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Virtual Surgical Pathology in Under-Developed Countries: The Zambia Project.

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ABSTRACT

Only one surgical pathology laboratory is available in Zambia, a country with a population of 12 million people. Since 2004 the Italian Association of Pathologists “Patologi Oltre Frontiera” has been working to create a virtual laboratory through the use of telemedicine. The project involved staining histological preparations on site with the interpretation of imaged slides done abroad through telepathology. Starting in April 2007, all surgical specimens obtained in Mtendere Mission Hospital, Chirundu were submitted for microscopic examination through whole slide scans. Two independent Italian pathologists evaluated the cases by means of satellite connection and the final diagnoses were sent to Zambian clinicians via the internet.

 

1. Sommario progetto
Sommario: 

ABSTRACT

Only one surgical pathology laboratory is available in Zambia, a country with a population of 12 million people. Since 2004 the Italian Association of Pathologists “Patologi Oltre Frontiera” has been working to create a virtual laboratory through the use of telemedicine. The project involved staining histological preparations on site with the interpretation of imaged slides done abroad through telepathology. Starting in April 2007, all surgical specimens obtained in Mtendere Mission Hospital, Chirundu were submitted for microscopic examination through whole slide scans. Two independent Italian pathologists evaluated the cases by means of satellite connection and the final diagnoses were sent to Zambian clinicians via the internet.

 

2. Paese (Città / Regione)
Stato: 
Italy
Città: 
monza
3. Nome dell'organizzazione che presenta il progetto
Organizzazione: 
Patologi Oltre Frontiera
4. Tipo di organizzazione
Scegli tipo: 
Associazione
5. Coordinatore del progetto
Nome e Cognome: 
Fabio PAGNI
E-Mail: 
petala.83@tiscali.it
6. Website
Il sito web del progetto: 
patologioltrefrontiera.it
7. Selezionate la categoria di appartenenza del vostro progetto
Youth Education Project. Select Project Users by age: 
Fino a 29 anni
Inserimento dei giovani nel mondo del lavoro: 
NOT Helping youth step in the job market
Creatività e Innovazione sociale: 
Creatività e Innovazione sociale
8. Da quando è funzionante il vostro progetto?
Da: 
01/04/2007
9. Obiettivi ed elementi di innovazione
Please explain the targets and the background of your project: 

The Mtendere Mission Hospital of Chirundu in Zambia, which started as a small Rural Health Centre in 1964, is currently a 145 bed facility. The Hospital offers an extensive range of diagnostic and treatment services including laboratories, radiology, operating theatres but lacks a cytopathology or histopathology laboratory.  Currently, the University Teaching Hospital in Lusaka represents the only centre offering a surgical pathology service, serving 12 million people and lacking medical staff, technicians and infrastructure. 
In 2004, Chirundu surgeons contacted the Italian association, Patologi Oltre Frontiera (POF) to establish a surgical telepathology laboratory in Chirundu. . In 2004, training of two applicants from the Chirundu internal hospital population completed a 2 years program. They were able to prepare the routine specimens and interface with the telepathology equipment.. So the specimens were then scanned and transmitted to be analyzed by volunteer Italian Pathologists, who subsequently rendered a diagnosis.
The goal of this work is to analyze the ability to make appropriate diagnoses via telepathology. Finally, a framework for the introduction of telepathology to other developing nations is explored.

Come, e con quali mezzi cerca di raggiungere gli obiettivi prefissati: 

Between April 1 and October 31, 2007, all surgical and cytology specimens obtained at the Mtendere Mission Hospital, Chirundu, Zambia were prepared using standard grossing and staining methods by two local technicians. The pathology slides were inserted into an Aperio Scanner ScanScope CS (Aperio Technologies Inc. 1360 Park Center Drive, Vista CA 92091). The virtual slides were saved on a local server. A database was created to link the virtual slides with pertinent clinical information added by the local Zambian technicians. The database information with the virtual slides was accessible overseas through file transfer protocol (FTP) via satellite connection. POF uses a 120cm/3Watt terminal accessing purchased satellite band (625kband channel) to view by ADSL (Asymmetric Digital Subscriber Line640kbs).  Two pathologists, located in Italy, independently examined the scanned virtual slides remotely. A third senior Pathologist examined diagnostic field images and rendered a final diagnosis. 
For quality assurance and control, the original microscopic slides were sent from Zambia to Italy, in December 2007. The slides were examined using traditional microscopic evaluation by three Pathologists. The definitive microscopic diagnoses were compared to those rendered on the digital format and agreement was analyzed using Cohen’s k statistical method

Quali opportunità/problemi affronta: 

We evaluated the telepathology method of diagnosis in developing nations compared to traditional microscopy, with review of the concordance and discordance of data. 

