Advanced telemedicine project in Asia-Pacific

and possible collaboration with Europe:

Importance of cooperation between doctors and engineers

Shuji Shimizu, MD, PhD Chairman of Medical Working GroupAsia-Pacific Advanced Network (APAN)Department of EndoscopicDiagnostics and Therapeutics,

Koji Okamura, PhDComputing and Communications CenterKyushu University, Fukuoka, Japan

http://www.apan.net/wg/medical.htmlhttp://www.aqua.med.kyushu-u.ac.jp 2007.12.12@ IRCCS Conference at Rome

shimizu@med.kyushu-u.ac.jp

Today’s menu

� Benefits

� Activities� Japan-Korea

� Asia-Pacific

� Lessons

� Challenges

Kyushu Univ., Fukuoka

New surgery: Key hole operationNew surgery: Key hole operation

Open Endoscopic

Conventional telemedicine…• Still pictures: – Radiology (CT, MR), Pathology

• Small-size moving images– Vital signs, ECG

• Compressed movies– Live surgery (bad quality)

•• Telemedicine is not popular due to poor quality.Telemedicine is not popular due to poor quality.

Broadband network is essential!Broadband network is essential!

Telephone line, etc.

Actual bandwidth in each network

0.40.40.40.4

30303030

0000

5555

10101010

15151515

20202020

25252525

30303030

ISD NISD NISD NISD N D V TSD V TSD V TSD V TS

Mbps

Telephone line,Still popular

Non-compressed images

Compressed images

Our project

D: Digital

V: Video

T: Transport

S: System

Bandwidth comparison: ISDN Bandwidth comparison: ISDN vsvs DVTSDVTS

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 instruments: easy & simple

DV Camcoder DVTS PCDVTS PCDVTS PCDVTS PC

Microphone

UTP(Ethernet)

Audio

InternetInternetInternetInternet

• DVTS: free software• No special teleconferencing equipments

>30Mbps>30Mbps

BROADBAND network is essential!BROADBAND network is essential!

Surgical instrumentSurgical instrumentSurgical instrumentSurgical instrument

IEEE1394

Korea- Japan Telemedical ProjectKoreaKorea-- Japan Japan TelemedicalTelemedical ProjectProject

Kyushu UnivKyushu Univ

((Hyeonhae/GenkaiHyeonhae/Genkai Project)Project)

Korea-Japan Cable

Network (KJCN)

Started in 2002

Bandwidth 2G Big Broadband NetworkBandwidth 2G Big Broadband Network

JP

•Education•Culture•Business•Medicine

Hanyang UHanyang U

KoreaKoreaKoreaKorea----JapanJapanJapanJapanCableCableCableCableNetworkNetworkNetworkNetwork

KoreaKoreaKoreaKoreaKoreaKoreaKoreaKorea--------JapanJapanJapanJapanJapanJapanJapanJapanCableCableCableCableCableCableCableCableNetworkNetworkNetworkNetworkNetworkNetworkNetworkNetworkＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳ ＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳＤＶＴＳ

Korea-Japan Advanced Medical Network

Kyushu-Univ.KyushuKyushu--Univ.Univ.

Image quality is as clear as original image.Image quality is as clear as original image.Image quality is as clear as original image.

Digital Video Transfer System

Digital Video Transfer System

KoreaKoreaKorea

Today’s menu

� Benefits

� Activities� Japan-Korea

� Asia-Pacific

� Lessons

� Challenges

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

Colon surgery: Live event 2003.11. 52004.7.30

Kyushu U

NCC

94th Japanese Urology Congress 2006.4.13

Seoul => Fukuoka Convention CenterSeoul => Fukuoka Convention Center

[2] Neurosurgery: Live demonstration[2] Neurosurgery: Live demonstration 2003.11.252005.5.25

Hanyang U

Kyushu U

TelementoringTelementoring for neurosurgeryfor neurosurgery 2003.11.25

Hanyang U Kyushu U

[3] Endoscopy

•• Cancer or not?Cancer or not?

•• Early stage or advanced?Early stage or advanced?

Moving images are becoming

more and more important for

therapeutic purpose.

EUS-FNA live demonstration2004.11.15

To NCC

EchoEcho

EndoscEndosc

StaffStaff MicroscopeMicroscope

StudentsStudents

[5] Tele-lecture: Gastric Cancer Study Group

2006.9.22

First to First to SNU SNU

main hospitalmain hospitalEquipments

Kyushu U

SNU Hosp

[6] Clinico-pathological Teleconference

Regular meeting every few months Hanyang U Kyushu U

Today’s menu

� Benefits

� Activities� Japan-Korea

� Asia-Pacific

� Lessons

� Challenges

Kyushu Univ., Fukuoka

[1] Extension to China 2004.10.12

Tsinghua U/BeijingTsinghua U/Beijing

Taipei Beijing

Fukuoka Seoul

2005.3.18

[2] Expansion to East Asia; [2] Expansion to East Asia;

MultiMulti--station teleconferencestation teleconference

Pancreatic Transplantation MeetingPancreatic Transplantation Meeting

BangkokBangkok

BandungBandung

SingaporeSingapore

Kyushu Univ.Kyushu Univ.

