of telemedicine in various consultations. The role of the Icelandic Health-net for telemedicine, including projects for teleobstetrics and telemedicine for emergency medicine, is described with the projects included:. A few other eHealth activities, including electronic patient record and information systems, are also described.

Health Status↗

PubMed2000

Telemedicine of the future: teleneuropathology.

The chief relevance of telemedicine lies in its capability to link medical practitioners and remote hospitals to larger or specialized facilities in a very fast electronic manner. This may become even more important due to current increase in subspecialization and demand for more precise diagnosis and consultation in difficult cases. A network attaching small clinics or laboratories to larger and more specialized units, and to highly specialized referral centers may improve the professional standard of health care services and education. For a wider use, a technological standardization will be required, since the existence of several types of computer and numerous image manipulation programs, have resulted in a proliferation of file formats. However, every potential user or client of telemedicine should keep in mind, that standardization also includes legal and ethical issues such as patient confidentiality and malpractice avoidance. The adoption of workable guidelines and protocols is required. Telepathology in general and teleneuropathology in particular is the practice of pathology at a distance, viewing digitized images of histological slides on a video monitor rather than directly through a light microscope. For the transmission of the digitized images from a telemicroscope to the remote diagnostic video monitor, different technologies such as ordinary telephone lines, broadband telecommunications channels, and the Internet can be used. The transmitted images may serve for primary neuropathological diagnosis, teleconsultation, quality assurance, proficiency testing, and distance learning. Static-imaging and dynamic-imaging are the two major competing technologies of telemicroscopy. Static-imaging systems appear to have levels of diagnostic accuracy which are not satisfactory for diagnostic neuropathology. On the contrary, high levels of diagnostic accuracy can be achieved using dynamic-imaging systems with the transmission of live video images in real time and by using a robotized telemicroscope with the possibility to examine the entire histological specimen under control of the remote teleneuropathologist.

Diagnostic Techniques, Neurological↗

PubMed2001

[Electronic communication in medicine].

Rapid developments in information and communication technology allow a fast transfer of extensive data. Geographical distances do not longer hinder an intense cooperation in diagnostics. The review shows the variety of possibilities for medical applications. Technique, routine application, experiences and the legal conditions are presented for telepathology as an example.

Humans↗

PubMed2002

Healthcare telematic applications in Cyprus.

OBJECTIVES: a) To present a review of ongoing health telematic applications in Cyprus. b) To promote the use of these health telematic applications in the Cyprus region. c) To help in the spin off of other health telematic applications thus enabling the offering of a better health service to the citizens. METHODS AND RESULTS: The health telematics applications include a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a system for the evaluation of the risk of stroke by telemedicine (EROS), a diagnostic telepathology network in gynaecological cancer (TELEGYN), a collaborative virtual medical team for home healthcare of cancer patients (DITIS), and a health telematics training network (HEALTHNET). The paper refers to the set-up and characteristics of these applications and tries to relate them with the health policies that should be applied in Cyprus. CONCLUSIONS: It is anticipated that this paper will promote the importance of health telematics applications for Cyprus and increase the awareness on the possibilities that these applications offer for health policies in all levels of health related human resources.

Ambulances↗

PubMed2005

iPath - a Telemedicine Platform to Support Health Providers in Low Resource Settings.

In many developing countries there is an acute shortage of medical specialists. The specialists and services that are available are usually concentrated in cities and health workers in rural health care, who serve most of the population, are isolated from specialist support [1]. Besides, the few remaining specialist are often isolated from colleagues. With the recent development in information and communication technologies, new option for telemedicine and generally for sharing knowledge at a distance are becoming increasingly accessible to health workers also in developing countries. Since 2001 the Department of Pathology in Basel, Switzerland is operating an Internet based telemedicine platform to assist health workers in developing countries. Over 1800 consultation have been performed since. This paper will give an introduction to iPath - the telemedicine platform developed for this project - and analyse two case studies: a teledermatology project from South Africa and a telepathology project from Solomon Islands.

Developing Countries↗

PubMed1995

Previous experience in teleradiology could serve as a first lesson to telepathologists.

The author draws the following conclusions from twenty years of experience with teleradiology and in telemedicine in general. 1) Standardise now. Use existing standards, keep protocols open for other partners. The use of "protected" or "slightly" modified standards will not open the market. On the contrary, it will slow down developments in telepathology. How many manufacturers are capable of exchanging images over normal communication lines (analog or ISDN) with others than themselves? 2) Develop adequate user-interfaces. Priority levels should be set. The display has to adapted to the user. For pathologists this means using a microscope to view the images that have been sent [11]. For radiologists this means a dynamic user-interface adapted to the radiologists needs and wishes and which provides the best possible working environment [5]. 3) Integration with the HIS. The purchase and installation of telemedicine equipment should be integrated in a whole informatisation strategy and not be considered as a standalone act.

