Advanced telemedicine project in Asia-Pacific and possible collaboration with Europe:

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1 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 Group Asia-Pacific Advanced Network (APAN) Department of Endoscopic Diagnostics and Therapeutics, Koji Okamura, PhD Computing and Communications Center Kyushu University, Fukuoka, Japan IRCCS Conference at Rome

2 Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka

3 New surgery: Key hole operation Open Endoscopic

4 Conventional telemedicine Still pictures: Radiology (CT, MR), Pathology Small-size moving images Vital signs, ECG Compressed movies Live surgery (bad quality) Telephone line, etc. Telemedicine is not popular due to poor quality. Broadband network is essential!

5 Bandwidth Actual bandwidth comparison: in each ISDN network vs DVTS Mbps Compressed images Telephone line, Still popular Non-compressed images 30 Our project D: Digital V: Video T: Transport S: System IS D N D V T S

6 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)

7 Basic instruments: easy & simple Surgical instrument DV Camcoder DVTS PC Internet IEEE1394 UTP(Ethernet) >30Mbps Microphone Audio DVTS: free software No special teleconferencing equipments BROADBAND network is essential!

8 Korea- Japan Telemedical Project (Hyeonhae/Genkai Project) Started in 2002 Hanyang U Korea-Japan Cable Network (KJCN) Education Culture Business Medicine JP Kyushu Univ Bandwidth 2G Big Broadband Network

9 Korea-Japan Advanced Medical Network Kyushu-Univ. Korea Digital Video Transfer System DVTS Korea-Japan Cable Network DVTS Digital Video Transfer System Image quality is is as as clear as as original image.

10 Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka

11 [1] Endoscopic Surgery: the first live event Aug 1, 2003 OR Surgical movie Lap. distal gastrectomy Security software used Kyushu Univ., Japan NCC, Korea

12 Live surgery: TV news reports Aug 22, 2003 RKB KBC NHK TNC in the evening news KBC

13 Colon surgery: Live event Kyushu U NCC

14 94 th Japanese Urology Congress Seoul => Fukuoka Convention Center

15 [2] Neurosurgery: Live demonstration Hanyang U Kyushu U

16 Telementoring for neurosurgery Hanyang U Kyushu U

17 [3] Endoscopy Cancer or not? Early stage or advanced? Moving images are becoming more and more important for therapeutic purpose.

18 EUS-FNA live demonstration Endosc To NCC Students Echo Staff Microscope

19 [5] Tele-lecture: Gastric Cancer Study Group Kyushu U SNU Hosp Equipments First to SNU main hospital

20 [6] Clinico-pathological Teleconference Regular meeting every few months Hanyang U Kyushu U

21 Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka

22 [1] Extension to China Tsinghua U/Beijing

23 [2] Expansion to East Asia; Multi-station teleconference Pancreatic Transplantation Meeting Fukuoka Seoul Taipei Beijing

24 Bangkok Bangkok Kyushu Kyushu Univ. Univ. [4] To South- East Asia Healthcare teleconference Singapore Japan Singapore Singapore Bandung Bandung First high-speed connection to Indonesia: Thailand Indonesia

25 [4]Extention to Australia Fukuoka Recent event Singapore Live bariatric surgery to SIN &AUS Nov 16, 2005 Adelaide

26 Done New Dehli Planned SirGanga Ram Hospital Mumbai Tata MH Hyderabad Kazakhstan Beijing Shanghai Hong Kong Hanoi Bangkok HaLong Kuala Lumper Singapore NUS <Asia Medical Project> Ho Chi Min Cho Rai Hosp Manila Philippine U Bandung ITB Jilin Seoul Jakarta, UI Taichung Adelaide Flinder s Hosp Sapporo Iwate Tokyo Iwate Yokohama Fukuoka Taipei Canberra ANU Melbourne Sydney California Stanford Hawaii Cairnes Auckland Christ- church

27 Number of Events Connected Institutes Connected Countries

28 Whole variety of medical contents Surgery Endoscopy Medical informatics Pathology Interventional radiology Nursing, Healthcare Bird flu, SARS Medical e-lecture Tele-consultation, etc.

29 Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka

30 Problems to be improved PAL versus NTSC Security for patient privacy Sound echo Last one mile Even better quality for HD

31 HD Live surgery between KR-JP Surgery Operating room 1.5Gbps HD uncompressed DVTS Chairman

32 Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka

33 Three characteristics of our system Easy Cheap Developing Expanding Academic Broadband Internet (TV & satellite) Handy for international communications High-quality Non-compressed Medical use Good for moving images International

34 Why broadband is essential for medicine? Big broadband Narrow band High-resolution Smooth Poor-resolution Sluggish Correct diagnosis Better education Misdiagnosis Inadequate education Image quality is the key in telemedicine!!!

35 International JP Academic Network EU CN HK VN 622 PH TH EU MY SG 45 ID

36 Academic Network in Europe The GÉANT2 network connects 34 countries in Europe. *GARR/IT *DNF in GE *SURFnet/NL *CESNET/CZ

37 First connection to Europe in telesurgery Xian, CN Seoul, KR Tokyo, JP Singapore, SN Manila, PH Sydney, AU Bordeaux, FR

38 First connection to Europe in endoscopy Bangkok, TH Xian, CN Fukuoka, JP Seoul, KR Kyoto, JP Hamburg, GR Kuala Lumpur, MY Taipei, TW

39 For the success in telemedicine project Engineering staffs New technology Medical staffs Standardization Medical education Government & Companies Budget

40 Live Demonstration from Japan Endoscopy using a model stomach -Dr Yada Recorded video of gastric surgery - Dr Tanabe First time to Italy *No real patient due to time difference

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