九州大学学術情報リポジトリ

九州大学学術情報リポジトリ

Kyushu University Institutional Repository

日韓遠隔医療システムの構築 : 非圧縮デジタル動画 像のインターネット配信

清水, 周次

九州大学病院光学医療診療部

中島, 直樹

九州大学病院医療情報部

名取, 良弘

九州大学脳神経外科

許斐, 裕之

九州大学臨床・腫瘍外科

他

http://hdl.handle.net/2324/8523

出版情報：遠隔医療研究会論文集. 8, pp.54-55, 2004-08-21. 遠隔医療システム研究会 バージョン：

権利関係：

╙㧤࿁㆙㓒ක≮⎇ⓥળ㧔#WIWUV, 2004㧕

㧙154㧙

ᣣ㖧㆙㓒ක≮ࠪࠬ࠹ࡓߩ᭴▽㧙㕖࿶❗࠺ࠫ࠲࡞േ↹௝ߩࠗࡦ࠲࡯ࡀ࠶࠻㈩ା㧙

٤ᷡ᳓๟ᰴ

ਛፉ⋥᮸

ฬข⦟ᒄ

⸵᢫⵨ਯ

ጟ᧛⠹ੑ

↰ਛ㓷ᄦ

1

਻Ꮊᄢቇశቇක≮⸻≮ㇱޔ

ක≮ᖱႎㇱޔ

⣖␹⚻ᄖ⑼ޔ

⥃ᐥ࡮⣲≌ᄖ⑼ޔ

ᖱႎၮ⋚࠮ࡦ࠲࡯ޔ

6

㖧࿖࿖┙߇ࠎ࠮ࡦ࠲࡯ᄖ⑼ޔ

ṽ㓁ᄢቇ∛㒮ౝ⑼

H

-

T

K

-J

Shuji Shimizu¹, Naoki Nakashima², Yoshihiro Natori³, Hiroyuki Konomi⁴, Koji Okamura⁵, Young-Woo Kim⁶, Joon-Soo Hahm⁷, Masao Tanaka⁴

1Departments of Endoscopic Diagnostics and Therapeutics, ²Medical Informatics, ³Neurosurgery,

4Surgery and Oncology, ⁵Computing and Communication Center, Kyushu University, Japan

6Gastric Cancer Surgery, National Cancer Center, Korea

7Departmenent of Internal Medicine, Hanyang University, Korea

Abstract: A broad-banded medical network was established between Korea and Japan using Digital Video Transport System (DVTS) over Internet protocol. We used Kyushu GigaPOP (QGPOP) (Japanese side), the Korea Advanced Research Network (Korean side), and the Korea-Japan Cable Network (international line). The teleconferences with real-time transmission of laparoscopic surgery, neurosurgery, and endoscopic examination were successfully performed. The bandwidth was 30 Mbps for a line of transmission and two lines of DVTS were utilized. The uncompressed moving image had the rate of 30 per second. The security software was also used to protect patient privacy. This internationl telecommunication using high-quality moving image is very helpful for the exchange of new medical techniques among different countries.

Keywords: Telemedicine, Internet, Digital Video Transport System

1. ⋡⊛

ㅢᏱߩᤋ௝ࠦࡦ࠹ࡦ࠷ߣ⇣ߥࠅޔක≮↪↹௝ߦߪᧄ᧪㜞

޿⸃௝ᐲ߇ⷐ᳞ߐࠇࠆޕߒ߆ߒߥ߇ࠄᓥ᧪ߩࠗࡦ࠲࡯ࡀ࠶

࠻✂ࠍ೑↪ߒߚേ↹㈩ାᛛⴚߢߪޔᚻⴚ߿ౝⷞ㏜↹௝ߥߤ ࠍ㜞⸃௝ᐲߩ߹߹ㅍାߔࠆߔࠆߎߣߪ࿎㔍ߢ޽ࠅޔേ↹௝

ࠍਛᔃߣߔࠆ㆙㓒ක≮ಽ㊁ߦ߅޿ߡචಽߦḩ⿷ߢ߈ࠆ⥃ᐥ ᔕ↪߇ⴕࠊࠇߡ߈ߚߣߪ⸒޿߇ߚ޿ޕᚒޘߪ੹࿁⑔ጟ-㊍ጊ 㑆ࠍήਛ⛮ߢធ⛯ߔࠆᶏᐩశࠤ࡯ࡉ࡞ߩቢᚑࠍᯏߦޔ㖧࿖

