A typical cooperative telediagnostic (e-diagnostic) environment is shown in Figure 2. Yearwood and Pham (2000) and Pham and Yearwood (2000) describe a cooperative telemedicine environment for interactive processing of visual data. This environment consists of databases containing medical/pathological images and textual information, a cooperative interaction facility, and telecommunication. The typical characteristics of such an environment are:

  • Remoteness of users: Users work remotely on common shared resources and applications and simultaneously communicate both visually and through audio. This environment becomes more flexible and useful if it can work in an integrated (wireless and wired-in) environment so that the services can be provided for mobile hosts .

  • Cooperation: Many e-medicine applications require doctors , specialists, and health-record officials to cooperate and discuss particular medical treatment. In this application we are concerned with a large data set such as radiological images, video images or signals, and text that are transferred to the host from a server. Cooperation among the participants requires special communication tools for conversation, e-pointing, and e-surgery.

  • E-pointing facility: E-pointing is the act of moving an on-screen tracking symbol, such as a cursor, by manipulating the input device. Such a tracker can be placed over text, images, icons, and menu items and is basic to human interaction with graphic interfaces. Such a facility can aid conversation between two or more participants dealing with medical images or signals. The interactive e-pointers (MacKenzie & Jusoh, 2001) 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 and discuss any abnormality for diagnostic purposes.

  • Facility for Internet link: Also users should be able to remotely access worldwide knowledge bases/databases, download files from the Internet, and browse the World Wide Web using portable and mobile devices such as laptops, palmtops, and PDAs. Further technological developments are needed to provide the PDA users with facilities to handle text, graphics, and audio messages and access interactive multimedia services.

Figure 2: A cooperative diagnostic mobile environment


The integrated computing environment consists of fixed host computers and wired-in/wireless mobile client computers (Bates, 1994, Hatfield, 1996; Imielinski & Badrinath, 1994). Fixed hosts (FHs) are connected together via a fixed high-speed network (Mbps to Gbps). The mobile clients (MCs) are capable of connecting to the fixed network via a wireless link. The components in the fixed network are called fixed hosts. Fixed hosts (FHs) provide mobile application services and coordinate tasks to mobile hosts . MCs support query invoking and information filtering from FHs to provide personal information service.

The remote access to image and other related databases may appear like automatic teller machine transactions, but they differ in several respects:

  1. They are long-duration transactions requiring the transfer of a large amount of data and require lengthy negotiation, cooperation, pointing, and decisions to reach a final diagnosis and therapy . In this cooperative environment, therefore, we need to sacrifice some of the properties of the traditional transaction model (Krishnamurthy & Murthy, 1992) that enforces ACID properties (atomicity, consistency, isolation, and durability). Note that, in particular, we cannot roll back any transaction in the context of e-surgery. Also isolation implies that the actions of one participant are invisible to another. Therefore, we need to introduce a more realistic model in which the isolation property is removed and intermediate results are made visible so that any catastrophic incidents can be avoided. Also precedence order in execution and context dependencies have to be taken care of. This means we must remove the atomicity constraint that requires "all or none" operation and rollback. This model is called "a workflow model" . More detailed aspects of this model and relevant software design features are described briefly in a later section and in Chapter 2 of this book.

  2. A service to permit two users to interact simultaneously with a medical imaging system for cooperative diagnosis. To help diagnosis we need to provide each user with a pointer of a desired identity that can be locally operated and at the same time can be visualised at the remote terminal. This is a concurrent action from two or more users on a read-only image database.

  3. Also an audio conference facility is needed for cooperative diagnosis.

  4. Collaborative multimedia environment allows medical specialists to cooperate in diagnosis. The environment has to support remote database access for medical images, the retrieval of relevant medical cases to support diagnosis, and communication among participants through telepointers and image annotation for freehand drawing.

  5. A telepointing device with a very high reliability.

Thus the key elements in the design of a telediagnostic system are:

  1. Design of an appropriate workflow model for telemedical applications.

  2. Supporting database access in a mobile cooperative environment for medical images, related text, and video signal images. Also additional support through handheld devices, such as PDAs, for supporting remote information sharing and processing.

  3. Providing a cooperative environment for communication among participants audiovisually through telepointers to visualize movements remotely.

  4. Appropriate hardware/software tools.

  5. Implementation of the reliability, fault tolerance, and recovery features.