6th ESACP Congress, Heidelberg, April 7-11, 1999

A074
SECOND OPINION TELEPATHOLOGY ON FROZEN SECTIONS BASED ON A ATM-NETWORK
Hufnagl P, Nguyen-Dobinsky TN, Dietel M

Institute of Pathology, Rudolf-Virchow-Haus, Charité, Berlin, Germany

Introduction and Aim: The University Hospital Charité consists of three campuses located in different parts of Berlin. A part of the Institute of Pathology belongs to each campus. In all these places intraoperative frozen section diagnostic takes place. Experts in special fields of pathology are not present at the same time in all parts of the institute. We tried to use telepathology to solve the problem of a fast second opinion for frozen sections. Material and Methods: At two of the three frozen section laboratories a computer controlled microscope with motor driven slide platform and lens revolver as well as autofocus was established. The video and audio signals have been transferred online in TV-quality using ATM network. Therefore three ATM-Audio-Video-Codecs have been established. The image size was 786*625 Pixel. We used a 3-chip TV camera (Sony 930p). The microscope is controlled by a separate ISDN line or via Internet using Timbuktu application sharing. The remote pathologist has the possibility to talk with the referring pathologist and also with the surgeon during operation. Results: The quality of the real time transferred pictures was sufficient. Primary diagnoses of frozen sections could successfully be done in 90%. The time, which was necessary to present a sufficient second opinion, varied between 1 and 10 minutes. Within a special trial we tried to present a remote diagnosis instead of a second opinion. In comparison with the "direct diagnoses" at the microscope revealed a difference only in 1 of 85 cases. To solve difficult cases online exchange of frozen as well as routine specimens appeared to be very helpful and elucidating. Conclusions: Telepathology is a promising tool to support routine and research work of pathologists. Future technical developments with highly enlarged data storage and data bases, with intelligent connections to other disciplines, e.g. radiology, genetics, surgery, patient data base etc., and easy to handle software will certainly contribute to a broad acceptance in the near future.