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June 28, 2001

Telepathology program permits real-time international consults

A telepathology system developed by UPMC Health System has been found to be an effective means for a transplant pathologist working in a UPMC-managed facility in Palermo, Sicily, to receive real-time consultations from transplant pathologists in Pittsburgh.

In the past year, more than 150 cases have been reviewed using the static image telepa-thology system, according to Yukako Yagi, who reported on the system at the annual meeting of the American Telemedicine Association.

"This rapid and interactive telepathology system not only helped to avoid misdiagnoses, it allowed the on-site pathologist in Palermo to confirm her impressions and diagnoses with colleagues in Pittsburgh, thus improving diagnosis, treatment and patient care," said Yagi, director of telepathology at UPMC's Center for Pathology Informatics.

The Mediterranean Institute for Transplantation and Advanced Specialized Therapies (Istituto Mediterraneo per i Trapianti e Terapie ad Alta) is a joint venture of the UPMC Health System, the Italian government and Civico and Cervello hospitals of Palermo, Sicily. The hospitals offer liver transplantation, living related kidney transplantation and hepatobiliary reconstruction and liver resection operations.

As part of the agreement, funded by the Italian government under a health reform law, UPMC manages the facility as it would an American medical center, incorporating the most advanced technologies.

UPMC pathologists and information systems experts developed the telepathology system in-house because no commercial system was available to meet the specific requirements of transplant pathologists. The system allows for real-time Internet chat, and all interactions are stored to maintain discussion context when decisions are made over several days.

A pathologist's diagnosis often determines if an organ transplant or liver resection operation should proceed, even as the patient is on the operating room table. In addition, the pathologist's report determines in large part if and how organ rejection is to be treated by the transplant team.

With a six-hour time difference between Pittsburgh and Palermo — and because organ transplants can occur at any time — it is not uncommon for pathologists in Pittsburgh to be notified of cases during off-hours. As part of the system, each pathologist has a specially equipped home computer and monitor upgraded to display images at high resolution as well as high-end laptops. The system automatically pages the consulting pathologist in Pittsburgh. In Palermo, the pathologist's microscope contains a high-definition camera and software that capture and send images to Pittsburgh.

"Given our experience with this system to date, I would estimate that up to 85 percent of all transplant pathology consultation could be done directly via the Internet, assuming there are committed and experienced users on either end," noted Anthony J. Demetris, professor of pathology and director of the division of transplant pathology at the Thomas E. Starzl Transplantation Institute, who helped to conceive and develop the system.

The same system recently was installed at the University of Kyushu in Fukuoka, Japan, where there is a liver transplant program. The team also plans to collaborate with a center in India.

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