©Telemedica Inc（https://telemedica.jp/en/）

Virtual auscultation simulator iPax

iPax is a virtual auscultation simulator developed for higher quality patient-oriented medical education.
The name iPax is derived from “inspection,” “palpation,” “auscultation,” and “examination,” with the hopethat it will play an active role as a system for learning bedside examination techniques.
１． Reproduces clinical auscultatory sounds
１．Sound source and cloud system
We have developed our own editing technology and system to reproduce actual patient auscultatory
sounds.
Even when heart sounds and lung sounds are actually recorded from the patient, fricatives andenvironmental sounds are mixed in during the recording. Telemedica has developed a special processing
technology and succeeded in removing noise.By installing these sound sources in the virtual space
simulator iPax, we have completed an auscultation education system in which the sound changes when
the auscultation site is changed, just like auscultation of an actual patient.
iPax is available on the dedicated site kikuzosound.com (kikuzosound.cn for China).
Supervisor / Adviser
Heart sounds Dr. Tsunekazu Takashina MD.PhD, FACC, FAHA
Lung soundsDr. Takeshi Saraya Department of Respiratory Medicine, Kyorin University School ofMedicine
AdviserDr. Chiaki Hidai MD, PhD, Professor of Nihon University School of Medicine

２．Stetho sound speaker “Kikuzo”
Kikuzo is an iPax exclusive speaker designed to reproduce only the frequency range of body organ
sounds. Although it is a handy size (small size), it can output deep bass of 20Hz. Conversely, it does not
reproduce sounds in bands (high frequencies) that the body does not emit.
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Computers and smartphones contain many electronic components, and these electronic components
may generate high-frequency noise. Ordinary commercially available speakers, earphones, andheadphones are designed to reproduce a wide range of sounds, when these devices are used, highfrequency electronic noise such as “chir chir chiri” can be heard together with heart sounds or lungsounds. When electronic noise is mixed with heart sounds and lung sounds, it may be difficult todistinguish between “heart murmur” and “adjunct noise” and electronic one. On the other hand, Kikuzo
does not reproduce high frequencies, so you can hear it as a realistic sound.

stetho sound speaker “Kikuzo” for iPax
（Manufacturing outsourced to Pioneer Corporation）

PatentJapanese patent Pat. No.6328223
US patent

US Pat.11,113,990

EU patent

EU Pat.3503077

iPax and Kikuzo are patented in Japan, the United States and EU.

２． iPax features and operations
１．Realistic auscultation sounds of iPax
iPax is designed to listen to sounds by moving the stethoscope icon on the screen on the illustrationof the chest/back. Many sound sources are installed in the front chest and back here, and they are all
played simultaneously. However, the sound output from the PC terminal is only the part where thestethoscope icon touches. Furthermore, each sound source is designed to have a gradation as thechestpiece icon moves. These specifications allow you to auscultate on the iPax as if you wereauscultating a real patient.
２．Basic operation
The iPax screen has a heart sound button, a pulse button, and a lung sound button on the right side.
Each button toggles between ON ⇆ OFF each time it is clicked. You can listen to heart sounds only,
listen to heart sounds and lung sounds at the same time, and switch the sound output on demand.
To switch to the back, press

next to the heart sound button.
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When the sound source has played to the end, the circular arrow ↻ will start blinking at the bottom
left of the screen. When you press this flashing ↻, the sound source will be reset and you will be able tolisten the sound again.（No auto-repeat feature）
Below is an example of aortic stenosis in iPax. Please try to click (or tap) on the chest or backillustration and listen to the sound. Heart murmurs that radiate over the neck and clavicle are also
reproduced.
※Please use earphones when listening to the sound.
Click “OK” button on the screen below, then click on the chest illustration. The chestpiece icon will moveand you will begin to hear sounds from that part.

３．Offline function
Pressing the “Offline” button at the bottom right of
the iPax screen will open the case in a separate tab. In
this state, you can continue to use this case even after
the Internet connection is cut off.

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４．iPax with variety
iPax has almost all “heart sound cases” and “lung sound cases” necessary for medical education.
There are also “skeleton cases (visible internal organs)” where the auscultatory part can be confirmed
anatomically. There are multiple patterns of adventitious sounds such as “Fine Crackles” and“Weezes”. In addition, we also have “case studies” created from information obtained from actual
cases such as X-rays and electrocardiograms.
The auscultation library includes mp3 and mp4 content (heart sounds, lung sounds, bowel sounds,
Korotkoff sounds, dialysis shunt sounds, etc.).

