MedLAN: Compact mobile computing system for wireless information access in emergency hospital wards

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.As the need for faster, safer and more efficient healthcare delivery increases, medical consultants seek new ways of implementing a high quality telemedical system, using innovative technology. Until today, teleconsultation (the most common application of Telemedicine) was performed by transferring the patient from the Accidents and Emergency ward, to a specially equipped room, or by moving large and heavy machinery to the place where the patient resided. Both these solutions were unpractical, uneconomical and potentially dangerous. At the same time wireless networks became increasingly useful in point-of-care areas such as hospitals, because of their ease of use, low cost of installation and increased flexibility. This thesis presents an integrated system called MedLAN dedicated for use inside the A&E hospital wards. Its purpose is to wirelessly support high-quality live video, audio, high-resolution still images and networks support from anywhere there is WLAN coverage. It is capable of transmitting all of the above to a consultant residing either inside or outside the hospital, or even to an external place, thorough the use of the Internet. To implement that, it makes use of the existing IEEE 802.11b wireless technology. Initially, this thesis demonstrates that for specific scenarios (such as when using WLANs), DICOM specifications should be adjusted to accommodate for the reduced WLAN bandwidth. Near lossless compression has been used to send still images through the WLANs and the results have been evaluated by a number of consultants to decide whether they retain their diagnostic value. The thesis further suggests improvements on the existing 802.11b protocol. In particular, as the typical hospital environment suffers from heavy RF reflections, it suggests that an alternative method of modulation (OFDM) can be embedded in the 802.11b hardware to reduce the multipath effect, increase the throughput and thus the video quality sent by the MedLAN system. Finally, realising that the trust between a patient and a doctor is fundamental this thesis proposes a series of simple actions aiming at securing the MedLAN system. Additionally, a concrete security system is suggested, that encapsulates the existing WEP security protocol, over IPSec

Plataforma web de monitorização de dose de radiação em imagem clínica

Mestrado em Engenharia de Computadores e TelemáticaA monitorização sistemática da exposição dos cidadãos à radiação ionizante associada aos procedimentos imagiológicos é fundamental para garantir a qualidade dos serviços clínicos. Esta atividade é importante no controlo de desempenho, na optimização de protocolos e na rápida rectificação das práticas erradas. Em teoria, os episódios de radiodiagnóstico devem sempre manter a exposição à radiação tão baixa quanto razoavelmente possível (princípio ALARA), preservando a qualidade de diagnóstico. Os sistemas de monitorização de dose automáticos podem ser úteis em todas as fases de procedimentos radiológicos, ajudando os profissionais de saúde a melhorar os seus comportamentos de dosimetria. Mais ainda, a exposição aplicada nos procedimentos deve ser planeada individualmente, o que significa que a monitorização da dose também deverá ser. Além disso, o acesso integrado à história imagiológica do paciente pode ser útil para efetuar um melhor tratamento. No entanto, muitos dos atuais sistemas de informação não permitem efetuar análise de dose e a sua monitorização contínua é rara. Neste contexto, o contributo desta dissertação é o Dose Center, uma ferramenta centrada no paciente que permite monitorizar e analisar a dose de radiação. Ela tem capacidade para extrair informação proveniente de diferentes fontes e permite uma visualização integrada de toda a informação relativa aos pacientes, quais os estudos realizados, a dose efetiva e cumulativa de radiação. A ferramenta permite ainda sinalizar os casos que excedam os limites pré-definidos de radiação, uma inequívoca contribuição para a melhoria da segurança do paciente.Systematic monitoring of radiation dose exposure is a key factor to increase the quality of radiological services. This activity may lead to performance control, protocol optimization and rapid rectification of wrong practices. Moreover, dose monitoring can help the healthcare professionals to improve their dosimetric behaviors. In theory, radiodiagnostic episodes should always keep the radiation exposure as low as reasonably achievable (ALARA), while preserving the quality of diagnosis. Hence, the applied exposure in the radiology departments shall be individually planned, which means that the dose monitoring should be performed individually to ensure an appropriate dose usage. Automatic dose monitoring systems may be helpful during all the phases of radiologic procedures and the integrated access to imagiologic history may be helpful to do a better patient treatment. However, many of actual healthcare information systems do not allow dose analysis and its continuous monitoring is rare. In this context, this document proposes the Dose Center, a software platform that provides a patient-centric radiation dose analysis and a monitoring system that was designed to automatically extract and analyze dose reports captured from distinct data sources. It provides several data analytics views like, for instance, by modality or patient, including the studies effective and cumulative dose radiation. Cases exceeding the radiation thresholds are signalizing, contributing this way to improve the patient safety

