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It is a matter of life and death when the skilled and steady hand of the surgeon, with years of training and experience, performs critical surgery on a seriously ill patient. Now, imagine that hand, scalpel poised in mid-air, being remotely and expertly guided by a specialist in a distant country, linked by a high-quality audio and video connection.
This level of surgery is now possible with safe, seamless telemedicine systems, as proved in a recent project involving doctors at Kyushu University in Japan and Chulalongkorn University in Thailand last spring. Completed with technical and logistical support from NTT Com, this groundbreaking project also demonstrated the quality of NTT Com's leading-edge engineering solutions. Impressive in themselves, the truly innovative experiments are just the first step in bold moves being spearheaded by NTT under the “Advanced Information Technology Collaboration Experiments" initiative, a technology-advancement program under the aegis of the Ministry of Information and Communication's Asia Broadband Plan strategy. On top of all this, the project also helped to reveal the economic and societal benefits of a pan-Asian broadband network.
The Ultimate Definition of “Mission Critical"
Over a period of three years, inter-university trials conducted under the project demonstrated the potential of advanced telemedicine to help people throughout the Asian region, where there is widespread need for improved medical services. NTT Com's technological solutions could in fact benefit people most in need. For example, in many remote areas of Asia where patients in local clinics don't have access to specialists, diagnosis using remotely based X-ray or CT scanning equipment could be a lifesaver, says Yukihiro Ueda, Deputy Associate Manager in the Enterprise Business Division of NTT Com. “There are many cases where patients cannot receive medical care, so access to Japan's advanced medical and network technology could contribute directly to their health. We have great expectations for telemedicine," he says.
The value of NTT Com's solutions is significant, given that they could actually help to save lives. Indeed, the trials represented more than just exchanges of real-time data or audio-video links for academic purposes. When corporations talk of “fault tolerant" or “mission critical" systems, it's safe to assume that the lives of their customers are not at stake. But in fact this was the level of reliability that NTT Com had to prove in the trials!
Conducted between November 2007 and March 2008, the project culminated in trials featuring the remote maneuvering of an endoscopic robot, a truly breakthrough experiment requiring faultless delivery of high-quality image data in real time, according to Dr. Makoto Hashizume, professor in the Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University.
If a scalpel is being operated by a surgeon separated from the patient by thousands of kilometers, the video feeds must be sharply focused to enable the surgeon to work remotely with accuracy and confidence. “It is critical for the medical practitioner to have sufficiently high video quality to see the physical details of the operation and the patient's countenance. The trials enabled us to verify that our system's video quality is excellent, time delays are minimal and the technology is practical," he says.
While endoscopic surgery is not yet common in Thailand, the trials featured a number of new technologies developed by NTT Laboratories that would enable such surgeries to be performed with the participation of doctors in remote locations.
One function particularly liked by Dr. Hashizume was the “annotation" function, where instructors can draw lines, arrows and messages superimposed on the video. “We could remotely draw on the video screen in real time, which enabled us to send very detailed information in an easily understandable graphic form. Professors from many universities were very interested in this feature of the system," he explains.
Leveraging Resources to Overcome Challenges
NTT Com is an ideal candidate to manage such experiments, considering its stature as Asia's leading Tier 1 telecommunications carrier with an impressive track record in ICT communications management, not to mention its globe-girdling broadband backbone. Many tasks in the trials were performed using NTT Com's vast array of existing solutions, such as WarpVision for teleconferencing. The project ultimately required cutting-edge ICT management, with NTT Com providing a comprehensive, end-to-end solution to confirm the configurations, bandwidths, codec latencies and encoding rates required to link Kyushu and Chulalongkorn universities' analogous intranets, and the ThaiSarn network, via the Japan Gigabit Network 2 (JGN II), a research test bed operated by the National Institute of Information and Communications Technology.
But according to Ueda, NTT Com also had to overcome many new challenges, thereby demonstrating not only its profound technical skills but also its broad experience in providing high-quality broadband services across Asia.
But there was one practical consideration for the surgeons that was critical for them and crucial for NTT Com to overcome - network latency.
“The second big achievement was the reduction of video time delay, which could directly affect the operation itself. By the end of the project we had significantly reduced the delay, to the point where it did not bother the surgeons, which was a big achievement," comments Hashizume.
