J. KSIAM IT series Vol.8, No.1 53-68, 2004

53

Intelligent Remote Diagnosis System : RED

HEE-WAN KIM, SEOK-SU KIM

< ABSTRACT >

In this paper, we design RED(Intelligent Remote Diagnosis System)

application system. This system is a real time collaborative telemedicine

system(including Video Conferencing) which is a low cost for the general

home PC user. And it supports a distance telemedicine between doctor and a

patient, among the doctors(the medical institutions) through the high

technology of information communication. Also it supports a telemedicine

within hospital, a home doctor , special site(a protective room of public

institution, a countryside, a gymnasium) by the various network (LAN, MAN,

PSTN, WAN). Also, the merit of this system including PACS(Picture Archiving

and Communications System ) is very many which are small depository, low

maintenance expense, good efficience(storage, speed) and good flexibility but

the development costs is higher.

This RED is composed of a application(audio/video/text data, materials, DB)

sharing, a white board to support interaction, the video window for

participators/AVI file play, user's interface with tool box/ICON and a

configuration of environment. And the technical components are composed of

a session management, access management, network control and media

control.

1. Introduction

Todays, information network super-highway with multimedia

technology is processing rapidly for base environment for society.

Keywords : RED, real time collaborative system, PACS, network control

HEE-WAN KIM, SEOK-SU KIM 54

This understood as an effort at government level (by recognizing the

importance of various network implementation that used to be

developed by educational institution including universities,

organizations, research center, local and federal government, etc.) to

implement integrated information service infrastructure for the demand

of various multimedia information service of user. Extended utilization

of Web on Internet and activation of various multimedia based

information service industries using high-speed network open new era

of information society[1].

The term multimedia implies the combination of many different forms

of information including images, computer graphics, video, audio, and

text, along with data distribution mechanisms and storage systems that

can provide such data with real time or interactive response. Until

recently, almost all systems were limited in their ability to manipulate

video data. To perform meaningful operations on image, graphics, video,

and audio data, and to process and integrate them for a useful

representation, a multimedia system needs various interactive

computing functions besides compression.

Our vision of a multimedia system has been an integrated computing

environment that acquires different formats of data, integrates them

while maintaining their relationship, manipulates them, and presents

them selectively upon user commands[2]. To support these functions,

the system should perform not only data acquisition and compression,

but also storage, processing, networking, and output of the multimedia

data. To be useful and affordable in a desktop environment, the

multimedia system should also be highly integrated by implementing as

many functions as possible on a single-plug-in-board or even directly

on the motherboard.

Such a system can be used in various fields, such as education or

training. With multimedia presentations, a trainee can better understand

the material, and through interactive control of the system repeatedly

view problem sections. These system can benefit the training of

assembly line workers, drivers, salespeople, and many others. Other

application areas include the office of the future, presentation graphics,

multimedia authoring and production, video teleconferencing, and

medical imaging including telemedicine.

A growing number of hospitals worldwide are implementing hospital-

wide Picture Archiving and Communications System (PACS). A great

Intelligent Remote Diagnosis System : RED 55

deal has been written on the advantages, disadvantages and cost

benefits of PACS.

Figure-1. Network structure for Telemedicine and Distance Education

In accordance with the improvement of standard of living, demanding

a support of comfortable life, support of safety, importance of health,

increasing frequencies of entertainment and game, searching for

convenient and effective business process, and searching for high

quality of cultural life become real. These features are natural chases

HEE-WAN KIM, SEOK-SU KIM 56

toward to be advanced countries. In accordance with this trend,

development of the various state-of-the-art equipment made

telemedicine feasible. Telemedicine system requires the

communication technology and multimedia technology (audio/video) to

support medical processing which is located distantly between doctors

and patients and fulfillment of content of telemedicine software

development for effective medicine to the situation. This situation can

be solved by the development of communication equipment and

compression technology to compress large audio/video data but needs

expensive facilities.

Specially, it requires rapid and large multimedia data (audio/video)

transferring on high-speed private communication network and

creation of session and application sharing to recognize the sessions on

communication network.

Figure-1 show Network structure for telemedicine and Distance

Education. that is, it supports a various Distance Education System(a

technical education about medicine, general application education,

seminal, conference, discussion and consultation) among the

doctors(the medical institutions) by the various network (LAN,MAN,

PSTN, WAN, Mobile)[3,4]. The structure of the system networking is

following., it is telemedicine for multimedia collaborative interaction

between each clinic room and a clinic assistance part and patient by

LAN within hospital. In case of ambulance and outside performed by

Multimedia mobile communication using IMT-2000 and satellite. In case

of home performed home doctor telemedicine using the internet by

ISDN, PSTN.

In case of among other hospital or HMIS, it assistant telemedicine by

fast Ethernet LAN. And within hospital connected by PACS, HMIS

including admission into a hospital, leaving hospital.

