(

. . ?. -
; ~
..
• •,
.. ,I
.

--.~-~~
--~
....;:;~
' ,_,,·t.1"
,-

,~· .

'·
Biomedical Telemetry and TelemecJne

~,m> 9.1 WIRELESS TELEMETRY

Wireless telemetrv permits examination of the physiological data of man or under n
conditions and m' natural surroundings without any disco~ort or obs::::-\) the pers~r:;_al
animal under investigation. Factors influencing healthy and sick person::. ·-te perform or
vv· 1 . . ance
of their daily tasks may thus be easily recognized a:1~ evaluated · ire ess_ ietry has made
possible the study of active subjects under conditions that so far prohi~asurement I
· h bl· s. t
is, therefore, an indispensable technique in situations w ere no ca f1on is feasible.
(Gandikola, 2000).
Using wireless telemetry, physiological signals can be obtained from_ 13 riders, athletes
pilots or manual labourers. Telemetric surveillance is most convenh transportatio '
within the hospital area as well for the continuous monitoring of patir other wards 0~
clinics for check-up or therapy.

9.1.1 Modulation Systems

The modulation systems used in wireless telemetry for transmitting ii~als makes use
of two modulators. This means that a comparatively lower frequen~s em~Ioyed in
addition to the VHF, which finally transmits the signal from the ~ principle of
double modulation gives better interference free performance ir~ ;~ enables the
reception of low frequency biological signals. The sub-modu\nai (frequency
mo~:_1l~~?n) systef!l or a PWM (Pulse Width Modulation) system modulator is
practically always an FM system. d
. ; by varying th
~requency Modulation: _In frequency modulation, intelligencave, while kee in e
mstantaneous frequency 1n accordance with the signal to be mods frequen p. g
·tud f th · · cy varies
.th~ampl~ e .o e earner wave constant. The rate at which t}Oes away from the
1s e mo u1a ting frequency. The magnitude to which the carrr amplitude of th
centre frequency is called "Frequency Deviation" and is pre e
 284
Handbook of Biomedical Instrumentation

modulating signal. Usually, an FM signal is

1:n
pr~duced by controlling the frequency of an
oscillator by the amplitude of the modulating
voltage. For example, the frequency of oscillation
for most oscillators depends on a particular value
of capacitance. If the modulation signal can be
c,il~ .-- vvv"""'

applied in such a way that it changes the value of

capacitance, then the frequency of oscillation will
change in accordance with the amplitude of the
modulating signal.
> Fig. 9.1 Circuit diagram of a frequency
Figure 9.1 shows a tuned oscillator that serves modulator usingvaractor diode
as a frequency modulator. The diode used is a
varactor diode operating in the reverse-biased +V
mode and, therefore, presen,ts a depletion layer
capacitance to the tank circuit. 1bis capacitance
is a function of the reverse-biased voltage across
the diode and, therefore, produces an FM wave
with the modulating signal applied as shown in
the circuit diagram. This type of circuit can allow
frequency deviations of 2- 5% of the carrier
frequency without serious distortion.
Pulse Width Modulation: Pulse width modula-
tion method has the advantage of being less
perceptive to distortion and noise. Figure 9.2
shows a typical pulse width modulator. Transistors
QI and Q2 form a free-running multi-vibrator.
Transistors Q3 and Q4 provide constant current
sources for charging the timing capacitors C1and
C2 and driving transistors Q1 and Q2 • When Q1 is
'off' and Q2 is 'on', capacitorc; charges through
R 1 to the amplitude of the modulating voltage em.
The other side of this capacitor is connected to the
base of transistor Q2 and is at zero volt. When QI
turns 'on' switching the cir_c uit to the other stage,
the base voltage of Q2 drops from approximatefy > Fig. 9.2 Pulse width modulator
zero to -em. Transistor Q2 will remain 'off' until the base voltage charges to zero volt. Since the
-charging current is constant at I, the time required to charge C2 and restore the circuit to the initial
stage is:

Similarly, the time that the circuit remains in the original stage is:
C1
• T1 = -•e
I m
t-
i;
r
L Biomedical Telemetry and Telemedicine 285

This shows that both portions of the astable period are directly proportional to the modulatin
~. g
~en a b~anced differential output from an amplifier such as the ECG amplifier is applied to
th~ mput pomts 1 and 2, the frequency of the astable multi-vibrator would remain constant, but the
width of the pulse available at the collector of transistor Q 2 shall vary in accordance with th
amplitude of the input signal. e
In practice, the negative edge of the square wave is varied in rhythm with the ECG signal.
Therefore, only this edge contains information of interest. The ratioP:Q (Fig. 9.3) represents the
momentary amplitude of the ECG. The amplitude or even the frequency variation of the square
L
J
wa~~ does not have an influence on the P: Q ratio and consequently on the ECG signal. The signal
output from this modulator is fed to a normal speech transmitter, usually via an attenuator, to
make-it suitable to the input level of the transmitter.