A Comprehensive Review on Medical Image Steganography Based on LSB Technique and Potential Challenges

The rapid development of telemedicine services and the requirements for exchanging medical information between physicians, consultants, and health institutions have made the protection of patients’ information an important priority for any future e-health system. The protection of medical information, including the cover (i.e. medical image), has a specificity that slightly differs from the requirements for protecting other information. It is necessary to preserve the cover greatly due to its importance on the reception side as medical staff use this information to provide a diagnosis to save a patient's life. If the cover is tampered with, this leads to failure in achieving the goal of telemedicine. Therefore, this work provides an investigation of information security techniques in medical imaging, focusing on security goals. Encrypting a message before hiding them gives an extra layer of security, and thus, will provide an excellent solution to protect the sensitive information of patients during the sharing of medical information. Medical image steganography is a special case of image steganography, while Digital Imaging and Communications in Medicine (DICOM) is the backbone of all medical imaging divisions, whereby it is most broadly used to store and transmit medical images. The main objective of this study is to provide a general idea of what Least Significant Bit-based (LSB) steganography techniques have achieved in medical images

MedLAN : compact mobile computing system for wireless information access in emergency hospital wards

As the need for faster, safer and more efficient healthcare delivery increases, medical consultants seek new ways of implementing a high quality telemedical system, using innovative technology. Until today, teleconsultation (the most common application of Telemedicine) was performed by transferring the patient from the Accidents and Emergency ward, to a specially equipped room, or by moving large and heavy machinery to the place where the patient resided. Both these solutions were unpractical, uneconomical and potentially dangerous. At the same time wireless networks became increasingly useful in point-of-care areas such as hospitals, because of their ease of use, low cost of installation and increased flexibility. This thesis presents an integrated system called MedLAN dedicated for use inside the A;E hospital wards. Its purpose is to wirelessly support high-quality live video, audio, high-resolution still images and networks support from anywhere there is WLAN coverage. It is capable of transmitting all of the above to a consultant residing either inside or outside the hospital, or even to an external place, thorough the use of the Internet. To implement that, it makes use of the existing IEEE 802.11b wireless technology. Initially, this thesis demonstrates that for specific scenarios (such as when using WLANs), DICOM specifications should be adjusted to accommodate for the reduced WLAN bandwidth. Near lossless compression has been used to send still images through the WLANs and the results have been evaluated by a number of consultants to decide whether they retain their diagnostic value. The thesis further suggests improvements on the existing 802.11b protocol. In particular, as the typical hospital environment suffers from heavy RF reflections, it suggests that an alternative method of modulation (OFDM) can be embedded in the 802.11b hardware to reduce the multipath effect, increase the throughput and thus the video quality sent by the MedLAN system. Finally, realising that the trust between a patient and a doctor is fundamental this thesis proposes a series of simple actions aiming at securing the MedLAN system. Additionally, a concrete security system is suggested, that encapsulates the existing WEP security protocol, over IPSec.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

