TABLE OF CONTENTS

 

FOREWORDS    
By Prof. Alain Pompidou, Member of the European Parliament 12  
INTRODUCTION    
O. Ferrer-Roca 14  
Definitions
References
THE AUTHORS		 16
17
18		  
 
CHAPTER 1. HISTORY OF TELEMEDICINE
M. Sosa-Iudicissa, R. Wootton, O. Ferrer-Roca		    
1.1. Introduction and Perspectives
1.2. An overview and early experiences
1.3. Main phases in view of the prevailing technologies		 23
24
24		  
  1.3.1. Preelectronic
1.3.2. Electronic
1.3.3. Telegraphy
1.3.4. Telephony
1.3.5. Radio
1.3.6. Television
1.3.7. Wireless		 24
25
25
25
25
26
26		  
1.4. Relevant international and country developments 26  
  1.4.1. United States
1.4.2. United Kingdom
1.4.3. Germany
1.4.4. Japan
1.4.5. France - L.Lareng, M.Sosa-Iudicissa
1.4.6. Norway- S. Pederden
1.4.7. Portugal
1.4.8. Italy - C. Ruggiero, R. Sacile, M. Giacomini
1.4.9. Spain
1.4.10. Greece - D. Sotiriou
1.4.11. Canada
1.4.12. The Netherlands
1.4.13. Finland
1.4.14. Belgium
1.4.15. Austria - T. Mairinger
1.4.16. China
1.4.17. Arab Countries
1.4.18. Russia
1.4.19. Australia
1.4.20. Iceland
1.4.21. Sweden		 27
28
29
29
29
30
30
31
32
33
35
35
35
36
36
36
36
37
37
37
37
1.5. Conclusions
1.6. References and Bibliography		 38
38		  
 
CHAPTER 2. MINIMAL TECHNICAL REQUIREMENTS
O. Ferrer-Roca, A. Sousa Pereira
Introduction
2.1.- Type of information to be sent and Standards used		 40
41		  
  2.1.1. Audio
2.1.2. Data		 41
42		  
    Standards : EDI, UN-EDIFACT
Systems
EHCR
Electronic Cards
Medical Vocabulary
DSS		 42
43
44
44
45
45		  
  2.1.3. Fax
2.1.4. Still Images : DICOM and other standards
2.1.5. CSCW , Computer supported co-operative work
2.1.6. Video		 46
47
50
51		  
    Standard Encoding protocols
Standard Image formats		 51
51		  
      Analogue
Digital : H.2xx, MPEG, Streaming, DVB		 51
51		  
2.2.- Types of communications and networking 55  
  2.2.1. Networking architecture 55  
    Structured Cabling
ISO model		 55
57		  
  2.2.2. POTS 57  
    Developments : ADSL, Internet Telephony 58  
  2.2.3. ISDN
2.2.4. ATM		 59
60		  
    2.2.4.1. Problems link to ATM
2.2.4.2. Standards		 60
61		  
  2.2.5. Other Fixed Networks
2.2.6. AIR/ Wireless Communications		 62
62		  
    2.2.6.1. Radio frequency. R. Luraschi
2.2.6.2. Microwaves transmission		 63
66		  
      LANs connectivity 66  
    2.2.6.3. Satellite 66  
      Orbital
Geostationary		 67
68		  
    2.2.6.4. GSM
2.2.6.5. Cellular Digital Packet Data ( CDPD )
Strength and weaknesses of various technical solutions		 68
70
72		  
2.3.- Acquisition and Display 73  
  2.3.1. Acquisition systems 73  
    2.3.1.1. Cameras: CRT, CCD, CMOS
2.3.1.2. Scanners		 73
73		  
      Image Quality 74  
    2.3.1.3. Other specialised acquisition systems 74  
  2.3.2. Display systems 75  
    2.3.2.1. Analogue devices
2.3.2.2. Liquid Crystal Displays
2.3.2.3. Laser Displays
2.3.2.4. Holographic representations
2.3.2.5. Virtual Screen Devices		 75
78
79
79
79		  
2.4.- Computation and Storage Systems 79  
  2.4.1. Computer speed up systems
2.4.2. Storage systems		 79
80		  
    2.4.2.1. Magnetic systems
2.4.2.2. Mixed Systems
2.4.2.3. Optical systems ( Laser devices )
2.4.2.4. Solid State disks
2.4.2.5. Experimental storage systems		 80
81
81
81
81		  
2.5. Human and organisational factors
2.6. Legal aspects
References		 82
82
82		  
 