It also requires expensive hardware equipment costs and high

technology of application sharing. CBM technology which is different

from CMC technology supports real-time interaction (dialog,

question/answer, etc) so that it is noticed as base environment for

telemedicine(including distance learning ) system using an interaction

media for multimedia data[5-6].

Intelligent Remote Diagnosis System : RED 57

2. RED (Intelligent Remote Diagnosis System )

RED(see figure-2) is Intelligent Remote Diagnosis System, the

component are (interaction, Diagnosis, Manipulation for Diagnosis and

Interface with DooRae. Each component’ s function is as following.

Interaction mode is multimedia collaboration system on DooRae

middleware which is session management, access control, network

control, concurrency control, etc. and application sharing and additional

functions for user.

AgentInteraction Diagnosis

Manipulation

for Diagnosis

Interface withDooRae

- Flow control - Camera- Audio

Interaction Mode

- Chatting

- Audio

- Video

-

- Async.

- Reservation

Patient

RED: Intelligent Remote Diagnosis System

155 Mbps

Sync.Clinic/ MedicalInformation Center

PatientsHistoryServer(includingPACS, RIS)

Figure-2. RED(Intelligent Remote Diagnosis System)

Diagnosis Function is connected between PACS and PHS(Patients

HEE-WAN KIM, SEOK-SU KIM 58

History Server), and Networking in between PHS and diagnosis system

is information communication super-highway or ATM LAN. It is

support to diagnosis after drive the need information by the intelligent

agent into PHS.

Manipulation for Diagnosis is support diagnosis connected by DooRae

middleware for multimedia collaborative system. Supporting functions

are flow control, video and audio.

RED system is telemedicine system for interaction mode(multimedia

collaborative system) between doctor and patient. To support this

system, doctor and patient need basic system specification to play

DooRae function which chatting, audio, video and reservation. In this

mode, the patient serviced telemedicine and universal hospital

information service from doctor or hospital also patient can receive

need information from Clinic/Medical Information Center.

The relationship among the patient, doctor and PHS is following

figure-3. One step, patient request diagnosis and treatment to doctor.

Two step, doctor is recognizing requesting information. Three step,

doctor request patient’ s information from PHS. Four step, PHS is

sending requesting information to doctor through intelligent search

agent. Five step, doctor response and decide patient’ s requesting

according to the result.

Doctor

1( Request ) 2( Recognition )

PHS

4( Response )3( Request )

Agent

5( Response)

Patient

Figure-3. RED medical protocol

Intelligent Remote Diagnosis System : RED 59

RED telemedicine has a various application(see figure-4). The case of

A is ambulance moving by call to 119 center at emergence occurrence

and case of B is telemedicine by the video conferencing(multimedia

communication) using the satellite or IMT(International Mobile

Telecommunication)-2000 between in ambulance and hospital. The

case of C is assistance diagnosis and treatment between hospital and

hospital((a public health center) which can support the mutual

assistance diagnosis and treatment also transfer to need information by

supporting PACS. And this system is supported expert system,

PHS(patient history server) and medical & health education database

by the superhighway information network. The case of D is

telemedicine within hospital. Which support to interactive multimedia

communication and other section(or other clinic room). Also this

system has HMIS which connect to PACS, expert system, PHS and

HMIS by intranet(ATM LAN) network. The case of E is telemedicine

which perform a diagnosis and a dialogue diagnosis fixed period for

between patient and doctor. That is, this system is home doctor

application system, also patient can perform self diagnosis by expert

system and medical health education database using the internet or

ISDN network, also can perform directly dialogue diagnosis between

doctor and patient and patient is received medical service from HMIS.

The case of F is telemedicine of a countryside which take medical

treatment from a public health center or hospital nearly by 119

emergence center. In case of this type is emergency or week a disease

symptoms situation. In case of emergency which is mobile video

multimedia communication using IMT-2000 or satellite between 119

ambulance and hospital for observation and treatment the patient’ s

situation in 119 ambulance.

The case of G is similar to case of E which is telemedicine to receive

self diagnosis or medical service by perform dialogue medical

treatment to patient from nearly public health center.

HEE-WAN KIM, SEOK-SU KIM 60

119

hospital B

hospital A

A public health centerOR Clinic

Patient

Figure-4. RED telemedicine has a various application

Figure-5 is viewed Network connection according to the each

situation. It is network connection for communication Inner home,

communication between hospital and home by internet. The case of the

within hospital is connect by intranet networking. The communication

between hospital and clinic, the communication between hospital and

119 emergency and the communication between home are connected

by Tl/E1 line.

