Medical Information Network
and Supuercomputer Systems
in National Cancer Center.

Hiroshi Mizushima

National Cancer Center Research Institute (Tokyo, JAPAN)
E-mail: hmizushi@ncc.go.jp

The National Cancer Center began providing information by gopher and www since 1993. In Apr. 1994, Clinical Information Network System started by linking Tsukiji campus (hereinafter NCC) in Chuo-ku, Tokyo, and East campus (hereinafter NCC-East) in Kashiwa, Chiba, 30km away, with 6Mbps Optical Fiber Leased line. There are 4 rooms in each institute available for tele-conferences using NTSC dynamic images and HDTV static images. Joint seminars and joint case studies are also available. The network expands nationwide based of this inter-institutional network, that institutions as National Sapporo Hospital(Hokkaido Cancer Center), National Kure Hospital(Chugoku Cancer Center), National Shikoku Cancer Center, National Kyushu Cancer Center, Aichi Cancer Center, and Miyagi prefectural Cancer Center have joined the network and actively exchange information. Three regional Cancer Centers are joining this network this year. Those institutions are linked by 64Kbps Frame Relay Network and 1.5M bps ISDN, public Optical Fiber. By those lines not only normal information exchange as e-mail, www but also applications as tele-conferences, telemedicine with transmitting HDTV precise images, and similar style of inter-LAN-connections as Tsukiji and Kashiwa are actively operated. IP protocol is used for basic protocol. Trials of international tele-conference and telepathology with foreign medical institutions by internet have begun recently.
Transmitting of medical information by internet requires several points as follows must be considered to protect patients' information: stability of network and security of the content. It is expected that more medical institutions will join this network in near future that we do hope that our experiences and trials in operation will contribute to formulate secure national and international medical information network in the future.

1. Clinical Network system between Tsukiji and Kashiwa campus

Fig.1 shows a diagram of National Cancer Center Network System between NCC and NCC-E campus. Telepathology system of diagnostic histopathology section in NCC has a robotics microscope, on which HDTV camera is attached, which can be remotely controlled from the other site from which magnification and quantity of light to scan slides can be changed. There are 4 rooms in each institute that tele-conference system is available. Among 4, 3 rooms can send HDTV images that case study, broadcasting seminars, clinical conferences are organized by point-to-point and/or multipoint sessions. The system is also used for administration meetings. This network can also be used for research network, using links to internet by IMnet.

2. B-ISDN trials using ATM-WAN

Exchanging high-defined images, as many as the point of dynamic images, is necessary for correct diagnosis and effective conferences. NCC and NCC-E have started Broad band ISDN trials of 156Mbps (Joint Research with Nihon Telephone and Telecommunication) and 45Mbps (Joint Research with Tokyo Tsushin Network co. LTD).
By utilizing 156Mbps leased line, trials as 1) accessing clinical Image database server in NCC from NCC-E, 2)accessing various clinical applications in NCC from NCC-E, 3) transmission of Super High Definition images(SHD 2000 x 2000) to evaluate SHD image can be used in medical field.
On the other hand, 45Mbps leased line connects NTSC images/sound directly to ATM switch. It actually utilized for conferences with High Definition NTSC dynamic images. We also are going to connect 156Mbps line to National Radio Medical Institute for Heavy Particle Radiotherapy information. We also have connected with Duke University in North Carolina(USA) with 2.8Mbps as a G7 project(GIBN), to perform telemedicine, International conference and remote usage of super computers, each other.

3. Establishment of National Medical Network

Fig.2 shows the network structure of Cancer Information Network. As this is the only nationwide medical network in Japan, many medical institutes and medical associations are joining. It is important for medical institutes to have a semi-closed network because of the security. Applications used through Cancer Information Network is as followings:

E-mail
	Network News
	Literature Search(MEDLINE)
	Genetic Analysis(mpsrch, fasta, blast)
	Information Search by www
	Information disclosure by www
	Real-time multipoint conferences(on demand)
	Broadcasting of seminars(on demand)
	Joint multipoint medical conference(2 hours/week)
	Tele-image conferences(2 hours/month)
	Nurse, para-medical's conference(2 hours/month)

When operating tele-conferences and telemedicine, broad bandwidth is necessary for fast communication to achieve comfortable session but it costs high. On the other hand, for internet communication by e-mails and literature search, constant and economical connection is most important than broad bandwidth. Considering cost reduction, quality in performance, and risk prevention, we used the combination of different types of bandwidths. Even in case of natural disasters combine usage will be able to keep connection. Internet access through firewall is also possible from inside the network to make users more comfortable when accessing information on internet.
Fig.3 shows main hall of The Second Cancer Prevention Meeting held in NCC on 3,4th of August 1995. Connected sites, Hokkaido Cancer Center(Sapporo Hospital), Aichi Cancer Center, National Hospital Shikoku Cancer Center, includes NCC are projected on the main screen. It was the first trial of nation-wide conference that used HDTV image transfer and multipoint conference system.

4. Supercomputer Systems

We introduced 'Total Supporting System for Cancer Diagnosis and Therapy' including 3 supercomputers in 1995. With these system, following projects are on-going.

4.1 AI expert consultaion system

Databasing Cancer Patients in our Hospital 
       Cancer Registration 
       Database for each Tissue 
       Clinical Data 
Statistical Analysis using Artificail Inteligence 
Reference Database

Medical records of the National Cancer Center Hospital will be integrated into a centralized database, and some of the useful information regarding diagnosis, treatment and care of cancer patients will become available for health care professionals outside the National Cancer Center.
In addition, a prognosis predicting system and a search system for patients with similar clinical characteristics will be developed.

4.2 High-level Image Processing System for Diagnosis and Treatment

Image database for X-ray, CT, MRI, Pathology, Endoscopy, etc. 
Image Reference Database 
3D image processing 
Radiotherapy Treatment Planning

Digital image database and three-dimentional images reconstructed by computer technology, will be used for increased accuracy in diagnosis and optimization of radiotherapy.

4.3 Virtual Reality (VR)

Operation simulation 
       Method discussion. 
       Education 
Diagnosis assistance 
Informed Consent
Patient's amenity

Medical Virtual Reality (MedVR) System is expected to be applied to clinical fields such as surgical simulation, medical education and palliative care.

4.4 Reference DataBase

Application using Neural-Net to suggest Image Diagnosis 
       Chest X-ray 
       Pathological Image

Useful diagnostic images will be stored as educational database, which can also be used to develop a computer-assisted image diagnosis system in the future.

4.5 Genetic Analysis and Drug Design

Genetic Homology Search 
3D molecular structure construction 
Computational Chemistry

High speed and sensitive homology search is a key for genetic research of cancer. Three dimentional molecular modeling system for oncogene products and aniticancer drug designig system are installed.

4.6 Cancer Information Service (NCC-CIS)

Cancer related information For Public, For Doctors

       Internet   http://wwwinfo.ncc.go.jp/NCC-CIS 
       PC-net     +81-3-3545-1500/login as info
       FAX        +81-3-3545-8888
       Tel        +81-3-5550-3982

The latest information about the diagnosis and treatment of cancer is widely distributed through telephones, facsimiles, and personal computers.

Fig.1 Diagram of Network System between NCC and NCC-E

Fig.2 National Medical Information Network in Japan.

Fig.3 Conference held in Aug 3rd, 1995

Last Update: 970125, hmizushi@ncc.go.jp

Medical Information Network and Supuercomputer Systems in National Cancer Center.