ADVANCES IN TELEMEDICINE: TECHNOLOGIES, ENABLING FACTORS AND SCENARIOS Edited by Georgi Graschew and Theo A. Roelofs Advances in Telemedicine: Technologies, Enabling Factors and Scenarios Edited by Georgi Graschew and Theo A. Roelofs Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Katarina Lovrecic Technical Editor Teodora Smiljanic Cover Designer Martina Sirotic Image Copyright Lasse Kristensen, 2010. Used under license from Shutterstock.com First published March, 2011 Printed in India A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advances in Telemedicine: Technologies, Enabling Factors and Scenarios, Edited by Georgi Graschew and Theo A. Roelofs p. cm. ISBN 978-953-307-159-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Part 1 Chapter 1 Chapter 2 Chapter 3 Part 2 Chapter 4 Chapter 5 Chapter 6 Preface IX Fundamental Technologies 1 Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 3 Eko Supriyanto, Emansa Hasri Putra, Jafri bin Din, Haikal Satria and Hamid Azwar Novel Wireless Communication Protocol for e-Health Applications 27 A. Zvikhachevskaya and L. Mihaylova Safety and Electromagnetic Compatibility in Wireless Telemedicine Applications 63 Victoria Ramos and José Luís Monteagudo Applied Technologies 85 High-Quality Telemedicine Using Digital Video Transport System over Global Research and Education Network 87 Shuji Shimizu, Koji Okamura, Naoki Nakashima, Yasuichi Kitamura, Nobuhiro Torata, Yasuaki Antoku, Takanori Yamashita, Toshitaka Yamanokuchi, Shinya Kuwahara and Masao Tanaka Lossless Compression Techniques for Medical Images In Telemedicine 111 J.Janet, Divya Mohandass and S.Meenalosini Video-Telemedicine with Reliable Color Based on Multispectral Technology 131 Masahiro Yamaguchi, Yuri Murakami, Yasuhiro Komiya, Yoshifumi Kanno, Junko Kishimoto, Ryo Iwama, Hiroyuki Hashizume, Michiko Aihara and Masaki Furukawa Contents Contents VI Sharp Wave Based HHT Time-frequency Features with Transmission Error 149 Chin-Feng Lin, Bing-Han Yang, Tsung-Ii Peng, Shun-Hsyung Chang, Yu-Yi Chien, and Jung-Hua Wang Teleconsultation Enhanced via Session Retrieval Capabilities: Smart Playback Functions and Recovery Mechanism 165 Pau-Choo Chung and Cheng-Hsiung Wang Statistics in Telemedicine 191 Anastasia N. Kastania and Sophia Kossida Video Communication in Telemedicine 211 Dejan Dinevski, Robi Kelc and Bogdan Dugonik Telemedicine & Broadband 233 Annarita Tedesco, Donatella Di Lieto, Leopoldo Angrisani, Marta Campanile, Marianna De Falco and Andrea Di Lieto Enabling Factors 259 Quality Control in Telemedicine - “CE” Label 261 O. Ferrer-Roca Innovative Healthcare Delivery: the Quest for Effective Telemedicine-based Services 271 Laura Bartoli, Emanuele Lettieri and Cristina Masella Scenarios 295 Real-time Interactive Telemedicine for Ubiquitous Healthcare: Networks, Services and Scenarios 297 Georgi Graschew, Theo A. Roelofs Stefan Rakowsky and Peter M. Schlag Could There Be a Role for Home Telemedicine in the U.S. Medicare Program? 319 Lorenzo Moreno, Arnold Chen, Rachel Shapiro and Stacy Dale Development of a Portable Vital Sensing System for Home Telemedicine 345 F. Ichihashi and Y. Sankai Implementing the Chronic Disease Self Management Model in Vulnerable Patient Populations: Bridging the Chasm through Telemedicine 357 Cardozo Lavoisier J, Steinberg Joel, Cardozo Shaun, Vikas Veeranna, Deol Bibban and Lepczyk Marybeth Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part 3 Chapter 12 Chapter 13 Part 4 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Contents VII The Spanish Ministry of Defence (MOD) Telemedicine System 379 Alberto Hernandez Abadia de Barbara A Telemedicine System for Hostile Environments 397 Ebrahim Nageba, Jocelyne Fayn and Paul Rubel Chapter 18 Chapter 19 Pref ac e Innovative developments in information and communication technologies (ICT) irre- vocably change our lives and enable new possibilities for society. One of the fi elds that strongly profi ts from this trend is Telemedicine, which can be defi ned as novel ICT- enabled medical services that help to overcome classical barriers in space and time. Through Telemedicine patients can access medical expertise that may not be available at the patient’s site. The use of specifi cally designed communication networks with sophisticated quality-of-service for Telemedicine (distributed medical intelligence) contributes not only to the continuous improvement of patient care, but also to reduc- ing the regional disparity in access to high-level healthcare. Telemedicine services can range from simply sending a fax message to a colleague to the use of broadband net- works with multimodal video- and data streaming for obtaining second opinions as well as medical telepresence. Depending on the specifi c medical service requirements, a range of classes-of-services is used, each requiring its own technological quality-of- service. Originally started as interdisciplinary eff orts of engineers and medical