shuji shimizu

1Kyushu University UI project Kyudai Taro,2007

Shuji Shimizu, MD

Director,Telemedicine Development Center of Asia,

Kyushu University Hospital, Fukuoka, Japan

Shuji Shimizu, MD Director,Telemedicine Development Center of Asia,Kyushu University Hospital, Fukuoka, Japan

May 9, 2013, Cali, Columbia

Remote Medical Education in Asia-Pacific- Possible expansion to Columbia-

1000 km

500 km

Tokyo

Seoul

Beijing

Shanghai

Taipei

Busan

Fukuoka

1500 km

Sapporo

Osaka

JAPANJAPAN

CHINACHINA

KOREAKOREA

East Asia

The World’s 10 Hottest Cities

1. Las Vegas/USA2.2. Fukuoka/JapanFukuoka/Japan3. Munich/Germany4. London/England5. Toulouse/France6. Nanchang/China7. Moscow/Russia8. Ghaziabad/India9. Goyang/Korea10.Florianopolis/Brazil

1. Las Vegas/USA2.2. Fukuoka/JapanFukuoka/Japan3. Munich/Germany4. London/England5. Toulouse/France6. Nanchang/China7. Moscow/Russia8. Ghaziabad/India9. Goyang/Korea10.Florianopolis/Brazil

July 2006

Today’s menu

Background Activities

Korea-Japan Asia-Pacific

Challenges

Kyushu Univ., Fukuoka

Surgical revolution: One exampleSurgical revolution: One exampleOpen Endoscopic

Benefits of Endoscopic SurgeryBenefits of Endoscopic Surgery

Small wound

Open Endoscopic

1 week after surgery

　 Pain　 Walking　Recovery

But, NOT popular in medical community yet

Why not?Why not?

Remote education

• New knowledge and procedures keep coming.• Young doctors do not have enough chances.

• Save time & travel expenses• Scalability: Daily use & Large audience

HUGE demands in education!

<Economical & Effective!>

Int’l Teleconf/Live demo

Expensive!

SatelliteSatelliteISDN/NarrowISDN/Narrow

Poor image!

?

1990s

FIFA World Cup 2002FIFA World Cup 2002

Situations dramatically changed in 2002Situations dramatically changed in 2002Situations dramatically changed in 2002Situations dramatically changed in 2002

We use BIG Internet!We use BIG Internet!

Korea- Japan was connected with Big

Broadband Network (2G).

Korea- Japan was connected with Big

Broadband Network (2G).

JapanJapan

KoreaKorea Hub in Kyushu

Univ.

Key technologies Key technologies

DVTS (Digital video transport system)

Academic network (Research and education network)

2000s

Actual bandwidth in each network

0.4

30

0

5

10

15

20

25

30

ISDN DVTS

Mbps

Compressed, degraded

Original quality

D: DigitalV: Video T: Transport S: System

Point 1: Big Broadband Network

Digital Video

Internet

Moving images

DVTS: Cheap and Simple

DV Camcoder DVTS　PC

Microphone

UTP(Ethernet)

Audio

Internet

• DVTS: free but powerful software• No special teleconferencing equipments

>30Mbps>30Mbps

Commercial network does not work!Commercial network does not work!

Surgical　instrument

IEEE1394

Point 2: Academic Network for Research and Education

Columbia: RENATA

Science 1986, “Computer Networking for Scientists”

High-speed Network for R&E in Japan

Ministry of Education

• Government-funded 　• No commercial use• All national universities are connected• No additional cost if connected• Big Internet is ready to use anytime

• Government-funded 　• No commercial use• All national universities are connected• No additional cost if connected• Big Internet is ready to use anytime

Practical Telemedicine has started.

Today’s menu

Background Activities

Korea-Japan Asia-Pacific

Challenges

Kyushu Univ., Fukuoka

OR Surgical movie

NCC, KoreaKyushu Univ., Japan

Needs! Laparosc. Surg.

Security software used

Aug 1, 2003

The first live demonstration of surgery

TV news reportsAug 22, 2003

TNC in the evening news

RKB

KBC

NHK

KBC

Routine Int’l Case Teleconference

Seoul Univ., KoreaKyushu Univ., Japan

2005.2.17

Tele-lecture: From Japan to Korea

2006.9.22

Equipment

Kyushu U

Seoul NU

DVTS package

Live Surgery from Korea to Japan2006.4.13

Seoul => Fukuoka International Convention Center

Live Surgery for Medical Students

2008.5

Seoul/KR

Fukuoka/JP Video

• Endosc Surg• Telemed• English

Today’s menu

Background Activities

Korea-Japan Asia-Pacific

Challenges

Kyushu Univ., Fukuoka

International academic network (APAN)

All connection fee is free!

Asia-Pacific Advanced Network

Kyushu Univ. as secretariat

Taipei Beijing

Fukuoka Seoul

2005.3.18

The first multi-station teleconference by DVTSThe first multi-station teleconference by DVTS

Pancreatic Transplantation MeetingPancreatic Transplantation Meeting New technical breakthrough

KRKR

ChinaChina

Gastric cancer

IndonesiaIndonesia

ThailandThailand

IndiaIndia

VietnamVietnam

MalaysiaMalaysia

JPJP

TaiwanTaiwan

SingaporeSingapore

PhilippinesPhilippines

Recovery

Less cost

Back to work

Endosc

Early

Admission

Recurrence

Death

Ope

Advanced

Diagnosis and treatment

Early detection is very important!

