Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience

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Evaluation of IP Video Technologies for
Telemedicine The East Carolina University
Experience

• Scott C. Simmons
• Director, Design Development
• ECU 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 PCs 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 FPS

• CLI _at_ 768 (H.320) 29 fps

VCON _at_ 768 (H.323) 14 fps
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Advertised vs. Actual FPS (contd)

• Proshare _at_ 400 (H.323) 15 fps

Polycom _at_ 768 (H.323) 26 fps
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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
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ltShow Video Testsgt
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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 Telemedicine Challenges

• 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

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How to Address IP Challenges

• 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

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Future Directions

• 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

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Regional Wireless Network Overview
1.9 mi.
22.5 mi.
1.1 mi.
Bertie Memorial Hospital
12.8 mi.
Roanoke/Chowan Hospital
16.3 mi.
12.6 mi.
All radio links 45 Mbps full duplex
(Diagram not to scale)
ECU Telemedicine Center
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Future IP Telemedicine Network
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Contact Information

• Scott C. Simmons
• Director, Design Development
• ECU Telemedicine Center
• 600 Moye Blvd., 1S-10
• Greenville, NC 27858-4354
• [phone]
• simmonss_at_mail.ecu.edu
• www.telemed.med.ecu.edu