Preparation of telemedicine demo at Manaus mini-workshop

<<February 12, 2000>>

Shin Takuma <st245@columbia.edu>

Ricardo Cabrera <rcabrera@3dechotech.com>

Dr. David A. Johnson <daj@utk.edu>

Alexandre Rivas <alex_mau@argo.com.br>

Salah H. Mandil <mandils@who.int>

Raj Gururaja <raj_gururaja@hp.com>

Prof. Jose Brenes Andre <jbrenes@cariari.ucr.ac.cr>

Yosuke Komatsu <yosuke_komatsu@hotmail.com>

Dear Electronic Colleagues:
===========================

(1) The dates of the mini-workshop in Manaus, Amazona is now set to May 31, June 1 and 2, 2000 -- see:

(a) "Revised schedule of mini-workshop in Manaus: May 31-June 2 -
February 8, 2000" at <http://www.kagawa-jc.ac.jp/~steve/global-univ-2000.html>, and

(b) its ATTACHMENT IV Fourth Draft: Mini-Workshop on TELEMEDICINE AND
DISTANCE EDUCATION ON SUSTAINABLE DEVELOPMENT FOR THE
INTERNATIONAL AMAZON" at
<http://www.geocities.com/Athens/Pantheon/7197/global-univ-2000/2-8-a.html>.

(2) ATTACHMENT I below is an article appeared in the recent BUSINESSWEEK.

Dear Shin:
==========

(3) The Volumetrics machine you use is mentioned in it.

The 3D imaging of human heart which you are doing with Richardo seems
the cutting-edge technology.

Dear David:
===========

(4) Many thanks for your soliciting interest from your UTK medical people
for participating in our telemedicine demo in Manaus (ATTACHMENT II and III).

Alex now confirmed the availability of PictureTel and ISDN at 254 Kbps.
He is also now working to get Hewlett-Packard's (HP) 5500 echocardiogram machine.

If your UTK telemedicine group has the same (or better) units, we can
do, at least, the same demo as we did at our Tampere event, i.e., a
pseudo-patient on treadmill can be diagnosed by the experienced doctor
at your UTK, as sending his echocardiograph image via the PictureTel and
the ISDN line from Manaus to your UTK medical school.

Pls ask your telemedicine people to contact Ricardo, though they may
know him already. Ricardo's software can produce a 3D image of the
patient's heart which can be cut in anyway. If possible, I would like
to have this feature during your UTK people's demo -- as to upgrading
the demo at our Tampere event.

Originally, Shin, Ricardo and I planned to have this feature for
our similar demo during our mini-workshop at Manila.

I would be very happy to discuss this matter when I visit you and those
UTK telemedicine team members next month.

Dear Ricardo:
=============

(5) I would like to expect your full cooperation with the UTK people for this demo.

Dear Alex:
==========

(6) Pls let me know when you have confirmed the HP-5500 echocardiogram machine.
As soon as I hear from you about this, I will ask Raj to provide us with
their videoconferencing bridge at free of charge.

He offered me such service for our demo at Tampere event, but,
alas, we could not find HP-made echocardiogram machine in Tampere at that time.

Dear Jose:
==========

(7) Many thanks for your msg (ATTACHMENT V).

You may join in this demo through the bridge at 254 Kbps -- which is the
speed Manaus people have and which you have to match.

However, you have to call into the bridge, i.e., you have to be
responsible for the cost of the call.

Dear Shin:
==========

(8) Referring to our recent phone conversation, pls describe me more how you
can make a demo of the low-cost distance education with the use of CD-ROM,

Web (and if necessary, NetMeeting video- or audio-conferencing) via
56 Kbps Internet, for Continuing Medical Education (CME).

If successful, this could be of strong interest to Salah Mandil at WHO, too.

Dear Yoh:
=========

(9) Referring to our recent phone conversation, pls describe to me more how you
can make a demo of the use of slow-speed (2,400 bps) INMARSAT satellite
with a portable dish antenna, for emergency medical care in remote areas
of developing countries.