Pulse generated by astable multi-vibrator (symmetrical 1000 Hz)

J I ~wt wj
I
I I I I .I I L
I
I
I I I I I I
,I ,I ,I ,I ,I ,I Input signal
·

------------:- ---- -------r-----' ----- :---- - - -- --- :------------, ------ - - - -

1 I I I 1
I I I I I
I I I 1 I
I I I I
I I I I
I I I
I I I
I J. I
Pulse width
modulated signal
p Q p Q

► Fig. 9.3 Variation ofpulse width with amplitude of the input signal
W = Pulse width as generated by the mu,lti-vibrator.
P = Variable pul~e width; variation in accordance with input signal.
Off-period, which also gets varied as the pulse width P varies with the
amplitude of the input signal.

Choke of Radio _Carrier Frequency

every country there are regulations governing the use of only certain frequency and bandwidth
for medical telemetry. Therefore, the permission to operate a particular telemetry system needs to
be obtained from the postal department of the country concerned. The radio frequencies normally
used for medical telemetry purposes are of the order of 37, 102, 153,159,220 and 450 MHz. The
transmitter is typically of 50 mW at 50 n, which can give a transmission range of about 1.5 km in
the open flat country. The range will be much less in built-up areas. In USA, two frequency bands
have been designated for short range medical telemetry work by the FCC (Federal Communications
-286 Handbook of Biomedical Instrumentation

Commission). The lower frequency band of 174-216 MHz, coincides with the VHF television
broad~as~ band (Channels 7-13). Therefore, the output of the telemetry transmitter must be limited
to av_01d mte:ference with TV sets. Operation of telemetry units in this band does not normally
reqwre any licence. In the higher frequency band of 450-470 MHz, greater transmitter power is
allowed, but an FCC licence has to be obtained for operating the system.
Radiow aves can travel through most non-conducting material such as air, wood, and plaster
with relative ease. However, they are hindered, blocked or reflected by most conductive material
and by concrete because of the presence of reinforced steel. Therefore, transmission may be lost or
be of poor quality when a patient with a telemetry transmitter moves in an environment with a
concrete wall or behind a structural column. Reception may also get affected by radio frequency
w;ive effects that may result in areas of poor reception or null spots, under some conditions of
p~tient location and carrier frequency. Another serious problem that is sometimes present in the
telemetry systems is the cross-talk or interference between telemetry channels. It can be minimized
by the careful selection of transmitter frequencies, by the use of a suitable antenna system and by
the equipment design.
The range of any radio system is primarily determined by transmitter output power and frequency.
However, in medical telemetry systems, factors such as receiver and antenna design may make
the power and frequency characteristics less significant. The use of a higher-powered transmitter
than is required for adequate range is preferable as it may eliminate or reduce some noise effects
due to interference from other sources.

9.1.3 Transmitter

Figure 9.4 shows a circuit diagram of the FM transmitter stage commonly used in medical tele-
metry. The transistor Tacts in a grounded base Colpitts R.F oscillator withL1 and C1 and C2 as the
tank circuit. The positive feedback to the emitter is provided from a capacitive divider in the
collector circuit formed by C1 and C2 . Inductor L1 functions both as a tuning coil and a transmitting
antenna . Trim capacitor C2 is adjusted to precisely set the transmission frequency at the desired

220 K

.::. 1.35 V
5-20 pf
0.001 µf
-----f - -- T
3~0 pf

0.001 1.2 K
µf

> Fig. 9.4 Typical circuit diagram ofa FM telemetry transmitter

 -
\I

Biomedical Telemetry and Telemedicine 287

point. In_thi~ case,_ it is within the standard FM broadcast band from 88 to 108 MHz. Frequency
~odulahon 1s ach:eved by variation in the operating point of the transistor, which in tum varies
its ~ol~ector capacitance, thus changing the resonant frequency of the tank circuit. The operating
pomt 1~ changed by the sub-carrier input. Thus, the transmitter's output consists of an RF signal,
tun_ed ~ the FM broadcast band and frequency modulated by the sub-carrier oscillator (SCO),
which m tum is frequency modulated by the physiological signals of interest. It is better to use a
separate power source for the RF osciliator from other parts of the circuit to achieve stability and
prevent interference between circuit functions (Beerwinkle and Burch, 1976).

