Robert S. H. Istepanian

Guest Editorial Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-Care Connectivity

M-Health can be defined as “mobile computing, medical sensor, and communications technologies for health-care.” This emerging concept represents the evolution of e-health systems from traditional desktop “telemedicine” platforms to wireless and mobile configurations. Current and emerging developments in wireless communications integrated with developments in pervasive and wearable technologies will have a radical impact on future health-care delivery systems. This editorial paper presents a snapshot of recent developments in these areas and addresses some of the challenges and future implementation issues from the m-Health perspective. The contributions presented in this special section represent some of these recent developments and illustrate the multidisciplinary nature of this important and emerging concept.

Comparative evaluation of despeckle filtering in ultrasound imaging of the carotid artery

It is well-known that speckle is a multiplicative noise that degrades the visual evaluation in ultrasound imaging. The recent advancements in ultrasound instrumentation and portable ultrasound devices necessitate the need of more robust despeckling techniques for enhanced ultrasound medical imaging for both routine clinical practice and teleconsultation. The objective of this work was to carry out a comparative evaluation of despeckle filtering based on texture analysis, image quality evaluation metrics, and visual evaluation by medical experts in the assessment of 440 (220 asymptomatic and 220 symptomatic) ultrasound images of the carotid artery bifurcation. In this paper a total of 10 despeckle filters were evaluated based on local statistics, median filtering, pixel homogeneity, geometric filtering, homomorphic filtering, anisotropic diffusion, nonlinear coherence diffusion, and wavelet filtering. The results of this study suggest that the first order statistics filter lsmv, gave the best performance, followed by the geometric filter gf4d, and the homogeneous mask area filter lsminsc. These filters improved the class separation between the asymptomatic and the symptomatic classes based on the statistics of the extracted texture features, gave only a marginal improvement in the classification success rate, and improved the visual assessment carried out by the two experts. More specifically, filters lsmv or gf4d can be used for despeckling asymptomatic images in which the expert is interested mainly in the plaque composition and texture analysis; and filters lsmv, gf4d, or lsminsc can be used for the despeckling of symptomatic images in which the expert is interested in identifying the degree of stenosis and the plaque borders. The proper selection of a despeckle filter is very important in the enhancement of ultrasonic imaging of the carotid artery. Further work is needed to evaluate at a larger scale and in clinical practice the performance of the proposed despeckle filters in the automated segmentation, texture analysis, and classification of carotid ultrasound imaging.

Mobile E-Health: the Unwired Evolution of Telemedicine

The movement of telemedicine from desktop platforms to wireless and mobile configurations may have a significant impact on future health care. This paper reviews some of the latest technologies in wireless communication and their application in health care. The new technologies can make the remote medical monitoring, consulting, and health care more flexible and convenient. But, there are challenges for successful wireless telemedicine, which are addressed in this paper.

Microarray image enhancement by denoising using stationary wavelet transform

Microarray imaging is considered an important tool for large scale analysis of gene expression. The accuracy of the gene expression depends on the experiment itself and further image processing. Its well known that the noises introduced during the experiment will greatly affect the accuracy of the gene expression. How to eliminate the effect of the noise constitutes a challenging problem in microarray analysis. Traditionally, statistical methods are used to estimate the noises while the microarray images are being processed. In this paper, we present a new approach to deal with the noise inherent in the microarray image processing procedure. That is, to denoise the image noises before further image processing using stationary wavelet transform (SWT). The time invariant characteristic of SWT is particularly useful in image denoising. The testing result on sample microarray images has shown an enhanced image quality. The results also show that it has a superior performance than conventional discrete wavelet transform and widely used adaptive Wiener filter in this procedure.

Design of a telemedicine system using a mobile telephone

This paper describes the design of a prototype integrated mobile telemedicine system that is compatible with existing mobile telecommunications networks and upgradable for use with third-generation networks. The system, when fully developed, will enable a doctor to monitor remotely a patient who is free to move around for sports medicine and for emergency situations.

