Transcript Telemedicine and Its New Trends Xiaomei Yu

Telemedicine and Its New Trends
Xiaomei Yu
Biomedical and Multimedia Information Technology (BMIT) Group,
Basser Dept. of Computer Science,University of Sydney, NSW 2006, Australia
E-mail: [email protected]
Telemedicine and Its New Trends
Xiaomei Yu
Introduction
Current Applications
Background
A Prototype of Telemedicine
Conclusions
Biomedical and Multimedia Information Technology (BMIT) Group, Basser Dept. of Computer Science,
University of Sydney, NSW 2006, Australia
E-mail: [email protected]
Introduction
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Abstract--With the advancement of information and communications technology,
how to use such technology to provide more efficient and convenient medical
services becomes a very important and unavoidable issue. Telemedicine is the use
of electronic information and communications technologies to provide and
support health care when distance separates the participants. It has been used
since 1920s. In the 1970s and 1980s, there are some large-scale demonstrations in
telemedicine involving satellites, and telemedicine experiments focused on the
transmission of medical images using television. WWW-based, ATM or ISDN
network telemedicine applications are widely developed in the 1990s, most trials
have experimented with the use of videoconferencing for remote consultation. In
this paper, we first give a brief review of the history of telemedicine, then
summarize the current applications, and provide a new prototype of telemedicine
system.
Generally speaking, the techniques of telemedicine system include: (1) image
acquisition, (2) storage and retrieval, (3)telecommunications, (4) display and
interpretation. (5) remote control.
Introduction
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In the 1970s and 1980s, the main techniques are: 1) network linked by
telephone, cable television, microwave and satellite; 2) transmission of
data, freeze-frame video, audio, facsimili, and medical information such as
stethoscpic, endoscopic, microscopic, X-ray, electrocardiogram (EKG),
and electro-encephalogram (EEG) brain-wave information. Black-white
two-way interactive television was mainly used. Remote camera control,
slow scan television and video tapes were used as well.
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In 1990s, the applications of telemedicine are more cost-effective, wide
spread and facilitated. Asynchronous Transfer Mode (ATM), Integrated
Services Digital Network (ISDN) and WWW-based network telemedicine
applications are widely developed. Most trials have experimented with the
use of videoconferencing for remote consultation.
Current Applications
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Internet, ATM or ISDN network
Internet is the global internet based on the Internet (TCP/IP) architecture,
connecting millions of hosts worldwide. Because it is wide spread and
cost efficient (just as telephone call), it is getting popular recently.
Example: Department of Radiological Sciences, Medical Center in UCLA
developed a WWW telemedicine system using Java and Common Gateway
Interface (CGI). Center of Medical Informatics, University Hospital of
Geneva, Swizerland developed a tool for in-house access to PACS images
and related data through WWW. They used ESQL for PACS database
retrieval and resulted image can be stored by FTP.
Current Applications
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Internet, ATM or ISDN network
ISDN is a digital communication service offered by telephone carriers and standardized
by ITU-T. It combines voice connection and digital data services in a signal physical
medium. The bandwidth range covers 56-144Kbps. Primary rate can be up to 1.54Mbps.
Its capacity provides the basic videoconferencing video, but with the high compression
ratio involved in these systems.
Examples: Univ. of Washington: test, 128, 256, 384kbps. Univ. of Pittsburgh: 128kbps.
ATM is a connection-oriented network technology that uses small, fixed size packets to
carry data. The bandwidth range is from 45Mb/s to 2.48Gb/s.
Examples: UCSF: 155Mbps, 8.3Mbytes/s(M-M). UCLA:137Mbps, 25Mbps.
The combination of ATM and ISDN: European RETAIN project, TELEMEDICINA (Spain)
( ATM 155Mbps & ISDN).
Current Applications
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PACS-based telemedicine
*A PACS consists of image and data acquisition, storage and display subsystems
integrated by various digital networks.
*Digital Imaging Communications in Medical (DICOM) provides standard formats for
images, a common information model, application service definitions and protocols
for communications.
*Significance of DICOM: solving the Interoperability including exchanging images
between equipments from multiple vendors, which is a long-standing problem for
implementation of PACS in hospital.
*an infrastructure to facilitate the implementation of telemedicine systems.
