Mobile-based Telemedicine Application using SVD and F-XoR Watermarking for Medical Images

منصة الخدمات الطبية عبارة عن تطبيق متنقل يتم من خلاله تزويد المرضى بتشخيصات الأطباء بناءً على المعلومات المستقاة من الصور الطبية. يجب ألا يتم تبديل محتوى هذه النتائج التشخيصية بشكل غير قانوني أثناء النقل ويجب إعادته إلى المريض الصحيح. في هذه المقالة، نقدم حلاً لهذه المشكلات باستخدام علامة مائية عمياء وقابلة للانعكاس وهشة استنادًا إلى مصادقة صورة المضيف. في الخوارزمية المقترحة، يتم استخدام الإصدار الثنائي من ترميز بوس_شوهوري _هوكوينجهام (BCH) للتقرير الطبي للمريض (PMR) والصورة الطبية الثنائية للمريض (PMI) بعد استخدام الغامض الحصري أو (F-XoR) لإنتاج العلامة الفريدة للمريض باستخدام مخطط المشاركة السرية (SSS). يتم استخدامه لاحقًا كعلامة مائية ليتم تضمينها في مضيف (PMI) باستخدام خوارزمية تحليل القيمة المفرد (SVD) العمياء القائمة على العلامة المائية. وهو حل جديد اقترحناه أيضًا بتطبيق SVD على صورة العلامة المائية العمياء. تحافظ الخوارزمية الخاصة بنا على مصادقة محتوى (PMI) أثناء النقل وملكية (PMR) للمريض لنقل التشخيص المصاحب فيما بعد إلى المريض الصحيح عبر تطبيق التطبيب عن بعد المحمول. يستخدم تقييم الخوارزمية لدينا علامات مائية مسترجعة توضح النتائج الواعدة لمقاييس الأداء العالية مقارنتا مع نتائج الاعمال السابقة في مقاييس الكشف عن التزوير وإمكانية الاسترداد الذاتي، مع قيمة 30NB PSNR، قيمة NC هي 0.99.A medical- service platform is a mobile application through which patients are provided with doctor’s diagnoses based on information gleaned from medical images. The content of these diagnostic results must not be illegitimately altered during transmission and must be returned to the correct patient. In this paper, we present a solution to these problems using blind, reversible, and fragile watermarking based on authentication of the host image. In our proposed algorithm, the binary version of the Bose_Chaudhuri_Hocquengham (BCH) code for patient medical report (PMR) and binary patient medical image (PMI) after fuzzy exclusive or (F-XoR) are used to produce the patient's unique mark using secret sharing schema (SSS). The patient’s unique mark is used later as a watermark to be embedded into host PMI using blind watermarking-based singular value decomposition (SVD) algorithm. This is a new solution that we also proposed to applying SVD into a blind watermarking image. Our algorithm preserves PMI content authentication during the transmission and PMR ownership to the patient for subsequently transmitting associated diagnosis to the correct patient via a mobile telemedicine application. The performance of experimental results is high compare to previous results, uses recovered watermarks demonstrating promising results in the tamper detection metrics and self-recovery capability, with 30db PSNR, NC value is 0.99

A novel robust reversible watermarking scheme for protecting authenticity and integrity of medical images

It is of great importance in telemedicine to protect authenticity and integrity of medical images. They are mainly addressed by two technologies, which are region of interest (ROI) lossless watermarking and reversible watermarking. However, the former causes biases on diagnosis by distorting region of none interest (RONI) and introduces security risks by segmenting image spatially for watermark embedding. The latter fails to provide reliable recovery function for the tampered areas when protecting image integrity. To address these issues, a novel robust reversible watermarking scheme is proposed in this paper. In our scheme, a reversible watermarking method is designed based on recursive dither modulation (RDM) to avoid biases on diagnosis. In addition, RDM is combined with Slantlet transform and singular value decomposition to provide a reliable solution for protecting image authenticity. Moreover, ROI and RONI are divided for watermark generation to design an effective recovery function under limited embedding capacity. Finally, watermarks are embedded into whole medical images to avoid the risks caused by segmenting image spatially. Experimental results demonstrate that our proposed lossless scheme not only has remarkable imperceptibility and sufficient robustness, but also provides reliable authentication, tamper detection, localization and recovery functions, which outperforms existing schemes for protecting medical image

Digital Health Technologies and Implications for Developing Country Media and Health Communication

