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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/USA
2.2. Fukuoka/JapanFukuoka/Japan
3. Munich/Germany
4. London/England
5. Toulouse/France
6. Nanchang/China
7. Moscow/Russia
8. Ghaziabad/India
9. Goyang/Korea
10.Florianopolis/Brazil
1. Las Vegas/USA
2.2. Fukuoka/JapanFukuoka/Japan
3. Munich/Germany
4. London/England
5. Toulouse/France
6. Nanchang/China
7. Moscow/Russia
8. Ghaziabad/India
9. Goyang/Korea
10.Florianopolis/Brazil
July 2006

Today’s menu
?
Background
?
Activities
?
Korea-Japan
?
Asia-Pacific
?
Challenges
Kyushu Univ., Fukuoka

Surgical revolution: One exampleSurgical revolution: One example
Open 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 technologiesKey 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: Digital
V: 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.

OR Surgical movie
NCC, KoreaKyushu Univ., Japan
?
Needs! Laparosc. Surg.
?
Security software used
Aug 1, 2003
The first live demonstration of surgery

TV news reports
Aug 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 Japan
2006.4.13
Seoul => Fukuoka International Convention Center

Live Surgery for Medical Students
2008.5
Seoul/KR
Fukuoka/JP Video
? Endosc Surg
? Telemed
? English

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/CN
2011.11.15
Beijing/CN
Regular meeting
Video

Continuous Medical Education in Asia
Fukuoka, JP Cho Ray Hospital
Ho Chi Minh, VN
Cancer Institute
Tokyo, 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 Africa
Kyushu 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
ManilaManila
Philippine UPhilippine U
BandungBandung
ITBITB
2005.11
2005.6
IwateIwate 2005.7
2005.11
TaichungTaichung
2005.11
New DehliNew Dehli
ERNETERNET
2004.10
HaLongHaLong
2006.6
2006.7
2006.7
TaipeiTaipei
MumbaiMumbai
Tata MHTata MH
2003.2
JilinJilin
Jakarta, UIJakarta, UI
HanoiHanoi
MelbourneMelbourne
SydneySydney
AucklandAuckland
2007.3
CanberraCanberra
ANUANU
HawaiiHawaii
Ho Chi MinHo Chi Min
Cho Rai HospCho Rai Hosp
2007.1
2007.1
Before 2005
After 2008
2006 - 2007
2007.1
AdelaideAdelaide
Flinder’s HospFlinder’s Hosp
2005.11
2007.3
CaliforniaCalifornia
2007.1
Stanford, UC IrvineStanford, UC IrvineHongHong
KongKong
BrazilBrazil
FukuokaFukuoka
YokohamaYokohama
CairnesCairnes
EgyptEgypt
Cairo UCairo U
2007.8＜＜ Asia Medical ProjectAsia Medical Project ＞＞
34 countries
221 institutions
360 events
SeoulSeoul
EuropeEurope
South AfricaSouth Africa

First DVTS trials with Latin America
MX
TX BR
Seattle
CL
Not so good…
U San Paolo, BR
2009

Dr Miguel/BO
Dr Pablo/AR
Dr Nicolas/CO
Dr Mauricio/MX

Dr Franco/CLDr Carlos/BZ
Dr Alberto/UY
Dr 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 networkRENATA 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 end
1) International
network
2) Domestic
(NREN)
?APAN
?RedClara
RENATA/C
O
RNP/BR
Internet2/US
Network
Point
Big academic
network
Connected
to hospital?
Network
Point
3) Hospital
Network
Point
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 demonstration
2012.2.16APAN-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 REN
Engineers
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 REN
Engineers

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!

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Shuji shimizu

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Shuji shimizu

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