࠰࠙࡞ߣ⑔ጟ㑆ߢ㕖࿶❗࠺ࠫ࠲࡞േ↹௝ࠍ࡝ࠕ࡞࠲ࠗࡓߢ ㅍାߔࠆߎߣߦࠃࠅޔ࿖㓙㑆ߢߩ㜞♖⚦ක≮↪േ↹௝㈩ା

ࠪࠬ࠹ࡓࠍ᭴▽ߒߚߩߢႎ๔ߔࠆޕ

2. ᣇᴺ

2.1 ࡀ࠶࠻ࡢ࡯ࠢ

⑔ጟᏒߩ਻Ꮊᄢቇ∛㒮߆ࠄ㖧࿖࠰࠙࡞߹ߢߩࡀ࠶࠻ࡢ࡯

ࠢ᭴ᚑߪޔ₵ᶏࡊࡠࠫࠚࠢ࠻ߩ⿥㜞ㅦࠗࡦ࠲࡯ࡀ࠶࠻✂ࠍ

↪޿ߡធ⛯ߐࠇߚ㧔࿑㧝㧕[1, 2, 3]ޕߔߥࠊߜᣣᧄ஥ߩࡀ࠶

࠻ࡢ࡯ࠢߪ਻Ꮊࠡࠟࡆ࠶࠻㧔QGPOP㧕ࠍޔ⑔ጟ࡮㊍ጊ㑆ߪ

₵⇇ἥᶏᐩశࠤ࡯ࡉ࡞㧔KJCN㧕ࠍㅢߒߡޔ߹ߚ㊍ጊ߆ࠄ࠰

࠙࡞߹ߢߪ㖧࿖㜞ㅦ⎇ⓥ↪ࡀ࠶࠻ࡢ࡯ࠢ㧔KOREN㧕ࠍ೑↪

ߒߡធ⛯ߐࠇߚ [4, 5]ޕ࠰࠙࡞஥ߩធ⛯వߪޔ㖧࿖࿖┙߇ࠎ

࠮ࡦ࠲࡯ߣṽ㓁ᄢቇઃዻ∛㒮ߩ2∛㒮ߢ޽ࠆޕ

2.2 ↹௝㈩ା

૶↪ߐࠇࠆ↹௝ᒻᑼߪDV (Digital Video) ߢޔߎࠇࠍή࿶

❗ߩ߹߹ㅢାߢ߈ࠆ DVTS㧔Digital Video Transport System㧕

࠷࡯࡞ࠍ↪޿ߚ [6]ޕ੹࿁ߩવㅍߦߪㅢᏱ2࿁✢ࠍ૶↪ߒޔ 㜞↹⾰ࠍ଻ߟߚ߼ߦ ᣇߩ࿁✢ߦߪᚻⴚ߿ౝⷞ㏜↹௝ࠍኾ

↪ߢવㅍߒߚޕ߽߁ ᣇߦߪᚻⴚቶ߿ࠞࡦࡈࠔ࡟ࡦࠬቶߩ

᭽ሶࠍಾࠅᦧ߃ߡ૶↪ߒޔⴚ೨ߩ᡼኿✢↹௝߿ࠬ࡜ࠗ࠼ࡊ

࡟࠯ࡦ࠹࡯࡚ࠪࡦ↹௝ߥߤ߽ߎߜࠄߩ࿁✢ࠍ೑↪ߒߚޕ㖸 ჿ߽↹௝ߣ౒ߦવㅍߐࠇߚޕ߹ߚᖚ⠪ࡊ࡜ࠗࡃࠪ࡯଻⼔ߩ

