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

远程病理学术中病理诊断（IPD）是远程医疗的一个领域，它可以改善区域内先进医疗管理质量的差异。我们于1997年11月启动了这一远程医疗，并在文部科学省（文部科学省）的“大学和社会合作补助金”的支持下，于2000年4月提出了扩大IPD-TP网络的挑战。在获得符合远程医疗条件的患者的知情同意后，截至2002年3月底，对249例患者进行了IPD-TP尝试，其中222例患者诊断正确，9例患者诊断错误。6例患者的诊断被批准，12例患者的诊断被保留。具有临床意义的诊断准确率计算为96.2%。制备冷冻切片所需的平均时间为21.7分钟，诊断标本所需的平均时间为7.8分钟。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，远程手术的支持，这已经受到另一个区域医疗项目的挑战，由我们的IPD-TP无法执行，因为谁是符合条件的病人，在我们的项目期间的合作。我们的中期数据公开给一个地区的医疗社会和一份问卷调查给普通人组。因为他们认为我们的项目很重要，而且因为向其提供IPD-TP的患者数量正在增加，所以得出结论，我们扩大IPD-TP网络并使这种远程医疗实用化的项目是成功的。由于现在可以使用基于宽带的信息技术，因此认为通过这种方式进行图像传输可以减少诊断所需的时间并提高诊断精度。

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.