CHAPTER 3. MAIN TELEMEDICINE APPLICATIONS
O. Ferrer-Roca
Introduction
Teleradiology C. Ruggiero		 84
86		  
  Definition
Basic Parts of a Teleradiology system
I.- Image Acquisition and management
II.- Display systems
III.- Communication Network
IV.- Interpretation section		 86
86
86
89
90
90		  
Telepathology O. Ferrer-Roca 91  
  Introduction
Applications
Requirements		 92
92
92		  
    1.- Multimedia Data Base
2.- Colour Images		 93
93		  
      2.1. Dynamic Range
2.2. Spatial Resolution
2.3. Compression Methods		 93
93
94		  
    3.- Interactive control of colour
4.- Controlled sampling
5.- Security and confidentiality tools		 94
95
95		  
  Telequantization at distance 96  
Telecytology S. Markidou, P. Karakistos, A. Pouliakis 97  
  Definition
Applications		 97
97		  
Telecardiology D. Sotiriu 99  
  Introduction
Main requirements
Examples
Portable solutions		 99
99
101
101		  
Tele-home care C. Ruggiero, R. Sacile, M Giacomini 102  
  Introduction
Technical aspects
Home based applications
Telealarm
Tele-home care
Cost Savings
Case example		 102
102
103
103
104
104
104		  
Teleoncology. C. Ruggiero, R. Sacile, M Giacomini 106  
  Introduction F. Puglisi
Advantages
Applications
Area of Domain
Diagnostic aspects
Teleradiology
Telepathology
Prognostic factors
Terapeutical aspects
Follow up aspects
Data Bases		 106
107
107
108
108
108
108
109
109
109
111		  
Telesurgery O. Ferrer-Roca 112  
  Introduction
Minimum requirements		 112
112		  
Telepsychiatry O. Ferrer-Roca 113  
  Introduction
Specific requirements		 113
113		  
Teledermatology R. Wootton, M Loane 115  
  Introduction
Techniques		 115
115		  
    Store and forward teledermatology
Real-time teledermatology		 115
115		  
  Conclusions 116  
Primary Care O. Ferrer-Roca 117  
  Computer based health records
Minimal injury Units
Telephonic medicine		 117
118
118		  
Telephonic Medicine O. Ferrer-Roca 118  
  Introduction
Applications		 118
119		  
 
CHAPTER 4: BASIC KNOWLEDGE OF MULTIMEDIA COMMUNICATIONS
Introduction
4.1. Some Technical Terms
4.2. Network classification
4.3. Categories of Multimedia Communications
4.4. Protocol Hierarchies for Multimedia Communications
4.5. The H.320 series ( Videophone based ISDN )
4.6. The T.120 series of recommendations
4.7. The H.324 series ( Videophone on PSTN )
4.8. The H.323 series ( Videophone over LANs and the Internet )
4.9. Media coding		 121
122
122
124
125
126
127
129
129
130		  
  4.9.1. Media coding for still images
4.9.2. Media coding for audio
4.9.3. Media coding for motion video
4.9.4. How does still image coding work ?
4.9.5. How does motion video coding work ?		 130
131
132
133
135		  
 
CHAPTER 5: QUALITY CONTROL AND QUALITY ASSURANCE IN TELEMEDICINE
O. Ferrer-Roca.
Introduction
5.1. Controlled variables
5.2 Control case management
5.3. Sufficient data for analysis
5.4. Serious and appropriate statistical analysis		 137
137
138
138
138		  
  5.4.1. Analysis of concordance -precision - reproducibility
5.4.2. Analysis of validity
5.4.3. Cost-Benefit Analysis
5.4.4. Cost-Efficacy		 139
139
140
141		  
5.5. Indications and Limitations 142  
 
