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Background/Aims: Telemedicine has opened the door to a wide range of learning experience and simultaneous feedback to doctors and students at various remote locations, However, there are limitations s...uch as lack of approved international standards of ethics. The aim of our study was to establish a telemedical education system through the development of high quality images, using the digital transfer system on a high-speed network. Methodology: Using telemedicine, surgical images can be sent not only to domestic areas but also abroad, and opinions regarding surgical procedures can be exchanged between the operation room and a remote place, The Asia Pacific Information Infrastructure (APII) link, a submarine cable between Busan and Fukuoka, was used to connect Korea with Japan, and Korea Advanced Research Network (KOREN) was used to connect Busan and Seoul. Teleconference and video streaming between Hanyang University Hospital on Seoul and Kyushu University Hospital in Japan were realized using Digital Video Transfer System (DVTS) over Ipv4 network. Results: Four endoscopic surgeries were successfully transmitted between Seoul and Kyushu, while contaminant teleconferences were taken place between the two throughout the operations. Enough bandwidth of 60Mbps could be kept for two-line transmissions. The quality of transmitted video image had no frame loss with a rate of 30 images per second. The sound was also clear, and time delay was less than 0.3 sec. Conclusions: Our experience has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video transmission over Internet protocol, which is easy to perform, reliable, and economical. Our network system may become a promising tool for worldwide telemedical communication in the future.show more
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