The 63rd Annual Meeting of the Japanese Respiratory Society NBI Lung stethoscope corner(For internal only)

At the 63rd Annual Meeting of the Japanese Respiratory Society, we set up a lung auscultation experience corner at the Nippon Boehringer Ingelheim Co., Ltd. booth. About 230 medical workers challenged the lung auscultation problem. Contrary to the results of the quiz, the satisfaction level was very high, and we were able to get a good reputation.

Overall satisfaction exceeded 90% for the sum of “Extremely satisfied” and “Slightly satisfied”.

Implementation content

This time, we used the virtual auscultation simulator iPax and the auscultation speaker Kikuzo to let everyone experience lung sound content.

The lung auscultation experience content consists of 3 questions of listening to sounds with an mp3 player and 2 questions (iPax) of the format of moving the stethoscope icon on the screen and solving the relationship between location and sound. ※Analysis results are described later.

In addition, we distributed these case explanations to those who experienced the lung auscultation content, and conducted a questionnaire for this corner.

The serious look of the teachers who challenged this content was very impressive.

Screen of lung auscultation content used in Booth

First, select your own “user attribute”. On the following page, there are 3 mp3 player questions, and after the 4th question, the question of operating the stethoscope icon on the screen. You can see questions unfolding in the video below.

Commentary with 2D barcode distributed at Booth (Q4 and Q5 only)

After their answering questions, we distributed case explanations (Q4 and Q5). The iPax auscultation content opens when the participant reads the two-dimensional barcode in the explanation with a smartphone. This allows them to hear the case’s sounds at home.

These cases were actually experienced by Dr. Takeshi Saraya (supervising doctor), and are published in the clinical magazine “Internal Medicine” published by Nankodo.

For reference IPF case used in Q5 Fine crackles are heard in the bilateral lungs and the bottom of the lungs.

Tap the chest or back auscultation area to move the chestpiece icon and listen to the sounds of that area. When listening to the sound, use the dedicated speaker Kikuzo or earphones.


stetho sound speaker Kikuzo

At Booth, we asked everyone to use Kikuzo, a special speaker for auscultation. A stethoscope is required when using Kikuzo. Physicians put on a stethoscope and are “ready to examine” (serious). That is also stated in the survey.

Kikuzo is a speaker for auscultation that can output only the frequency band of sound emitted from the living body, and is manufactured by Pioneer Corporation.

Patent(iPax and Kikuzo)

Japanese patent pat. No.6328223
US patent  US Pat.11,113,990
European patent submitted

Patent(auscultation site function)submitted


After the lung auscultation experience corner for everyone, we conducted a questionnaire survey using a tablet (out of 202 respondents to all questions, 141 responded to the questionnaire, 69.8%). Although filling out the questionnaire was voluntary, we were able to receive a large number of entries. ※Results are given below.

Participants answering the questionnaire

Reference: SNS post article

FB post by Dr. Takeshi Saraya (Kyorin University), supervising doctor of lung auscultation content
Dr. Saraya visited the booth together with his acquaintances, medical staff and professors from Kyorin University. We can see that respiratory specialists are interested in this content.

Analysis results of lung auscultation experience content

Q1-Q3 were questions to answer by listening to the sound of the mp3 player, and Q4-Q5 were questions to answer by operating the stethoscope icon on the screen. Their correct answer rate is as follows.

The correct answer to Q4 is “pulmonary hypertension”

Many pulmonologists chose “left heart failure”

Telemedica comment;Q4 is a difficult question.
Since the sounds from Q1 to Q3 were lung sounds, it is possible that the doctor’s attention was directed to “lung sounds” in the following Q4. In addition, since many of the subjects were respiratory specialists, it is possible that they were conscious of “lung sounds/adjuvant noises” and made it difficult to distinguish heart sounds (II p enhancement).
On the other hand, when listening to the heart sounds at the pulmonary valve region and the apex, the pulmonary valve component of the Ⅱ sound is exaggerated. Because of that, we set up this question to select “pulmonary hypertension”.