9.1.4 The Receiver

In most cases, the receiver can be a common broadcast receiver with a sensitivity ·of lµV. The I:
output of the HF unit of the receiver is fed to the sub-demodulator to extract the modulating signal.
In a FM/FM system, the sub-demodulator first converts the FM signal into an AM signal. This is
II
followed by an AM detector which demodulates the newly created AM waveform. With this
arrangement, the output is linear with frequency deviation only for small frequency deviations.
Other types of detectors can be used to improve the linearity.
In the PWM/FM system, a square wave is obtained at the output of the RF unit. This square
wave is clipped to cut off all amplitude variations of the incoming square wave and the average
value of the normalized square wave is determined. The value thus obtained is directly propor-
tional to the area which in turn is directly proportional to the pulse duration. Since the pulse
duration is directly proportional to the modulating frequency, the output signal is directly
proportional to the output voltage of the demodulator. The output voltage of the demodulator is
adjusted such that it can be directly fed to a chart recorder. The receiver unit also provides signal
outputs where a magnetic tape recorde_r may be directly connected to store the demodulated signal.
Successful utilization of biological telemetry systems is usually dependent upon the user's
systematic understanding of the limits of the system, both biological and electrical. The two major
areas of difficulty arising in biotelemetry occur at the system interfaces. The first is the interface
between the biological system and the electrical system. No amount of engineering can correct a
shoddy, hasty job of instrumenting the subject. Therefore, electrodes and transducers must be put
on with great care. The other major area of difficulty is the interface between the transmitter and
rec~ver. It must be k~pt in mind that the range of operation should be limited to the primary service
area, otherwise the fringe area reception is likely to be noisy and unacceptable. Besides this, there
are problems caused by the pati.e nt's movements, by widely varying signal strength and because
of interference from electrical equipment and other radio systems, which need careful equipment
design and operating procedures.

1000► 9.2 SINGLE CHANNEL TELEMETRY SYSTEMS

In a majority of the situations requiring monitoring of the patients by wireless telemetry, the
parameter which is most commonly studied is the electrocardiogram. It is known that the display
of the ECG and cardiac rate gives sufficient information on the loading of the cardiovascular
system of the active subjects. Therefore, we shall first deal with a single channel telemetry system
suitable for the transmission of an electrocardiogram.
 ,,

Handbook of Biomedical Instrumentation

I 9.2. 1 ECG Telemetry System

Figure 9.5 shows the diagram of a single channel telemetry system suitable for the transmission
of an electroc ogram. There are two main parts:
• T e Telemetry Transmitter which consists of an ECG amplifier, a sub-carrier oscillator and
a UHF transmitter along with dry cell batteries.
• Telemetry Receiver consists of a high frequency unit and a demodulator, to which an elec-
trocardiograph can be connected to record, a cardioscope to display and a magnetic tape
recorder to store the ECG. A heart rate meter with an alarm facility can be provided to
continuously monitor the beat-to-beat heart rate of the subject.

Transmitter Receiver
antenna antenna
t
\V
II

Transmitter R.F. amplifier

Tape
Demodulator L---
I recorder

Heart rate Graphic

monitor H--
recorder

Battery Cardioscope 14--

> Fig. 9.5 Block diagram of a single channel telemetry system

For distortion-free transmission of ECG, the following requirements must be met (Kurper et al, 1996).
• The subject should.be able to carry on with his normal activities whilst carrying the instru-
P:ents without the slightest discomfort. He should be able to forget their presence after
some minutes of application.
• Motion artefacts and muscle potential interference should be kept minimum.
• The battery life should be long enough so that a complete experimental procedure may be
carried out.
• While-monitoring paced patients for ECG through telemetry, it is necessary to reduce
pac emaker pulses. The amplitude of pacemaker pulses can be as large as 80 m V compared
to 1-2 m V, which is typical of the ECG. The ECG amplifiers in the transmitter are slew rate
(rate of change of output) limited so that the relatively narrow pacemaker pulses are re-
duced in amplitude substantially.
 Biomedical Telemetry and Telemedicine
S 289
ome ECG telemetry
trans · · systems operate in the 450-470
iln;:5s1on within a hospital and has the add d d MHz band, which is well-suited for
ava a le. The circuit details of an ECG t 1 e a vantage of hav~g a large number of channels
Transmitter· A bl k d " e emetry system are described below:
· oc iagram of the tr · · • .
three pre-gelled electrodes attached ~tter ~s s~own m Fig. 9.6. The ECG signal, picked up by
modulate a 1 kHz sub c . th o e patients chest, is amplified and used to frequency

'
• - arner at in turn f d 1
signal is radiated by f h requency-mo u ates the UHF carrier The resulting
circuitry is rotected on: o t e electro~e leads (RL), which serves as the ante~a. The input
P agamst large amplitude pulses that may result during defibrillation.
Battery