This article examines the relationship that exists among the media, the development of digital health technologies, and the implications of the trend on Africa. Reviewing four articles published on digital health technology-related issues, it is found that media, particularly social media which complement conventional media, tend to be influential in the aspect of digital health. The social communication devices such as mobile phones and tablets PCs enable social networks to promote healthcare through platforms for interaction. Similarly, mobile applications help in offering other medical services. The conventional media hence appear to be useful mainly in creating awareness about such developments. This trend however, is found to be of implication to Africa, particularly Nigeria where the level of development in technology is still low and conventional media coverage of digital health technology appears to be a new ground. Thus, this article recommends to journalists and social media users to intensify the promotion of digital health to enable both health providers and the public harness the potentials of these technologies. Keywords: Digital health technologies, social media, conventional media, e-Health, mHealt

Digital watermarking in medical images

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 05/12/2005.This thesis addresses authenticity and integrity of medical images using watermarking. Hospital Information Systems (HIS), Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (P ACS) now form the information infrastructure for today's healthcare as these provide new ways to store, access and distribute medical data that also involve some security risk. Watermarking can be seen as an additional tool for security measures. As the medical tradition is very strict with the quality of biomedical images, the watermarking method must be reversible or if not, region of Interest (ROI) needs to be defined and left intact. Watermarking should also serve as an integrity control and should be able to authenticate the medical image. Three watermarking techniques were proposed. First, Strict Authentication Watermarking (SAW) embeds the digital signature of the image in the ROI and the image can be reverted back to its original value bit by bit if required. Second, Strict Authentication Watermarking with JPEG Compression (SAW-JPEG) uses the same principal as SAW, but is able to survive some degree of JPEG compression. Third, Authentication Watermarking with Tamper Detection and Recovery (AW-TDR) is able to localise tampering, whilst simultaneously reconstructing the original image

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

Watermark Based on Singular Value Decomposition

Watermarking operation can be defined as a process of embedding special wanted and reversible information in important secure files to protect the ownership or information of the wanted cover file based on the proposed singular value decomposition (SVD) watermark. The proposed method for digital watermark has very huge domain for constructing final number and this mean protecting watermark from conflict. The cover file is the important image need to be protected. A hidden watermark is a unique number extracted from the cover file by performing proposed related and successive operations, starting by dividing the original image into four various parts with unequal size. Each part of these four treated as a separate matrix and applying SVD on it, the diagonal matrix is selected to determine its norm. The four norms will be processed to produce one unique number used as a watermark and this number can be developed  in future by exploiting some other features in constructing watermark number other than SVD process to construct two watermark numbers, each one of them owned special methodology, for avoiding some challenges and changings in the transformation process.

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Picture archiving and communication systems in the South African public healthcare environment : a suitable structure and guidelines to assist implementation and optimisation