For the “Auscultation and Palpation Contents”
for blood pressure measurement exercises, twoKikuzos are connected for learning.This allows
simultaneous auscultation and palpation.（Leftphoto: Koyo Gakuen Koyo High School,
Nursing

Department/Advanced

Nursing

Course, a scene of blood pressure measurementpractice）
５．auscultation quizzes
There are two types of quizzes (mp3 playback and iPax auscultation). Both have an errata at theend, and you can see the correct answers and explanations by opening the explanation page.

You can take an “auditory test” within the iPax site. The exam screen design is similar to the quiz
screen, with the following differences:4©Telemedica Inc（https://telemedica.jp/en/）
You can try the same quiz as many times as you like, but you can only take the exam once.

In the case of exams, no correct/incorrect or commentary will be displayed. When the last
question is finished, “exam end mail” is automatically issued to the examinee, and at the sametime the examinee’s data is recorded on the administrator page.

On the administrator page, you can check the log of which questions the examinees solved andwhich choices they chose. You can download all data as csv.

Administrator log screen: Download data from the csv icon on the top right of the page.

３．Connection and setting of Kikuzo
Connection：Connect the Kikuzo to your computer with the included 3.5mm stereo cable. （Kikuzo
does not have Bluetooth function）
Volume：The PC side is fixed at around 50% to 70%, and the Kikuzo side is set to the minimum
volume. Please check the volume first in this state.

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When using Kikuzo as a palpator, set the volumeof Kikuzo to “maximum”. Now you can feel thethrill and pulse. The volume control dial is next tothe power switch.

Using the pulse function (L/R branch cable)
When using the pulse function, use the included
L/R branch cable. Connect one side of the branchcable to the PC, and connect one Kikuzo to each of
the two branched joints.
The name tags “Auscultation” and “Palpation” areattached to the actual L/R branch cables. Please use
Kikuzo with “minimum volume on the Auscultationside” and “maximum volume on the Palpation side“.
※When palpating the pulse, lightly place your finger
on the silicone surface. If you press hard, it will bedifficult to feel the pulse.

※Caution！
If you do not use Kikuzo, please use external speakers or earphones. You can hardly hear the soundfrom the speakers built into your computer, tablet or smartphone.

４． iPax Licensing and Management Function
１．iPax Licensing（Available as a one-year or multi-year contract）
If you want to use it at medical universities, simulation centers, hospitals, medical offices, etc., pleaseapply for a “university license”. There are four types of “university licenses”. “Basic plan” for nursing
colleges, medical faculties, and medical vocational schools, and “heart and lung sound plan” for university
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medical schools, medical colleges, and postgraduate education. In addition, “Lung Sound Plan” and“Heart Sound Plan” are available. For case details in the plan, please see the PDF.
２．Student license and Management Function（Option）”Student license” is a license for students to use iPax individually. It can also be used on smartphones
and tablets (earphones recommended).

We also have a “management function (managementpage)” that manages student usage history. On themanagement page, you can set up original cases createdby the university. You can add your own data (images
such as X-rays and CT, videos such as UCG) andpublish them to your university students on demand.
※ University

licenses,student

licenses,andmanagement functions are offered on a one-year or
multi-year contract basis.
※One set (two units) of Kikuzo is attached to each
“university license”. Please contact us if you need toadd Kikuzo. Please note that Kikuzo is not for sale.

３．Setting up quizzes and exam questions
You can set up quizzes and exam questions from the management page（You can choose how to ask
the questions in the order of the questions or randomly）. If you prepare a large number of questions(question pool) in advance and specify the number of questions, the system will randomly extract
questions and display them on the UI side. Each question can be set with a time limit.
４．Real-time monitoring function（option application）

You can monitor the “iPax screen operated bystudents” on the management screen. （Patentsubmitted）

7

©Telemedica Inc（https://telemedica.jp/en/）（Left) Management screen and (right)
Student screen: The status of student
operations is displayed in real time on
the management screen.

５．Auscultation site recording function（option application）

The parts auscultated by students are recorded
individually, and the administrator(teacher) cancheck the data at any time.（Patent submitted）

５．Contact information
Telemedica customer center
email 3sp@telemedica.co.jp
Telemedica Inc.
Office 1-3-9, Aobadai, Aoba-ku, Yokohama, Kanagawa, JAPAN
Tel. +8145-532-4613
HP（Japanese・English） https://telemedica.jp/ja/
iPax Web site（Japanese・English） https://kikuzosound.com/8