Computer Communication Networks↗

PubMed1995

Pathology consultation services via the Arizona-International Telemedicine Network.

The Arizona-International Telemedicine Network (AITN) links 4 cities in Arizona and two international sites in China and Mexico, into a telepathology diagnostic network. Established in 1993, the Network provides second opinions on surgical pathology and cytopathology cases. Workstations are 486 PC-based computers. Static images (1024 x 774 x 8 pixels) are grabbed with a variable resolution video camera and sent by 14,400 bit per second modems over ordinary telephone lines. Second opinions are either rendered directly by a general telepathologist or triaged to a specialist. Experience with the first 37 cases indicates a high level of success in providing useful information to referring pathologists over the Network.

Computer Communication Networks↗

PubMed1995

Remote frozen section service in Norway.

Remote frozen section service has been in regular use in northern Norway since 1990. Two local hospitals are equipped with a motorized video microscope remote controlled from the workstation at the University Hospital. The video images are transmitted via a two ways audio and video telenetwork. This dynamic telepathology system utilizes a videocodec for image compression and a transfer rate of 384 Kbit/s. The video images of surgical specimens and frozen sections are displayed on monitors at both the sender and receiver site. From 1990 until 1. July 1994 tissue from 100 patients have been examined. Breasts and thyroid tissues accounts for 74 of cases. Correct benign versus-malignant diagnosis has been given obtained in 89 cases. One false positive, three false negative and seven deferred diagnosis regarding malignancy have occurred. The false positive diagnosis had no major consequences for the patient. Two of the deferred diagnosis turned out to be malignant. The average time taken for examination of each frozen section was 12 minutes (range, 3 to 45 min). Our concept of remote frozen section service can be recommended for hospitals without a local service in surgical pathology.

Breast Neoplasms↗

PubMed1995

Supporting telemicroscopy and laboratory medicine activities. The Greek "TELE.INFO.MED.LAB" project.

In this paper the authors present the basic results of the study for the "TELE.INFO.MED.LAB" project. This study is based on the local experience of the Metaxas Cancer Institute case and on international references. The possibilities rendered by current developments in telemedicine and particularly in telepathology accelerate and facilitate the communication of crucial medical data and creation of "second level" medical services overcoming the geographical particularities of the country. The availability of data transmission (signals, images, texts, etc.) enables the creation of a "uniform market" for various services. This system must take into account the financial realities, geographical aspects transportation problems and technological developments. Organization of this system, the choices of technical standards and the realization of a complete pilot project are described. For this system we also describe the functional and technical aspects, as well as software and hardware components for the different types of units.

Computer Communication Networks↗

PubMed1996

[The cervico-vaginal smear. What is new with the Papanicolaou method in 1996?].

Recently, quality control became one of the priorities of cytopathology applied to screening for carcinoma of the uterine cervix. Taking into account the evolution of our knowledge and the progress of telematics in medicine, several new methods provided a potential benefit. The main ones were the following : telepathology, making distant transmission of microscope images possible, in order to require the opinion or advice of a more experienced colleague; an image data bank, illustrating typical or unusual images, as an aid to diagnosis and to teaching; computer assisted systems, able to process conventional smears and to optimize the detection of atypical cells, in order to reduce the number of false negatives. These methods are tools at the clinician's disposal- and not the contrary -bearing in mind the idea that cytodiagnosis is, and must remain, a medical labour.

Female↗

PubMedDate not supplied

A national treasure goes online: the Armed Forces Institute of Pathology.

With the advent of the 21st century, the Armed Forces Institute of Pathology is delivering online medical consultation to the global health care community. By incorporating widely available open system technology into the paradigm of telepathology, the AFIP is providing world class expertise in pathology and access to a wealth of information for physicians and the general public. The national treasure known as the Armed Forces Institute of Pathology has more than a glorious history; it has a pretty bright future, too.

Computer Communication Networks↗

PubMed1999

Telemedicine: the new must for surgery.