The correct answer for Q5 is “IPF”

About half answered correctly, but many pulmonologists chose “COPD”

Telemedica comment;We had the impression that many doctors auscultated the auscultation site at the base of the lung slightly above the standard (see the auscultation site analysis PDF).
With the iPax, fine crackles are heard louder at the base of the lung. If the auscultation site is different, the sound becomes smaller the farther away from the site to be listened to. This is probably why the correct answer rate is low.
Excerpt from Dr. Takeshi Saraya’s commentary video “How to Diagnose Lung Diseases Associated with Collagen Diseases”

Auscultation site analysis

Analysis of the auscultation site

All data (n = 202) and pulmonologists data (n = 107) obtained this time were aggregated.


  1. Those who answered correctly auscultated the lung side and the base of the lung.
  2. Incorrect answers did not auscultate neither the lung side nor the base of the lung.

All data

Pulmonologists data

Below are examples of typical auscultation sites of doctors who took the quiz this time (those who answered incorrectly and those who answered correctly in Q5).

Incorrect answer: The part to be auscultated is higher than the point that should be auscultated.(Although it is possible to hear the consciousness of listening to the base of the lungs, that part is higher)

This is the recorded data of the pulmonologist. Looking at the auscultation site on the back, we can see that he listened just below the shoulder blade. Fine crackles are barely audible in this area. The part where the stethoscope should be placed (the base of the lung) is much lower than that.

(Audiometry site data for participants with incorrect answers (chosen COPD)

Correct answer: Auscultation at the correct site.

This is the record of a resident who answered Q5 correctly. You can see that he is auscultating the lung side and the base of the lung in the correct area.

Auscultation site data of an intern who answered correctly (He is listening to the base of the lung properly)

Data download

Quiz analytics data(PDF)

Q4(Pulmonary hypertension)Auscultation site analysis

Q5(IPF)Auscultation site analysis

Survey results

About half of the attributes were “Pulmonologists”.

Approximately 70% of pulmonologists answered that they were “satisfied”.

・Touch panel operation is new
・It was interesting
・Comparison was easy to understand
・I learned something
・Because the sound was easy to hear
・I can’t listen well.
・There are difficult cases, but it is important
・Useful for education
・It was a practical version
・Because I got it right
Sound source is not good
・Good for real education
・Learn from young people
・Similar audio can be shared
・Unprecedented method
・It’s good because using a stethoscope gives you a real sense of tension.
・Interesting as if we were in contact with an actual patient
・Can be checked by two people
・the use of a stethoscope and the fact that I can do it while being instructed
・Unprecedented content
・ Content that has never been experienced
・Where a stethoscope is used
・New learning method
・Booth noise disturbs
・Very useful for education
・It was real
・I have never heard a stethoscope so far.
・Lack of opportunities like this

Telemedica comment;About sound quality

While there is an opinion that “the sound source is not good”, there is also a description that “the sound was real”. You can see that this difference is the difference in volume. There was a lot of noise around the exhibition booth, so some people occasionally increased the volume of Kikuzo. It is understandable that when the volume was not returned to the original correct volume and another person listened to it as it was (at a high volume), they felt that the sound source was not good.

All the sound sources used this time were recorded by Dr. Takeshi Saraya from actual patients. We Telemedica processed the noise of the recorded sound sources and posted them on iPax.In addition, we have Dr. Saraya check the sound while using the Kikuzo, and adjust it so that it sounds the same as auscultating an actual patient.

More than 80% of pulmonologists answered that “the question was appropriate”

・Some sounds were a little hard to hear
・ Fun to do
・It was difficult
・Because it is diverse
・Necessary information is available
・Hard to hear fine crackles
・It is even better if you know the timing of inhalation and exhalation.
・Because we can re-recognize what it means to listen consciously
・Relatively easy to understand
・It’s good that you don’t just listen to the auscultation sound, but you have to auscultate at the appropriate part.
・ Questions range from basic to applied
・Just the right difficulty
・Not easy, just right
・Suitable for each level
・We don’t usually have this kind of opportunity

More than 90% chose “I want to use it again”

・Looks good for education
・Because I am interested in other questions
・It was interesting
・For education, etc. Education is important.
・I want to use it for trainee guidance
・This is an unprecedented method as training for observations that are rarely involved.
・Using a stethoscope gives the tension of a real situation
・A new way of learning. Can be used in group discussions and conferences
・Never-before-seen content
・Can be shared by multiple
・For self-study, conferences and group discussions
・Repeated practice leads to improvement of diagnostic skills
・We don’t usually have this kind of opportunity

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