5 asia telemedicine symposium at kyushu univ. …...hdtv monitor ws+ pc(tablet) slide station...

Telemedicine System for Kanto LADG (Laparoscopy-Assisted Distal Gastrectomy)

Meeting.

Isao OKADA, Kazuyuki KOJIMA, Atsushi ITO, Hiroshi TANAKA

Tokyo Medical and Dental University

Hiroshi MIZUSHIMANational Institute of Public Health, JAPAN

Assistant Professor; University of Hawaii, School of MedicineFormer APAN Medical WG co-chair (with KC Lun)

[email protected]

5th Asia Telemedicine Symposium2011/12/16 16:15-16:30

At Kyushu Univ.

Dec. 16, 2011 (c) H.Mizushima 2011, All rights reserved. 2

History of NCC Telemedicine

NCC-Tokyo

NCC-east

Sapporo

Kyushu

Shikoku

Kure

Aichi

Miyagi

AomoriChibaIbaraki

Iwate

１９９４１９９４１９９５１９９５１９９６１９９６１９９７１９９７

Multipoint

１９９８１９９８１９９９１９９９

Saitama

Niigata

NCC-Hosp.NCC-Res.Inst

APAN


Photo at APAN 2004 in Hawaii


Kyushu Univ. Hospital

Hawaii

National Cancer Center (Tokyo)

Network Image of Telemedicine at 2004

QGPOP

ＡＰＡＮ－ＪＰ

KORENAPII

JGN

Korean Partner

（Venue for 17th APAN

meeting）

DV Camera

Display orProjector

DV Camera DV Camera DV Camera

【Hanyang Univ. Hospital】【National Cancer Center Hamamatsucho Office }

【 Hawaii（Venue for 17th APAN meeting）】

DVTS

Ｃｏｎｖｅｒｔ DV signal／composite signal

DVTS

M/C M/C

DVTS

M/C M/C

DVTS

M/C M/C

DVTS

M/C M/C

AudioMixer

【Genkai XP（Meinohama iDC）】Video Switcher

Change video output image．（Ｆｕｌｌ screen、2 split screens、4 split screens）

Comment DVTS,

DVcomm

◆System configuration image

VTR

Endoscope image etc.

Comment DVTS

RGBIEEE1394 IEEE1394 IEEE1394

RCA pin

IEEE1394 IEEE1394

RCA pin

IEEE1394 RGB

IEEE1394

RCA pin

DVTS(WIDE PC) (WIDE PC)

DVTS DVTS(WIDE PC) (WIDE PC)

DVTS

M/C M/C

Display orProjector

Display orProjector

Display orProjector

【Kyushu Univ. Hospital】

DVTS(WIDE PC) (WIDE PC)

DVTS


Cancer Center Network of Japan

NCC-C

Chiba-CC

NCC-E

Ibaragi

Miyagi-CC

AomoriSapporo

Shikoku-cc

Kure

Aichi-CC

Kyushu-CC

Iwate

Niigata-CCSaitama-CC

Osaka

Yamagata


Conference with Medical Images

Telepathology

•Remote Controllable Microscope

•Combination of NTSC and HDTV image


High End Telemedicine

• Super High Definition Image（SHD）

– 2000 x 2000 , 60 frames per second.

– 156 Mbps Requirement

– Special Monitor , No camera at that time

– Collaboration with NTT Research institute.


Easy Telemedicine SystemInternet and JAVA


Duke-U(USA)

International TelemedicineChinese-U

(Hong Kong+China)

Institut Gustave Roussy (France)Georgetown-U(USA)Grenoble-U(France)Singapore National-U (Singapore)Korea, etc….

AFIP(USA)

U.Hannover(Germany)


Multipoint TV conference system(B-ISDN) in 1994

MCU

384k

MCU=Multipoint Control Unit

機能:： (NTSC 動画) と音声を多地点間でやりとりする

High vision Image transfer and cooperation System in 1994.

• Pre-transfer of High Definition Image by FTP

• Collaboration system for Slide change

• Collaboration system for Pointer

Dec. 16, 2011 (c) H.Mizushima 2011, All rights reserved. 13HDTV Monitor WS+ PC(tablet)

Slide Station

ConnectingServer

INS1500FR

Desktop Cam

Tokyo Medical and Dental Univ.


Placed in Center of Tokyo

5min from Tokyo Station

Medical and Dental Univ.

Medical Hosp.

700 beds, 2200 daily outpats.

Dental Hosp.

Grad.School of Bioscience

2010.12.24

Kanto LADG (Laparoscopy-Assisted Distal Gastrectomy) Meeting

• Established for communication between doctors using LADG near Kanto area


History of Kanto LADG Meetings

• Meeting 20 2011/10/8(Sat) DVTS

• Meeting 19 2011/4/16(Sat)

• Meeting 18 2010/11/6(Sat) DVTS+W



• Meeting 15 2008/4/18(Sat)



• Meeting 12 2007/10/27(Sat)

• Meeting 11 2007/4/7(Sat)

• Meeting 10 2006/10/28(Sat)

• Meeting 9 2006/4/8(Sat)

• Meeting 8 2005/11/5(Sat)


• Meeting 6 2004/11/6(Sat)

• Meeting 5 2004/4/19(Sat)

• Meeting 4 2003/11/8(Sat)

• Meeting 3 2003/5/17(Sat)

• Meeting 2 2002/11/2(Sat)





DVTS connection with Yonsei Univ.

