The CESNET supports telemedicine in Czech Republic Talk focused on - PDF document

Jiri Navratil, CESNET The CESNET supports telemedicine in Czech Republic Talk focused on live-surgery and communication tools used for HD video Jiri Navratil, CESNET a.l.e. Zikova 4, Prague, 16000 Czech Republic 7th – Asia Telemedicine Symposium December 13 th – 14 th 2013 Bangkok, Thailand CESNET provides live-surgery as service Live demo surgery or 3D video productions become the integral part of big medical symposia, annual conferences and specialized workshops Such events are today only cases for which Czech MD are able to make a time. It is the an occasion where to exchange their experiences and to show their own mastering Our service integrate communication between end sites (surgery room and venue) and the multimedia presentations in the venue. It is complex service requiring several types of specialists We transmit (live video or video recordings in different format, size and quality) from different medical theatres to different rooms/halls/etc. The size and the place of the conference defines the presentation mode and the tools used for such event. Currently such service is not commercially available on the market. The 7th Asia Telemedicine Symposium, 2013 1

Jiri Navratil, CESNET Microsurgery Brno - Exhibition area We transfer different video signal from different surgery theatres Urology Gynekology Ostrava new concert hall Pod ě brady spa 100 Gbps CESNET connects all University and academic institutions (including hospitals) as S.Shimizu said it is not enough for telemedicine, telemedicine need to be everywhere It is also valid for the live-demos The 7th Asia Telemedicine Symposium, 2013 2

Jiri Navratil, CESNET Neurosurgery CENS2012 Microsurgery Prague - old town Brno - Exhibition area Conference venues are in different places Urology Gynekology Ostrava new concert hall Pod ě brady spa Neurosurgery CENS2012 Microsurgery Prague - old town Brno - Exhibition area Conference venues are in different places Urology Ostrava new concert hall The 7th Asia Telemedicine Symposium, 2013 3

Jiri Navratil, CESNET Standard tools used in Live Surgery Telepresentations 1) H323 videoconference units ( 0,5 - 6 Mbps with compression) Codec – high compression Low quality of coloures and grey scale, High latency (1 -5 s) With MCU up to 40 clients for Point-to-Multipoint VC 2) DVTS - Plus based on DVTS (2001) DV stream on IEEE1394 encapsulated to IP (developed in CERNET/Tsinghua University) Client-Server technique clients 35 Mbps IEEE 1394 IP IP Server-MCU HD camera Free software, no compression, no internal latency Quality defined by the camera Widely used in APAN medical community The 7th Asia Telemedicine Symposium, 2013 4

Jiri Navratil, CESNET Streaming service Two levels of connection (V->S, S->Ib) Surgery room Bandwidth: 1 - 25 Mbps Java driven (JRE) Client bandwidth required ~= 2 Mbps for SD ~= 6 Mbps for HD Different Internet browsers Streaming service Venue screens Photos from EYE CLINIC VETERANS MEMORIAL MEDICAL CENTER (Quezon City, Philippines) The 7th Asia Telemedicine Symposium, 2013 5

Jiri Navratil, CESNET More complicated situations need more complex solutions - Transfer more HD signals in both directions - 3D mode - on-line transmission without latency - large formats 4K appeared in medical devices (cardiology - Siemens Artic zee ) etc. We have two platforms for advance video transmissions - 4K Gateway (HW box) - ULTRAGRID (software on PC or MAC) Both were developed in CESNET research teams during last 4 years, they have very similar characteristics and their own advantages) MVTP-4K (Modular Video Transfer Platform) Old name for 4K Gateway http://www.4kgateway.com/ • 2x 4K or 8x 2K/HD • unlimited distance over regular Internet • full-duplex • embedded audio • no compression adds less than 2 ms to networking delay (latency) • since 2013 JPEG 2000 compression with factor 1:10 • output synchronization for 3D without clock source IN: 8x HD-SDI OUT: 8x HD-SDI Network – 10 Gigabit Ethernet http://www.4kgateway.com/content/files/VisualUnity_4KGateway_techspec.pdf The 7th Asia Telemedicine Symposium, 2013 6

Jiri Navratil, CESNET Scheme of using 4K Gateway for 3D live-demo with own video production Video from Modular Video Transport Platform - codec Operation room http://www.ces.net/project/qosip/hw/mvtp-4k.pdf Robot da Vinci MVTP-4k NETWORK 2 HD videosignals 10Gbps (Left a Right eye) + VC videos with sound MVTP-4k Video from 2 HD videosignals Operation room Left a Right eye F10 AS3D Stereo projector F10AS3D ZD101 DLP Multiple HD signals into venue Satellite AM44 ZOF2013 with satellite link from Italy CAMO Milano, Italy Zlin, CZ Distance ~5 km The 7th Asia Telemedicine Symposium, 2013 7

Jiri Navratil, CESNET ZOF Satellite transmission Milano - Zlín Projection to multiple screens http://www.ultragrid.cz/en The 7th Asia Telemedicine Symposium, 2013 8

Jiri Navratil, CESNET Basic scheme of using ULTRAGRID Network Nvidia GeForce GTX 580 The 7th Asia Telemedicine Symposium, 2013 9

Jiri Navratil, CESNET Famous ULTRAGRID users The 7th Asia Telemedicine Symposium, 2013 10

Jiri Navratil, CESNET From the hospital to the venue transmitted via Ultragrid 3D laparoscopic surgery Urogynecology and pelvic reconstructions Zlin, October 2013 http://urogyn2013.bpp.cz “ we provide live-surgery as service but .. ” On big events we need collaboration with multimedia companies (Main problem, it needs extra money) The 7th Asia Telemedicine Symposium, 2013 11

Jiri Navratil, CESNET Strong projectors, 3D projectors with glasses, etc. Flexible Managing (Picture in picture, different images in different screens,etc.) The 7th Asia Telemedicine Symposium, 2013 12

Jiri Navratil, CESNET XXI conference of Č KS (Czech Cardio society) May 2013 ULTRAGRID transfer 3D video (doubled lines, etc .) Projection to multiple screens The 7th Asia Telemedicine Symposium, 2013 13

Jiri Navratil, CESNET ACKNOWLEDGMENT This work was supported by project MPO FR-TI3/869 and by project FR CESNET a.l.e. number 431. Thanks to my colleagues: Sven Ubik, Pavel Peciva, Petr Holub and to many others CESNET employees for their materials and help References: http://www.cesnet.cz/ http://www.ultragrid.cz/en http://ultragrid.sitola.cz http://sourceforge.net/p/ultragrid/ http://www.internet2.edu/presentations/fall12/20120425-Holub-UltraGrid.pdf http://www.4kgateway.com/ http://www.cesnet.cz/research/technologies-for-network-applications/?lang=en http://en.wikipedia.org/wiki/JPEG_2000 http://en.wikipedia.org/wiki/CUDA http://www.fsdeveloper.com/wiki/index.php?title=DXT_compression_explained http://www.cesnet.cz/cesnet/reports/press-releases/ doctors-commented-their- own-surgeries-on-line/?lang=en Thank you for attention The 7th Asia Telemedicine Symposium, 2013 14