Digital Pulse - Ch 3 - Sec 1 - Internet Pathology Suite (iPath)

Development Issues: Health, Technology

Programme Summary

Developed in 1999 through a telemedicine research project at the Pathology Department of University of Basel, Switzerland, this online knowledge-exchange programme enables the international organisation and exchange of various kinds of medical information. The Internet Pathology Suite (iPath) is intended to facilitate group work - case discussion, remote diagnosis, and consultation - on the part of medical specialists in different fields (like pathology, radiology, dermatology, and so on).

In 2001, a hospital with no resident pathologists, the National Referral Hospital of Honiara, Solomon Islands, approached the University of Basel for help. The University worked to establish a tiny histology lab at the Hospital. Specimens are prepared there and digital images are sent to the server, where a number of pathologists from Europe and US review the cases. Over 50 cases have been diagnosed there so far.

Telemedicine is more and more regarded as a viable method to provide expertise knowledge to unprivileged regions of our world. However, there is very little literature and only a few trials have been carried out. A major problem is the lack of a platform to conduct such experiments. As iPath is released free and with open source, it is easily adaptable to new applications and not requiring high operating costs. iPath could be an ideal platform to carry out such experiments and to establish telemedicine services for developing countries.

Summary of ICT Initiatives

By visiting the iPath site, information needed to diagnose and treat disease may be exchanged. Physicians may share knowledge with colleagues by:

• Entering a medical discussion forum where cases may be presented to other physicians for discussion and comment within dedicated user groups. (The sender of the information controls who has access to the consultation information; the intention is to foster mutual discussion where questions are invited);
• Accessing information about cases from various sources; and
• Connecting their microscopes to the Internet and then sharing their findings with others (who then may provide feedback to senders of specimens).

The iPath server has several other desirable features:

• Not only pictures, but documents and other data files can be put into the database.
• To prevent influencing the diagnosis of a new viewer, comments can be hidden until she or he has entered his or her own comments.
• Access to the pictures can be restricted to a small closed group or made available to several groups.
• A chat (online-communication) with a colleague or the microscope operator is possible.
• An additional small program allows pictures to be transferred automatically from the camera to the database with frame-grabber hardware.

To date, physicians from Bangladesh, Germany, India, Iran, Poland, South Africa, Switzerland, Thailand, USA, and Vietnam have utilised the service. Although the programme has expanded to enable many kinds of specialists to utilise the service, the software was initially developed for pathologists. Examples of pathology-related applications include: Samedan is a small regional hospital in the Swiss Alps without a resident pathologist. iPath-Telemicroscopy enables frozen section diagnosis by pathologists from the University of Basel. In addition, members of the German bone tumour working group (AGKT) use iPath to discuss difficult cases with their colleagues. Images and case description are stored on the server. The server sends an email notification to all members of the working group, who then give their opinions.

The IHNS (Inland Northwest Health Service) has funded a telepathology network for the Spokane, WA region of the US that is intended to provide support for rural hospitals. Pathologists and lab techs at the Sacred Heart Medical Center and at the Holy Family Hospital in Spokane may help with remote frozen sections and consult with each other. Other applications of iPath have been utilised in West and South Africa. Specifically, the Norwegian-based Kizuki Group has started a West African Doctors Network that includes a telemedicine facility based on the iPath software. The site [click here] is used for telepathology collaborations. To facilitate collaboration within Africa and to strengthen a south-south dialogue, the server is open to all health workers and doctors in Africa.

The iPath site also provides access for users of this service to a steady stream of software fixes and updates, as well as reference materials for software developers interested in creating similar projects or contributing to current iPath initiatives. The creation of a database of clinical materials and examples of different samples is also underway.

Observations

Capitalizing on the initial successes of the program, the iPath team is looking to develop:

• A image grabber application for generating cytology images. A stack of images from different focal planes are taken to provide an realistic 3d view.
• Improved facilities for organizing expert groups and "virtual pathology departments" on iPath-Server.
• Improving usage of iPath for developing countries.
• Full email-to-web and web-to-email functionality
• Decentralised database with a server for a small hospital's intranet that can synchronize its content regularly with another server where the experts can access the consultations on-line. This option will provide a way how every doctor and lab technician can access the data at any time without needing a constant online connection, suitable for work with email only or satellite connections.

Partners: The Kizuki Group, SourceForge, South Pacific Medical Projects, AGKT,

Source: Letters sent from Kurt Brauchli to the Communication Initiative on June 7 and 22, 2002, and the iPATH site.

For More Information Contact:

Kurt Brauchli

Department of Pathology, University of Basel

Tel.: +41 61 265 2828

kurt.brauchli@unibas.ch