DIGITAL WATERMARKING OF 3D MEDICAL VISUAL OBJECTS

At present, medical equipment provides often 3D models of scanning organs instead of ordinary 2D images. This concept is supported by Digital Imaging and COmmunications in Medicine (DICOM) standard available for telemedicine. This means that the confidential information under transmission ought to be protected by special techniques, particularly digital watermarking scheme instead of textual informative files represented, for example, on CD disks. We propose a multilevel protection, for which a fragile watermark is the first level of protection. The Region Of Interest (ROI) watermark and textual watermarks with information about patient and study (the last ones can be combines as a single textual watermark) form the second level of protection. Encryption of the ROI and textual watermarks using Arnold’s transform is the third level of protection. In the case of 3D models, we find the ROI in each of 2D sliced images, apply the digital wavelet transform or digital shearlet transform (depending on the volume of watermarks) for the ROI and textual watermarks embedding, and embed a fragile watermark using digital Hadamard transform. The main task is to find the relevant regions for embedding. To this and, we develop the original algorithm for selecting relevant regions. The obtained results confirm the robustness of our approach for rotation, scaling, translation, and JPEG attacks

Design of a secure architecture for the exchange of biomedical information in m-Health scenarios

El paradigma de m-Salud (salud móvil) aboga por la integración masiva de las más avanzadas tecnologías de comunicación, red móvil y sensores en aplicaciones y sistemas de salud, para fomentar el despliegue de un nuevo modelo de atención clínica centrada en el usuario/paciente. Este modelo tiene por objetivos el empoderamiento de los usuarios en la gestión de su propia salud (p.ej. aumentando sus conocimientos, promocionando estilos de vida saludable y previniendo enfermedades), la prestación de una mejor tele-asistencia sanitaria en el hogar para ancianos y pacientes crónicos y una notable disminución del gasto de los Sistemas de Salud gracias a la reducción del número y la duración de las hospitalizaciones. No obstante, estas ventajas, atribuidas a las aplicaciones de m-Salud, suelen venir acompañadas del requisito de un alto grado de disponibilidad de la información biomédica de sus usuarios para garantizar una alta calidad de servicio, p.ej. fusionar varias señales de un usuario para obtener un diagnóstico más preciso. La consecuencia negativa de cumplir esta demanda es el aumento directo de las superficies potencialmente vulnerables a ataques, lo que sitúa a la seguridad (y a la privacidad) del modelo de m-Salud como factor crítico para su éxito. Como requisito no funcional de las aplicaciones de m-Salud, la seguridad ha recibido menos atención que otros requisitos técnicos que eran más urgentes en etapas de desarrollo previas, tales como la robustez, la eficiencia, la interoperabilidad o la usabilidad. Otro factor importante que ha contribuido a retrasar la implementación de políticas de seguridad sólidas es que garantizar un determinado nivel de seguridad implica unos costes que pueden ser muy relevantes en varias dimensiones, en especial en la económica (p.ej. sobrecostes por la inclusión de hardware extra para la autenticación de usuarios), en el rendimiento (p.ej. reducción de la eficiencia y de la interoperabilidad debido a la integración de elementos de seguridad) y en la usabilidad (p.ej. configuración más complicada de dispositivos y aplicaciones de salud debido a las nuevas opciones de seguridad). Por tanto, las soluciones de seguridad que persigan satisfacer a todos los actores del contexto de m-Salud (usuarios, pacientes, personal médico, personal técnico, legisladores, fabricantes de dispositivos y equipos, etc.) deben ser robustas y al mismo tiempo minimizar sus costes asociados. Esta Tesis detalla una propuesta de seguridad, compuesta por cuatro grandes bloques interconectados, para dotar de seguridad a las arquitecturas de m-Salud con unos costes reducidos. El primer bloque define un esquema global que proporciona unos niveles de seguridad e interoperabilidad acordes con las características de las distintas aplicaciones de m-Salud. Este esquema está compuesto por tres capas diferenciadas, diseñadas a la medidas de los dominios de m-Salud y de sus restricciones, incluyendo medidas de seguridad adecuadas para la defensa contra las amenazas asociadas a sus aplicaciones de m-Salud. El segundo bloque establece la extensión de seguridad de aquellos protocolos estándar que permiten la adquisición, el intercambio y/o la administración de información biomédica -- por tanto, usados por muchas aplicaciones de m-Salud -- pero no reúnen los niveles de seguridad detallados en el esquema previo. Estas extensiones se concretan para los estándares biomédicos ISO/IEEE 11073 PHD y SCP-ECG. El tercer bloque propone nuevas formas de fortalecer la seguridad de los tests biomédicos, que constituyen el elemento esencial de muchas aplicaciones de m-Salud de carácter clínico, mediante codificaciones novedosas. Finalmente el cuarto bloque, que se sitúa en paralelo a los anteriores, selecciona herramientas genéricas de seguridad (elementos de autenticación y criptográficos) cuya integración en los otros bloques resulta idónea, y desarrolla nuevas herramientas de seguridad, basadas en señal -- embedding y keytagging --, para reforzar la protección de los test biomédicos.The paradigm of m-Health (mobile health) advocates for the massive integration of advanced mobile communications, network and sensor technologies in healthcare applications and systems to foster the deployment of a new, user/patient-centered healthcare model enabling the empowerment of users in the management of their health (e.g. by increasing their health literacy, promoting healthy lifestyles and the prevention of diseases), a better home-based healthcare delivery for elderly and chronic patients and important savings for healthcare systems due to the reduction of hospitalizations in number and duration. It is a fact that many m-Health applications demand high availability of biomedical information from their users (for further accurate analysis, e.g. by fusion