Technology and Network

Interactive Tele-Video (ITV) Systems

Video conferencing uses an Interactive Tele-Video System which consists of some version of a video monitor, video camera, speakers, microphone, and a CODEC. The CODEC (stands for coder-decoder) uses hardware and/or software to simultaneously code and decode (compress and decompress) digital video and audio information and sends it to another CODEC where the same process is also being done.

There are several brands of ITV systems currently available on the market, most are compatible with one another. The KUCTT has connected with ITV systems all over the world including Europe and Australia.

Bandwidth

Bandwidth refers to the amount of data that can be transmitted at one time. The greater the bandwidth, the more data can be transferred. Greater bandwidth allows for a higher image and motion quality, but at a higher cost (over ISDN lines). Currently, the KUCTT does most of its clinical consults at 384 kbps H.323 Internet Protocol. For consults more visually intensive (dermatology, rehabilitation therapy, etc.), a higher bandwidth of 512 kbps is used.

The newest type of video conferencing uses High Definition over H.323 which requires quite a bit more bandwidth, starting at 1.5Mb for true HD on up to 3 Mb. HD will most likely be in the future for KUCTT.

ISDN vs. IP

ISDN and IP are two ways that data is carried for video conferencing. ISDN (Integrated Services Digital Network) lines are designed to carry voice, data, and video over an existing telephone network infrastructure. There are two types of ISDN lines that the KUCTT uses, BRI (Basic Rate Interface) and PRI (Primary Rate Interface). The main difference between the two are the amount of bandwidth each can carry.

BRI lines carry up to 128 kbps of bandwidth. Sites associated with the TeleKidcare® project use one BRI line; other sites at the KUCTT and throughout Kansas use 3 BRI lines to get up to 384 kbps of bandwidth.
PRI lines can carry up to 1.5 MB of bandwidth. A CODEC must be using a PRI line in order to achieve a higher bandwidth than 384 kbps on an ISDN-based network.
IP (Internet Protocol) uses IP addresses rather than dialing an ISDN number. An IP address consists of 4 Octets, ranging from 0 to 255, separated by a period. (example: 129.145.23.4).

IP and ISDN video systems can not communicate with each other directly. A video bridge or ISDN/IP Video Gateway is needed for an ISDN-based site to connect to an IP-based site.

Peripherals

What really separates telemedicine from ordinary video conferencing is the use of peripherals. Peripherals enhance what a specialist can examine without having to be at the same location of a patient. With the assistance of a nurse or other medical professionals, the doctor is able to hear breath sounds, see inside the ear, nose, or throat, view echocardiograms, etc. Any medical device that produces a video signal is compatible with the teleconferencing technology used by the KUCTT.

Some of the peripherals used by the KUCTT include:

Electronic Stethoscope –
The electronic stethoscope uses a sending unit at one site and a receiving unit at another site. The sending unit has a standard stethoscope membrane attached and sends the breath sounds over a plain-old-telephone-system (POTS) line to the receiving unit where the doctor can hear the breath sounds through standard headphones. The electronic stethoscope operates independently of the teleconferencing system.
KUCTT now also uses digital stethoscopes that transmit the heart and lung sounds across the same H.323 IP connection as the audio and video,except it uses the data channel.
Otoscope –
Similar to a clinical otoscope, this device allows the doctor to see inside a patient’s ear, nose or throat. Used extensively in the TeleKidcare® project.
General Examination Camera / Dermascope – A camera with a very short focal length designed for dermatological consults.

For further information, please contact:

Dennis Schukman

Systems Coordinator

HIPAA Technical Compliance Manager
dschukman@kumc.edu

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