experts, Telemed- icine is more and more evolving into a multidisciplinary approach. Consequently, com- piling a book on recent “Advances in Telemedicine” will have to cover a correspond- ingly wide range of topics. In addition, if each topic shall be treated in suffi cient depth to allow the reader to get a comprehensive understanding of both the developmental state-of-the-art as well as the broad spectrum of issues relevant to Telemedicine, one might easily end up with a huge tome, too big to be practical in handling. Therefore, this book “Advances in Telemedicine” has been split into two volumes, each covering specifi c themes: Volume 1: Technologies, Enabling Factors and Scenarios; Volume 2: Applications in Various Medical Disciplines and Geographical Regions. The Chapters of each volume are clustered into four thematic sections. The current Volume 1 “Advances in Telemedicine: Technologies, Enabling Factors and Scenarios” contains 19 Chapters clustered into the following thematic sections: • Fundamental Technologies (Chapters 1-3), • Applied Technologies (Chapters 4-11), • Enabling Factors (Chapters 12-13), • Scenarios (Chapters 14-19). The section on Fundamental Technologies starts off with a thorough study on a novel cross-layer design of wireless-LAN (1) that combines the SVC extension of the H.264 X Preface video coding standard with the recent IEEE 802.11e WLAN standard. This new ap- proach allows for the transmission of video streams over WLAN with an assigned guaranteed bandwidth (QoS) as required for telemedicine video applications in suf- fi ciently high quality. The next study reports on the development of a wireless cross- standard communication protocol (2) that supports the creation of network-of-net- works for e-Health applications from existing commercial (WiFi, WiMAX) and military (HIDL, Link 11) communication systems. This new protocol has been implemented in a demonstrator network that allows for the operation and investigation of various real-life healthcare scenarios. The section is closed up by extensive considerations on safety and electromagnetic compatibility (3) in wireless WiFi-, DECT- or GSM-based telemedicine applications. The electromagnetic environment of typical urban homes is characterised and an assessment for the potential safe use of home telemonitoring systems is presented. The need for adequate and harmonised legislation and regula- tion is also addressed. The next section on Applied Technologies begins with an exploration of combining digital video transport systems with global research and education networks (4) for high quality video streaming in telemedicine. This new combination can help to over- come many of the bo lenecks in telemedicine implementation in daily routine, such as: insuffi cient image quality, too-high cost for set-up and operation, too diffi cult to use by medical experts. Next, a new algorithm for lossless compression of medical images (5) of various kinds using Huff man-based contourlet transform coding is presented. It is demonstrated that this new algorithm achieves higher compression ratios and yet superior image quality for diff erent classes of medical images as compared to existing methods in the literature. The next chapter addresses the critical question as to the reli- ability of colour representation in transmission and display of medical videos and still images by presenting a novel sophisticated multispectral colour reproduction system (6). Experimental evaluation of this new system used in video-based telemedicine ap- plications for dermatology, surgery and general teleconsultation demonstrates that the reproduced colour is perceived as almost identical to the original, enabling improved remote diagnosis. The following chapter describes the application of Hilbert Huang transformation-based time-frequency analysis approach for studying normal and sharp waves in electroencephalograms contaminated by transmission errors (7). Es- pecially when applied as a tool to diagnose, diff erentiate and classify various stages of epilepsy this novel analysis approach yields more accurate results. The section contin- ues with a presentation of three-level indexing hierarchy (TIH)-based smart playback and recovery functions to enrich teleconsultation systems with retrieval capabili- ties (8). Thanks to the smart combination of cross-linked referencing and prioritised recovery the system allows a range of smart playback functions (e.g. replaying all the segments of a session controlled by a particular physician, or replaying all the session segments for which a particular medical image is discussed). The next chapter exten- sively treats a wide range of diff erent aspects of the application of statistics in telemed- icine (9). It treats diverse aspects of qualitative and quantitative statistical methods in telemedicine such as for research and evaluation, for testing web-based platforms with diff erent numbers of users, for new biomarker detection, or for electronic medical records and bio-banks. This work uncovers corresponding opportunities and challeng- es and provides the reader with useful guidelines. The subsequent chapter provides a survey on the technological and perceptive aspects of video communication (10) as used in various classes of services in telemedicine. It describes video applications [...]