Advanced telemedicine over academic network: from Korea-Japan to the world
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1 Advanced telemedicine over academic network: from Korea-Japan to the world Department of Endoscopic Diagnostics and Therapeutics Kyushu University Hospital, Fukuoka, Japan Shuji Shimizu, MD, PhD Busan U
2 Today s menu Medical situation Activities Korea-Japan Asia-Pacific Directions to go Kyushu Univ., Fukuoka
3 Gallstones Black stones Cholesterol stones Mixed stones Bilirubin stones
4 Surgical development: One example Open Endoscopic
5 Surgical view of new surgery Lift Trocar Instrument Surgery I, Kyushu Univ
6 Benefits of Endoscopic Surgery Small wound 1 week after surgery Pain Walking Meal Cost Open Endoscopic
7 Dramatic change in surgery 100% 50% Open Endosc 0% 20 years ago Now
8 How to learn new surgery To 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?
9 Surgical accidents and many complications サンデー毎日 2000 Endoscopic surgery is scary and dangreous!
10 Remote Education: Convenient and Useful! Practically Theoretically But, NOT popular in our clinical situation Why not?
11 Conventional telemedicine ISDN /Narrow band ~1Mbps Still pictures Radiology (CT, MR), Pathology Small-size moving images Vital signs, ECG Surgery: compressed 1. Video transmission was impossible in good quality. 2. Cost for special equipments (even for bad image).
12 Situations changed in 2002: K-J Project Hanyang U Korea Advanced Research Network (KOREN) Education Culture Business Medicine Korea-Japan Cable Network (KJCN) QGPOP Kyushu Univ Bandwidth 2G Big Broadband Network
13 Key technologies DVTS (Digital video transport system) Academic network (Research and education network) Kyushu Univ., Fukuoka
14 Actual Point 1: bandwidth Big Broadband in each Network network 30 Mbps 30 Original quality Minimal delay Still pictures Compressed, degraded D: Digital V: Video T: Transport S: System ISDN DVTS Digital Video Internet
15 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 ( Digital Video over Internet Protocol ) Developed in Japan Direct connection between DV and PC (IEEE1394)
16 Basic equipment: Cheap & simple Surgical instrument DV Camcoder DVTS PC Internet IEEE1394 UTP(Ethernet) >30Mbps Microphone Audio DVTS: free but powerful software No special teleconferencing equipments BROADBAND network is essential!
17 Point 2: Academic Network for Research and Education
18 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
19 Conventional versus New telemedicine Bandwidth Equipment Cost Image quality Image movement Main content Engineers support Conventional Small (0.12Mbps) a Special system Expensive Poor Sluggish Still pictures Not so important New Big (30 Mbps) PC b, video camera Cheap Good Smooth Video images Very important a In the case of Integrated Services Digital Network (ISDN); b PC: personal computer
20 Korea-Japan Advanced Medical Network Kyushu-Univ. Korea Digital Video Transfer System DVTS Korea-Japan Cable Network Digital Video Transfer System DVTS Image quality is as clear as original image.
21 Today s menu Medical situation Activities Korea-Japan Asia-Pacific Directions to go Kyushu Univ., Fukuoka
![[1] Endoscopic](/docs-images/83/87061583/images/22-0.jpg "Surgery: the first")
22 [1] Endoscopic Surgery: the first live event OR Surgical movie Aug 1, 2003 Lap. distal gastrectomy Security software used Kyushu Univ., Japan NCC, Korea
23 Live surgery: TV news reports Aug 22, 2003 RKB KBC NHK TNC in the evening news KBC
24 Live surgery: Open to mass media Aug 22, 2003
25 Live Surgery from Korea to Japan Seoul => Fukuoka International Convention Center
26 Korea Medical Association Congress Venue Bundang Hosp, Ewha U Kyushu U
![[2]](/docs-images/83/87061583/images/27-2.jpg)
27 [2] Neurosurgery: Live demonstration Hanyang U Kyushu U
28 Telementoring for neurosurgery Hanyang U Kyushu U
29 [3] Endoscopy Cancer or not? Early stage or advanced? Moving images are becoming more and more important for therapeutic purpose.