Thesis (MScEng)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: South Africa has a great number of patients and not enough medical expertise to attend to their patient needs. The South African Department of Health (DoH) has recognised the potential benefit of the Picture Archiving and Communication System (PACS) to address the health needs of rural patients who do not have access to specialised medical care. PACS allows specialist remote access to patient information to assist the diagnosis and treatment process remotely. South African healthcare institutions have been implementing PACS for over a decade, in an attempt to address the health needs of rural patients that do not have access to specialised medical care. Despite numerous deployment attempts, and the DoH’s support for PACS, the system is not operating successfully in South Africa. PACS was chosen due to its proven success as an appropriate technical system in most international hospitals of first and third- world countries (van Wetering, 2008) (Horri, 2010). However, specifications, guidelines and best practice operational methods for the appropriate PACS technical structure are lacking in South African literature and in governmental strategies. Additionally, there are no guidelines for implementation or support for hospital decision makers to manage the system and enterprise change. The purpose of this thesis is to (a) define a PACS technical and operational structure suited for the South African public healthcare environment and, (b) to develop guidelines for implementation and optimisation of PACS for managing the system and the enterprise change and progressively reach the defined structure. A combination of literature research, field observations and focus group discussions led to the understanding of the current (“As-Is”) PACS healthcare delivery system in South Africa and its barriers. Three types of PACS structures were found to be currently available: a DICOM-only image management system; a vendor supplied PACS; and a super-PACS. It was found that currently very few PACS systems in South Africa are operational and integrated with other healthcare institutions. This was due to a combination of factors: a) the complex, long chain of interdependent process steps and domains; b) vendor imposed limitations and propriety data formats; in combination with c) a lack of governing standards to ensure integration of digital PACS systems within the healthcare delivery environment; and lastly d) key decision makers lack the expert knowledge necessary to make informed decisions to deploy and manage PACS optimally. Further research led to establishing the (“To-Be”) PACS technical and operational structure suited for the South African public healthcare environment. Research has shown that the suited PACS technical and operational structure is a hospital-owned PACS system, free from vendor-imposed limits. The system consists of two databases, one with patient information and the other with patient images. The two databases are integrated by a hospital-owned server, which accesses the separate data files by means of patient identity keys. The requirements for the PACS implementation and optimisation guidelines for managing the system and the enterprise change to progressively reach the defined structure were developed. Different Enterprise Architectural Frameworks, as improvement and optimisation guidelines, were considered and compared in accordance with the requirements established. A maturity model (MM) was deemed as the appropriate framework to offer guidelines for managing PACS implementation and optimisation in the public medical sector of South Africa. After establishing that the available MMs were not sufficient in process or technical system detail, a new MM was developed for the deployment and maturation of PACS. The study was validated by means of usability study, user acceptance and goal checking, through focus group discussion and expert review. Users found the model to be a suitable deployment and optimisation guide, as well as a strategic planning tool. Verification was achieved by means of requirement analysis and consistency checking through the focus group discussions. It was found that it is needed to define a PACS technical and operational structure is suited for the South African public healthcare environment and that the guidelines for implementation and optimisation of PACS for managing the system and the enterprise needs to change to reach the defined structure functional. Implementing the use of PACS MM to reach the defined structure in South Africa will assist in improving healthcare delivery in South Africa and improving PACS system operation.AFRIKAANSE OPSOMMING: Suid-Afrika het 'n groot aantal pasiënte en nie genoeg mediese kundiges om aan hul pasiënt behoeftes te voorsien nie. Die Suid-Afrikaanse Departement van Gesondheid (DvG) erken die potensiële voordeel van ‘n Foto Argief en Kommunikasie Stelsel (PACS) om die gesondheidsbehoeftes van alle Suid-Afrikaners aan te spreek – tot die landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie. PACS laat spesialiste toe om toegang te kry tot afgeleë pasiënt inligting, en daardeur fasiliteer dit die diagnose- en behandelingsproses. Suid-Afrikaanse gesondheidsorginstellings poog al vir meer as ‘n dekade om PACS te implementeer, om daardeur die gesondheidsbehoeftes van landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie, aan te spreek. Ten spyte van talle ontplooiings pogings, en die DvG se steun vir PACS, is die stelsel steeds nie suksesvol in Suid-Afrika nie. PACS is gekies as ‘n oplossing, as gevolg van die sisteem se bewese sukses as 'n geskikte tegniese stelsel in meeste internasionale hospitale in eerste en derde wêreld lande (van Wetering, 2008) (Horri, 2010). Suid-Afrikaanse regering strategie en literatuur het egter ‘n gebrek aan spesifikasies, riglyne en beste- praktyk operasionele metodes vir die toepaslike PACS tegniese struktuur. Benewens is daar geen riglyne vir die implementering en ondersteuning van die stelsel en die onderneming se verandering vir hospitaal besluitnemers nie. Die doel van hierdie tesis is om (a) 'n PACS tegniese en operasionele struktuur, geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing te definieer, en (b) riglyne vir die implementering en afronding van PACS vir die bestuur van die stelsel en die onderneming se verandering teen doel om progressief die gedefinieerde struktuur te bereik. 'n Kombinasie van literatuur navorsing, veldwaarnemings en fokusgroepbesprekings het gelei tot die begrip van die huidige ("as- is") PACS gesondheidsorg proses in Suid-Afrika en die hindernisse daarvan. Drie tipes PACS strukture is tans beskikbaar in SA: 'n DICOM (net-mediese- beelde) beheer stelsel, 'n verkoper verskafde PACS, en 'n super-PACS. Deur uitgebreide navorsing is daar gevind dat baie min PACS stelsels in Suid-Afrika tans operasioneel en geïntegreer is met ander gesondheidsorg instellings. Dit was te danke aan 'n kombinasie van faktore: a) die kompleks, lang ketting van interafhanklike proses stappe en gebiede; b) ondernemer opgelê beperkings en ordentlikheid data formate; in kombinasie met c) 'n gebrek aan beheer standaarde integrasie van digitale PACS stelsels om te verseker binne die lewering van gesondheidsorg-omgewing, en laastens d) sleutel besluitnemers nie die deskundige kennis wat nodig is om ingeligte besluite te sit en te bestuur PACS optimaal te benut. Verdere navorsing het gelei tot die vestigting van die geskikde("to-be") PACS tegniese en operasionele struktuur, vir die Suid-Afrikaanse openbare gesondheidsorg omgewing. Die geskik PACS tegniese en operasionele struktuur bestaan uit ‘n hospitaal-besitde PACS stelsel, vry van ondernemer-opgelegde grense. Die stelsel bestaan uit twee databasisse, een met 'n pasiënt inligting en die ander met dei pasiënte se mediese beelde. Die twee databasisse geïntegreer deur 'n hospitaal-besitde-rekenaarbediener, wat toegang tot die afsonderlike data lêers het deur middel van die unieke pasiënt nommers. Die vereistes vir die PACS implementering en afrondings riglyne, vir die bestuur van die stelsel en die ondernemings veranderinge, is ontwikkel. Verskillende ondernimings argitektuur raamwerke is oorweeg en vergelyking in terme van hulle vermoe om aan die gesigde vereistes et voldoen. As ‘n resultaat is die volwassenheid model (MM) beskou as die toepaslike raamwerk om riglyne vir die bestuur van PACS implementering en afronding in die openbare mediese sektor van Suid-Afrika te bied. Na die beskikbare MMs geasseseer was en nie voldoende bewys is, was 'n nuwe MM ontwikkel vir die implementeering en afronding van PACS. Die studie was gevalideer deur middel van die bruikbaarheid studie, gebruikers aanvaarding en doelwit asseseering, deur middel van fokusgroep besprekings en kundige oorsig. Gebruikers het gevind dat die model geskikte as implementeerings en afrondings gids, sowel as 'n geskikte strategiese beplanning hulpmiddel is. Verifikasie is bereik deur middel van vereiste-ontleding en konsekwentheid analiseering deur die fokusgroep besprekings en spesifikasie analise. Die PACS tegniese en operasionele struktuur wat definieer was, is geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing en dat die riglyne vir die implementering en afronding van PACS funksioneel is . Die implementering en gebruik van die gedefinieerde struktuur deur mideel van die PACS MM in Suid-Afrika, sal help in die verbetering van gesondheidsorg dienslewering en die verbetering van PACS stelsel operasie

