Digital Video Transport System Research Articles

Ten-year experience of remote medical education in Asia.

Moving images are often essential in medical education, to learn new procedures and advanced skills, but, in the past, high-quality movie transmission was technically much more challenging than transmitting still pictures because of technological limitations and cost. We established a new system, taking advantage of two advanced technologies, the digital video transport system (DVTS) and the research and education network (REN), which enabled satisfactory telemedicine on a routine basis. Between 2003 and 2013, we organized 360 programs connecting 221 hospitals or facilities in 34 countries in Asia and beyond. The two main areas were endoscopy and surgery, with 113 (31%) and 106 (29%) events, respectively. Teleconferences made up 76% of the total events, with the remaining 24% being live demonstrations. Multiple connections were more popular (63%) than one-to-one connections (37%). With continuous technological development, new high-definition H.323 and Vidyo(®) (Hackensack, NJ) systems were used in 47% and 39% of events in 2011 and 2012, respectively. The evaluation by questionnaires was favorable on image and sound quality as well as programs. Remote medical education with moving images was well accepted in Asia with changing needs and developing technologies.

Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. We conducted four CME seminars in 2007-2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720 × 480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Videoconferences are excellent channels for CME programs associated with laparoscopic training.

International Live Endoscopic Multichannel Demonstration Using Superfast Broadband Internet Connections

Background/AimsTelemedicine is a convenient and efficient tool for remote education in various fields. The telemedicine system can also be used to educate doctors and medical students. The aim of our study was to establish the effectiveness of the telemedical system for use in a live endoscopic multichannel demonstration conference and to test the effectiveness and usefulness of a multicenter-based live endoscopic demonstration through live, interactive, high resolution video transmission using advanced networks and the digital video transport system (DVTS).MethodsThis study is a prospective multicenter pilot study. A live demonstration of an endoscopic submucosal dissection (ESD) and an endoscopic retrograde cholangiopancreatography (ERCP) using advanced network technology was performed.ResultsThe DVTS successfully transmitted uncompressed, high-resolution, digital lectures with endoscopy video during a multichannel endoscopic live demonstration of ESD and ERCP over multiple advanced networks. The overall satisfaction rating when the endoscopic lecture demonstration was performed by combining DVTS was generally good.ConclusionsWe believe that a multicenter-based live endoscopic demonstration is a very effective conferencing method when using advanced networks and DVTS.

Live Endoscopy Demonstration Using Superfast Broadband Internet Connections: The Future of Medical Education and Conferences

See International Live Endoscopic Multichannel Demonstration Using Superfast Broadband Internet Connections by Sang Pyo Lee, Hang Lak Lee, Joon Soo Hahm, et al., on page 73-77 With rapid technologic advances in telecommunications and informatics, various technologies and tools for providing teleconferencing via Internet became available for real-time interaction. In the article by Lee et al.,1 a bidirectional transmission system with digital video transport system (DVTS) and Korea Advanced Research Network (KOREN) was used for two multicenter live endoscopy demonstrations in South Korea. DVTS enables transmission of digital video by applying additional compression and thus results in higher image quality.2,3 KOREN is a research and education network funded by Korean government and is more stable and faster than the generally used, commercial network.3 Therefore, it is no wonder that Lee et al.1 reported high satisfaction rate of 91% regarding both sound and image qualities. This finding is also in accordance with findings of a previous study.4 This study by Lee et al.1 is significant as one of few original articles on teleconferencing, especially using DVTS.1,4,5 This study enlightens gastrointestinal endoscopists on technologic advances in teleconferences and stimulates the interests in and need for the establishment of such system. However, it would have been better if the authors specified the parameters in which the participants showed satisfaction and which they were not satisfied. While teleconferencing using superfast broadband Internet connections is promising for everyone in healthcare, one should bear in mind that hardware, software, and dedicated personnel are essential for set-up and maintenance of superfast broadband Internet connections. Once established, this shall be an increasingly useful education and conference modality for both the novice and experienced endoscopists. In addition to live endoscopy demonstrations, there will be many more applications for superfast broadband Internet connections. We hope to see and experience these in a very near future.