ߚ߼ߦޔᥧภൻ࠰ࡈ࠻㧔C4-VPNޔࡈࠜ࡯ࠞࠬࠪࠬ࠹ࡓ࠭␠ޔ

᧲੩㧕ࠍ૶↪ߒߚ [7, 8]ޕ

3. ⚿ᨐ

ᐔᚑ15ᐕ8᦬ߦ⣻⣧㏜ਅ⢗ಾ㒰ⴚࠍޔ10᦬ߦ⣻⣧㏜ਅ

⢙ྙ៰಴ⴚࠍޔ11 ᦬ߦ⣻⣧㏜ਅ⋥⣺ಾ㒰ⴚࠍޔᐔᚑ 15 ᐕ 11᦬ߣᐔᚑ16ᐕ5᦬ߦߪ㗼ᓸ㏜ਅ⣖ᄖ⑼ᚻⴚࠍޔ߹ߚᐔ ᚑ16ᐕ2᦬ߦߪౝⷞ㏜⊛⤟⢙㆏ㅧᓇ㧔ERCP㧕ࠍߘࠇߙࠇ

࡜ࠗࡉߢ㈩ାߒޔߘࠇࠍၮߦ࠺ࠖࠬࠞ࠶࡚ࠪࡦࠍⴕߞߚޕ ᚻⴚ߿ౝⷞ㏜↪ࡕ࠾࠲࡯ߦᤋߒ಴ߐࠇࠆⴚ⠪↪േ↹௝

ࠍޔ↹⾰ࠍ៊ߥ߁ߎߣߥߊ㜞↹⾰ߩ߹߹㖧࿖஥߳વㅍߢ߈ ߚޕ෺ᣇߦࡕ࠾࠲࡯↹㕙ࠍ↪ᗧߒޔㅍାߐࠇࠆౝⷞ㏜ᚻⴚ ᤋ௝߿ᚻⴚቶ࡮ࠞࡦࡈࠔ࡟ࡦࠬቶߩ᭽ሶߥߤࠍⷰኤߒߚ㧔࿑

㧞㧕ޕ

㈩ାᤨ㑆ߪ޿ߕࠇ߽⚂㧟ᤨ㑆ߢ޽ࠅޔߘߩ㑆቟ቯߒߚࠗ

ࡦ࠲࡯ࡀ࠶࠻ⅣႺࠍ଻ᜬߔࠆߎߣ߇ߢ߈ߚޕࡈ࡟࡯ࡓ࡟࡯

࠻ߪ࠹࡟ࡆߣหߓ30ࡈ࡟࡯ࡓᲤ⑽ߢޔ↹௝ߩേ߈ߪṖࠄ߆ ߢ޽ߞߚޕDVTS ߩ૶↪ࡃࡦ࠼᏷ߪ 1 ࿁✢޽ߚࠅᐔဋߢ 30Mbpsߢ ޔㅢᏱ60Mbpsޔᦨᄢ70Mbpsߢ޽ߞߚޕ

4 ⠨ኤ

ᧄᴺߪ⿥㜞ㅦࠗࡦ࠲࡯ࡀ࠶࠻ߣDVTSࠍ↪޿ߚ࿖㓙㑆ߩ ක≮↪േ↹௝ォㅍߢ޽ࠆޕᓥ᧪ߩISDN߿ADSLߩવㅍߢ ߪᓧࠄࠇߥ߆ߞߚޔ㕖࿶❗㜞♖⚦ߥ࠺ࠫ࠲࡞↹௝ߣࠬࡓ࡯

