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研究生:梁文議
研究生(外文):Wen-Yih Liang
論文名稱:應用經濟的遠距病理系統做手術中冰凍切片諮詢之研究
論文名稱(外文):Apply a Low-cost Telepathology System for Intraoperative Frozen Section Consultation
指導教授:蔣以仁蔣以仁引用關係
指導教授(外文):I-Jen CHiang
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫學資訊研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:英文
論文頁數:28
中文關鍵詞:遠距病理網際網路冰凍切片諮詢
外文關鍵詞:telepathologyInternetfrozen sectionconsultation
相關次數:
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
病理醫師在面對冰凍切片時, 常需要在很短的時間內給外科醫師診斷, 而外科醫師則根據這個診斷進行下一步的處置, 如果有診斷錯誤的情況發生, 對病人和醫師都是無法彌補的, 也因此病理醫師的壓力是可想而知的. 若能在診斷上有疑慮時即時的得到相關專家或資深醫師提供諮詢和建議, 是一件很有幫助的事情
我們自行開發一個經濟的遠距病理系統做手術中冰凍切片諮詢且加以評估, 經過分析50個實際操作的病例後發現, 在縮短診斷時間和提高診斷正確率上都有明顯的改善, 我們的經驗指出遠距病理技術是可以應用於冰凍切片診斷諮詢.
We have established a low-cost, non-commercialized system of dynamic real-time telepathology (TP) for light microscopic (LM) diagnosis. It was used to aid intradepartmental consultation of frozen section diagnosis. Fifty cases were performed and completely recorded. For each case, multiple diagnoses were made and compared, including those made by the doctor on duty (D1), by a subspecialist or senior using TP (D2), by the same doctor as D2 but using LM (D3), and the final diagnosis of the case (D4). A comparison of D1 and D2 revealed that 37 cases (74%) were more precisely diagnosed in D2. Nine of 50 (18%) of the cases got a positive major impact to operation by teleconsultation. The results of D2 and D3 showed a good agreement. (kappa = 0.97). The average time span of TP is rather short compared with routine intradepartmental consultation. Our experience showed that TP was a good tool for frozen section consultation and with little additional cost.
Table of Content
_________________________________________________________________________________
Page
Title page...............................................................................................................i
Signature and approval Page................................................................................ii
上網授權書.........................................................................................................iii
Acknowledgements.............................................................................................iv
Table of Content...................................................................................................v
List of Tables.......................................................................................................vi
List of Figures....................................................................................................vii
中文摘要...........................................................................................................viii
Abstract................................................................................................................ix
I. Introduction
1.1 Background.........................................................................................1
1.2 Motivation...........................................................................................2
1.3 Objective.............................................................................................3
II. Literatures Review
2.1 Frozen section diagnosis......................................................................4
2.2 Method of telepathology......................................................................4
2.3 Applications of telepathology..............................................................5
III. Materials and Methods
3.1 Equipment...........................................................................................7
3.2 Selection and reading of Cases.........................................................10
3.1 Data Analysis....................................................................................13
IV. Results.........................................................................................................14
V. Discussion and Conclusion
5.1 Discussion........................................................................................19
5.2 Conclusion........................................................................................24
VI. References...................................................................................................26
v
List of Tables
Table 1. Record sheet for the study....................................................................10
Table 2. The results of the 50 cases....................................................................17
Table 3. Distribution of organ systems involved in telepathology frozen section consultations (n = 50).........................................................................................20
List of Figures
Figure 1: The previous system of telepathology used in the hospital..................3
Figure 2: The picture of our TP system................................................................8
Figure 3: The picture displayed at the screen of the computer of the client site.9
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3. Dunn BE, Almagro UA, Choi H, et al. Dynamic-robotic telepathology: Department of Veterans Affairs feasibility study. Hum Pathol 1997;28:8-12.
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8. Dunn BE, Choi H, Almagro UA, et al. Routine surgical telepathology in the Department of Veterans Affairs: experience-related improvements in pathologist performance in 2200 cases. Telemed J 1999;5:323-37.
9. Pan CC, Liang WY, Huang CW, et al. Diagnosing minimal adenocarcinoma on prostate needle biopsy by real-time dynamic telepathology through the Internet: evaluation of an economic technology for remote consultation. Hum Pathol 2002;33:242-6.
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10. Liang WY, Pan CC, Chiang H. Real-time dynamic telepathology through the Internet: evaluation of a new and economic technology at Taipei Veterans General Hospital. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64:277-82.
11. Kaufman Z, Lew S, Griffel B, et al. Frozen-section diagnosis in surgical pathology. A prospective analysis of 526 frozen sections. Cancer 1986;57:377-9.
12. Lessells AM, Simpson JG. A retrospective analysis of the accuracy of immediate frozen section diagnosis in surgical pathology. Br J Surg 1976;63:327-9.
13. Rogers C, Klatt EC, Chandrasoma P. Accuracy of frozen-section diagnosis in a teaching hospital. Arch Pathol Lab Med 1987;111:514-7.
14. Adachi H, Inoue J, Nozu T, et al. Frozen-section services by telepathology: experience of 100 cases in the San-in District, Japan. Pathol Int 1996;46:436-41.
15. Mizushima H, Uchiyama E, Nagata H, et al. Japanese experience of telemedicine in oncology. Int J Med Inform 2001;61:207-15.
16. Kaplan KJ, Burgess JR, Sandberg GD, et al. Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation. Mod Pathol 2002;15:1197-1204.
17. Petersen I, Wolf G, Roth K, et al. Telepathology by the Internet. J Pathol 2000;191:8-14.
18. A.M. Marchevsky, S.K. Lau, E. Khanafshar et al., Internet teleconferencing method for telepathology consultations from lung and heart transplant patients. Hum Pathol 2002:33;, 410–414.
19. Demichelis F, Barbareschi M, Boi S, et al. Robotic telepathology for intraoperative remote diagnosis using a still-imaging-based system. Am J Clin Pathol 2001;116:744-52.
20. Chorneyko K, Giesler R, Sabatino D, et al. Telepathology for routine light microscopic and frozen section diagnosis. Am J Clin Pathol 2002;117:783-90.
21. Moser PL, Lorenz IH, Sogner P, et al. The accuracy of telediagnosis of frozen
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sections is inferior to that of conventional diagnosis of frozen sections and paraffin-embedded sections. J Telemed Telecare 2003;9:130-4.
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