Telepathology applications of the Internet multimedia electronic mail

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.