࠭ߥᤋ௝㈩ାࠍᓧࠆߎߣ߇ߢ߈ߚޕ

ᓥ᧪ޔࡀ࠶࠻ࡢ࡯ࠢ߳ߩ⽶⩄ࠍシᷫߔࠆ⋡⊛ߢേ↹ࠍ࿶

❗ߒߡ㈩ାߔࠆᣇᴺ߇⋓ࠎߦⴕࠊࠇߡ޿ࠆ߇ޔߎࠇ߹ߢ↪

޿ࠄࠇߡ޿ࠆMPEG1߿MPEG4ߥߤߩ㜞࿶❗↹௝ߢߪޔⴚ ਛߩ⚦߆ߥ⸃೬߿☼⤑㕙ߩᓸ⚦ߥᄌൻࠍᛠីߔࠆߎߣߪ೔

ᐩਇน⢻ߢ޽ߞߚ [9-12]ޕ߹ߚኈ㊂ߩᲧセ⊛ᄢ߈ߥMPEG2

↹௝ߢߪߘࠇࠄߦᲧߴᡷༀߪߐࠇࠆ߽ߩߩޔ↹⾰߅ࠃ߮વ ㅍㅦᐲߦ߅޿ߡߘߩ㒢⇇ߪุ߼ߕޔ໡↪ࠗࡦ࠲࡯ࡀ࠶࠻਄

ߢߪേ↹ߩേ߈߇߉ߎߜߥ޿ߎߣ߽㗫❥ߦ⚻㛎ߐࠇࠆߎߣ ߢ޽ߞߚ[13]ޕ

╙㧤࿁㆙㓒ක≮⎇ⓥળ㧔#WIWUV, 2004㧕

㧙155㧙

ߥ߁ߎߣߥߊ㕖࿶❗ߢવㅍߐࠇࠆߚ߼ޔක≮↪ߦ⠴߃ࠆ㜞

↹⾰ߥേ↹ㅍା߇น⢻ߢ޽ࠆޕ߹ߚ↹௝ࠍ࿶❗ߔࠆߦߪⶄ 㔀ߥࠦࡦࡇࡘ࡯࠲࡯ಣℂ߇ᔅⷐߢ޽ࠆߩߣߪኻᾖ⊛ߦޔ DVTS ߢߪߎࠇࠄߩಣℂ߇ਇⷐߢ޽ࠆߚ߼વㅍㆃᑧ߇ᭂജ ᛥ߃ࠄࠇࠆޕ߹ߐߦක≮↪ߦᦨㆡߥࠪࠬ࠹ࡓߢ޽ࠆߣ⸒߃ ࠆޕߒ߆߽Ꮢ⽼ߩ࠺ࠫ࠲࡞ࠞࡔ࡜ࠍIEEE1394ߣ๭߫ࠇࠆࠗ

