A NEW SYSTEM TO IMPROVE DIFFERENCES IN QUALITY OF ADVANCED MEDICAL MANAGEMENT ; ESTABLISHMENT OF TELEPATHOLOGY NETWORK FOR INTRAOPERATIVE PATHOLOGY DIAGNOSIS

术中病理学远程诊断（IPD- tp）是远程医疗的一个领域，可以改善区域内先进医疗管理质量的差异。我们在1997年11月开始了这种远程医疗，并在教育，文化，体育，科学和技术部（MEXT）的“大学和社会合作补助金”的支持下，我们在2000年4月挑战扩大我们的IPD-TP网络。在取得有资格接受远程医疗的病人的知情同意后，于2002年3月底，对249名病人进行了IPD-TP试验。正确诊断222例，误诊9例。批准诊断6例，保留诊断12例。临床诊断正确率为96.2%。准备冷冻切片的平均时间为21.7 min，标本诊断的平均时间为7.8 min。我们的IPD-TP网络通过一个预先存在的区域医疗项目向区域诊所开放。然而，我们的IPD-TP无法支持远程手术，因为在我们的项目期间没有有资格获得这种合作的病人。远程手术曾受到另一个区域医疗项目的挑战。我们的中期数据向一个地区医学协会开放，并向一个普通人群发放了一份问卷。因为他们认为我们的项目很重要，而且因为IPD-TP提供给病人的数量在增加，所以我们得出结论，我们扩大IPD-TP网络并使这种远程医疗实际使用的项目是成功的。由于基于宽带的信息技术现已可用，因此认为通过这种方式传输图像可以减少诊断所需的时间并提高我们的诊断准确性。

Intraoperative pathology diagnosis (IPD) by telepathology (IPD-TP) is a field of telemedicine, which can improve differences in quality of advanced medical managements in the regional areas. We started this telemedicine in November, 1997 and, supported by the "Grant-in-Aid for University and Society collaboration" of the Ministry of Education, Culture, Sports, Science and Technology (MEXT), we challenged to expand our IPD-TP network in April, 2000. With obtaining the informed consent from patients who were eligible for this telemedicine, IPD-TP was attempted to 249 patients by the end of March, 2002.Among these patients, 222 patients were correctly diagnosed, but 9 patients had erroneous diagnoses. Diagnoses in 6 patients were approved and those in 12 patients were reserved. The rate of clinically significant diagnostic accuracy was calculated to be 96.2%. Average time required to prepare a frozen section was 21.7 min and that to make a diagnosis for a specimen was 7.8 min.Our network of this IPD-TP was made open to regional clinics via one pre-existing regional medical project. However, support of tele-surgery, which had been challenged by another regional medical project, by our IPD-TP could not be performed because of the absence of patients who were eligible for this collaboration during the period of our project.Our interim data were made open to a regional medical society and a questionnaire was given to an ordinary people group. Because they though that our project was important, and because the number of patients, to whom IPD-TP was provided, was increasing, it is concluded that our project to expand IPD-TP network and to make this telemedicine being of practical use is successful. Since broad band-based information technology is now available, it is considered that image transmission by this can decrease time required for diagnosis and improve our diagnostic accuracy.