Best, Tak
****************************************
ATTACHMENT I

BUSINESSWEEK LIFESTYLE

Live and in 3-D, Your Body at Work
Imaging advances allow detailed diagnoses without scalpels

By KATE MURPHY

BUSINESSWEEK ONLINE : FEBRUARY 21, 2000 ISSUE
<http://www.businessweek.com/@@LmAIAmUQIVNROQEA/premium/00_08/b3669132.htm>

Cliff Burks, 74, has mild coronary-artery disease but didn't want to have
another angiogram. Twenty years ago, the retired construction-company owner
from Galveston, Tex., had undergone the procedure, in which dye is injected
into an artery to provide a clearer X-ray image of the heart's blood vessels.
''It was uncomfortable, to say the least,'' says Burks of having a catheter
threaded through an artery in his groin and then up to his heart. No wonder he
jumped at the chance to try a noninvasive imaging technique that didn't even
exist three years ago. Using a $250,000 ultrasound device, physicians were
able to get a three-dimensional view of his beating heart. ''It was amazing,''
he says. ''There was my heart pumping on a screen in 3-D.'' Doctors could tell
right away everything was fine, compared with the three hours or so it would
have taken to reach a diagnosis with an angiogram. As a result, Burks was on
his way home in a heartbeat.

The marriage of better imaging devices with computers in the past five years
has allowed ''views inside the body never before seen,'' says Masood Ahmad,
Burks's doctor and director of echocardiography at the University of Texas
Medical Branch in Galveston. Moreover, these images are obtained with little
or no discomfort to patients. Physicians--using the latest developments in
sound waves, radio waves, X-rays, and magnetic fields--

not only can cost-effectively examine the body's organs and other structures in exquisite
detail, they can watch them at work, whether they're beating hearts or bending knees.

Doctors, primarily at major research institutions and teaching hospitals that
can afford the equipment, are still sorting out how best to use the
technologies. However they are utilized, these imaging procedures may
eventually cost less than traditional or invasive types of examinations,
because none requires sedation or hospitalization. The scans are likely to run
from $500 to $5,000, depending on the part of the body to be studied and the
degree of detail needed. Magnetic resonance imaging (MRI) generally costs the
most, ultrasound the least.

Medicare and private insurers have yet to provide coverage for these tests,
since many of the technologies' applications are still considered
experimental. But that may change in a year or two, says David J. Vining,
associate professor for diagnostic radiology at Wake Forest University School
of Medicine in Winston-Salem, N.C. ''The science is there, so the funding will follow.''

One new device is called a multidetector computed tomography (CT) scan. The
scanner has multiple rings of X-ray detectors that circle around the patient,
picking up more details in a quarter of the time it takes older models, which
have only one ring. ''It takes you longer to drop your drawers and get on the
table than it takes to complete the scan,'' says Vining, whose hospital has
one of the $1 million machines. Made by General Electric, Siemens, and
Marconi, the devices came on the market less than two years ago. Doctors and
technicians take the scanner's finely rendered images and feed them into the
same types of computers used to create virtual-reality video games. ''The
perspective we gain is incredible,'' says Geoffrey Rubin, co-director of
Stanford University Medical School's 3D Imaging Laboratory, which uses a
multidetector CT scan. ''We have taken recent gains in imaging and leveraged
them with technology developed for the entertainment industry.''

Three-dimensional views of tumors can be rotated for a better vantage point
and finer analysis. Aortic aneurysms can be measured to determine precisely
the size of the stents and grafts to be surgically implanted. Doctors have
also used these technologies to perform so-called virtual colonoscopies, with
an accuracy of up to 90%, in a mere 20 seconds.

MRI has taken a leap forward, too, a result not only of subtle improvements in
equipment design but of ''a better understanding of which pulse sequences'' of
radio waves through a body in a magnetic field ''will yield the best
pictures,'' says Philip Alderson, chairman of the department of radiology at
Columbia University Medical School in New York. The images have become so
refined that for the past two years, doctors, aided by computers, have been
able to perform what is known as functional MRI, in which they track the
movement of oxygen to monitor blood flow and phosphorus to assess metabolic activity.

This is ideal for discovering vascular problems and diagnosing cancerous
growths--and it can also help in the exploration of how the mind works. By
watching the flow of oxygen and consumption of phosphorus, ''we can actually
watch how the brain responds to different stimuli and discover key cognitive
pathways,'' Alderson says. Already, researchers at the University of
Pennsylvania School of Medicine in Philadelphia and the University of Alabama
School of Medicine in Birmingham are using functional MRI to learn more about
such brain disorders as Alzheimer's disease and schizophrenia. The technology
also holds great promise for testing the efficacy of drug regimens, such as
chemotherapies aimed at blocking the formation of the blood vessels that stoke tumors.