Emerging Technologies for Telemedicine

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

Is Laparoscopic Intraoperative Cholangiogram the Method of Choice? A Review of the Literature

Advanced technologies were introduced for the first time at the 19th World Congress of the Inter-national Association of Surgeons, Gastroenterologists and-Oncologists (IASGO) in Beijing, China. Live surgery and multi-station teleconferencing were performed using the super high-speed inter-net to transmit and preserve the high quality life- like images of surgical operations. This is the first time in the history of IASGO that use has been made of this worldwide academic network and user friendly digital video transport system, which has many advantages over traditional telemedicine systems. Here we briefly report these epoch-making sessions and their future expectations

P23.14: Remote ultrasound diagnosis of fetal cardiac abnormality using real‐time high quality digital video transport system

Although initial evaluation of the pregnant patientpresenting with abdominal pain, fever, bleeding, and various othersymptoms will be obstetric, medical and surgical etiologies must alsobe considered. Given the concern for radiation exposure to the fetus,ultrasound is often utilized for evaluation of multiple organs duringpregnancy. MRI has been increasingly utilized in the evaluation ofthe pregnant patient owing to the absence of ionizing radiation,multiplanar capability with a wide field of view, and excellent tissuecharacterization.

Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures

With the rapid and marked progress in gastrointestinal endoscopy, the education of doctors in many new diagnostic and therapeutic procedures is of increasing importance. Telecommunications (telemedicine) is very useful and cost-effective for doctors' continuing exposure to advanced skills, including those needed for hepato-pancreato-biliary diseases. Nevertheless, telemedicine in endoscopy has not yet gained much popularity. We have successfully established a new system which solves the problems of conventional ones, namely poor streaming images and the need for special expensive teleconferencing equipment. The digital video transport system, free software that transforms digital video signals directly into Internet Protocol without any analog conversion, was installed on a personal computer using a network with as much as 30 Mbps per channel, thereby providing more than 200 times greater information volume than the conventional system. Kyushu University Hospital in Japan was linked internationally to worldwide academic networks, using security software to protect patients' privacy. Of the 188 telecommunications link-ups involving 108 institutions in 23 countries performed between February 2003 and August 2009, 55 events were endoscopy-related, 19 were live demonstrations, and 36 were gastrointestinal teleconferences with interactive discussions. The frame rate of the transmitted pictures was 30/s, thus preserving smooth high-quality streaming. This paper documents the first time that an advanced tele-endoscopy system has been established over such a wide area using academic high-volume networks, funded by the various governments, and which is now available all over the world. The benefits of a network dedicated to research and education have barely been recognized in the medical community. We believe our cutting-edge system will be a milestone in endoscopy and will improve the quality of gastrointestinal education, especially with respect to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures.

Teleconferences on thoracoscopic surgery using an academic network between Asian institutions

Internet teleconferences using an advanced academic network are now quite common in the medical field. However, such conferences are still not particularly common in the area of pulmonary surgery. Here, we report the practical lessons learned from participating in international teleconferences on video-assisted thoracic surgery. Between November 2007 and February 2010, teleconferences with high-definition live video feeds were held five times between Fukuoka University Hospital and other institutions across the Asia-Pacific region. For these teleconferences, a digital video transport system, connected with the high-performance network of the Asia-Pacific Advanced Network, was used to establish communication. In all conferences, discussions were conducted without difficulty. No surgeries were performed live; a video presentation of the recorded surgery was sufficient. Though technical assistance is required to connect and communicate with other professionals, international teleconferences are a worthwhile and intellectually stimulating activity.

Teleteaching endoscopy: the feasibility of real-time, uncompressed video transmission by using advanced-network technologies

Teleteaching of endoscopy has been limited by the exorbitant cost and time inherent in high-quality digital endoscopy video transmission. The Digital Video Transport System (DVTS) transmitted over advanced networks, such as Internet2 and the Asia-Pacific Advanced Network (APAN), provides a unique infrastructure for sharing uncompressed digital videos of endoscopy. This may allow high-quality, real-time, international training of diagnostic and therapeutic endoscopy techniques at a low cost. To test the proof of concept of long-distance teaching through live, interactive, high-resolution video transmission by using advanced networks and the DVTS. We used teleteaching of image-enhanced endoscopy techniques as a model. Prospective multicenter pilot study. Trainees, faculty, and staff at 3 international endoscopy units. An image-enhanced endoscopy video lecture with advanced-network technologies. We compared image-based prelecture and postlecture test scores and secondarily assessed technical feasibility and quality. The DVTS transmitted over advanced networks successfully transmitted uncompressed, high-resolution, digital lectures with endoscopic video (digital video format 720 x 480 pixels). Postsession scores improved. Participants highly rated the technical and informational quality. The majority reported a definite interest in participating in future sessions, with a mean rating (out of 5 [scale 1-5]) of 4.7 +/- 0.5. Pilot study with a limited number of participants and sessions. The DVTS transmitted over advanced networks such as Internet2 and APAN can provide the infrastructure for transmission of high-resolution, uncompressed video endoscopy for the purpose of teleteaching endoscopy.