of various signals) to guarantee high quality of service, which on the other hand entails increasing the potential surfaces for attacks. Therefore, it is not surprising that security (and privacy) is commonly included among the most important barriers for the success of m-Health. As a non-functional requirement for m-Health applications, security has received less attention than other technical issues that were more pressing at earlier development stages, such as reliability, eficiency, interoperability or usability. Another fact that has contributed to delaying the enforcement of robust security policies is that guaranteeing a certain security level implies costs that can be very relevant and that span along diferent dimensions. These include budgeting (e.g. the demand of extra hardware for user authentication), performance (e.g. lower eficiency and interoperability due to the addition of security elements) and usability (e.g. cumbersome configuration of devices and applications due to security options). Therefore, security solutions that aim to satisfy all the stakeholders in the m-Health context (users/patients, medical staff, technical staff, systems and devices manufacturers, regulators, etc.) shall be robust and, at the same time, minimize their associated costs. This Thesis details a proposal, composed of four interrelated blocks, to integrate appropriate levels of security in m-Health architectures in a cost-efcient manner. The first block designes a global scheme that provides different security and interoperability levels accordingto how critical are the m-Health applications to be implemented. This consists ofthree layers tailored to the m-Health domains and their constraints, whose security countermeasures defend against the threats of their associated m-Health applications. Next, the second block addresses the security extension of those standard protocols that enable the acquisition, exchange and/or management of biomedical information | thus, used by many m-Health applications | but do not meet the security levels described in the former scheme. These extensions are materialized for the biomedical standards ISO/IEEE 11073 PHD and SCP-ECG. Then, the third block proposes new ways of enhancing the security of biomedical standards, which are the centerpiece of many clinical m-Health applications, by means of novel codings. Finally the fourth block, with is parallel to the others, selects generic security methods (for user authentication and cryptographic protection) whose integration in the other blocks results optimal, and also develops novel signal-based methods (embedding and keytagging) for strengthening the security of biomedical tests. The layer-based extensions of the standards ISO/IEEE 11073 PHD and SCP-ECG can be considered as robust, cost-eficient and respectful with their original features and contents. The former adds no attributes to its data information model, four new frames to the service model |and extends four with new sub-frames|, and only one new sub-state to the communication model. Furthermore, a lightweight architecture consisting of a personal health device mounting a 9 MHz processor and an aggregator mounting a 1 GHz processor is enough to transmit a 3-lead electrocardiogram in real-time implementing the top security layer. The extra requirements associated to this extension are an initial configuration of the health device and the aggregator, tokens for identification/authentication of users if these devices are to be shared and the implementation of certain IHE profiles in the aggregator to enable the integration of measurements in healthcare systems. As regards to the extension of SCP-ECG, it only adds a new section with selected security elements and syntax in order to protect the rest of file contents and provide proper role-based access control. The overhead introduced in the protected SCP-ECG is typically 2{13 % of the regular file size, and the extra delays to protect a newly generated SCP-ECG file and to access it for interpretation are respectively a 2{10 % and a 5 % of the regular delays. As regards to the signal-based security techniques developed, the embedding method is the basis for the proposal of a generic coding for tests composed of biomedical signals, periodic measurements and contextual information. This has been adjusted and evaluated with electrocardiogram and electroencephalogram-based tests, proving the objective clinical quality of the coded tests, the capacity of the coding-access system to operate in real-time (overall delays of 2 s for electrocardiograms and 3.3 s for electroencephalograms) and its high usability. Despite of the embedding of security and metadata to enable m-Health services, the compression ratios obtained by this coding range from ' 3 in real-time transmission to ' 5 in offline operation. Complementarily, keytagging permits associating information to images (and other signals) by means of keys in a secure and non-distorting fashion, which has been availed to implement security measures such as image authentication, integrity control and location of tampered areas, private captioning with role-based access control, traceability and copyright protection. The tests conducted indicate a remarkable robustness-capacity tradeoff that permits implementing all this measures simultaneously, and the compatibility of keytagging with JPEG2000 compression, maintaining this tradeoff while setting the overall keytagging delay in only ' 120 ms for any image size | evidencing the scalability of this technique. As a general conclusion, it has been demonstrated and illustrated with examples that there are various, complementary and structured manners to contribute in the implementation of suitable security levels for m-Health architectures with a moderate cost in budget, performance, interoperability and usability. The m-Health landscape is evolving permanently along all their dimensions, and this Thesis aims to do so with its security. Furthermore, the lessons learned herein may offer further guidance for the elaboration of more comprehensive and updated security schemes, for the extension of other biomedical standards featuring low emphasis on security or privacy, and for the improvement of the state of the art regarding signal-based protection methods and applications