ࡦ࠲࡯ࡈࠚࠗࠬࠍ੺ߒߡޔࡄ࡯࠰࠽࡞ࠦࡦࡇࡘ࡯࠲ߦ❬ߋ ߛߌߢធ⛯߇ቢੌߔࠆߚ߼ޔࠪࠬ࠹ࡓߩ᭴▽߇◲නߢ޽ࠆ [6]ޕ

ක≮↪↹௝ࠍᛒ߁㓙ߦᦨ߽ᵈᗧߒߥߌࠇ߫ߥࠄߥ޿ߎߣ ߪޔᖚ⠪ࡊ࡜ࠗࡃࠪ࡯ߩ଻⼔ߢ޽ࠆޕ․ߦ࡝ࠕ࡞࠲ࠗࡓߢ

↹௝ࠍ㈩ାߔࠆ㓙ߦߪޔߘߩାภ߇றฃߐࠇߥ޿ࠃ߁ߥච ಽߥኻ╷ࠍ⻠ߓࠆߎߣ߇ਇนᰳߢ޽ࠆޕᦨㄭᥧภᒝᐲࠍ⛽

ᜬߒߥ߇ࠄㅢାㅦᐲࠍ៊ߥࠊߥ޿ᛛⴚࠍ૶↪ߔࠆߎߣߦࠃ ࠅᓥ᧪ߩ VPN ᛛⴚࠃࠅ߽㜞޿࠮ࠠࡘ࡝࠹ࠖ࡯ࠍ⏕┙ߒߚ

࠰ࡈ࠻࠙ࠚࠕ߇㐿⊒ߐࠇޔᚒޘߪߎࠇࠍ૶↪ߔࠆߎߣߢߎ ߩ໧㗴ࠍ⸃᳿ߒߚ[7, 8]ޕ

⃻࿷ࠗࡦ࠲࡯ࡀ࠶࠻✂߇ᕆㅦߦ⊒㆐ߒߚߣߪ⸒߃ޔ60 Mbps ߩ㜞ኈ㊂ࠍᏱߦ቟ቯߒߚ⁁ᘒߢ޽ࠄࠁࠆ࿾ၞ߳ଏ⛎

ߔࠆߎߣߪޔᧂߛኈᤃߢߪߥ޿ޕߒ߆ߒߥ߇ࠄ࿖ౝߢ߽⎇

ⓥ↪ࡀ࠶࠻ࡢ࡯ࠢ㧔SuperSinet߿ JGN2ߥߤ㧕ߢߪᣢߦ 10

ࠡࠟߩኈ㊂߇೑↪น⢻ߢ޽ࠅޔ߹ߚ৻⥸ኅᐸߦ߽Ꮢ⽼ߩశ ࡈࠔࠗࡃ࡯߇ㅧ⸳น⢻ߥᤨઍߦߥߞߡ߈ߡ޿ࠆޕ੹ᓟࠗࡦ ࡈ࡜ߪߐࠄߦలታߒޔᧄࠪࠬ࠹ࡓ߇৻⥸⊛ߥ࡟ࡌ࡞ߢ೑↪

ߢ߈ࠆⅣႺ߇ᢛ஻ߐࠇߡ޿ߊߎߣߪ㑆㆑޿ߥ޿ޕ

ක≮ߦ߅ߌࠆ࿖㓙㑆ߩ੤ᵹߪᧂߛ᳿ߒߡචಽߣߪ⸒߃ߥ

޿ޕᢥൻ߿ࠪࠬ࠹ࡓߩᄢ߈ߊ⇣ߥࠆⅣႺਅߢߩ੤ᵹߪޔ࿾

ℂ⊛〒㔌એ਄ߦߘߩ၂ᩮߪ㜞޿ޕ࿖ౝߢ߽޿ߊߟ߆ห᭽ߩ

ࠪࠬ࠹ࡓࠍ೑↪ߒߚ⹜ߺ߇ߥߐࠇߡ޿ࠆ߇ޔࠗࡦ࠲࡯ࡀ࠶

࠻ࠍ೑↪ߒߚᧄࠪࠬ࠹ࡓߪ࿖㓙㑆ߢߩ੤ᵹߎߘᗧ⟵߇ᄢ߈

޿ߣ⠨߃ߡ޿ࠆ[14, 15]ޕ੹ᓟߪᚻⴚ߿ౝⷞ㏜↹௝ߦ⇐߹ࠆ ߎߣߥߊක≮ߩ޽ࠄࠁࠆಽ㊁ߢᣣ㖧੤ᵹࠍଦㅴߒޔਔ࿖ߦ ߅ߌࠆ৻ጀߩ੤ᵹଦㅴࠍ࿑ࠆߣ౒ߦޔࠕࠫࠕ࿾඙ో૕ߩක

