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

shimizu@med.kyushu-u.ac.jp

Today’s menu

Medical situation Activities

Korea-Japan Asia-Pacific

Directions to go

Kyushu Univ., Fukuoka

Gallstones

Cholesterol stonesBlack stones

Bilirubin stonesMixed stones

Surgical development: One exampleOpen Endoscopic

Surgical view of new surgery

Surgery I, Kyushu UnivInstrumentTrocar

Lift

Benefits of Endoscopic Surgery

• Small wound

Open Endoscopic

1 week after surgery

Pain Walking Meal Cost

Dramatic change in surgery

0%

50%

100%

20 years ago Now

Open Endosc

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?

Surgical accidents and many complications

サンデー毎日２０００

Endoscopic surgery is scary and dangreous!

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

Point 2: Academic Network for Research and Education

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

Live surgery: TV news reportsAug 22, 2003

TNC in the evening news

RKB

KBC

NHK

KBC

Live surgery: Open to mass mediaAug 22, 2003

Live Surgery from Korea to Japan2006.4.13

Seoul => Fukuoka International Convention Center

Korea Medical Association Congress2005.5.14

• Venue• Bundang Hosp,• Ewha U• Kyushu U

[2] Neurosurgery: Live demonstration 2003.11.252005.5.25

Hanyang U

Kyushu U

Telementoring for neurosurgery 2003.11.25

Hanyang U Kyushu U

[3] Endoscopy

• Cancer or not?• Early stage or advanced?

Moving images are becoming more and more important for therapeutic purpose.

Demonstration of endoscopy2006.8.21In a very casual atmosphere

Kyushu U Nagasaki U

EUS-FNA live demonstration 2004.11.15To NCC

Echo

Endosc

Staff Microscope

Students

Formal big Congress- Korea GI Meeting -

2008. 3

JP-1 JP-2

JP-3Korea

[4] For students: Robotic seminar 2004.7.16

Kyushu U

Ewha U

Live Surgery for Medical Students

2008.5

Bundang H

Kyushu U

Video

[5] Tele-lecture: Gastric Cancer Study Group

2006.9.22

First to SNU main hospitalEquipments

Kyushu U

SNU Hosp

[6] Clinico-pathological Teleconference

Regular meeting every few months Hanyang U Kyushu U

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

[1] Extension to China 2004.10.12

Tsinghua U/Beijing

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.

International Network (APAN)

Asia-Pacific Academic Network

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

First to Africa: Cairo University/Egypt Cairo, EG

Kyoto, JP

Fukuoka, JP

2009.5

Univ of San Paolo: First to South America

2009.7.1

Dr Dantas

Dr Troncon

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

Problems and future directions

• Multi-connection system: Quatre

• 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.

Problems to be considered

• Multi-connection system: Quatre

• Transmission of HD quality

High-definition surgical equipments for sale

Newly released!

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

To start advanced telemedicine project

• Network– Check availability

• Instruments– Computers – Audio-visual equipments

• Staff– Medical staff– Network engineers– Local engineers

Medical staffs

Engineers