Virchows Archiv

, Volume 444, Issue 5, pp 403–409 | Cite as

Diagnostic telepathology: long-term experience of a single institution

  • Kurt Brauchli
  • Hermann Oberli
  • Nina Hurwitz
  • Klaus-Dieter Kunze
  • Gunter Haroske
  • Gernot Jundt
  • Gerhard Stauch
  • Lech Banach
  • Mark Wirdnam
  • Michael Mihatsch
  • Martin Oberholzer
Review Article



The paper reviews the development of the application of telepathology in a department of surgical pathology between 1991 and 2003. The goal of the efforts during this time was to give up the concept of programming a single application, available only between two fixed workstations with sophisticated devices and special software, and to find the virtual “largest common denominator” for implementing as many different applications as possible with the same basic system.


A new telepathology system was designed as a client–server system with a relational database at its centre. The clients interact together by transferring the questions (texts and images) to a record (case) in the database on the server and by transferring the answers to the same record on the database.


The new “open” telepathology system iPath ( has been very well accepted by many groups around the world. The main application fields are: consultations between pathologists and medical institutions without a pathologist (e.g. for frozen section diagnoses or for surgical diagnoses in hospitals in South Asia or Africa), tumour boards, field studies and distance education (


Having observed that with iPath we have succeeded in satisfying all our telepathology needs, we are inclined to put the emphasis on the nature of the tasks being performed, as opposed to the methods or technical means for performing a given task. The three organisation models proposed by Weinstein et al. (2001) [24] can be reduced to only two models: the model of discussion groups and the model of expert groups (virtual institutes).