- Inner Home<-> Internet

- Between Hospital and home<-> Internet

- Within Hospital<-> Intranet

- Between Hospital and Clinic< -> T1/E1 Line

- Between Hospital and 119 < -> T1/E1 Line :

- Hospital or hospital< -> T1/E1 Line

:

119(Emergency)

Hospital and Clinic

Patient

Figure-5. Network connection according each situation.

Intelligent Remote Diagnosis System : RED 61

Figure-5 is the flow diagram of user interface. First, if the exist the

medical examination request, separate 3 type that are urgent patient

revive, medical examination consultation and medical treatment

administration service. And then each mode is dived according the

detail situation. That is, in case of emergency patient is divided hospital

or 119 emergency center, in case of medical examination consultation

is connected by hospital which is divided to 4 type situation(clinic

consulation, clinic application service, database and clinic

information).And the medical treatment administration service support

to medical examination reservation system which support to admission ,

leaving and etc.

medical examinationreservation system

Hospital connection119 connection

Hospital connection

Medical treatment administration service

Medical examination consultationUrgent patient revive

Ambulance Telemedicine

Local Medical

Network

-Connection to Hospital- Telemedicine whthin Ambulance

- Clinic consultation

- Connection to very important medical consultation- Telemedicine, Distance Education- Study for Clinic- Demendia

Clinic Application

Service

It Support to Telemedicinewhich at the lack site for medical service

Database

- Emergency Medical Information- Blood Information- Etc.

Clinic Information

- Compare Contagious disease

- cancer information for treatment & prevention

- The chart for Patient- supporting- Admission to a hospital- Leaving hospital

Medical examination request

Figure-6. Flow diagram of user interface

Figure 6 is for example video window of RED system that shows

doctor and patient and the patient's medical record in the medical

session. This video window can open several patients by software

CODEC and performs high quality and rapid video process by hardware

CODEC.

The widow of bottom-right applies for medical consultation process

by showing medical consultation and discussion between doctor and

patient with pictures and slide, etc. The whiteboard of top-right applies

HEE-WAN KIM, SEOK-SU KIM 62

for treatment of patient's medical and psychological state by patient

through drawing graphic, writing text, learning and dialogue between

doctor and patient. The tool box of bottom left is the user interface

part and displays the user friendly icon.[5-6].

Figure 7 shows flow of data transfer having clear responsibility by

defining main object between data sending and receiving. And this

modeling is automation system of telemedicine within hospital. Each

mode in figure 7 is interaction & change according to the mode

situation & rule.

M utual view Control w indow box Patient chart and w hite view

M y apperance view H ospital management system

Remote m edical treatm ent systemfirst stage screen

Figure-7. Example of telemedicine system widow

Intelligent Remote Diagnosis System : RED 63

RED

Drugstore

Receiver

Admission

into a hospital

Nurse

Medical examination

B

Emergency

Medical examination

A

Medical examination

C

Normal

1

2

3

456

7

8

910

11

12

13

14

15

16

Intelligent Multi agent for RED(including PACS, HIS, RIS)

1. Visit to general patient2. Visit to emergency patient3. Admission4. Diagnosis and treatment5. - Obtain new picture for examination - Join examination information & past picture 6. Interactive between nurse and RED7. A prescription for admission patient8. An injection for admission patient9.10. A rotation into hospital for admission patient (a doctor’s round of visits)11. An injection for general patient12. A prescription for general patient13.14 Interactive between nurse and doctor15. Receiving a drug patient16. Co-diagnosis and treatment among the relation parts

Figure 8 - Automation system of telemedicine within hospital

HEE-WAN KIM, SEOK-SU KIM 64

3. Analysis and Result

Table 1. Compare with this system(including PACS) and conventional

system

A depository

Maintenance expenses

Development costs

Efficiency (Storage)

Efficiency(Speed)

Flexibility

This System(PACS + Collaborative)

ConventionalMedical System

Large

High

Bad

Slow

Bad

High

Low

Good

Fast

Good

Small

Don’t care

A growing number of hospitals worldwide are implementing hospital-

wide Picture Archiving and Communications System (PACS). A great

deal has been written on the advantages, disadvantages and cost

benefits of PACS. A merit of PACS same as the following table which

are a depository, maintenance expense, development costs,

efficience(storage, speed), flexibility(see table 1).

We have result, Estimation & Compare of RED system and

conventional method for medical treatment method on table 2. In this

compare, this system has an interaction, various communication type, a

question and an answer, multi session, application sharing, high degree

of efficiency, high degree of cooperative, low degree of periodical cost

and time constraint. Specially, RED support to mobile function inner

hospital or all region environment for IMT-2000 or satellite, so we can

flexible distance application telemedicine using this system.