CHAPTER 6: INTERNET IN TELEMEDICINE
V. Della Mea
6.1.- The Internet
6.2.- Basic concepts
6.3.- Security issues		 144
145
147		  
  6.3.1. Secure sockets layer
6.3.2. Firewalls and proxies		 147
147		  
  6.5.1. Internet electronic mail
6.5.2. Group collaborations : Newsgroups and mailing lists:		 147
149		  
6.6.- Medical Data sharing : the WWW
6.7.- Forthcoming developments		 151
156		  
  6.7.1. IPv6
6.7.2. Real time transport in Internet
6.7.3. ATM
6.7.4. Agents		 156
157
157
157		  
6.8.- Internet and Telemedicine 158  
  6.8.1. Telemedicine needs
6.8.2. E-mail applications for telemedicine
6.8.3. WWW applications in telemedicine		 158
158
159		  
6.9.- Internet problems
Conclusions		 159
159		  
 
CHAPTER 7: DISTANT TRAINING TELEWORKING AND TELETEACHING
A. Kastania.
Introduction
7.1.- Organisational environments		 161
161		  
  7.1.1. Technology equipment and standards used
7.1.2. Manager
7.1.3. Studio
7.1.4. Staff		 162
165
165
167		  
7.2.- Teleworking design and development 167  
  7.2.1. Definitions and importance
7.2.2. Usage guidelines and modalities		 167
168		  
Conclusion
References		 168
169		  
 
CHAPTER 8. DATA SECURITY AND PRIVACY
O. Ferrer-Roca, F. Allaert
Introduction
8.1.- Standards
8.2.- Mechanism of security		 170
171
172		  
  8.2.1. Encryption
8.2.2. Phases of encryption
8.2.3. Digital signature		 172
173
175		  
8.3.- Security in Internet
8.4.- Security and Legal issues associated with CPR
References		 176
179
181		  
 
CHAPTER 9: LIABILITY AND LEGAL ASPECTS
O. Ferrer-Roca, F. Allaert
Introduction
9.1.- Main deontological applications		 182
182		  
  9.1.1. Security and privacy of medical data
9.1.2. Protection against malpractice		 182
183		  
9.2.- Contract scenarios 184  
  9.2.1. Teleassistance
9.2.2. Teleconsultancy
9.2.3. Exceptions		 184
186
186		  
9.3.- Legal protection
9.4.- Conclusions
References		 186
187
187		  
 
CHAPTER 10. ECONOMICS AND MANAGEMENT IN TELEMEDICINE
V. Strobl , O. Ferrer-Roca
10.1.- Introduction
10.2.- Constrains		 189
190		  
  10.2.1. Linked to economy
10.2.2. Linked to acceptance		 190
191		  
10.3.- Cost/Benefits 192  
  10.3.1. Source of Data
10.3.2. Difficulties in cost/benefit analysis		 192
193		  
10.4.- Strategic Planning 195  
  10.4.1. Analysis situation and demands
10.4.2. Portfolio technique
10.4.3. Decision Theory
10.4.4. Cost/Benefits
10.4.5. Plan Implementation		 196
197
198
199
200		  
Conclusions
References		 200
200		  
 
CHAPTER 11. SOCIAL ASPECTS AND TECHNOLOGY TRANSFER
T. Mairinger, O. Ferrer-Roca
11.1.- Definitions
11.2.- Introduction
11.3.- Forces affecting technology transfer
11.4.- Scenarios for Telemedicine Technology transfer
11.5.- Technology transfer requirements
11.6.- Strategy of Telemedicine Technology transfer
11.7.- Conclusions
References		 201
201
202
204
205
206
207
207		  
 
CHAPTER 12. EMERGING ISSUES
O. Ferrer-Roca, V. Della Mea
12.1.- Multimedia packet oriented networks
12.2.- IP-Switching
12.3.- Virtual LANs
12.4.- MOS ( Multimedia Operating Systems )
12.5.- Cellular digital packet data
12.6.- Agent technology V. Della Mea		 208
208
209
210
210
211		  
  12.6.1. Definitions
12.6.2. Functioning
12.6.3. Applications		 211
212
212		  
    Brokers
Health Care		 212
213		  
  12.6.4. Agent Languages
12.6.5. Standards		 213
214		  
 