Example: UCLA, UCSF have devoted some efforts on PACS-based telemedicine. Access
image data stored at the remote hospital PACS archive was as easy as access to any
images stored on any of the local distributed PACS archives. The images come from
another hospital or from a local archive was transparent to the user.
Current Applications
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Videoconferencing/Remote control
Videoconferencing is a very hot topic in multimedia network currently. The goals of
videoconferencing and remote control are identical: to achieve real time
synchronized teleconsultation. A large number of some-scale telemedicine systems
have applied videoconferencing.
In Japan, a telemedicine system is developed by Center Research laboratory of
Hitachi, Ltd., which sent control data (such as telepointer, drawing line, comment) to
reach remote control through the 64kbps N-ISBN during the actual conference. [36]
The image data is sent to each side on duplicate IS&C (image save and carry) disks
(650Mbyte) by mail or courier before the conference. The telepointer could be
controlled with no noticeable delay by sending only the pointer's coordinates.
Another kind of remote control is applied in telesurgery, in which the surgeon works
on a virtual patient while a "robot" performs the actual surgery on the human subject
at a remote location.
PC-based, House-based telemedicines have been developed as well.
Background
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Telemedicine has a long history in Australia as well. The Children's
Hospital Westmeat has installed a large-scale PACS for two years which
is serviced by a comprehensive database of images and reports with
integration through the ethernet to a Radiology Information System (RIS)
and a Hospital Information System (HIS). There are about 60 terminals in
hospital. The doctor and radiologist referring patient images do not
need any films at all. A teleradiology system is being designed to link
with Dubbo Base Hospital by 384kbps ISDN.
One of the telemedicine requirements is real time consultation of
obstetrical ultrasound examination of potential high-risk pregnancies.
The 384kbps bandwidth provides the real time transfer, with compressed
ultrasound images (25 frames/s).
A prototype of telemedicine system
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A prototype of telemedicine system -----Object-oriented Teleultrasound.
Advantages: the content-based retrieval and video indexing are applied in it.
Some image processing techniques also are used. A WWW interface for
database accessed by internet is also designed. A remote control for
teleconsultation will be used as well. (tele-education and consultation off
hours.)
Significance: 1) the current retrieval used in telemedicine systems and PACSs
is key word retrieval, which using patient ID, birthday or other item of record
as word to search. However, when a doctor encounters a special case of
images, he prefers find some other similar images to refer. This can not be
achieved by key word retrieval. However, content-based retrieval can provide
it. It can be widely used in tele-education as well. 2) In teleultrasound, a large
number of ultrasound sequences images are stored on a database. For such
database, efficient retrieval and management are important and potential
issues. 3) To satisfy some clinical requirements such as real time boundary
detection and measurements of ultrasound image at the receiver side.
A prototype of telemedicine system
The contents of telemedicine system are
shown as follows:
1) image acquisition: ultrasound images
are directly obtained from ultrasound
scanner.
2) DICOM & compression: received
ultrasound sequences are converted
to DICOM format, then compressed.
3)
communication:
any
universal
communication tools can be used,
such as ISDN, ATM. Internet also will
be applied to access database.
4) Database: content-based retrieval and
video indexing.
5) Display and remote control: border
detecting and parameter measuring
are used. Remote control will be used
as well.
Ultrasound DICOM server
image
&
acquisition compression/
Communication
decompression
Display
border detecting
and measure
remote control
DATABASE
content-based
retrieval/
video indexing
DICOM server
&
compression/
decompression
Internet
server
DATABASE
Display
content-based
border detecting
retrieval/
and measure
video indexing remote
control
Figure.1 A object-oriented teleultrasound system
Conclusions
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A lot of telemedicine systems have been developed and used in rural areas
recently. Some life safe examples have shown the significance of
telemedicine.
Although the current communications and computer technologies have
enough capability to support preliminary requirements of telemedicine,
there are still some technical challenges. Other factors such as law, cost
effectiveness, patient acceptability and physician tolerance will affect the
implement of telemedicine.
In the future, with the further advancement of information, communication
technology and the support of governments, telemedicine systems can be
implemented on any area to replace current medical model in the world.
In this paper, we have given a brief review of the history of telemedicine and
summarized the current application. The prototype of telemedicine system
is also provided to solve some requirements of telemedicine.
Further
research is necessary to explore video coding and motion analysis of
ultrasound.