• First DVTS connection at 2008/4/19 (Sat)

• Tokyo Medical and Dental Univ. and Yonsei Univ. Korea.

• About 200 participants in Tokyo and about 30 in Korea.

Last LADG Meeting 2011/10/8

Dec. 16, 2011 18(c) H.Mizushima 2011, All rights reserved.

Portable Instruments


Video from Busan


Network Diagram

Kyushu Quatro

Lotte Hotel Busan

Kanazawa Univ.

Tokyo Medical and Dental Univ.Kyushu Univ. Hosp.


Internet

HUB

Router（AR450）

202.242.188.201

192.168.1.1

192.168.1.10

RGB

Switcher

ProjectorProjector

Projection

202.242.188.202

Receiving PC

SendingPCFirewireA/D converter(Canopus)

Switcher

Down ConverterDown Converter

SpeakerAudience

TMDU Network

Web camera

PresentationPC


Pointer.Wriing System

Special Issue for Japan-Korea connection with translation.

• Full simultaneous translation between Japanese and Korean is provided for better discussion.

• Accumulation of Translator at One site for economy and performance.

• We made L/R bilingual system with support of Dr.Torada.


Audio system for Bilingual connection

Dec. 16, 2011 (c) H.Mizushima 2011, All rights reserved. 24Figure made by Dr.Torada 2009Figure made by Dr.Torada 2009

Issue at TMD Hall

• TMD Hall has 500 seats with new AV system.

HOWEVER

• Cost much even to Academic events– 1day = 300,000 yen

• Built in AV System– Cannot connect AV in/out


IP address information

TMDUTransmission PC: 192.168.1.10 (use VPN)Reception PC: 192.168.1.20Subnet mask: 255.255.255.0Default gateway: 192.168.1.1Destination IP: 192.168.100.104

Kyushu U HospTransmission PC: 133.5.212.144Reception PC: 133.5.212.145Subnet mask: 255.255.255.0Default gateway: 133.5.212.254Destination IP: 133.5.10.126

Kanazawa UTransmission PC: 133.28.23.27Reception PC: 133.28.23.26Subnet mask:Default gateway:Destination IP: 133.5.10.126

Lotte Hotel BusanTransmission PC: 203.255.249.51Reception PC:Subnet mask:Default gateway:Destination IP:133.5.10.126


Traffic Analysis30min Average Traffic at the segment.Max: 30Mbps, average:18Mbps on Saturday

30min Av. Traffic at TMD gateway


Other telemedicine

• Depending on the – Network Resource

– Audio Video Resource

– Number of Speaker / Audience

– Language

– Camera / Projection Availability

– Light

We select most adequate system configuration.



Internet broadcasting.

• Real Video Broadcasting

• Started Oct. 1997

• Now can be done with U-STREAM easily


Broadcast System

Net Camera Net CameraNet Camera

Presentation PC

Down Converter

Projector Projector

Video Switcher

Camera Control PC

RealEncoder PCMicrophone

Real ServerInternet

Audience

WEB

Audience Audience

Monitor PC

Audience

Speaker Chairman Audience


Remote Camera control by PC


Broadcasting ALS Patient Group Meeting


Echo in Context Seminar

• 2003/8/23

• DVTS conference between TMDU and Osaka-Univ.

• Speaker: Prof.Kisslo from Duke Univ. at TMDU

• InfraRed Network between TMDU-KDDI, then by JGN.

• Visual switching by Professional TV team (TBS).


Telemedicine Gateway

• Gateway system to perform Telemedicine between different systems.

System A

System B

System C

System D

System A

System B

System C

Matrix Switch

Multi Image Processor

Matrix Audio Mixer


Human Recorder for home telecare

• Ubiquitous recorder – like Flight/ Drive recorder

• ECG, 3D motion, temp

• Wireless

• Good to get normal data.

• Good to get emergency situation at Home/Outside.


Summary

• Kanto Laparoscopy-Assisted Distal Gastrectomy (LADG) meeting was established in 2002 for exchanging up-to-date information. We have been organizing local meeting once or twice a year with attendance of about 200 doctors. In April 2008, we first tried DVTS connection with Seoul National University.

• Our system consists of Remote controllable Local Cameras, audio and video mixers, PCs, video titler, DV-NTSC converter, and interpreter system. We will talk about history, future and other Telemedicine activities in Japan.


Thank you ….Links

LADGhttp://kanto-lag.kenkyuukai.jp/

National Institute of Public Healthhttp://www.niph.go.jp/

Tokyo Medical and Dental Universityhttp://bioinfo.tmd.ac.jp/

Hiroshi Mizushimahttp://hiroshi.mizushima.info/

Hiroshi Mizushima Ph.D.

[email protected]

Acknowledgement

Dr. Shimizu, Dr. Torada Telemed Team Kyushu Univ. HospitalTelemed Team National Cancer Center

5 asia telemedicine symposium at kyushu univ. …...hdtv monitor ws+ pc(tablet) slide station...

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