... are two medium access coordination functions, namely the basic Distributed Coordination Function (DCF) and the optional Point Coordination Function (PCF) 8 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios Recently, IEEE 802.11e standard proposed a new MAC layer coordination function in the datalink layer to provide QoS support, namely HCF (Hybrid Coordination Function) HCF consists... Application Considering QoS Provision 19 Fig 11 The throughput values of SVC video flow over HCCA downlink, HCCA uplink, and EDCA Fig 12 The delay values of SVC video flow over HCCA downlink, HCCA uplink, and EDCA 20 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios 5.2 HCCA simulation analysis Throughput curve on Figure 11 shows that both downlink HCCA and uplink HCCA schemes succeed... simulation model) 14 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios 4.3 IEEE 802.11e EDCA prototype IEEE 802.11e EDCA prototype consists of a wireless Access Point (AP) and a wireless station (STA) A wireless Access Point (AP) constitutes a personal computer (PC) equipped with a wireless TP-LINK TL-WN551G card, and Debian 4 Linux OS, and configured as wireless Access Point (AP) through... wireless environments have specific 4 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios characteristics which may influence and degrade the quality level of the telemedicine application, namely time-varying bandwidth, delay, jitter and loss (Kim et al 2006) There are previous works which concern with cross layer techniques in wireless network In (Choi et al., 2006), the focus was... telemedicine system including Telemedicine, H.264/SVC, and IEEE 802.11e Wireless Network is explained in Section II Section III explains our proposed cross layer design of wireless LAN for video telemedicine transmission The prototype and simulation model is described in Section IV Results and Analysis is explained in Section V Then, we conclude this paper in Section VI 2 Telemedicine system 2.1 Telemedicine... capture packets delivered over wireless LAN during this experiment 16 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios 5 Results and analysis We analyze results of two NS2 simulation models, namely EDCA and HCCA Simulation, and experiments of IEEE 802.11e EDCA prototype respectively Then, we investigate whether results of the NS2 simulation and the IEEE 802.11e EDCA prototype fulfill... Telemedicine System of the Spanish Ministry of Defense (18) is described, with emphasis on its role in tactical and strategical medical evacuation scenarios in the context of international (NATO-coordinated) interventions abroad The standard system components have been selected to support both store -and- forward and real-time telemedical scenarios Emphasis has been put on system standardisation according... begun with FTP and Ping application running firstly, namely from t = 0 s to t = 4.3 s Beginning at t = 4.3 s, the Foreman QCIF video streaming flow is begun and begins competing for channel access with the previous applications Finally, at t = 16.46 s, the live video streaming finishes and the other applications also follow to finish after that Cross Layer Design of Wireless LAN for Telemedicine Application... privacy policies, security standards, interoperability guidelines, patients’ acceptance and proof of cost effectiveness The section on Enabling Factors starts with a chapter on Quality Control in Telemedicine (12) Describing the transposition of a corresponding Directive by the European Union into Spanish national legislation, the paper explains in detail how quality control in distant medical service... with single layer H.264/AVC, temporal scalability, and spatial scalability (Auwera et al., 2008) respectively is delivered over the proposed cross layer design In addition, we also utilize a “Jurassic Park 1” MPEG4 video (Trace, 1993) delivered over the proposed cross layer design 12 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios Parameter Application Layer Video coding Datalink . ADVANCES IN TELEMEDICINE: TECHNOLOGIES, ENABLING FACTORS AND SCENARIOS Edited by Georgi Graschew and Theo A. Roelofs Advances in Telemedicine: Technologies, Enabling Factors and Scenarios Edited. at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advances in Telemedicine: Technologies, Enabling Factors and Scenarios, Edited by Georgi Graschew and Theo. thematic sections. The current Volume 1 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios contains 19 Chapters clustered into the following thematic sections: • Fundamental