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What 5G enables in hospitals and production

5G is much more than the successor to LTE: medical technology manufacturers can use it to build their own networks and thus advance factory automation. In addition, 5G enables a medical Internet of Things through short latency times and high reliability. The starting signal for new medical devices?

Sabine Koll
Journalist in Böblingen

As a rule, new smartphones are the focus of the Mobile World Congress (MWC) in Barcelona. But in February a medical application caused a sensation: the first live operation via a 5G network. Specifically, it was a real-time streaming between a team of doctors in the Hospital Clinic and Dr. Antonio de Lacy, Head of Gastrointestinal Surgery there, in the main auditorium of the MWC. During the demonstration, de Lacy made markings in the video transmission that were immediately seen by the surgical team in the clinic. "Before 5G we had to freeze the picture to draw, but the surgeon keeps working and that's not ideal," explained de Lacy. The first 5G teleoperation took place almost simultaneously in China: a neurostimulator was implanted in the brain of a Parkinson's patient at the Plagh Hospital in Beijing. The doctor was in a clinic on Hainan Island, 2,700 km from Beijing.

5G is used in China with medical devices

The two examples show the great advantage of 5G for telemedicine: Compared to LTE with latencies between 40 and 100 ms, delays of well below 10 ms are expected with 5G. There is even talk of 1 ms. In the public eye, 5G primarily stands for speed with high data transmission rates of up to 20 Gbit / s. For the industry, however, it is more important that 5G brings advantages that are important for sophisticated machine-to-machine communication. For example, up to one million devices should be able to send and receive per square kilometer. In addition, a reliability of more than 99.999% is promised.

However, not all functionalities are available in one fell swoop. “The current version of the standard only covers the high data rates for classic consumer business. Only in Release 16, which should be available at the end of 2019, will the other functionalities that are of interest for industrial applications be included, ”explains Dr. Andreas Müller. He is Head of Communication and Network Technology at Bosch Corporate Research and at the same time Chairman of the 5G Alliance for Connected Industries and Automation (5G-ACIA) in the ZVEI.

TU Munich: Pilot study with 5G and medical devices

The Klinikum rechts der Isar of the Technical University of Munich has already looked into the possibilities of 5G. The Clinic and Polyclinic for Surgery at the Technical University of Munich carried out a twelve-month pilot study with 5G prototypes in 2017/18. Three medical use cases were evaluated: On the one hand, this was the aforementioned tele-surgery. “The spatial separation of the operating doctor and the technical equipment performing the operation basically has the charm that specialists can also offer patients in remote areas medical assistance, including operations. But we have found that 5G cannot exploit all of its advantages at the same time, ”says PD Dr. med. Michael Kranzfelder, senior physician at the clinic and polyclinic for surgery. “For the transmission of CT data, for example, we need a large bandwidth with a high data transmission rate. For tele operations, however, a low latency is important. You therefore have to decide what is important for the respective application. The egg-laying woolly milk pig is not 5G. ”One also has to discuss whether public 5G networks are secure enough to run telemedical applications. “You also have to be aware that there will be no ubiquitous 5G network in Germany. In rural regions it will therefore be difficult with applications such as tele-surgery. "

Transmit ultrasound data over 5G

That could also be a disadvantage for the second 5G scenario, which was piloted at the Klinikum rechts der Isar: the transmission of ultrasound data from a moving object (such as an ambulance) and the subsequent diagnosis back to the point of care. “The more and ever The earlier information about a patient is available, the better and faster he can be helped. Here 5G could bring a breakthrough due to the bandwidth and reliability of the data transmission. "

Independently of public 5G networks, however, the third scenario of the Munich medical professionals could work: process optimization in the hospital through track & trace - of patients and equipment. “The aim would be to use 5G to know where a patient is currently in the hospital. This would enable us to improve the processes in the clinic and, for example, reduce long waiting times, ”says Kranzfelder. In principle, this is already possible today with WLAN and the patient's smartphone. "However, security requirements and data protection aspects pose challenges here."

Use 5G to locate expensive medical devices in the clinic

He envisions a clinic app for patients in which they not only have a real-time appointment planner for their appointments in the hospital, but also their diagnostic information, for example from imaging procedures. According to Kranzfelder, 5G would also be advantageous for tracking equipment in the clinic - if you could, for example, locate expensive medical devices in the clinic at any time. “The Internet of Things can only be implemented in the clinic with 5G.” However, he argues, real-time display is not easy to implement even with 5G in hospitals - because some rooms are relatively small and there is not network coverage everywhere.

In order to increase the efficiency of the processes in the clinic, one must, according to Kranzfelder, discuss a separate 5G network for security reasons. This is also a novelty compared to the current generation of mobile communications: 5G enables local campus networks to be set up for the first time. From the second half of 2019, the regulatory authority will apply frequencies from 3.7 to 3.8 GHz to companies, regional network operators or municipalities. This possibility is being discussed at the Klinikum rechts der Isar. First, however, a 5G testbed with a focus on e-health will be set up at the Technical University of Munich.