Telepathology Surgical pathology Telemedicine 


  1. 1.
    Baak JP, van Diest PJ, Meijer GA (2000) Experience with a dynamic inexpensive video-conferencing system for frozen section telepathology. Anal Cell Pathol 21:169–175PubMedGoogle Scholar
  2. 2.
    Belnap CP, Freeman JH, Hudson DA, Person DA (2002) A versatile and economical method of image capture for telepathology. J Telemed Telecare 8:117–120CrossRefPubMedGoogle Scholar
  3. 3.
    Brauchli K, Christen H, Haroske G, Meyer W, Kunze KD, Oberholzer M (2002) Telemicroscopy by the Internet revisited. J Pathol 196:238–243CrossRefPubMedGoogle Scholar
  4. 4.
    Brauchli K, Helfrich M, Christen H, Jundt G, Haroske G, Mihatsch M, Oberli H, Oberholzer M (2002) [The future of telepathology. An Internet “distributed system” with “open standards”]. Pathologe 23:198–206CrossRefPubMedGoogle Scholar
  5. 5.
    Cross SS, Dennis T, Start RD (2002) Telepathology: current status and future prospects in diagnostic histopathology. Histopathology 41:91–109CrossRefPubMedGoogle Scholar
  6. 6.
    Della Mea V, Cataldi P, Boi S, Finato N, Della Palma P, Beltrami CA (1998) Image selection in static telepathology through the Internet. J Telemed Telecare 4[Suppl 1]:S20–S22Google Scholar
  7. 7.
    Della Mea V, Cortolezzis D, Beltrami CA (2000) The economics of telepathology—a case study. J Telemed Telecare 6[Suppl 1]:S168–S169Google Scholar
  8. 8.
    Demichelis F, Barbareschi M, Boi S, Clemente C, Dalla Palma P, Eccher C, Forti S (2001) Robotic telepathology for intraoperative remote diagnosis using a still-imaging-based system. Am J Clin Pathol 116:744–752PubMedGoogle Scholar
  9. 9.
    Dietel M, Nguyen-Dobinsky TN, Hufnagl P (2000) The UICC Telepathology Consultation Center. International Union Against Cancer. A global approach to improving consultation for pathologists in cancer diagnosis. Cancer 89:187–191CrossRefPubMedGoogle Scholar
  10. 10.
    Dunn BE, Almagro UA, Choi H, Sheth NK, Arnold JS, Recla DL, Krupinski EA, Graham AR, Weinstein RS (1997) Dynamic-robotic telepathology: Department of Veterans Affairs feasibility study. Hum Pathol 28:8–12PubMedGoogle Scholar
  11. 11.
    Furness PN, Bamford WM (2001) Telepathology. Review. Curr Diagn Pathol 7:281–291CrossRefGoogle Scholar
  12. 12.
    Gombas P, Skepper JN, Hegyi L (2002) The image pyramid system—an unbiased, inexpensive and broadly accessible method of telepathology. Pathol Oncol Res 8:68–73PubMedGoogle Scholar
  13. 13.
    Küng H (2002) Erkämpfte Freiheit. Erinnerungen. Pieper Verlag GmbH, MünchenGoogle Scholar
  14. 14.
    Loane M, Wootton R (2002) A review of guidelines and standards for telemedicine. J Telemed Telecare 8:63–71CrossRefGoogle Scholar
  15. 15.
    Nordrum I (1998) Real-time diagnoses in telepathology. Adv Clin Pathol 2:127–131Google Scholar
  16. 16.
    Nordrum I, Eide TJ (1995) Remote frozen section service in Norway. Arch Anat Cytol Pathol 43:253–256PubMedGoogle Scholar
  17. 17.
    Oberholzer M, Fischer HR, Christen H, Gerber S, Bruhlmann M, Mihatsch M, Famos M, Winkler C, Fehr P, Bechthold L (1993) Telepathology with an integrated services digital network—a new tool for image transfer in surgical pathology: a preliminary report. Hum Pathol 24:1078–1085PubMedGoogle Scholar
  18. 18.
    Oberholzer M, Fischer HR, Christen H, Gerber S, Bruhlmann M, Mihatsch MJ, Gahm T, Famos M, Winkler C, Fehr P (1995) Telepathology: frozen section diagnosis at a distance. Virchows Arch 426:3–9PubMedGoogle Scholar
  19. 19.
    Person DA (2000) Pacific Island Health Care Project: early experiences with a Web-based consultation and referral network. Pac Health Dialog 7:29–35Google Scholar
  20. 20.
    Remmelinck M, Lopes MB, Nagy N, Rorive S, Rombaut K, Decaestecker C, Kiss R, Salmon I (2000) How could static telepathology improve diagnosis in neuropathology? Anal Cell Pathol 21:177–182PubMedGoogle Scholar
  21. 21.
    Rogers N, Furness P, Rashbass J (2001) Development of a low-cost telepathology network in the UK National Health Service. J Telemed Telecare 7:121–123PubMedGoogle Scholar
  22. 22.
    Stredney D, Crawfis R, Wiet GJ, Sessanna D, Shareef N, Bryan J (1999) Interactive volume visualizations for synchronous and asynchronous remote collaboration. Stud Health Technol Inform 62:344–350PubMedGoogle Scholar
  23. 23.
    Weinberg DS, Allaert FA, Dusserre P, Drouot F, Retailliau B, Welch WR, Longtine J, Brodsky G, Folkerth R, Doolittle M (1996) Telepathology diagnosis by means of digital still images: an international validation study. Hum Pathol 27:111–118PubMedGoogle Scholar
  24. 24.
    Weinstein RS, Descour MR, Liang C, Bhattacharyya AK, Graham AR, Davis JR, Scott KM, Richter L, Krupinski EA, Szymus J, Kayser K, Dunn BE (2001) Telepathology overview: from concept to implementation. Hum Pathol 32:1283–1299CrossRefPubMedGoogle Scholar
  25. 25.
    Wells CA, Sowter C (2000) Telepathology: a diagnostic tool for the millennium? J Pathol 191:1–7CrossRefPubMedGoogle Scholar
  26. 26.
    Williams BH (1998) The AFIP center for telemedicine application-pathology for the twenty-first century. Telemed Virtual Real 3:64–65PubMedGoogle Scholar
  27. 27.
    Wolf G, Petersen I, Dietel M (1998) Microscope remote control with an Internet browser. Anal Quant Cytol Histol 20:127–132PubMedGoogle Scholar
  28. 28.
    Wootton R (1997) The possible use of telemedicine in developing countries. J Telemed Telecare 3:23–26CrossRefGoogle Scholar
  29. 29.
    Wright D (1997) Telemedicine and developing countries: a report of Study Group 2 of the ITU Development Sector. J Telemedicine Telecare 4:1–85Google Scholar
  30. 30.
    Zhao Y, Nakajima I, Juzoji H (2002) On-site investigation of the early phase of Bhutan Health Telematics Project. J Med Syst 26:67–77CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Kurt Brauchli
    • 1
  • Hermann Oberli
    • 2
  • Nina Hurwitz
    • 1
  • Klaus-Dieter Kunze
    • 3
  • Gunter Haroske
    • 4
  • Gernot Jundt
    • 1
  • Gerhard Stauch
    • 5
  • Lech Banach
    • 6
  • Mark Wirdnam
    • 1
  • Michael Mihatsch
    • 1
  • Martin Oberholzer
    • 1
  1. 1.Department of Pathology of the UniversityBaselSwitzerland
  2. 2.National Referral HospitalHoniaraSolomon Islands
  3. 3.Institute of PathologyTechnical UniversityDresdenGermany
  4. 4.Institute of PathologyKreiskrankenhaus Dresden-FriedrichsstadtDresdenGermany
  5. 5.Institute of PathologyAurichGermany
  6. 6.Institute of Pathology of the University of TranskeiUmtataSouth Africa

Personalised recommendations