Optimal zonal wavelet-based ECG data compression for a mobile telecardiology system

A new integrated design approach for an optimal zonal wavelet-based ECG data compression (OZWC) method for a mobile telecardiology model is presented. The hybrid implementation issues of this wavelet method with a GSM-based mobile telecardiology system are also introduced. The performance of the mobile system with compressed ECG data segments selected from the MIT-BIH arrhythmia database is evaluated in terms of bit error rate (BER), percent rms difference (PRD), and visual clinical inspection. The compression performance analysis of the OZWC is compared with another wavelet-based (Discrete Symmetric Wavelet Compression) approach. The optimal wavelet algorithm achieved a maximum compression ratio of 18:1 with low PRD ratios. The mobile telemedical simulation results show the successful compressed ECG transmission at speeds of 100 (km/h) with BER rates of less than 10/sup -15/, providing a 73% reduction in total mobile transmission time with clinically acceptable reconstruction of the received signals. This approach will provide a framework for the design and functionality issues of GSM-based wireless telemedicine systems with wavelet compression techniques and their future integration for the next generation of mobile telecardiology systems.

Evaluation of a mobile phone telemonitoring system for glycaemic control in patients with diabetes.

We conducted a randomized controlled trial using mobile health technology in an ethnically diverse sample of 137 patients with complicated diabetes. Patients in the intervention group (n = 72) were trained to measure their blood glucose with a sensor which transmitted the readings to a mobile phone via a Bluetooth wireless link. Clinicians were then able to examine and respond to the readings which were viewed with a web-based application. Patients in the control arm of the study (n = 65) did not transmit their readings and received care with their usual doctor in the outpatient and/or primary care setting. The mean follow-up period was 9 months in each group. The default rate was higher in the patients in the intervention arm due to technical problems. In an intention-to-treat analysis there were no differences in HbA1c between the intervention and control groups. In a sub-group analysis of the patients who completed the study, the telemonitoring group had a lower HbA1c than those in the control group: 7.76% and 8.40%, respectively (P = 0.06).

The mobile patient: wireless distributed sensor networks for patient monitoring and care

The concept of a three layer distributed sensor network for patient monitoring and care is introduced. The envisioned network has a leaf node layer (consisting of patient sensors), an intermediate node layer (consisting of the supervisory processor residing with each patient) and the root node processor (residing at a central monitoring facility). The paradigm has the capability of dealing with the bandwidth bottleneck at the wireless patient-root node link and the processing bottleneck at the central processor or root node of the network.

Medical QoS provision based on reinforcement learning in ultrasound streaming over 3.5G wireless systems

The design of an efficient mobile healthcare system using 3.5G and 4G wireless networks is a challenging problem especially for bandwidth demanding telemedical applications. In this paper, we focus on the concept of medical quality of service (m-QoS) applied to a typical bandwidth demanding m-health application. Based on this concept, we propose a novel multiobjective rate-control mechanism for the optimized delivery of diagnostically acceptable ultrasound video images over 3.5G wireless networks. The performance of the proposed algorithm has been evaluated via both simulations and experimental studies. The proposed optimal rate control algorithm achieved performance improvements that are compatible with the medical QoS requirements.

UNWIRED E-MED: the next generation of wireless and internet telemedicine systems

The movement of telemedicine to wireless and mobile Internet applications is imminent in the next few years. This migration from desktop platforms to wireless and mobile configurations will have a significant impact on future healthcare delivery systems and their globalization. Recent telecommunications and biomedical computing advances will significantly enhance the current methodologies of telemedicine and telecare systems. This editorial will present some of the evolutionary issues and important aspects that have to be considered in developing technologies for the next generation of Internet and third generation of mobile systems geared for future telemedical applications. These will provide new dimensions to existing medical services and areas of outreach that are not possible with the current generation that will have tremendous impact on how healthcare delivery will be shaped for the 21st century.