Optimization of medical image steganography using n-decomposition genetic algorithm

Protecting patients' confidential information is a critical concern in medical image steganography. The Least Significant Bits (LSB) technique has been widely used for secure communication. However, it is susceptible to imperceptibility and security risks due to the direct manipulation of pixels, and ASCII patterns present limitations. Consequently, sensitive medical information is subject to loss or alteration. Despite attempts to optimize LSB, these issues persist due to (1) the formulation of the optimization suffering from non-valid implicit constraints, causing inflexibility in reaching optimal embedding, (2) lacking convergence in the searching process, where the message length significantly affects the size of the solution space, and (3) issues of application customizability where different data require more flexibility in controlling the embedding process. To overcome these limitations, this study proposes a technique known as an n-decomposition genetic algorithm. This algorithm uses a variable-length search to identify the best location to embed the secret message by incorporating constraints to avoid local minimum traps. The methodology consists of five main phases: (1) initial investigation, (2) formulating an embedding scheme, (3) constructing a decomposition scheme, (4) integrating the schemes' design into the proposed technique, and (5) evaluating the proposed technique's performance based on parameters using medical datasets from kaggle.com. The proposed technique showed resistance to statistical analysis evaluated using Reversible Statistical (RS) analysis and histogram. It also demonstrated its superiority in imperceptibility and security measured by MSE and PSNR to Chest and Retina datasets (0.0557, 0.0550) and (60.6696, 60.7287), respectively. Still, compared to the results obtained by the proposed technique, the benchmark outperforms the Brain dataset due to the homogeneous nature of the images and the extensive black background. This research has contributed to genetic-based decomposition in medical image steganography and provides a technique that offers improved security without compromising efficiency and convergence. However, further validation is required to determine its effectiveness in real-world applications