A newfangled version of the oldest imaging technology, ultrasound, also has
made it to market. Until three years ago, it was impossible to use ultrasound
to examine a three-dimensional image of the heart in real time--as Dr. Ahmad
did--because the organ's movement distorted the picture. But Volumetrics in
Durham, N.C., developed tiny transducers that, when placed between the
patient's ribs, rapidly fire sound waves in a pyramidal fashion. The
technology can therefore capture the entire heart in one shot--rather than the
several shots needed by older models that emit only a two-dimensional beam.

Ultrasound has become sensitive enough to show blood flow, an improvement that
might make some biopsies unnecessary. Researchers at Thomas Jefferson
University Medical College in Philadelphia are using ultrasound devices made
by companies such as Medison and Siemens to determine if growths in the uterus
and breast are cancerous simply by looking at their vascular activity--without
lifting a scalpel. Thanks to these advances, the kindest cut is no cut at all.
========================================
Image Makers

COMPUTED TOMOGRAPHY (CT) SCAN
X-rays of the body from thousands of different angles are processed by
computer to create a visual cross-section of tissues and organs.

MAGNETIC RESONANCE IMAGING (MRI)
The body is put into a magnetic field and then bombarded by radio waves.
Images are created because magnetized material excited by radio waves returns
to normal in a distinct, visually decipherable way.

ULTRASOUND
The variations in how sound waves bounce off different tissues create images.

Copyright 2000, by The McGraw-Hill Companies Inc. All rights reserved.
****************************************
ATTACHMENT II

Date: Mon, 24 Jan 2000 10:38:11 -0500
From: djohnutk <djohnutk@utkux.utcc.utk.edu>
To: Tak Utsumi <utsumi@columbia.edu>
Subject: FWD: RE: Wireless Internet with ITFS

Tak:

I am forwarding this reply from our Associate Vice Chancellor, for your
information. We have a good level of interest now to build on. While I can't
provide support for your travel to Tennessee, I do hope you can arrange a
visit to Knoxville and Nashville in the near future. I am now working on
trying to set up the telemedicine demo to Manaus.

Regards,

Dave

>===== Original Message From gcooper@knoxville-notes.ips.utk.edu =====
The telemedicine project does sound like the best project for a
demonstration. And, I agree that if we could get a Global University group
to the Renaissance Center, that might help "spark" more ideas for projects.
Also, your idea of attracting a couple of the potential funding sources,
like World Bank or USAID. We're anxious to work with you in any way.

Gayle
****************************************
ATTACHMENT III

Date: Thu, 10 Feb 2000 19:12:08 -0500
From: djohnutk <djohnutk@utkux.utcc.utk.edu>
To: Alex Rivas <alex_mau@argo.com.br>, utsumi@columbia.edu
Cc: David Johnson <daj@utk.edu>

To: Alex, Tak and others interested in Unamaz conference:

I met today with our Univ. of Tenn officials in telemedicine and distance
education to solicit interest in UT participation in the Unamaz conference.
Yes, there is interest. We have good telemedicine capabilities here and the
staff would be interested in participating in a demo. The University is in
transition right now and so there is a great deal of uncertainty about where
we are headed. I will keep pushing, I am optimistic, and will keep you
informed. The Chinese say, "May you live in interesting times." We do.

Regards,

Dave
****************************************
ATTACHMENT IV

Date: Mon, 7 Feb 2000 16:21:33 -0500
From: djohnutk <djohnutk@utkux.utcc.utk.edu>
To: Jose Brenes <jbrenes@cariari.ucr.ac.cr>
Cc: utsumi@columbia.edu
Subject: Response to yr msg

>===== Original Message From Jose Brenes <jbrenes@cariari.ucr.ac.cr> =====
>Dear David
>Tak requested me t get in touch with you and let you know whther I stll
>wanted to go on with GUCA. As I told him in an E-mail, I was a bit stuck
>last year because

Hello Jose:

Good to hear from you. I was glad to learn of all the developments that have
occurred since Tampere. Yes, certainly we all wish to have Central America
consortium participation in the pilot projects of the GUS. From your earlier
communications, I gathered that there were some problems in coalescing the
group from the Central American universities. Our suggestion at that time was
to consider merging the Central American participation with the UNAMAZ event
scheduled for late May/early June in Manaus, Brazil. I realize that may not
be the best solution from your point of view. Is this idea at all feasible?

My situation is a bit sticky right now as I have had more eye problems and am
scheduled for another operation in a few weeks. This has slowed me down a
bit. I do want to try to assist your efforts, but I believe it would be more
productive for you to work directly with Tak Utsumi on developing your
initiatives, at least until I get past my eye problems.

