conferences/spr2002/presentations/ssimmons/simmons.ppt
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TRANSCRIPT
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Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience
Scott C. SimmonsDirector, Design & DevelopmentECU Telemedicine Center
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Overview
• ECU Telemedicine Center Overview• Internet Telemedicine• NIH/NLM Biomedical Applications of
the NGI• Testing CODEC/Network Performance• Lessons Learned• Future Directions
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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)
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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
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IP Collaboration Technologies
• Can use existing IP infrastructure?
• Different technologies– H.323– MPEG-1, 2, (4)– Access Grid
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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”
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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
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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
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Advertised vs. Actual FPSCLI @ 768 (H.320) = 29 fps
14.5MIN INON TAPE CLI
FRAMES 768
1 12 23 34 45 56 67 78 89 9
10 911 1012 1213 13
VCON @ 768 (H.323) = 14 fpsON TAPE 8.5MIN IN
VCON @768
FRAMES
1 32 53 54 55 86 87 108 109 11
10 1311 1312 1613 1614 1715 1716 1917 19
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Advertised vs. Actual FPS (cont’d)
Proshare @ 400 (H.323) = 15 fps Polycom @ 768 (H.323) = 26 fps
OnTape PROSHARE@ 400
FRAMES
1 12 13 34 35 56 57 78 79 7
10 911 1112 1113 1114 1315 1516 1517 17
ON TAPE POLYCOMVIEWSTATION
FRAMES 768
1 12 33 44 55 66 77 88 89 9
10 1011 1212 1313 1314 1515 1516 1617 18
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Video Testing
SMPTE Color Bars – Waveform SMPTE Color Bars – Vectorscope
Luminance 5 Step Multiburst 100
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Video Testing Setup
Hub
Codec Codec
Test Generator
AV Router
AV Router
Time Code Gen
Test Pattern
Test Pattern + Time code
WFM/Vectscope
HI 8VCR
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<Show Video Tests>
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Audio Testing – White Noise
Polycom
Minerva Vbrick
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Audio Testing – Stethoscope
Polycom
Minerva Vbrick
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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
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Physician Assessment Test N/W
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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)
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• 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
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• 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
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• 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
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Regional Wireless Network Overview
BethelRepeater
WIlliamstonRepeater
WIndsorRepeater
AhoskieRepeater
ECUTelemedicine
Center
BertieMemorialHospital
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
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Proposed Router
Radio tower
Existing CHSC Switch
GE 99Router
Radio tower
L3 Switch Ahoskie
L3 Switch WindsorRadio tower
School for the Deaf
Cherry Hospital
Tarboro
Duplin
Onslow
Health East 1
Health East ??
T1's from remote sites
Radio tower
Future IP Telemedicine Network
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Contact Information
Scott C. SimmonsDirector, Design & DevelopmentECU Telemedicine Center600 Moye Blvd., 1S-10Greenville, NC 27858-4354(252) [email protected]