And this system has been done for creating multimedia-based

telemedicine system to be run on multimedia home PCs hooked on

network environment. Such this system would contribute to change home PCs

Intelligent Remote Diagnosis System : RED 65

with their major areas in stand-alone mode and in monomedia-based non-

interactive application to workstations for patient-doctor collaborations

through various modes of interactions in cyberspace

Table 2.Estimation & Compare of RED system and conventional method

for medical treatment method.

4. Conclusion

Traditionally, almost all medical images have been printed on

radiological films. These films are expensive to produce and easy to

misplace and usually only one copy exists, thus limiting the number of

persons who have simultaneous access to the images. But the merit of

this system including PACS(Picture Archiving and Communications

System ) is very many which are small depository, low maintenance

RED systemon DooRaeenvironmrnt

Communication type

Interaction

Time Constraint

Degree of the cooperative

Degree ofefficiency

Multisession

1:1 1 : 1(1 : n)(n : n)

x

Low

x

o

o

Low

High

High

x o

model

Estimation type

Application sharing x o

Real-time

Internet Service

Degree of Data management

Evaluation

o

o

x

x

HighMedium

Medium High

Mobile usingthe wireless LAN

o x

ConventionalMedical

treatementmethod

HEE-WAN KIM, SEOK-SU KIM 66

expense, good efficience(storage, speed) and good flexibility but the

development costs is higher.

RED system is Intelligent Remote Diagnosis System, the component

are (interaction, Diagnosis, Manipulation for Diagnosis and Interface

with DooRae. Each component’ s function is as following.

Interaction mode is multimedia collaboration system on DooRae

middleware which is session management, access control, network

control, concurrency control, etc. and application sharing and additional

functions for user.

This RED system can decrease the overload of hospital (or clinic)

patients, and give the opportunities to individuals who are distantly

located or cannot effort to visit the hospital (or clinic) to have medical

benefits through indirect medical treatment and eventually makes out

the public medical welfare.

This RED system is a real time collaboration telemedicine system

which is a low cost for the general home PC user. And it supports a

distance telemedicine between doctor and a patient, among the doctors

through the high technology of information communication. Also it

supports a telemedicine within hospital by the LAN, and a home doctor,

specially site(a protective room of public institution, a countryside, a

gymnasium) and cooperative. Also it supports a various application

system(a technical education about medicine, general application

education, seminal, conference, discussion and consultation) among the

doctors by the various network (LAN,MAN,PSTN,WAN, Mobile)

Integrated multimedia environment technology in this RED system

contains application sharing, whiteboard, multi video window open,

audio support, icon-type user interface, environment setup, etc. and

provides session management, access control, network control, and

media control technologies.

This RED is composed of a application (Audio /video/text data,

teaching materials, DB) sharing, a white board to support interaction,

the video window for participators/AVI file play, the audio for

dialogue/AVI file play, user's interface with Tool box/ICON and a

configuration of environment. And the technical components are

composed of a session management, access management, network

control and media control. Most of telemedicine used hardware and

exclusive line of high cost as CATV broadcasting technique. But RED

will contributes to change the Home-PC for better use of collaborations

Intelligent Remote Diagnosis System : RED 67 among doctor and patients(teacher and student) through various

modes of interactions in cyberspace.

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the Internet CSCWD 2001," London, Ontario. Canada, July 2001.

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[9] PACS pages: Eric John Finegan's PACS / Telemedicine Resource

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Korea, Apr., 1997.

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김희완(金熙晥, Hee-Wan Kim)

1987 년 광운대학교 전자계산학과 졸업(이학사)

1995 년 성균관대학교 정보공학과 졸업(공학석사)

2002 년 성균관대학교 전기전자 및 컴퓨터공학부

졸업(공학박사)

1991 년 한국전력공사 정보처리처 근무

1996 년 정보처리기술사(정보관리)취득

1999 년 공인 정보시스템 감리인 자격 취득(한국전산원)

1996 년 삼육의명대학 전산정보과 조교수

2001 년~현재 삼육대학교 컴퓨터과학과 조교수

관심분야: 컴퓨터보안, 동시성제어, 분산 DB, 보안 시뮬레이션,

웹데이터베이스

김석수(金錫洙, Seok-Soo Kim)

1989 년 : 경남대학교 계산 통계학과 졸업

1991 년 : 성균관대학교 정보공학과 공학석사

1991 년 1996 년 : 정풍물산(주) 중앙연구소 근무

1996 년~2002.2 : 성균관대학교 대학원 정보공학과

공학박사

1996 년~2000.2 : 거창전문대학 컴퓨터정보시스템과

전임강사

2000.2 ~ 2003.2 : 동양대학교 컴퓨터공학부 교수

2003.3~현 한남대학교 정보통신멀티미디어학부 교수

관심분야 : 멀티미디어 및 CSCW, 원격진료, 소프트웨어공학, 웹

프로그래밍, 데이터베이스, 멀티미디어통신