China-Japan Early Gastric Cancer Teleconference

Tokyo/JPFukuoka/JP

Shanghai/CN2011.11.15

Beijing/CN

Regular meeting

Video

Continuous Medical Education in Asia

Fukuoka, JP Cho Ray HospitalHo Chi Minh, VN

Cancer InstituteTokyo, JPShanghai, CN

2009.6.26

Bariatric Surgery from Australia

Adelaide

Fukuoka

Singapore

2005.11.16

Learn from others easily

Endoscopic Demonstration with Europe

Bangkok, TH

Kyoto, JP

Hamburg, GR Kuala Lumpur, MY Taipei, TW

Xian, CN

Fukuoka, JP

Seoul, KR

2007.8

• France• Italy• Belgium• Czech• Spain• Norway

Video

Expansion of Network

to South Africa

2010

First to Cape Town in South AfricaKyushu U, JP

Cho Ray, VN

U Cape Town, ZA

2011.9.21 2011.3

14,000km

Video

1. Smaller bandwidth for better quality- better compression system- high-definition image

2. Mobile technology- anytime, anywhere

New Technologies 2010s

Generalization!Generalization!

HD-H.323/Vidyo

Global endoscopic conference with Vidyo

2012.8.28

IN

LKTW KR

GEIN KRSG

HK

Video

Post-graduate course across border

2012.10.23

KR １

KR ２

KR ３

JP

VN

TH

Seoul Univ.Prof Kim HH

Select a system depending on a program/conditions

Telemedicine Development Center of Asia (TEMDEC) 2008.4

http://www.temdec.med.kyushu-u.ac.jp/eg/index.html

Organize all programs with doctors and engineers

2004.7

SapporoSapporo

2004.1

BeijingBeijing

2004.12

2005.1

TokyoTokyo

BangkokBangkok

ShanghaiShanghai

SingaporeSingapore

Kuala LumperKuala Lumper

NUSNUS

2004.7

2004.1

BrisbaneBrisbane

ManilaManilaPhilippine UPhilippine U

BandungBandungITBITB2005.11

2005.6

IwateIwate 2005.7

2005.11

TaichungTaichung2005.11

New DehliNew DehliERNETERNET

2004.10

HaLongHaLong2006.6

2006.7

2006.7

TaipeiTaipei

MumbaiMumbaiTata MHTata MH

2003.2JilinJilin

Jakarta, UIJakarta, UI

HanoiHanoi

MelbourneMelbourneSydneySydney

AucklandAuckland

2007.3

CanberraCanberraANUANU

HawaiiHawaii

Ho Chi MinHo Chi MinCho Rai HospCho Rai Hosp

2007.1

2007.1

Before 2005

After 2008

2006 - 2007

2007.1AdelaideAdelaide

Flinder’s HospFlinder’s Hosp

2005.11

2007.3

CaliforniaCalifornia

2007.1Stanford, UC IrvineStanford, UC IrvineHongHong

KongKong

BrazilBrazil

FukuokaFukuokaYokohamaYokohama

CairnesCairnes

EgyptEgyptCairo UCairo U

2007.8＜＜ Asia Medical ProjectAsia Medical Project ＞＞

34 countries221 institutions360 events

SeoulSeoul

EuropeEurope

South AfricaSouth Africa

Today’s menu

Background Activities

Korea-Japan Asia-Pacific

Challenges

Kyushu Univ., Fukuoka

Network in Latin America

First DVTS trials with Latin America

MX

TX BR

SeattleCL

Not so good…

U San Paolo, BR

2009

Dr Miguel/BO

Dr Pablo/ARDr Nicolas/CO

Dr Mauricio/MX

Dr Franco/CLDr Carlos/BZ

Dr Alberto/UYDr Gabriel/CR

Dr Carlos/BR

Visiting Latin America with engineers Alemana Hosp/CL

USP/BR

Univ. of La Plata/ARINNSZ/MX

Endoscopy teleconf. with Central/Latin America

2013.1

Hawaii

Mexico

Brazil

Chile

APAN venue

　 Dr Yao

　 Dr Uedo

UNAM

　 Dr Tanimoto

UERJ

　 Dr Fatima

REUNA

　 Dr Ignacio

RENATA is expanding network RENATA is expanding network in Columbiain Columbia

Good timing to start the project!

You need…•Engineers (network & system)

- who make it possible•Doctors (programs)

- who make it meaningful

Engineers: Network to the very endEngineers: Network to the very end1) International network

2) Domestic (NREN)

•APAN•RedClara

RENATA/CORNP/BRInternet2/US

NetworkPoint

Big academic network

Connected to hospital?

NetworkPoint

3) Hospital

NetworkPoint

Support of engineers

Big enough and stable network at all steps

Firewall

Doctors: Make attractive programs• Surgery/Endoscopy

• Cardiac intervention

• Rehabilitation

• Dental

• Bird flu, SARS, HIV

• Basic Science

• Nursing

• Medical students, etc.

A lot more needs…

Cardiac Intervention: live demonstration2012.2.16APAN-Chiang　Mai

Taiwan Univ.

Osaka Univ./JPSingapore Univ.

Thai main venue

Int’l Endoscopic Nurse Teleconference

Kyushu U

U Malaya

Singapore

Brisbane

Thailand

Team buildingTeam building

National RENEngineers

Local Engineer(Network &

Audio-visual)

The success depends on how good team you can make.

Medical Doctors

Medical Doctors

Local Engineer(Network &

Audio-visual)

National RENEngineers

Conclusions

1. Quality preservation of moving image transmission is essential in telemedicine.

2. R&E network has made the clear and smooth medical streaming possible with low cost.

3. Good time to foster continuous remote medical education programs in Columbia.

Let us start working together!