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/conferences/spr2002/presentations/ssimmons/simmons.ppt

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Transcript

  • 1. Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience Scott C. Simmons Director, Design & Development ECU Telemedicine Center
  • 2. Overview
    • ECU Telemedicine Center Overview
    • Internet Telemedicine
    • NIH/NLM Biomedical Applications of the NGI
    • Testing CODEC/Network Performance
    • Lessons Learned
    • Future Directions
  • 3. ECU Telemedicine Center
    • Links patients to physicians, MD-to-MD, hospital to hospital
    • Over 8,000 consults since 1991
    • Hospitals, clinics, homes
    • 14,000 square mile service area
    • 32 clinical specialties
    • Distance Learning and Grand Rounds
    • Virtual Surgery (DaVinci)
  • 4.  
  • 5. Internet Telemedicine
    • IP videoconferencing (H.323, MPEG)
    • Use of PC’s and Internet for asynchronous consults, i.e. “store-and-forward”
    • Other capabilities
      • telemetry of data
      • electronic mail with attachments
      • file transfer
      • whiteboarding
      • application sharing
      • chat
  • 6. IP Collaboration Technologies
    • Can use existing IP infrastructure?
    • Different technologies
      • H.323
      • MPEG-1, 2, (4)
      • Access Grid
  • 7. Biomedical Applications of the Next Generation Internet (NGI)
    • NLM (NIH) initiative for “innovative medical projects that demonstrate the application and use of NGI capabilities:
      • Quality of service
      • Medical data privacy and security
      • Nomadic computing
      • Network management
      • Infrastructure technology for scientific collaboration”
  • 8. ECU TM Center NLM Contract
    • ECU Telemedicine Center awarded 3-year, $4.6 M contract for “Internet Protocol Telemedicine and Pediatric Cardiology Education” (N01-LM-9-3541)
      • IP telemedicine (10 specialties)
      • Store-and-forward cineangiograms
      • Electromyography
      • Pediatric cardiology education
      • Microwebservers
  • 9. Testing CODEC & N/W Performance
    • First test in lab, then in Eastern NC network
    • SMPTE time code – dropped video frames
    • Video test equipment – objective video quality
    • Clinical opinion of diagnostic quality using “gold standard” sources
  • 10. Advertised vs. Actual FPS
    • CLI @ 768 (H.320) = 29 fps
    VCON @ 768 (H.323) = 14 fps
  • 11. Advertised vs. Actual FPS (cont’d)
    • Proshare @ 400 (H.323) = 15 fps
    Polycom @ 768 (H.323) = 26 fps
  • 12. Video Testing SMPTE Color Bars – Waveform SMPTE Color Bars – Vectorscope Luminance 5 Step Multiburst 100
  • 13. Video Testing Setup
  • 14. <Show Video Tests>
  • 15. Audio Testing – White Noise Polycom Minerva Vbrick
  • 16. Audio Testing – Stethoscope Polycom Minerva Vbrick
  • 17. Physician Assessment of Dx Quality
    • Gold standard DV tapes developed in 10 specialties: Adult Cardiology, Allergy, Dermatology, Endocrinology, Obstetrics, Pediatric cardiology, Psychiatry, Pulmonology, Rehabilitation Medicine, Trauma
    • Tapes played through codecs with different network (bandwidth) settings
    • Three physicians/specialty assessed point at which video/audio was unusable for Dx
    • Results used to select codecs for regional network
  • 18. Physician Assessment Test N/W
  • 19. Findings from Physician Assessment
    • Polycom best H.323
    • Vbrick best MPEG
    • 7 video packet/minute loss threshold for diagnosis
    • H.323 manages lost audio by repeating – this can sound like cardiac anomaly
    • Similarly, crackles (lung sound) can be lost
    • MPEG best for clinical audio (heart & lung sounds)
  • 20.
    • IP networks not designed/optimized for videoconferencing
    • Technical issues:
      • Congestion/packet loss
      • Variable bit rate
      • Security
      • Directory services
      • IP multicast
    • Latency is 250+ ms w/o network with current videoconferencing products
    IP Telemedicine Challenges
  • 21.
    • Overprovision your network
    • Implement quality of service mechanism
      • Works within your network/campus
    • Reduce inherent latency associated with digitization/encoding
    • Avoid/eliminate bottlenecks
      • Hubs
      • Routers (use non-blocking wire-speed switches instead)
      • Firewalls
      • 802.11
    How to Address IP Challenges
  • 22.
    • Conduct regional assessment in 45 Mbps wireless network
    • Study reverse of initial lab study to look for correlation ( i .e. worst-to-best)
    • Evaluate line-speed encryption technologies
    • Examine new software-only videoconferencing system from TeraMedia & Tulane University Bioinformatics
    • Pilot testing of H.323 to homes connected by cable and xDSL service
    Future Directions
  • 23. Regional Wireless Network Overview ECU Telemedicine Center Bertie Memorial Hospital Roanoke/Chowan Hospital 12.6 mi. 16.3 mi. 12.8 mi. 22.5 mi. 1.9 mi. 1.1 mi. (Diagram not to scale) All radio links 45 Mbps full duplex
  • 24. Future IP Telemedicine Network
  • 25. Contact Information
    • Scott C. Simmons
    • Director, Design & Development
    • ECU Telemedicine Center
    • 600 Moye Blvd., 1S-10
    • Greenville, NC 27858-4354
    • (252) 816-3852
    • [email_address]
    • www.telemed.med.ecu.edu