Cloud technology options towards Free Flow of Data

This whitepaper collects the technology solutions that the projects in the Data Protection, Security and Privacy Cluster propose to address the challenges raised by the working areas of the Free Flow of Data initiative. The document describes the technologies, methodologies, models, and tools researched and developed by the clustered projects mapped to the ten areas of work of the Free Flow of Data initiative. The aim is to facilitate the identification of the state-of-the-art of technology options towards solving the data security and privacy challenges posed by the Free Flow of Data initiative in Europe. The document gives reference to the Cluster, the individual projects and the technologies produced by them

Innovative ICT solutions in telemedicine to support clinical practice and research in hospitals

2010/2011The scope of this study was to examine ICT telemedicine innovations and potentialities in web-portals, intranet services and tele-radiology topics respectively, in order to design, develop and, possibly, realize apposite telemedicine systems and solutions for healthcare and in particular for the hospitals. ICT techniques and technologies are nowadays applied in every area of our common living from work places to our homes, our free-time, schools, universities and so on. The healthcare services offered by hospitals are heavily supported by technologies and, behind them, by a wide research both in ICT and biomedical sciences. Thanks to these advances telemedicine is now becoming a fundamental part of services offered by hospitals and healthcare structures. The healthcare management, the doctors and the common people are now experimenting how telemedicine is an added value to all the services offered in terms of the quality of care, the patient follow up, the early diagnose and treatment of pathologies and diseases. In this research is presented an all-inclusive approach to telemedicine problems and challenges in particular studying, developing and proposing ICT methods and technologies in the above mentioned three areas of interest: •innovative healthcare and telemedicine-ready hospital website or portal design and development; •analysis and study of models for the realization of intranet healthcare services to enhance both quality of care and the management of healthcare personnel evaluation; •tele-radiology and some of its actual new perspectives as the study and the evaluation of the “mobile” tele-radiology approach using commercial tablets (and what it could mean).For the first topic the results may be summarized in the development of a more interactive and “social” hospital web-portal offering original solutions and services to all the categories of users (audience, professionals, researchers), allowing them – through the use of advanced tools - to configure and select their own pages and interests. The originality of this approach consists in a good cost/effective result in the respect of the last and worldwide accepted Internet regulations and policies too. A similar approach regarded the intranet services and the design of web interfaces for the clinical practice and the executive evaluation. These kind of innovative systems regard a limited and selected number of more skilled users, typically belonging to a corporation or to specific offices. As above the approach is important: interactive services, innovative tools and affordable instruments are the keywords of the systems designed or proposed to solve specific problems or needs. The last research topic concerned the proposal of a protocol for the assessment of medical images on commercial displays, interesting the stakeholders and the groups involved in medical images treatment, visualization and communication. The potentialities of the mobile tablet devices improve day after day and new devices are marketed every week and the innovation is round the corner. These potentialities must encounter the medical diagnostics world and meet the standards and the regulations the international community established. It will be difficult for a commercial tablet to obtain the medical device CE mark not only for commercial reasons, but the technical limits may be reached and even surpassed adopting objective measures and evaluations. This study demonstrates that commercial tablets may be used in clinical practice for the correct visualization and diagnose of medical images. The measures of some display characteristics may be considered acceptable for mobile interpretation (even report?) of medical images, but if and only if the ambient lighting conditions are under objective control and integrated automated systems in tablets warns physicians about bad or borderline technical and ambient restrictions or bonds.XXIII Ciclo197

Modern Information Systems

The development of modern information systems is a demanding task. New technologies and tools are designed, implemented and presented in the market on a daily bases. User needs change dramatically fast and the IT industry copes to reach the level of efficiency and adaptability for its systems in order to be competitive and up-to-date. Thus, the realization of modern information systems with great characteristics and functionalities implemented for specific areas of interest is a fact of our modern and demanding digital society and this is the main scope of this book. Therefore, this book aims to present a number of innovative and recently developed information systems. It is titled "Modern Information Systems" and includes 8 chapters. This book may assist researchers on studying the innovative functions of modern systems in various areas like health, telematics, knowledge management, etc. It can also assist young students in capturing the new research tendencies of the information systems' development