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 http://www.apan.net/wg/medical.html http://www.aqua.med.kyushu-u.ac.jp shimizu@med.kyushu-u.ac.jp 2007.12.12@ IRCCS Conference at Rome
Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka
New 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) Telephone line, etc. Telemedicine is not popular due to poor quality. Broadband network is essential!
Bandwidth Actual bandwidth comparison: in each ISDN network vs DVTS 30 25 20 15 10 Mbps Compressed images Telephone line, Still popular Non-compressed images 30 Our project D: Digital V: Video T: Transport S: System 5 0 0.4 IS D N D V T S
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)
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!
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
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.
Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka
[1] Endoscopic Surgery: the first live event Aug 1, 2003 OR Surgical movie Lap. distal gastrectomy Security software used Kyushu Univ., Japan NCC, Korea
Live surgery: TV news reports Aug 22, 2003 RKB KBC NHK TNC in the evening news KBC
Colon surgery: Live event 2003.11. 5 2004.7.30 Kyushu U NCC
94 th Japanese Urology Congress 2006.4.13 Seoul => Fukuoka Convention Center
[2] Neurosurgery: Live demonstration 2003.11.25 2005.5.25 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.
EUS-FNA live demonstration Endosc 2004.11.15 To NCC Students Echo Staff Microscope
[5] Tele-lecture: Gastric Cancer Study Group 2006.9.22 Kyushu U SNU Hosp Equipments First to SNU main hospital
[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/Beijing
[2] Expansion to East Asia; Multi-station teleconference Pancreatic Transplantation Meeting Fukuoka Seoul 2005.3.18 Taipei Beijing
Bangkok Bangkok Kyushu Kyushu Univ. Univ. [4] To South- East Asia Healthcare teleconference 2006.7.20 Singapore Japan Singapore Singapore Bandung Bandung First high-speed connection to Indonesia: Thailand Indonesia
[4]Extention to Australia Fukuoka Recent event Singapore Live bariatric surgery to SIN &AUS Nov 16, 2005 Adelaide
Done New Dehli Planned SirGanga Ram Hospital Mumbai Tata MH Hyderabad Kazakhstan 2005.1 Beijing Shanghai Hong 2006.7 Kong Hanoi Bangkok HaLong Kuala Lumper 2004.10 Singapore 2005.11 2005.6 NUS <Asia Medical Project> 2006.6 Ho Chi Min Cho Rai Hosp Manila 2004.12 Philippine U Bandung ITB 2003.2 Jilin Seoul 2006.7 Jakarta, UI Taichung 2005.11 Adelaide Flinder s Hosp Sapporo Iwate Tokyo 2005.11 2004.7 Iwate 2005.7 2004.1 Yokohama Fukuoka 2005.11 Taipei 2007.3 Canberra ANU 2007.3 Melbourne Sydney California Stanford 2007.1 Hawaii 2004.1 Cairnes 2004.7 Auckland Christ- church
100 80 60 Number of Events Connected Institutes Connected Countries 40 20 0 1 2 3 4 5 6 7 8 9 1011 1112 12 1 2 3 4 5 6 7 8 9 1011 1112 12 1 2 3 4 5 6 7 8 9 1011 1112 12 1 2 3 4 5 6 7 8 9 1011 1112 12 1 2 3 4 5 6 7 8 9 10 1112 12 2003 2004 2005 2006 2007
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 improved PAL versus NTSC Security for patient privacy Sound echo Last one mile Even better quality for HD
HD Live surgery between KR-JP 2007.3.23 Surgery Operating room 1.5Gbps HD uncompressed DVTS Chairman
Today s menu Benefits Activities Japan-Korea Asia-Pacific Lessons Challenges Kyushu Univ., Fukuoka
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
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!!!
International JP Academic Network EU CN 1000 622 622 622 155 45 HK VN 622 PH TH EU 155 622 45 MY SG 45 ID http://apan.net/ http://www.tein2.net/
Academic Network in Europe The GÉANT2 network connects 34 countries in Europe. *GARR/IT *DNF in GE *SURFnet/NL *CESNET/CZ
First connection to Europe in telesurgery Xian, CN Seoul, KR Tokyo, JP Singapore, SN Manila, PH Sydney, AU Bordeaux, FR 2007.8.30
First connection to Europe in endoscopy 2007.8.29 Bangkok, TH Xian, CN Fukuoka, JP Seoul, KR Kyoto, JP Hamburg, GR Kuala Lumpur, MY Taipei, TW
For the success in telemedicine project Engineering staffs New technology Medical staffs Standardization Medical education Government & Companies Budget
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