Please explain what is unique or special in your project: 

 

This project is therefore reliable enough to replicate in other under-developed countries showing the ability of telepathology to facilitate diagnoses in areas with low resources.
10. Risultati
Describe the results of your project as per today: 

We analysed 322 cases (261 surgical, 61 extra-cervical cytology) by telepathology between April and October 2007. There were a varied group of sites sampled with a high prevalence of gynaecologic pathology . We observed that the majority of gynaecologic samples were of HPV-related lesions (Human PapillomaVirus).  In Zambia, haematopathology was also a major component of the histologic samples received through telepathology. We received samples from 21 lymph nodes and 22 fine-needle aspiration biopsies (FNAB) of lymph nodes.
We calculated an average of 4 days for the first 261 histological diagnoses from Chirundu, Zambia. To verify the diagnostic accuracy of the virtual system, we re-evaluated all cases by traditional microscopy. We compared the first diagnosis by telemedicine and the diagnosis by microscopy.  We actually obtained no major diagnostic changes in the cytological specimens (except minor descriptive changes to the report).

In che misura risponde ai bisogni degli utenti: 

Abbiamo offerto alla popolazione zambiana un laboratorio di anatomia patologica precedentemente inesistente e ora gestito da personale locale indigeno (in particolare abbiamo formato 2 tecnici di laboratorio biomedico zambiani, di età inferiore ai 30 anni).

Quanti utenti interagiscono con il progetto mensilmente e in quale modo: 

Giovani medici italiani mensilmente sono i responsabili online della diagnostica via satellite

Descrivete in quale modo il progetto contribuisce a migliorare l'educazione e la formazione dei giovani: 

personale locale indigeno (in particolare abbiamo formato 2 tecnici di laboratorio biomedico zambiani, di età inferiore ai 30 anni) è responsabile integralmente della gestione del laboratorio

Descrivete in quale modo il progetto ha ottimizzato la partecipazione di professionisti, ragazzi, giovani o altri soggetti: 

personale locale indigeno (in particolare abbiamo formato 2 tecnici di laboratorio biomedico zambiani, di età inferiore ai 30 anni).

Descrivete in quale modo il progetto favorisce l'uso delle nuove tecnologie da parte di professionisti, ragazzi e giovani per lo sviluppo culturale e didattico: 

Vedi allegato

Descrivete i criteri che usate per misurate i risultati raggiunti dal vostro progetto: 

Vedi allegato

11. Sostenibilità
Indicate la durata complessiva del progetto: 
Più di 6 anni
Indicate il costo di massima del vostro progetto (in Euro): 
Da 75.001 a 500.000
Come è finanziato il vostro progetto: 
Finanziamenti pubblici o privati
Is your project economically self sufficient now: 
Si
Insert date: 
07/29/2009
12. Trasferibilità
Il progetto è stato replicato/adattato altrove: 
No
Che cosa possono imparare altri soggetti dal vostro progetto: 

 

The main objective of this study was to analyze the potential of telepathology to assist surgical and cytologic pathology in developing nations. The results obtained overall show evidence that there is high correlation between telepathology and traditional microscopy. From this, the project may be repeated similarly in other developing countries.
There are major limits and problems to overcome.  Referring to the costs, a partial solution to this apparent problem may be the division of the connection costs between more than one hospital, even more than one region or country (for example Madagascar, Tanzania). Another limit of the method is the slowness and the weather dependence of the connection. This is a critical point, especially if we want to expand the technology to include time dependent functions such as intra-operative diagnoses by telepathology.
Despite these issues, there are benefits from this system of telepathology.  As others in the literature have shown, it is possible to have different opinions on difficult cases from highly qualified hospitals throughout Europe.
We evaluated the telepathology method of diagnosis in developing nations compared to traditional microscopy, with review of the concordance and discordance of data. We obtained no substantial differences diagnoses in cytological specimens.
This project offers one solution to facilitate Pathology in order to help guide clinicians in the management of their patients in underdeveloped countries.. After one-year of experience in Zambia with telepathology, we believe that the positive aspects of the project outweigh the encountered difficulties such as equipment costs, maintenance and the necessary improvements that may be required in the future.
 
NOTE: part of this material is taken from a paper submitted for publication to an Internation Scientific Journal, copyright reserved and property of authors.
Siamo disponibili ad aiutare altri soggetti a sviluppare progetti o a migliorare progetti esistenti: 
Siamo disponibili ad aiutare altri soggetti a sviluppare progetti o a migliorare progetti esistenti.
13. Informazioni aggiuntive
Background: 

Vedi allegato

Ostacoli: 

Vedi allegato

Soluzioni: 

Vedi allegato

Future plans and wish list: 

Vedi allegato

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Fig.1b.pdf128.89 KB
Fig.2.pdf116.55 KB
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