In achieving this, NTT Com had to establish the shortest route on the network to avoid latency during the experiment and use optimal IP addressing systems, while making sure all new equipment was integrated faultlessly. The expertise of NTT Thailand, which was particularly important for these tasks, demonstrated NTT Com's unique Asia-wide strengths.
Overall, NTT Com's solution encompassed a wide array of technical and project-management issues, ranging from support, consulting and planning to testing, delivery and management of a globally effective, highly efficient network," says Ueda. “The project demonstrated NTT Com's capabilities not only in terms of technology implementation and integration, it also highlighted our vast experience with broadband consulting, project planning, testing and operations, all of which help to solidify the foundation of our highly global network capabilities."
The technical achievements of the trials were all the more impressive in view of the extremely narrow bandwidth used. Up until the trials, it had been assumed that at least 100 Mbps would be necessary for real-time video. However, many Asian countries offer relatively low bandwidth due to infrastructure that is quite limited, especially compared to the cutting-edge infrastructure operated by NTT Com. In India, for example, 512 Kbps is considered
"broadband." So to keep the solution practical, bandwidth had to be restricted.
It is testament to NTT Com's engineering capabilities that a viable network was created it with only 3 Mbps of guaranteed bandwidth. The key was to use H.264 codec compression and Region of Interest technologies, the latter developed by NTT Laboratories.
Overlaying NTT Com's technical expertise was its project-management abilities. As a provider of ICT solutions for global managed networks, NTT Com was able to offer one-stop management of the entire project.
“Each network's quality differed from those of the others, and they had completely separate administrative and operational policies. We had to connect all these networks into a single route, across borders and operators. While there were many benefits to this experiment, from a network point of view, we proved to configure a stable, guaranteed international network using current equipment, which reflected the depth of our project-management and technical capabilities," Ueda says.
Telemedicine: Opening a New Network Paradigm in Asia
The success of this telemedicine project is the first step toward a pan-Asian telemedicine network in which Japan is expected to serve as a hub. Other trials NTT Com has conducted under the Asia Broadband Plan include tele-education with Thailand and Singapore, an electronic transaction system with Singapore and IPv6 interconnection between Japan and China. Ultimately, such initiatives will enable countless Asian broadband network users to benefit from NTT Com's global ICT know-how.
The technologies demonstrated in the telemedicine trials, says Ueda, can also be applied so that people in remote areas of Japan can have access to top specialists, who tend to be concentrated in major cities.
“There will always be a need for systems that facilitate support when medical specialists are not available. Japanese people would welcome a system that ensures 24-hour medical support. Moreover, a 24-hour system offering full medical support could be integrated with Japan's advanced medical technologies for the benefit of patients throughout Asia, not just Japan. So we have great expectation for telemedicine," says Dr. Hashizume.
Chulalongkorn University, the oldest university in Thailand, is networked with regional medical institutes all over the country. Following the trials, the university is keen to boost its telemedicine technology for deeper collaboration with these regional institutes. At the same time, the university hopes to elevate care for its own patients, such as endoscopic surgery based on telemedicine technology from Japan.
Beyond standard telemedicine applications, the technologies demonstrated in the trials have opened whole new vistas of possible applications in the corporate and public spheres, such as highly technical intra-corporate training and post-disaster management, particularly in Japan, says Ueda.
Dr. Hashizume, as head of Kyushu University's emergency center, is keenly aware of the usefulness of the technology for disasters. “We could save many more lives in emergencies if we have the infrastructure for telemedicine. I feel it is Japan's responsibility to build such systems and spread the technology worldwide," he says.
To the delight of NTT Com, all the doctors who have participated in the trials have been sold on the system. With Chulalongkorn University having highly evaluated the system and expressed its interest in further development, NTT Com is now looking to expand the scope of its telemedicine trials into other Southeast Asian markets where it has a local presence, including Malaysia, Singapore, Vietnam and Indonesia.
“We wish to pursue opportunities with many other countries. Emerging nations such as those in Southeast Asia have many regions where essential medical care is not available to locals. The ultimate goal is to build a system where advanced medical care would be available to anyone, anywhere, anytime," says Dr. Hashizume.