I will in the meantime continue, along with Tak, to look for support for your
proposal for the Central America region.

Regards,

Dave
****************************************
ATTACHMENT V

Date: Tue, 8 Feb 2000 13:20:51 -0500
From: Jose Brenes <jbrenes@cariari.ucr.ac.cr>
To: utsumi@friends-partners.org
Subject: Re: Revised schedule of mini-workshop in Manila

Dear Tak

Thanks a lot for the information

As one of the Central American people involved with Global University, I
am very pleased to see that Amazonian region is moving ahead.

I have also detected that you plan to use PictureTel at 384 kbps

We have such a system, and may get some people interested in participating
in the demo. It may also help start the Central American part.

If you need some people on this part of the world to be hooked at that
demo, please let me know how I can help

Best

Jose Brenes
****************************************
List of Distribution

Shin Takuma, M.D.
Post doctoral research fellow of Medicine
Cardiology Division
Columbia Presbyterian Medical Center
Department of Medicine
College of Physicians & Surgeons
Columbia University
630 West 168th street
New York, NY 10032-10391
USA
Tel: +1-212-305-9875
Fax: +1-212-305-9049
st245@columbia.edu

Ricardo Cabrera
Director, Sales & Marketing/Americas
3D EchoTech
555 Burbank Street Unit A
Broomfield, CO 80020
(800) 957-3246
Fax: (303) 438-8430
rcabrera@3dechotech.com
http://www.3DEchoTech.com

Dr. David A. Johnson, AICP
Board member of GLOSAS/USA
Former President of Fulbright Association
Professor Emeritus, School of Planning
College of Arts and Sciences
University of Tenneseee
108-I Hoskins Library
Knoxville, TN 37996-4015
USA
Tel: +1-423-974 5227
Fax: +1-423-974 5229
daj@utk.edu
davidj@buncombe.main.nc.us
http://web.utk.edu/~djohnutk/

Alexandre Rivas, Ph.D.
Adjunct Professor
Director of the Center for Environmental Sciences
University of Amazonas - Brazil
C.P. 4208, Manaus 69053-140
BRAZIL
+55-92-635 32 33
+55-92-644 23 22
Fax: +55-92-644 23 84
alex_mau@argo.com.br
http://www.argo.com.br/~alex_mau/alex.htm

Salah H. Mandil, Ph.D.
Director-Advisor
Health Informatics & Telematics
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
SWITZERLAND
+41-22-791-2426 (direct)
+41-22-791-2111
Fax: +41-22-791-4702
ISDN +41.22 791 1132 and 1133
mandils@who.int
mandils@who.ch

Raj Gururaja
Hewlett Packard
Andover, MA
978-659-2765
978-659-2097 (his secretary)
raj_gururaja@hp.com

Prof. Jose Brenes Andre
President of Consta Rica Fulbright Association
Escuela de Fisica
Universidad de Costa Rica
San Pedro
COSTA RICA
Tel: +506-207-5019
Fax: +506-225-5511
jbrenes@cariari.ucr.ac.cr

Yosuke Komatsu, MD, PhD
LCDR, MC, FS, JMSDF (Japanese Navy)
Visiting Scientist
Clinical Sciences Division
Department of Military and Emergency Medicine
National Naval Medical Center
and the Uniformed Services University of the Health Sciences (USUHS)
4301 Jones Bridge Road
Bethesda, MD 20814-4799
301-295-1774
Fax: 301-295-6773
Pager: 1-800-759-8888 PIN number 1358774
yosuke_komatsu@hotmail.com
ykomatsu@usuhs.mil
http://www06.u-page.so-net.ne.jp/ca2/yosuke-k/index-j.html
**********************************************************************
* Takeshi Utsumi, Ph.D., P.E., Chairman, GLOSAS/USA *
* (GLObal Systems Analysis and Simulation Association in the U.S.A.) *
* Laureate of Lord Perry Award for Excellence in Distance Education *
* Laureate of Planet Earth Pathfinder Award *
* Founder of CAADE *
* (Consortium for Affordable and Accessible Distance Education) *
* President Emeritus and V.P. for Technology and Coordination of *
* Global University System (GUS) *
* 43-23 Colden Street, Flushing, NY 11355-3998, U.S.A. *
* Tel: 718-939-0928; Fax: 718-939-0656 (day time only--prefer email) *
* Email: utsumi@columbia.edu; Tax Exempt ID: 11-2999676 *
* http://friends-partners.org/GLOSAS/ *
**********************************************************************

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