Advanced telemedicine over academic network: from Korea-Japan to the world
Department of Endoscopic Diagnostics and TherapeuticsKyushu University Hospital, Fukuoka, Japan
Shuji Shimizu, MD, PhD
http://www.apan.net/wg/medical.htmlhttp://www.aqua.med.kyushu-u.ac.jp 2009.10.30@ Busan U
Today’s menu
Medical situation Activities
Korea-Japan Asia-Pacific
Directions to go
Kyushu Univ., Fukuoka
Benefits of Endoscopic Surgery
• Small wound
Open Endoscopic
1 week after surgery
Pain Walking Meal Cost
How to learn new surgeryTo watch a real surgery is most important.
Few hospitals have experts in all fields Limited chance to visit other hospitals Waste of time, waste of money Not continuous, but only once
Do you think you can learn it enough?
Remote Education: Convenient and Useful!
But, NOT popular in our clinical situation
Why not?
Theoretically
Practically
Conventional telemedicine…
• Still pictures– Radiology (CT, MR), Pathology
• Small-size moving images– Vital signs, ECG
ISDN /Narrow band ~1Mbps
1. Video transmission was impossible in good quality.2. Cost for special equipments (even for bad image).
Surgery: compressed
Situations changed in 2002: K-J Project
Kyushu Univ
Korea Advanced Research Network (KOREN)
Korea-Japan Cable Network (KJCN)
Bandwidth 2G Big Broadband Network
QGPOP
•Education•Culture
•Business•Medicine
Hanyang U
Key technologies DVTS(Digital video transport system)
Academic network(Research and education network)
Kyushu Univ., Fukuoka
Actual bandwidth in each network
0.4
30
0
5
10
15
20
25
30
ISDN DVTS
Mbps
• Still pictures • Compressed, degraded
• Original quality• Minimal delay
D: DigitalV: Video T: Transport S: System
Point 1: Big Broadband Network
Digital Video
Internet
DVTS: Digital Video Transport System
1. High quality video• No compression of images
2. Little time delay• No compression process
3. Less expensive• Commercially available standard PC and DV camera
4. System is simple• Direct connection between DV and PC (IEEE1394)
( Digital Video over Internet Protocol )
Developed in Japan
Basic equipment: Cheap & simple
DV Camcoder DVTS PC
Microphone
UTP(Ethernet)
Audio
Internet
• DVTS: free but powerful software• No special teleconferencing equipments
>30Mbps
BROADBAND network is essential!
Surgical instrument
IEEE1394
What is Academic Network? Government-funded network for
education or research (no commercial purposes)
Many universities and/or research institutions are already connected,free access without any surcharge.
Best tuned and Expanding
Highway versus Standard road
Conventional versus New telemedicine
Conventional New
BandwidthEquipmentCostImage qualityImage movementMain contentEngineers’ support
Small (0.12Mbps)a
Special systemExpensivePoorSluggishStill picturesNot so important
Big (30 Mbps)PCb, video cameraCheapGoodSmoothVideo imagesVery important
aIn the case of Integrated Services Digital Network (ISDN); bPC: personal computer
Korea-JapanCable
NetworkDVTS DVTS
Korea-Japan Advanced Medical Network Kyushu-Univ.
Image quality is as clear as original image.
Digital Video Transfer System
Digital Video Transfer System
Korea
Today’s menu
Medical situation Activities
Korea-Japan Asia-Pacific
Directions to go
Kyushu Univ., Fukuoka
OR Surgical movie
NCC, KoreaKyushu Univ., Japan
Lap. distal gastrectomy
Security software used
Aug 1, 2003[1] Endoscopic Surgery: the first live event
[3] Endoscopy
• Cancer or not?• Early stage or advanced?
Moving images are becoming more and more important for therapeutic purpose.
[5] Tele-lecture: Gastric Cancer Study Group
2006.9.22
First to SNU main hospitalEquipments
Kyushu U
SNU Hosp
KonKuk Univ
Korea Univ
USA
Japan
6M
10M
155M
KIX Singapore
Europe
KWANJU
DEAJON
SUWON
SEOUL Seoul-XP
TAEGU
BUSAN
2G
1GMbps Subscriber
GSR
GSR
GSR
GSR
GSR
GSR
Gyeongsang Univ
National Cancer Center
Ehwa Womans Univ
Seoul National Univ(Bundang Hospital)
Hanyang University Hospital
Extension of advanced network in Korea
Chungnam National University
Connected Preparation
Seoul National Univ (Main Hospital)
KOREN: Korea Research Network
Yonsei Univ
Asan MC
Institutions in Japan
Kyushu U/Fukuoka
Iwate Med U
Tomishiro Hosp/Okinawa Fujita Health Hygene U/Nagoya
Fujimoto Hayasuzu Hosp/Miyazaki
Nagasaki U
Sapporo Med College
Kyushu RC of Nusing/Munakata
Meeting venuesat Yokohamaat Fukuoka
Oita U
Kyoto U
Sapporo East Tokushu-kai
Hiroshima U
Kyoto 2nd Red Cross Hospital
Fukuoka U
Kamakura Shonan Hosp
• NCC Res Center• Tokyo Med Dent U
Kyushu Sangkyo Med U
Hokkaido U
MIT Training Center
Today’s menu
Medical situation Activities
Korea-Japan Asia-Pacific
Directions to go
Kyushu Univ., Fukuoka
Taipei Beijing
Fukuoka Seoul
2005.3.18
[2] Expansion to East Asia; Multi-station teleconference
Pancreatic Transplantation Meeting
Bangkok
Bandung
Singapore
Kyushu Univ.