ANNEX I. STANDARDISATION BODIES
M. Sosa- Iudicisa, JL Monteagudo, O. Ferrer-Roca
I.1.- Introduction
I.2.- Types of Standards
I.3.- Standards and Telemedicine
I.4.- Changing scenario
I.5.- Impact on Telemedicine
I.6.- Activities in Europe
I.7.- Activities in the US
I.8.- From research to market
I.9.- Importance of participating
I.10.- Other regulatory bodies
I.11.- Conclusions
References		 215
215
216
217
218
219
220
221
222
222
223
226		  
 
ANNEX II. MOST COMMON STATISTICAL EVALUATIONS
O. Ferrer-Roca
II.1.- Two Binormal ROC-curve analysis 228  
  II.1.1. Of Independent data sets
II.1.2. Of Correlated data sets		 228
229		  
References 230  
 
ANNEX III. LIST OF NEW TERMS
O Ferrer-Roca, M Sosa-Iudicissa
231		  
 
ANNEX IV.- COLOUR THEORY
O. Ferrer-Roca
IV.1.- Introduction
IV.2.- Lights colours and colours of the objects
IV.3.- Tridimentional representation of colours
IV.4.- Colour spaces
IV.5.- Response of the detectors		 236
236
237
238
238		  
  IV.5.1. Gamma correction
IV.5.2. Detector response		 238
240		  
    IV.5.2.1. Light spectrum sensitivity
IV.5.2.2. Densitometry		 240
241		  
References 243  
 
ANNEX V. NETWORKING SCHEMES
O. Ferrer-Roca
V.1.- IEEE model for LANs
V.2.- Requirements and network segmentation
V.3.- Common Management Information Systems. P.Baquero		 244
245
246		  
 
ANNEX VI. TCP/IP FUNCTIONING
O. Ferrer-Roca, V Della Mea
VI.1.- Transmission control protocols and IP protocols
VI.2.- IP Addresses		 247
248		  
  VI.2.1. Subnetwork mask
VI.2.2. Network classes
VI.2.3. Special conventions
VI.2.4. Multiple IP addresses		 249
249
250
250		  
VI.3.- TCP Protocols
VI.4.- TCP Commands		 251
252		  
  VI.4.1. File transfer commands
VI.4.2. Backup commands		 252
254		  
VI.5.- Other issues related with Internet 255  
  VI.5.1. Codification of e-mails
VI.5.2. Compression systems		 255
255		  
 
ANNEX VII. EXAMPLE QUESTIONNAIRE FOR TELEMEDICINE IMPLEMENTATION
T. Mairinger
257		  
 
ANNEX VIII. ELECTRONIC TRANSACTIONS. LEVELS OF PROTECTION
O. Ferrer-Roca
VIII.1.- Introduction
VIII.2.- Standards
VIII.3.- Transactional issues in Internet
VIII.4.- Levels of protection
References		 261
261
261
264
264		  
 
ANNEX IX. PERCEPTION DIAGRAM
O Ferrer-Roca
265		  
 
ANNEX X. IMAGE FORMATS
O. Ferrer-Roca, A. Sousa., R.J. Rodriguez
X.1.- GIF format 267  
  X.1.1. Minimum format
X.1.2. Image Definition
X.1.3. Extensions		 268
269
269		  
X.2.- TIFF format
X.3.- MPEG2 format		 271
272		  
  X.3.1. MPEG2 variants
X.3.2. Differences between MPEG1 and MPEG2		 273
273		  
X.4.- PNG format 274  
  X.4.1. Chunks 275  
 
ANNEX XI. A BIT OF MATHS AND COMPUTERS
E. Ruiz Enriquez
XI.1.- ASCII
XI.2.- Binary notation
XI.3.- Integer mathematics
XI.4.- Prime numbers
XI.5.- Blocks, Product Cipher and Cipher feed-back		 276
276
277
278
278		  
 
ANNEX XII. BROADCAST MULTIMEDIA
Introduction
XII.1.- Broadcast multimedia communications: H.331
XII.2.- Future trends		 280
280
281		  
  XII.2.1. Switched versus packed networks 281  
 
ANNEX XIII. LETTERS OF CONSENT

SUBJECT INDEX		 283

285-309		  

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