Generic telepathology system to establish interactive cross-ocean transplant consultations between Pittsburgh and Palermo

Fort Lauderdale 04 June 2001A telepathology system, which is developed by the University of Pittsburgh Medical Center (UPMC), has been found to be an effective means for a transplant pathologist working alone in a UPMC-managed facility in Palermo, Sicily, to receive real time consults from transplant pathologists located in Pittsburgh. In the past year, more than 150 cases have been reviewed using the static image telepathology system, reported Yukako Yagi at ATA 2001, the annual meeting of the American Telemedicine Association.

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"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", explained Mrs. Yagi, director of telepathology at UPMC's Center for Pathology Informatics.

The success of the system is relevant because a pathologist's diagnosis can often determine whether an organ transplant or liver resection operation will proceed, even when the patient is already on the operating room table. In addition, diagnosing organ rejection can be tricky, as there can be nuances in how rejection can manifest itself. The pathologist's report determines in large part if and how rejection is to be treated by the transplant team.

UPMC pathologists and information systems experts developed the system in-house because not a single commercial system could be found to meet the specific requirements of transplant pathologists. The system is available 24-hours-a-day, seven days a week, and operates over a secure private network between Dr. Marta Ida Minervini, M.D., the UPMC-trained pathologist at the Mediterranean Institute of Transplantation and Advanced Specialised Therapies in Palermo and pathologists at UPMC in Pittsburgh. It allows for real time chat, and all interactions are stored to maintain discussion context when decisions are made over several days.

With a six-hour time difference between Pittsburgh and Palermo, and also because organ transplants can occur at any time, day or night, it is not uncommon for pathologists in Pittsburgh to be notified of cases during off hours. As such, 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 when a new case is submitted. In Palermo, the pathologist's microscope contains a high-definition camera and software which capture and send images to Pittsburgh.

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

The very same system was recently installed at the University of Kyushu in Fukuoka, Japan, where there is an active liver transplant programme. The team also plans to collaborate with a centre in India. The Mediterranean Institute for Transplantation and Advanced Specialised Therapies, or 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, currently offering liver transplantation, living related kidney transplantation, as well as hepato-biliary reconstruction and liver resection operations.

As part of the agreement, funded by the Italian government under a health reform law, UPMC manages the facility just as it would an American medical centre, incorporating the most advanced technologies. Surgeons at UPMC have performed over 11.000 organ transplants, a single-centre experience unmatched by any other programme in the world.


Leslie Versweyveld

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