A 5G test platform will also be created at Mannheim University Hospital in the coming months. The project group for automation in medicine and biotechnology (PAMB) of the Fraunhofer Institute IPA is setting up a test environment for evaluating the possible uses of 5G in hospitals and for developing and testing 5G-suitable applications. The researchers see possible areas of application in digitally networked operating rooms with wireless instruments such as endoscopes and (capsule) robots or in the continuous monitoring of vital parameters during patient transports.

Preparations for surgery could take place in the hospital room

“The first considerations were that we could use devices such as endoscopes in the operating theater wirelessly and without cables, as 5G promises high data transmission rates and low latency. Cables are always a source of interference and take a lot of time to prepare. A cordless operating theater not only enables a general improvement in ergonomics, but also efficient processes in operating theater setup, ”says Professor Jan Stallkamp, ​​head of Fraunhofer PAMB. “In the locked intervention room, 5G is in competition with the new WLAN standard Wi-Fi6, among other things. These systems offer similarly high data rates and low transmission times, but lack mobility and a seamless transition between local and mobile networks. 5G guarantees continuous data collection inside and outside the clinic in the event of process-related changes of location. "

Stallkamp sees further application scenarios for 5G in the future: “In principle, 5G enables medical devices to be developed without intelligence. The intelligence, i.e. part of the software, can be moved away from the end device, for example into a central cloud; with all the advantages of a central system and data management. The life cycle of devices could be continuously monitored with 5G, so that their availability can be increased and maintenance costs reduced through special approaches such as predictive maintenance. This is only possible if a highly reliable radio link is available across the board. However, this is also a regulatory nightmare. "

For 5G, some medical devices would have to be fundamentally redeveloped

Like Kranzfelder, he observes that medical technology manufacturers are very interested in exploring the potential of this new technology. "However, they are still holding back," said Stallkamp. "Wireless endoscopes with 5G functionality, for example, would have to be fundamentally redeveloped and approved by the industry. At first it is up to us as a research institute, for example to set up endoscopes as a reference and to test their feasibility. "

"Network slicing, i.e. the encapsulation of networks with differently defined services, will certainly become an issue for hospitals in order to ensure the quality of service for individual services," emphasizes Olli Liinamaa, Nokia project manager for the 5G test network in Oulu, Finland. This has been in operation since 2015, currently still externally connected to the 4G network, but Nokia plans to set up the first 5G base stations here from the second half of the year. In addition to the University of Oulu, the Finnish research center VTT, around 500 companies - including 100 medical technology and life science companies - and the Oulu University Hospital are affiliated.

Finland is testing what the combination of 5G and medical devices can bring

The Finns think on a very large scale: “The city of Oulu has decided to build a completely new hospital to replace the existing one, which is no longer suitable for changing needs. The future hospital wants to maximize the use of technological innovations not only in the healthcare sector, but also in services for staff and hospital visitors, ”said Liinamaa. A test lab for testing new e-health solutions based on 5G has been set up at the Oulu University Hospital. Doctors and engineers work hand in hand here. According to the Nokia experts, this laboratory is also used for the practical training of medical students and for the flexible testing of new operating room alternatives with movable walls.

“In Oulu, too, the decision has yet to be made whether the clinic will later use a private or public network. A private network would give the hospital the independence and transparency to make decisions about network quality, robustness, security, privacy and services according to its own requirements, ”says Liinamaa. “On the other hand, operating a cellular network is an independent business with regulated frequency licensing, and someone has to set up and maintain the network. Trust in the public network and current licensees would free health organizations from learning and investing in communication technology. A secure network can be set up with both models, since the network components are the same for both options. "

Hospitals and manufacturers are becoming network operators

The question of becoming the operator of a 5G network is not only a question of hospitals, but also of manufacturing companies. For example, the Swiss medical technology manufacturer Ypsomed has already tested 5G at its plant in Solothurn, where insulin pens are manufactured - using four production applications.

In particular, the evaluation of sensor data provided by the injection molding machine data has brought advantages: The data can be recorded and evaluated in real time with 5G. This enables a constant overview of the production parameters. “In addition, 5G enables predictive maintenance diagnostics on the machines,” says company spokesman Julian Stressig. 5G is also well suited for virtualizing machine PCs on a mobile device. This simplifies troubleshooting by production employees and also provides flexibility to optimize production regardless of the cabling. This is increasingly important, especially for assembly systems.

The six-month pilot with Swisscom ended in spring 2018. “The bottom line is that 5G has proven itself for us. We see that in the future there will be no getting around it if we want to produce in accordance with the latest standards in Switzerland, ”says Ypsomed company spokesman Julian Stressig. "Ultimately, 5G enables us to automate and digitalize production even more."

Background: This is a campus network

Campus networks are exclusive cellular networks for a defined local company site, university or individual building. They are tailored to the individual needs of the user. Access from the public network to the campus network is not possible. Conversely, however, the private radio network is connected to the normal cellular network so that companies can communicate with partners, external service providers or suppliers. Experts call this combination of a private and a public network a "dual slice solution"
Graphic: Deutsche Telekom

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