One Hundred Case Studies of Asia-Pacific Telemedicine Using a Digital Video Transport System over a Research and Education Network

Although the use of video in telemedicine is most helpful, the transmission of high-quality moving images is difficult in conventional systems due to the limitation of network bandwidth and the quality of service. We have established a new system via the academic broadband network that can preserve the original quality and assure smooth movement of the image. Here we report on 100 case studies and discuss the lessons we have learned. Kyushu University Hospital in Fukuoka, Japan, was linked to 53 medical institutions and meeting venues in 13 countries and regions over the Asia-Pacific Advanced Network, an international research and education consortium. The digital video transport system (DVTS), free software that transforms digital video signals directly into Internet Protocol, was installed on a personal computer (PC) with a network bandwidth of 30 Mbps per channel. Between February 2003 and June 2007, 100 telecommunication sessions were held, 94 of which were international and 6 domestic. Furthermore, 47 involved real-time demonstrations and 53 interactive teleconferences using video or PC presentations. Multiple stations were connected in 37 events, and the number of connected stations in total reached 269. The time delay was restricted to 0.3-1.0 seconds between the stations. Participants provided feedback via questionnaires, and with respect to image quality, 509 (68.3%) participants reported "very good," 206 (27.7%) reported "good," 19 (2.6%) reported "poor," and 11 (1.5%) reported "very poor." DVTS is both economical, with a minimal initial investment, and simple to set up, and this is the first time that this advanced system has been used so widely in the Asia-Pacific region. Because the high-speed academic network for research and education is available worldwide, we believe our cutting-edge technology will facilitate medical standardization beyond geographic borders in the world.

Live multi-station teleconferences at the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association via academic broadband Internet

Telecommunication is useful, but it is not widely accepted in medicine, partly because image quality is often inadequate for medical use and partly because an initial investment in special equipment is necessary. We conducted live multi-station teleconferences at the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association (APHPBA), using a new telemedicine system which transmits original-quality images in a simple and economical manner. The venue in Japan was linked to Hong Kong, Singapore, and Manila for an endoscopic surgery session, and to Seoul, Beijing, and Taipei for a pancreas transplant session. A digital video transport system (DVTS), which transforms digital video signals directly to Internet protocol, was set up at each station. The presentations were smooth and clear, and were followed by interactive discussion between the four stations for each session. Although our system requires a broadband Internet connection of at least 30 Mbps, a high-speed academic network has been established already in many countries in the Asia-Pacific region and is readily used for research and educational purposes. Application of this high-performance but user-friendly system can make teleconferences more useful and exciting. Telecommunication based on DVTS and a high-speed academic network should revolutionize the future of such conferences as the APHPBA, as well as those in other fields and locations.

Live Demonstrations of the Recent Endoscopic Procedures Using Advanced Network

Background & Aim: Recent progress in the gastrointestinal endoscopy is marked, and several endoscopic procedures have been developed and introduced into the clinical practice. Many live demonstrations were held all over the world to help physicians learning such new techniques. However, it is sometimes hard for physicians to attend such demonstrations because of time and geographical reasons. Recent advanced network enables transfer of high quality images. We thus planned to hold live demonstrations using advanced network. Methods: We used the Digital Video Transport System, which employs differentiated data transmission, for sending full-resolution moving images to the remote stations. The digital camcorder or video output from endoscopic devices was connected by IEEE 1394 interface to a personal computer, by which the broadband Internet was accessible. The necessary bandwidth was 30 Mbps per channel and audio was transmitted simultaneously with the image. To protect patient privacy, we used a security program during live demonstrations. Results: We held five medical conferences via broadband internet system. We linked to Korea, China, Taiwan, Thailand, Malaysia and Germany. These medical conferences were Kyushu University-Seoul National Cancer Center conference, Asia-Pacific Advanced Network (APAN)-Tokyo, The 26th Joint Conference on Medical Informatics, Siriraj Hospital Endoscopic Seminar and APAN-Xian with real-time demonstration of endoscopic procedures, ie endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), endoscopic submucosal dissection (ESD) and teleconferences of PC presentation. The number of connected stations was from two to eight, and the key station was Kyushu University Hospital in all conferences. The endoscopic images had been transmitted simultaneously with the sounds and transmitted images were uncompressed digital data. Thus, the image quality was as same as high quality of original endoscopic system. After the live demonstration of APAN-Xian, 14 participants responded the questionnaire. Concerning the quality of moving image, 7 respondents reported “excellent” and 7 reported “good”. Concerning the quality of sound, 3 respondents reported “excellent”, 9 reported “good” and 2 reported “poor”. Conclusions: Though there were some problems on sound quality, the endoscopic live demonstration and teleconference using advanced network seemed to be useful. And we believe this advanced system enables to connect worldwide stations for exciting discussion with multi-directional communication and will promote efficient remote endoscopic education with high quality images and active academic exchange worldwide.