Performance evaluation of cooperation strategies for m-health services and applications

Health telematics are becoming a major improvement for patients’ lives, especially for disabled, elderly, and chronically ill people. Information and communication technologies have rapidly grown along with the mobile Internet concept of anywhere and anytime connection. In this context, Mobile Health (m-Health) proposes healthcare services delivering, overcoming geographical, temporal and even organizational barriers. Pervasive and m-Health services aim to respond several emerging problems in health services, including the increasing number of chronic diseases related to lifestyle, high costs in existing national health services, the need to empower patients and families to self-care and manage their own healthcare, and the need to provide direct access to health services, regardless the time and place. Mobile Health (m- Health) systems include the use of mobile devices and applications that interact with patients and caretakers. However, mobile devices have several constraints (such as, processor, energy, and storage resource limitations), affecting the quality of service and user experience. Architectures based on mobile devices and wireless communications presents several challenged issues and constraints, such as, battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, and network delays. In this sense, cooperation-based approaches are presented as a solution to solve such limitations, focusing on increasing network connectivity, communication rates, and reliability. Cooperation is an important research topic that has been growing in recent years. With the advent of wireless networks, several recent studies present cooperation mechanisms and algorithms as a solution to improve wireless networks performance. In the absence of a stable network infrastructure, mobile nodes cooperate with each other performing all networking functionalities. For example, it can support intermediate nodes forwarding packets between two distant nodes. This Thesis proposes a novel cooperation strategy for m-Health services and applications. This reputation-based scheme uses a Web-service to handle all the nodes reputation and networking permissions. Its main goal is to provide Internet services to mobile devices without network connectivity through cooperation with neighbor devices. Therefore resolving the above mentioned network problems and resulting in a major improvement for m-Health network architectures performances. A performance evaluation of this proposal through a real network scenario demonstrating and validating this cooperative scheme using a real m-Health application is presented. A cryptography solution for m-Health applications under cooperative environments, called DE4MHA, is also proposed and evaluated using the same real network scenario and the same m-Health application. Finally, this work proposes, a generalized cooperative application framework, called MobiCoop, that extends the incentive-based cooperative scheme for m-Health applications for all mobile applications. Its performance evaluation is also presented through a real network scenario demonstrating and validating MobiCoop using different mobile applications

The development and implementation of e-health services for the Libyan NHS: case studies of hospitals and clinics in both urban and rural areas

This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future