≮ࡀ࠶࠻ࡢ࡯ࠢࠍ᭴▽ߒߡ޿߈ߚ޿ޕ

㧡 ⚿⺰

ᧄࠪࠬ࠹ࡓߪක≮↹௝ߦᔅⷐߥ↹⾰ߣ㈩ାࠬࡇ࡯࠼ࠍ଻

ᜬߔࠆታ↪⊛ߥࠪࠬ࠹ࡓߣߒߡޔ੹ᓟߩ࿖㓙ක≮੤ᵹߦነ ਈߢ߈ࠆޕ

ෳ⠨ᢥ₂

[1] http://genkai.info

[2] ᷡ᳓๟ᰴޔYoung-Woo KimޔᎹᧄ㓷ᒾޔઁ㧦⿥㜞ㅦࠗࡦ࠲࡯

ࡀ࠶࠻ࠍ੺ߒߚᣣ㖧㆙㓒ᚻⴚᡰេ. ක≮ᖱႎቇ 23(Suppl.):

672-673, 2003

[3] Shimizu S, Joon-Soo Hahm, Young-Woo Kim, et al: Telemedicine with digital video transport system over the Korean-Japan Cable Network. J Kr Soc Med Info 9(Suppl): s322-326, 2003

[4] http://www.qgpop.net/drafts/Genkai083101/KJCN.pdf [5] http://www.koren21.net/eng/network/topology.asp [6] http://www.dvts.jp/.

[7] ฎᎹବᴦޔᷰㆻ᣽ᒾޔ⍹੗⺈৻㇢ޔઁ㧦ౝⷞ㏜ਅᚻⴚߦ߅ߌ ࠆ㆙㓒ᚻⴚᢎ⢒ࠪࠬ࠹ࡓ. ⥃ᄖ, 57: 25-32, 2002

[8] ๺↰ೣੳޔฎᎹବᴦޔ⏷ㇱ㓁ޔઁ㧦Internet protocolߦࠃࠆ㆙

㓒 ක ≮ ߩ ߚ ߼ ߩ ᥧ ภ ൻ ߩ ᒝ ᐲ ߣ ㅦ ᐲ ߩ ᬌ ⸛. ᣣ ᄖ ળ

⹹,105:262,2004

[9] Kim CY: Compression of color medical images in gastrointestinal endoscopy: a review. Medinfo, 9:1046-1050, 1998

[10] ቟⮮⑲᣿ޔદ⮮㓷ੳޔ૒⮮ൕޔઁ㧦㆙㓒ᚻⴚ࡜ࠗࡉࠞࡦࡈ10

࡟ࡦࠬ. ᚻⴚ 56: 1445-1449, 2002

[11] ⽴⠀⟵ᶈޔ㤥Ꮉ⦟ᦸޔᄢᯅ⑲৻ޔઁ㧦ᄖ⑼㗔ၞߦ߅ߌࠆ࠹࡟

ࠨ࡯ࠫࠚ࡝࡯ߩ⃻ᴫ. ⥃ᄖ 57: 21-24, 2002

[12] ᄢᯅ⑲৻㧦㆙㓒ᚻⴚᡰេࠪࠬ࠹ࡓ. කቇߩ޽ࠁߺ 205: 615-618,

2003

[13] Rabenstein T, Maiss J, Naegele-Jackson S, 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;34:703-710.

[14] ㄖᏈᴦਯޔᚭୖ৻ޔ᣿⍹ᶈผޔઁ㧦චൎࡊࡠࠫࠚࠢ࠻ߢߩක

≮ᡷ㕟. ᣂක≮ 8: 108-110, 2003

[15] ᄢᯅਭ⟤ሶޔ੖๧ᖘ৻㇢ޔጟ↰દ૒↵㧦ઁ㧦DV over IPᣇᑼ

ࠍ↪޿ߚࡉࡠ࡯࠼ࡃࡦ࠼ක≮↹௝ォㅍታ㛎. ක≮ᖱႎቇ 23:

137-144,2003

࿑㧝㧦ᣣ㖧㆙㓒ක≮ࡀ࠶࠻ࡢ࡯ࠢ࿑

3)212਻Ꮊࠡࠟ 212ޔ-14'0㖧࿖⎇ⓥ↪ࡀ࠶࠻ࡢ࡯ࠢ

࿑㧞㧦࡜ࠗࡉᚻⴚ↹௝㈩ାߩ᭽ሶ