Broadcast of Live Endoscopic Surgery from Korea to Japan Using the Digital Video Transport System

To assess the quality of sound and uncompressed images during an international broadcast of live surgery using the newly developed digital video transport system (DVTS). Three networks connected hospitals in Seoul, Korea, and Fukuoka, Japan. A teleconference system with bidirectional transmission over the network was set up. DVTS was used to send and receive visual and audio signals during a live broadcast of a laparoscopic partial nephrectomy to viewers at the 94th annual meeting of the Japanese Urological Association. A questionnaire was used to assess the quality of images and sound. Of 713 questionnaires distributed, 418 were collected. The quality of image and voice was ranked very good or good by 95% and 92% of the audience, respectively. The quality of live surgery was considered high by 94% of the audience. Digital video images can be transformed directly to an Internet protocol without compression of the motion images using DVTS. Live surgery via teleconference using DVTS can help surgeons learn the skills of endoscopic surgery.

Qualitative and quantitative assessment of video transmitted by DVTS (digital video transport system) in surgical telemedicine

Real-time video pictures can be transmitted inexpensively via a broadband connection using the DVTS (digital video transport system). However, the degradation of video pictures transmitted by DVTS has not been sufficiently evaluated. We examined the application of DVTS to remote consultation by using images of laparoscopic and endoscopic surgeries. A subjective assessment by the double stimulus continuous quality scale (DSCQS) method of the transmitted video pictures was carried out by eight doctors. Three of the four video recordings were assessed as being transmitted with no degradation in quality. None of the doctors noticed any degradation in the images due to encryption by the VPN (virtual private network) system. We also used an automatic picture quality assessment system to make an objective assessment of the same images. The objective DSCQS values were similar to the subjective ones. We conclude that although the quality of video pictures transmitted by the DVTS was slightly reduced, they were useful for clinical purposes. Encryption with a VPN did not degrade image quality.

Development of a Broadband Telemedical Network Based on Internet Protocol in the Asia-Pacific Region

To promote the exchange of knowledge and standardization of medical procedures and medical systems in the Asia-Pacific region, we established a medical network with high-quality moving images over broadband Internet lines in February 2003. Real-time teleconferences and live demonstrations with medical-quality videos, broadcast via the Digital Video Transport System, have been used to teach surgical techniques and other medical procedures across national borders. The Asia-Pacific Advanced Network (APAN) committee in August 2005 formally approved our proposal to establish a medical working group within APAN. The network was expanded by the launch of the Trans-Eurasia Information Network 2 in 2006. By the end of 2006, we had conducted 82 events, in 10 countries in the Asia-Pacific region. The multi-station event has increased every year. There have been no serious transmission problems or ethical conflicts so far. With these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific. This system is a promising and very useful tool for the standardization of medical system and procedures across national borders. Drawing upon these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific region.

Development of International Medical Teleconference System Using Advanced Research Network and Digital Video Transport System(DVTS)

Objective: The purpose of this study is to develop telesurgical conference system by establishing a gigabit broad-banded network between hospitals in Korea and Japan using Digital Video Transport System(DVTS) on internet protocol, and to audit performance of this system through questionnaire study. Methods: The Korea Advanced Research Network(Korean side), the Fukuoka Gigabit Highway(Japanese side), and the Korea-Japan Cable Network(international line)were used for assuring a high speed network connectivity. DVTS streaming was propagated with 30 M bps bandwidth for two channels on IPv4 network. Network security was built with virtual private network solution to guarantee protecting patient's privacy. Technological performance and satisfaction of users were evaluated following the events. Results: The teleconference sessions and live surgery transmission with DVTS on Internet protocol using advanced research network were performed successfully. Bandwidth of 60 Mbps for two-line transmission was maintained throughout the conference. The quality of the transmitted pictures had no frame loss with the rate of 30 frames per second. The sound was also clear and the time delay was less than 0.3 sec. Effectiveness of telesurgical conference using advanced network was felt beneficial for 94% of the attendants in questionnaire study. Conclusion: Establishing an international telesurgical conference system with high quality digital video transmission over internet protocol using international gigabit network was performed successfully. With the improvement of network engineering, this system is expected to contribute penetration of medical skills and knowledge through network infrastructure.