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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