The vision of telesurgery comprises a multitude of new communicative elements influencing the way surgeons will treat their patients in the future. The first prerequisite for effective telecommunication is to digitize surgical data. Many medical imaging modalities provide primarily digital data sets, and digital image communication is already entering clinical practice under the labels of teleradiology and telepathology. However, for any surgical purpose, images must refer to tissues. Three-dimensional image reconstruction is warranted, and if such data shall be useful during surgery, different image sources must be combined into some virtual, multiparametric body model and matched to an intraoperatively distorted organ contour. A multitude of detail problems arise, beginning with image standards, data interfaces, data transport, image fusion, registering, contour matching, and, once the data are integrated, all the aspects of surgery-suitable data display and interaction. We refer here to several demonstration projects illustrating such a complex surgical data set and its interactive telecommunication. In all instances, telecommunication was to enable a concentration of distributed medical intelligence at the site where the patient was treated. With further technological development, such telesurgical applications will have a growing influence on patient management and surgical decision making. In the very near future, computer-aided navigation and robotic assistance, based on the same surgical data sets, will be available to all fields of surgery. How decisive the role these methods will play for specific procedures or diseases needs to be determined.

Computer Simulation↗

PubMed2006

Virtual microscopy in virtual tumor banking.

Many systems have already been designed and successfully used for sharing histology images over large distances, without transfer of the original glass slides. Rapid evolution was seen when digital images could be transferred over the Internet. Nowadays, sophisticated virtual microscope systems can be acquired, with the capability to quickly scan large batches of glass slides at high magnification and compress and store the large images on disc, which subsequently can be consulted through the Internet. The images are stored on an image server, which can give simple, easy to transfer pictures to the user specifying a certain magnification on any position in the scan. This offers new opportunities in histology review, overcoming the necessity of the dynamic telepathology systems to have compatible software systems and microscopes and in addition, an adequate connection of sufficient bandwidth. Consulting the images now only requires an Internet connection and a computer with a high quality monitor. A system of complete pathology review supporting biorepositories is described, based on the implementation of this technique in the European Human Frozen Tumor Tissue Bank (TuBaFrost).

Databases, Factual↗

PubMed1996

Supportive care programs in cancer at the National Cancer Center in Tokyo.

Until recently, supportive care for cancer patients in Japan was not well organized. Not too many oncologists paid attention to the improvement of daily life of patients with advanced or terminal cancer. Oncological staffs such as doctors, nurses, psychologists, and pharmacists at hospitals in Japan did not really cooperate efficiently. Recently, however, we have begun to develop and to expand activities for supportive care of cancer patients using new concepts of treatment. At the National Cancer Center in Japan an effort is being made to expand activities in PCU, the application of Chinese acupuncture for pain relief, and the development of a virtual reality technique. A system to connect cancer centers has been established and is now being expanded to facilitate a new database on up-to-date cancer information. We have already started holding multi-institutional medical teleconferences, telepathology and teleradiology on a weekly basis, covering nine cancer centers throughout Japan.

Hospital Units↗

PubMed1995

Health Care Financing Administration (HCFA) and reimbursement in telemedicine.

Telemedicine has real potential to improve the availability of services and advice of medical specialists to primary care practitioners and their patients. Use of the term "telemedicine" for the purposes of this article will refer to two-way, interactive video systems over which medical consultation takes place. This does not include the use of telecommunications technology to transport still images, particularly radiologic images, from one site to another. We are quite aware that teleradiology and telepathology is already in common use in many sites. We are currently exploring the question of quality standards for teleradiology in addition to other forms of telemedicine.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2000

[Telemedicine in otorhinolaryngology exemplified by a Tübingen-Leipzig video conference].

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability, reliability, costs and quality were determined and compared with other technologies for audiovisual data transfer.

Curriculum↗

PubMed2000

[Audiovisual telecommunication by multimedia technology in HNO medicine. ISDN--internet--ATM].

Telemedicine includes all medical activities in diagnosis, therapeutics, or social medicine undertaken by means of an electronic transfer medium, enabling the transmission of visual and acoustic information over long distances to doctors not personally present at the place of the requested consultation. Most experience with telemedicine applications has been gained in the field of diagnosis (teleconsultation, teleradiology, telepathology) and is expanding to quality control and quality assurance. Decisive for each form of application is its availability, practicability, cost, safety, and especially quality of audiovisual transmission. For telesurgical applications, particularly the use of minimally invasive techniques in otorhinolaryngology, head, and neck surgery, the high quality transmission of audiovisual data in real time is necessary. Rapid expansion and further developments in transmission technologies and networks in the last decade have created several technologies with increased quality and costs. In this paper, we tested different transmission media for audiovisual telecommunication--integrated services digital network (ISDN), Internet, and asynchronous transfer mode (ATM)--using real time video transmission of typical operations in otorhinolaryngology. Their applications, costs, and future perspectives are discussed.

Germany↗