Development of a Telediagnosis Endoscopy System over Secure Internet

Summary

Objectives: We developed a new telediagnosis system to securely transmit high-quality endoscopic moving images over the Internet in real time. This system would enable collaboration between physicians seeking advice from endoscopists separated by long distances, to facilitate diagnosis.

Methods: We adapted a new type of digital video streaming system (DVTS) to our teleendoscopic diagnosis system. To investigate its feasibility, we conducted a two-step experiment. A basic experiment was first conducted to transmit endoscopic video images between hospitals using a plain DVTS. After investigating the practical usability, we incorporated a secure and reliable communication function into the system, by equipping DVTS with “TCP2”, a new security technology that establishes secure communication in the transport layer. The second experiment involved international transmission of teleendoscopic image between Hawaii and Japan using the improved system.

Results: In both the experiments, no serious transmission delay was observed to disturb physicians’ communications and, after subjective evaluation by endoscopists, the diagnostic qualities of the images were found to be adequate. Moreover, the second experiment showed that “TCP2-equipped DVTS” successfully executed high-quality secure image transmission over a long distance network.

Conclusions: We conclude that DVTS technology would be promising for teleendoscopic diagnosis. It was also shown that a high quality, secure teleendoscopic diagnosis system can be developed by equipping DVTS with TCP2.

Keywords

Telemedicine - remote consultation - videoconferencing - endoscopy - computer security

• References

• 1 DV (Digital Video) over IP (DVTS).. WIDE project & DVTS Consortium. c2001-06 (updated 2006 April 27). Available from: http://www.sfc. wide.ad.jp/DVTS/.
• 2 Sugiura K, Sakurada T, Ogawa A, Nakamura O, Nakagawa S, Murai S. DVTS using portable notebook computers. IPSJ SIGNotes Distributed Processing System 2002; 107: 139-144.
• 3 ITU-R BT.500-11 Methodology for the Subjective Assessment of the Quality of Television Pictures, March 2002. ITU-R Recommendations.
• 4 Ohashi K, Gomi Y, Mizushima H, Tanaka H. Proposal of secured medical network with TCP2. Proc JAMI 2004; 3G: 2-3.
• 5 JGN (Japan Gigabit Network).. Japan Gigabit Network; c2004 (updated 2004 March 1). Available from: http://www.jgn.nict.go.jp/jgn_archive/english/02-about/2-1.html/
• 6 ITU-R BT.500-7 Methodology for the Subjective Assessment of the Quality of Television Picture, October 1999. ITU-R Recommendations.
• 7 The picture quality assessment system (VP21S).. K-Will Corporation; c2007 (updated 2007 Feb 21). Available from: http://www.kwillcorporation.com/products/VP21S.html/.
• 8 Total Telecommunication Technology. T.T.T. Co., Ltd.;. c1996-2007. Available from: http://www.tttnet.ne.jp/.
• 9 Zhang J, Yu F, Sun J, Yang Y, Liang C. DICOM image secure communications with Internet protocols IPv6 and IPv4. IEEE Trans Inf Technol Biomed 2007; 11 (01) 70-80.
• 10 APAN (Asia Pacific Area Network). Asia-Pacific Advanced Network; c2007 (updated 2007 May 5). Available from: http://www.apan.net/.
• 11 DeBaley ME. Telemedicine has now come of age. Telemed J 1995; 1: 3-4.
• 12 Lewin M, Xu C, Jordan M, Borchers H, Ayton C, Wilbert D. et al. Accuracy of pediatric echocardiographic transmission via telemedicine. J Telemed Telecare 2006; 12 (08) 416-421.
• 13 Yamazaki Y, Saida T, Takizawa M, Murase S. Interhospital teledermatology conference using a videophone network. Igaku Butsuri 2003; 23 (01) 40-43.
• 14 Seidenari S, Pellacani G, Righi E, Di Nardo A. Is JPEG compression of video-microscopic images compatible with telediagnosis? Comparison between diagnostic performance and pattern recognition on uncompressed TIFF images and JPEG compressed ones. Telemed J E Health 2004; 10 (03) 294-303.
• 15 Bruno D, Delvecchio FC, Preminger GM. Digital still image recording during video endoscopy. J Endourol 1999; 13 (05) 353-356 discussion 356-357.
• 16 Kim CY, Etemad B, Glenn TF, Mackey HA, Viator GE, Wallace MB. et al. Remote clinical assessment of gastrointestinal endoscopy (teleendoscopy): an initial experience. Proc AMIA Symp 2000 pp 423-427.
• 17 Wildi SM, Kim CY, Glenn TF, Mackey HA, Viator GE, Wallace MB. et al. Tele-endoscopy: a way to provide diagnostic quality for remote populations. Gastrointest Endosc 2004; 59 (01) 38-43.
• 18 Rabenstein T, Maiss J, Naegele-Jackson S, Liebl K, Hengstenberg T, Radespiel-Troeger M. et al. Tele-endoscopy: influence of data compression, bandwidth and simulated impairments on the usability of real-time digital video endoscopy transmissions for medical diagnoses. Endoscopy 2002; 34 (09) 703-710.
• 19 Nakashima N, Okamura K, Hahm JS, Kim YW, Mizushima H, Tatsumi H. et al. Telemedicine with digital video transport system in Asia-Pacific area. Proceedings of Advanced Information Networking and Applications (AINA) 2005 pp 253-257.
• 20 Yamaguchi M, Haneishi H, Fukuda H, Kishimoto J, Kanazawa H, Tsuchida M. et al. High-fidelity video and still-image communication based on spectral information: Natural Vision system and its applications. Spectral Imaging: Eighth International Symposium on Multispectral Color Science. Proc. SPIE-IS&T Electronic Imaging, SPIE 2006. p 6062
• 21 Miyake Y, Miyata K. Color image processing based on spectral information and its application. Image Processing 1999. ICIP 99. Proceedings International Conference 1999; 3: 41-44.
• 22 Linkous JD. Toward a rapidly evolving definition of telemedicine. Retrieved from http://www.atmeda.org/news/definition.html/. January 22, 2004
• 23 The American Telemedicine Association ATA; c2005-06 (updated 2003 March 7). Available from: http://www.atmeda.org/news/library.htm/.
• 24 Wootton R. Realtime telemedicine. J Telemed Telecare 2006; 12 (07) 328-336.
• 25 Choong KM, Logeswaran R, Bisterb M. Costeffective handling of digital medical images in the telemedicine environment. Int J Med Inf 2007; 76: 646-654.
• 26 HIMSS (Healthcare Information and Management System Society); c2007 (update 2007 August). Available from: http://www.himss.org/
• 27 Kuhn KA, Wurst SR, Bott OJ, Giuse DA. Expanding the Scope of Health Information Systems. Methods Inf Med 2006; 45 (01) 43-52.