30 Demonstration of endoscopy In a very casual atmosphere Kyushu U Nagasaki U
31 EUS-FNA live demonstration Endosc To NCC Students Echo Staff Microscope
32 Formal big Congress - Korea GI Meeting - JP-1 JP-2 Korea JP
![[4] For](/docs-images/83/87061583/images/33-0.jpg "students:")
33 [4] For students: Robotic seminar Kyushu U Ewha U
34 Live Surgery for Medical Students Video Bundang H Kyushu U
![[5] Tele-lecture:](/docs-images/83/87061583/images/35-0.jpg "Gastric Cancer")
35 [5] Tele-lecture: Gastric Cancer Study Group Kyushu U SNU Hosp Equipments First to SNU main hospital
![[6]](/docs-images/83/87061583/images/36-0.jpg)
36 [6] Clinico-pathological Teleconference Regular meeting every few months Hanyang U Kyushu U
37 Extension of advanced network in Korea Hanyang University Hospital National Cancer Center Asan MC GSR SEOUL KIX Seoul-XP 6M 10M 155M Singapore Europe USA Seoul National Univ (Bundang Hospital) TAEGU Ehwa Womans Univ GSR SUWON GSR Korea Univ Yonsei Univ GSR DEAJON Seoul National Univ (Main Hospital) Chungnam National University Gyeongsang Univ KonKuk Univ GSR KWANJU GSR BUSAN 2G Japan KOREN: Korea Research Network Connected Preparation 1GMbps Subscriber
38 Institutions in Japan Sapporo Med College Sapporo East Tokushu-kai Kyushu U/Fukuoka Hiroshima U Kyoto U Hokkaido U Kyushu RC of Nusing/Munakata Fukuoka U Nagasaki U Kyoto 2nd Red Cross Hospital Kyushu Sangkyo Med U MIT Training Center Iwate Med U Meeting venues at Yokohama at Fukuoka Fujimoto Hayasuzu Hosp/Miyazaki Tomishiro Hosp/Okinawa Oita U NCC Res Center Tokyo Med Dent U Kamakura Shonan Hosp Fujita Health Hygene U/Nagoya
39 Today s menu Medical situation Activities Korea-Japan Asia-Pacific Directions to go Kyushu Univ., Fukuoka
![[1]](/docs-images/83/87061583/images/40-0.jpg "Extension")
40 [1] Extension to China Tsinghua U/Beijing
![[2] Expansion to East Asia;](/docs-images/83/87061583/images/41-0.jpg "Multi-station teleconference")
41 [2] Expansion to East Asia; Multi-station teleconference Pancreatic Transplantation Meeting Fukuoka Seoul Taipei Beijing
![Bandung [3] First](/docs-images/83/87061583/images/42-3.jpg "highspeed")
42 Kyushu Univ. Healthcare teleconference Bangkok Singapore Japan Singapore Bandung [3] First highspeed connection to Indonesia Thailand Indonesia
![[4] Continuous](/docs-images/83/87061583/images/43-0.jpg "Medical")
43 [4] Continuous Medical Education to Asia Fukuoka, JP Cho Ray Hospital Ho Chi Minh, VN Shanghai, JP Cancer Institute Tokyo, JP
![[5] First connection to India](/docs-images/83/87061583/images/44-0.jpg "for live surgery Seoul, KR")
44 [5] First connection to India for live surgery Seoul, KR Mumbai, IN Fukuoka, JP Tata Memorial Hosp. In Mumbai, India
45 [6]Extension to Australia: Bariatric Surgery Fukuoka Singapore Live bariatric surgery to SIN &AUS Recent Video Nov 16, 2005 Adelaide
46 Today s menu Medical situation Activities Korea-Japan Asia-Pacific Directions to go Kyushu Univ., Fukuoka
47 Three characteristics of our system Easy Cheap Developing Expanding High-quality Non-compressed Medical use Good for moving images Broadband Internet International (TV & satellite) Handy for international communications
48 Gastric cancer Diagnosis and treatment JP KR China Taiwan India Thailand Advanced Ope Early Endosc Vietnam Malaysia Singapore Philippines Indonesia Admission Recurrence Death Recovery Less cost Back to work Bad quality may lead to misdiagnosis, which can make serious results to patients.
49 Research & Education Network in Asia-Oceania Korea: KOREN Taiwan: TWAREN China: CERNET Aus:AARNet Core network bases Sapporo Fukuoka Kanazawa Nagano Sendai Osaka Okayama Kochi Okinawa NICT Koganei Headquart ers Tsukuba Nago Otemachi ya Japan: JGNII or SuperSinet
50 Academic Network in Western countries USA: Internet2 connects over 200 universities. Europe: GÉANT2 connects 34 countries. *JANET/UK, SurfNet/NE
51 International Network (APAN) Asia-Pacific Academic Network
52 Kyushu U Rome Live Fujita HU Tokyo
53 Bird flu teleconference connecting the US Indonesia China Australia United States Philippines Vietnam Thailand Japan Manila venue Peking U Australia National U Stanford U Nagasaki U Chulalongkorn U National Hospital of Pediatrics / Hanoi Indonesia U
54 First to Africa: Cairo University/Egypt Cairo, EG Fukuoka, JP Kyoto, JP
55 Univ of San Paolo: First to South America Dr Troncon Dr Dantas
56 <Telemedicine Project> 23 countries 108 institutions 192 events New Dehli SirGanga Ram Hospital Mumbai Tata MH Bangkok Kuala Lumper Before After Singapore Hong Kong Hanoi NUS EU Beijing Shanghai HaLong Ho Chi Min Cho Rai Hosp Sapporo Seoul Tokyo Fukuoka Yokohama Manila Philippine U Bandung ITB Tai pei Jakarta, UI Jilin Taichung Adelaide Flinder s Hosp Canberra ANU Melbourne Sydney /JP 16/KR /CN /TW 4/TH 1/SG /VN /MY 2/PH 9/AU 6/US 10/EU Iwate California Stanford, UC Irvine Hawaii Cairnes /EG Auckland Brisbane 1/BZ Brazil
57 Problems and future directions Multi-connection system: Quatre
58 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.
59 Problems to be considered Multi-connection system: Quatre Transmission of HD quality
60 High-definition surgical equipments for sale Newly released!
61 High Definition: Uncompressed HD =>Still experimental! G Surgery/HD Operating room/ DVTS Chairman
62 Problems to be considered Multi-connection system: Quatre Transmission of HD quality Network to hospitals; last one mile
63 To start advanced telemedicine project Network Check availability Instruments Computers Audio-visual equipments Staff Medical staff Network engineers Local engineers Medical staffs Engineers
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