[4] To South[4] To South--

East Asia East Asia

Healthcare teleconference 2006.7.20Healthcare teleconference 2006.7.20Healthcare teleconference 2006.7.20

First highFirst high--speed speed

connection toconnection to

Indonesia:Indonesia:

SingaporeSingapore

IndonesiaIndonesiaThailandThailand

JapanJapan

[4]Extention to Australia[4]Extention to Australia

Adelaide

Fukuoka

Singapore

Nov 16, 2005

Live bariatric surgery to SIN &AUS

Recent event

2004.7

CairnesCairnes

SapporoSapporo

2004.1

BeijingBeijing

2004.12

2005.1

TokyoTokyo

BangkokBangkok

ShanghaiShanghai

SingaporeSingapore

Kuala Kuala LumperLumperAdelaideAdelaide

Done

Planned

NUSNUS

FlinderFlinder’’ss HospHosp

2004.7

2004.1

＜＜Asia Medical ProjectAsia Medical Project＞＞ChristChrist--

churchchurch

ManilaManilaPhilippine UPhilippine U

BandungBandungITBITB

2005.11

2005.11

2005.6

IwateIwate 2005.7

YokohamaYokohama2005.11

TaichungTaichung2005.11

HyderabadHyderabad

New New DehliDehliSirGangaSirGanga Ram HospitalRam Hospital

KazakhstanKazakhstan

2004.10

FukuokaFukuoka

HaLongHaLong2006.6

HongHong

KongKong2006.7

2006.7

TaipeiTaipei

MumbaiMumbaiTataTata MHMH

SeoulSeoul

2003.2 JilinJilin

Jakarta, UIJakarta, UI

HanoiHanoi

MelbourneMelbourne

SydneySydney

AucklandAuckland

2007.3

CanberraCanberra2007.3ANUANU

CaliforniaCalifornia

2007.1

StanfordStanford

HawaiiHawaii

Ho Chi MinHo Chi MinChoCho RaiRai HospHosp

1111 2222 3333 4444 5555 6666 7777 8888 9999 101010101111111112121212 1111 2222 3333 4444 5555 6666 7777 8888 9999 101010101111111112121212 1111 2222 3333 4444 5555 6666 7777 8888 9999 101010101111111112121212 1111 2222 3333 4444 5555 6666 7777 8888 9999 101010101111111112121212 1111 2222 3333 4444 5555 6666 7777 8888 9999 101010101111111112121212

2003200320032003 2004200420042004 2005200520052005 2006200620062006 2007200720072007

0000

20202020

40404040

60606060

80808080

100100100100

Number of Events

Connected Countries

Connected Institutes

Whole variety of medical contents

• Surgery

• Endoscopy

• Medical informatics

• Pathology

• Interventional radiology

• Nursing, Healthcare

• Bird flu, SARS

• Medical e-lecture

• Tele-consultation, etc.

Today’s menu

� Benefits

� Activities� Japan-Korea

� Asia-Pacific

� Lessons

� Challenges

Kyushu Univ., Fukuoka

Problems to be improvedProblems to be improved

• PAL versus NTSC

• Security for patient privacy

• Sound echo

• Last one mile

• Even better quality for HD

•• PAL versus NTSCPAL versus NTSC

•• Security for patient privacySecurity for patient privacy

•• Sound echoSound echo

•• Last one mileLast one mile

•• Even better quality for HDEven better quality for HD

HD Live surgery between KR-JP 2007.3.23

HD uncompressed DVTS

SurgerySurgery

Operating roomOperating room

Chairman

1.5Gbps

Today’s menu

� Benefits

� Activities� Japan-Korea

� Asia-Pacific

� Lessons

� Challenges

Kyushu Univ., Fukuoka

Three characteristics of our system

Academic

Broadband

Internet

High-quality International

•Non-compressed•Medical use•Good for moving images

•Handy for international

communications

• Easy• Cheap• Developing• Expanding

(TV & satellite)

Why broadband is essential for medicine?

Correct diagnosis

Better education

High-resolution

Smooth

Big broadband

Misdiagnosis

Inadequate education

Poor-resolution

Sluggish

Narrow band

Image quality is the key in telemedicine!!!Image quality is the key in telemedicine!!!

International International

Academic NetworkAcademic Network

622155

45

45

155

PH

VN

TH

CN

ID

MY

45

622SG

JP

HK

622

1000

622

EU

EU

622

http://apan.net/ http://www.tein2.net/

Academic

Network in

Europe

The GÉANT2network connects 34 countries in Europe.*GARR/IT*DNF in GE*SURFnet/NL*CESNET/CZ

First connection to Europe in telesurgery

Tokyo, JP

Singapore, SN

Manila, PH

Bordeaux, FR

Xian, CN

Sydney, AU

Seoul, KR

2007.8.30

First connection to Europe in endoscopy

Bangkok, TH

Kyoto, JP Hamburg, GR Kuala Lumpur, MY

Taipei, TW

Xian, CN

Fukuoka, JP

Seoul, KR

2007.8.29

For the success in telemedicine project

Medical

staffsEngineering

staffs

Government

& Companies

•Standardization•Medical education•New technology

• Budget

Live Demonstration from Japan

• Endoscopy using a model stomach-Dr Yada

• Recorded video of gastric surgery- Dr Tanabe

*No real patient due to time differenceFirst time to Italy