A mobile multimedia telediagnostic environment (MMTE) permits users to work remotely on common shared resources and applications and simultaneously communicate both visually and through audio. Such an environment becomes more flexible and useful if it can work in a wireless and wiredin (integrated) environment so that the services can be provided for mobile hosts . As already mentioned, mobility of users becomes very important for many applications in telemedicine, where doctors , specialists, and health-record officials can cooperate and discuss particular medical treatment. In this application we are concerned with a large data set such as radiological images, video images of signals, and text that are transferred to the host from a server. Typically, in this case the communications are asymmetric in the sense that the server transfers a large amount of information, while the mobile host sends only a small amount of information in the opposite direction. Here the users have interfaces of PDA or laptops interacting remotely. In this application we need cooperation among the participants through special communication tools for conversation (Roth, 2001) and e-pointing (MacKenzie & Jusoh, 2001). The conversation can be of conference type, where two or more participants are involved. The e-pointers aid each participant to point out a particular segment of an image or a video image of a signal so that each of the other participants can visualise the movements of the remote pointer. This would provide for greater clarity and effectiveness of discussion about the particular image. Also in telesurgery (e-surgery) where two or more operating rooms are connected by a network, live video signals may require to be transferred from endo-camera (camera for photographing internal organs) and operating room camera to other remote locations for consultancy. This would allow surgeons not only to see but also visualise surgical instrument movements with 3-D models in real time during the surgery.


Reliable Communication Network and Equipment

A reliable multimedia communication network that links the remote centres with hospitals is essential. The delivery of multimedia content in a timely fashion is very important. The key is to find a method of delivery that is universally acceptable, easy to use, and reliable. The answer comes from the Internet. The Internet offers a developer the ability to publish information very quickly. It provides a widely used and uniform communications medium to link users together to access or deliver multimedia information. However, while using mobile devices and the Internet as vehicles for multimedia delivery and interaction, the following factors are to be taken into account:

Type of application

The application requirements can range from a very simple radio to very complex real-time image/signal processing system

Communication bandwidth requirements

Text requires the lowest bandwidth, while audio and video data and signals require a significant increase in bandwidth. Specification of bandwidth to be used and compression techniques used are to be laid down so that the data and images that are transmitted are of diagnostic quality. The following issues arise in using networked communication:

  1. Choice of equipment and bandwidth management for fast, reliable, and secure transmission of patient data.

  2. Costs involved.

Bandwidth Management

Bandwidth determines the information capacity of a network per unit of time. Wireless networks deliver lower bandwidth than wired networks. Hence software techniques based on compression should be used. Also scheduling communication intelligently can save bandwidth. For use in telemedicine, the techniques should be extremely reliable. Current cutting-edge technologies are yet to develop. Bandwidth requirements along with applications are given in (approximate) logarithmic scale in Figure 1.

Figure 1: Bandwidth (log scale) requirements for applications

Three common technologies used are (bps = bits per second; K= Kilo; M= Mega; G = Giga):

  • Dial-up mode: Rate 28.8 Kbps

  • T1: 1.544 Mbps

  • DS3: 45 Mbps

As an example, standard X-ray transmission takes 30 minutes in dial-up mode, 30 seconds in T1 mode, and 1 second in DS3. It is obvious that the cost goes up as we want to increase the bandwidth to communicate voice, data, and pictures.

As mentioned earlier, even a low-cost dial-up mode can be helpful in telemedicine. Of course the more sophistication we introduce the more complex and costly the system gets, and the system has to be supported by governmental agencies or health insurance providers.

DS3 is a dedicated, private line service designed for point-to-point communication. This service uses fibre- optic cable. One can have the option of tiered DS3 service from lower to higher bandwidth from 5 Mbps to 45 Mbps, depending upon cost considerations and transmission requirements.

Choice of multimedia hardware

We need a proper choice of graphics and audio equipment for quality images and audio for diagnosis.

Low-Cost Computing Environment

Low-cost workstations are to be made available at the user 's and health provider's end. Suitable software and hardware are to be developed so that the workstations are easy to use by doctors , nurses, and other paramedical staff. For this purpose, suitable training centres are to be made available.

Cost of Consultation

Low cost per consultation, faster diagnosis, faster reply to queries, and quicker medical aid when compared with the conventional method of a direct visit to the doctor.

Case Evaluation and Emergency Attention

Quick evaluation of emergency cases and arrangement for transportation to hospitals supported with mobile telemedical personnel and equipment.