Healthcare teleconference
2006.7.20
[3] First high-speed connection to Indonesia
Singapore
IndonesiaThailand
Japan
[4] Continuous Medical Education to Asia
Fukuoka, JP Cho Ray HospitalHo Chi Minh, VN
Cancer InstituteTokyo, JPShanghai, JP
2009.6.26
[5] First connection to India for live surgery
Tata Memorial Hosp.In Mumbai, India
Seoul, KR
Fukuoka, JP
Mumbai, IN 2008.4.28
[6]Extension to Australia: Bariatric Surgery
Adelaide
Fukuoka
Singapore
Nov 16, 2005
Live bariatric surgery to SIN &AUS
RecentVideo
Today’s menu
Medical situation Activities
Korea-Japan Asia-Pacific
Directions to go
Kyushu Univ., Fukuoka
Three characteristics of our system
Broadband Internet
High-quality International• Non-compressed
• Medical use• Good for moving images
• Handy for international
communications
• Easy• Cheap
• Developing• Expanding
(TV & satellite)
KR
China
Gastric cancer
Indonesia
Thailand
India
Vietnam
Malaysia
JP
Taiwan
Singapore
Philippines
RecoveryLess cost
Back to work
Endosc
Early
AdmissionRecurrence
Death
Ope
Advanced
Diagnosis and treatment
Bad quality may lead to misdiagnosis, which can make serious results to patients.
Kanazawa Sendai
Sapporo
Nagano
Kochi Nagoya
Fukuoka
Okinawa
OkayamaTsukuba
Core network bases
Osaka
Otemachi
NICT Koganei Headquarters
Research & Education Network in Asia-OceaniaChina: CERNETKorea: KOREN
Japan: JGNII or SuperSinet
Aus:AARNet
Taiwan: TWAREN
Academic Network in Western countries
Europe: GÉANT2 connects 34 countries.*JANET/UK, SurfNet/NE
USA: Internet2 connects over 200 universities.
2009.5.15
Rome Live
Kyushu U
Fujita HU Tokyo
Bird flu teleconference connecting the US• Manila venue• Peking U• Australia
National U• Stanford U• Nagasaki U• Chulalongkorn U• National Hospital
of Pediatrics / Hanoi
• Indonesia U
2006.1.24Indonesia
Philippines Vietnam Thailand Japan
United States
Australia
China
2004.7
Sapporo
2004.1
Beijing
2004.12
2005.1
Tokyo
Bangkok
Shanghai
Singapore
Kuala Lumper
NUS
2004.7
2004.1
Brisbane
ManilaPhilippine U
BandungITB2005.11
2005.6
Iwate 2005.7
2005.11
Taichung2005.11
New DehliSirGanga Ram Hospital
2004.10
HaLong2006.6
2006.7
2006.7
Taipei
MumbaiTata MH
2003.2Jilin
Jakarta, UI
Hanoi
MelbourneSydney
Auckland
2007.3
CanberraANU
Hawaii
Ho Chi MinCho Rai Hosp
2007.1
2007.1
Before 2005
After 20082006 - 2007
2007.1Adelaide
Flinder’s Hosp
2005.11
2007.3
California
2007.1Stanford, UC IrvineHong
Kong
Brazil
23 countries108 institutions192 events FukuokaYokohama
Cairnes
25/JP 16/KR5/CN5/TW4/TH1/SG4/VN1/MY2/PH9/AU6/US10/EU1/EG1/BZ
<Telemedicine Project>Seoul
EU
• Only equipment available for DVTS multi-point connection
• Very powerful and useful
• Support NTSC, but not PAL• Available only in Japan
New technologies are essential and strongly awaited.
High Definition: Uncompressed HD2007.3.23
Surgery/HDOperating room/
DVTS
Chairman
1.6G =>Still experimental!
Problems to be considered
• Multi-connection system: Quatre
• Transmission of HD quality
• Network to hospitals; last one mile
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