~
Electrode Osc. bias
off Regulator and
Patient shutdown
~
electrodes 1 KHz
RA ... 6.2 volts
LA
'O ... 0
1: ~ ·cQ) -~
...
Q) 'O t'
... e
a>- '-.c
(U._
....... (,) >
......
·;:: Q) Q) (I)
e>= 0
RL c3 C.c:;:;
(U Q) (U 0 -

0 ::::,-
o-
.c-
t= o> 1:0 iii~
- ... (1)

0 Cl)~ ::J
Cl) 00

- 230 MHz
X2
frequency
multiplier
460 MHz
> Fig. 9.6 Block diagram of ECG telemetry transmitter (redrawn after Larsen et al.,
1972; by permission of Hewlett Packard, USA)

The ECG input amplifier is ac coupled to the succeeding stages. The coupling capacitor not
only eliminates de voltage that results from the contact potentials at the patient-electrode interface,
but also determines the low-frequency cut-off of the system which is usually 0.4 Hz. The
sub-carrier oscillator is a current-controlled multi"'.vibrator which provides ±320 Hz deviation
from the 1 kHz centre frequency for a full range(± 5 mV) ECG signal. The sub-carrier filter removes
the square-wave harmonic and results in a sinusoid for modulating the RF carrier. In the event of
one-of the electrodes failing off, the frequency of the multi-vibrator shifts by about 400 Hz. This
con~ii_!:ion when sensed in the receiver turns on an 'Electrode inoperative' alarm.
The carrier is generated in a crystal-controlled oscillator operating at 115 MHz. The crystal is a
fifth overtone device and is connected and operated in the series resonant mode. This is followed
by two frequency doubler stages. The first stage is a class-C transistor doubler and the second is a
- series connected step recovery diode doubler. With the output power around 2 mW, the system
has an operating range of 60 m within a hospital.
Receiver: The receiver uses an omnidirectional receiving antenna which is a quarter-wave
monopole, mounted vertically over the ground plane of the receiver top cover. This arrangement
works well to pick up the randomly polarized signals transmitted by moving patients.
The receiver (Fig. 9.7) comprises an RF amplifier, which provides a low noise figure, RF filtering
and image-frequency rejection. In addition to this, the RF amplifier also suppresses local oscillator
 F
290 Handbook of Biomedical Instrumentation

438.18 MHz
Antenna
Local
oscillator
~ - - - - - - - - ; AFC
21.82 MHz

...
Cl) ... ...
C1l
.!!1
LL~ X LL :E
a: a. - a.
E ~ E
ctl ctl

460 MHz

► Fig. 9. 7 Block diagram ofhigh frequency section ofECG telemetry receiver (adapted
from Larsen et al, 1972; by pennission Hewlett Packard, USA)
radiation to -60 dBm to minimize the possibility of cross-coupling where several receivers are
used in one central station. The local oscillator employs a crystal (115 MHz) similar to the
one in the transmitter ~d x 4 multiplier and a tuned amplifier. The mixer uses the square law
characteristics of a FET to avoid interference problems due to third-order intermodulation. The
mixer is followed by an 8-pole crystal filter that determines the receiver selectivity. This filter with
a 10 kHz bandwidth provides 60 dB of rejection for signals 13 kHz from the IF centre frequency
(21.82 MHz). The IF amplifier provides the requisite gain stages and operates an AGC amplifier
which reduces the mixer gain under strong signal conditions to avoid overloading at the IF stages.
The IF amplifier is followed by a discriminator, a quadrature detector. The output of the discrimi-
nator is the 1 kHz sub-carrier. -This output is ave.raged and fed back to the local oscillator for
automatic frequency control. The 1 kHz sub-carrier is demodulated to convert frequency-to-voltage
to recover the original ECG waveform. The ECG is passed through a low-pass filter (Fig. 9.8)
having a cut-off frequency of 50 Hz and then given to a monitoring instrument. The 1 kHz sub-
carrier is examined to determine whether or not a satisfactory signal is being received. This is done
by establishing a window of acceptability for the sub-carrier amplitude. If the amplitude is within
the window, then the received signal is considered valid. In the case of AM or FM interferenc~, an
'inoperative' alarm lamp lights up .
Different manufacturers use differen t carrier frequencies in their telemetry equipment. Use _o f
the FM television band covering 174 to 185.7 MHz (VHF TV channels 7 and 8) is quite common.
However, the output is limited to a maximum of 150 µV /mat a distance of 30 rn to eliminate
interference with commercial television channels.
Some tr~~tters are also provided with special arrangements like low transmitter battery and
nur~e ~all facility. In bot~ these situations, a fixed frequency signal is generated, which causes a
d_evia~on ~f ~e sub-earner and when received at the receiver, actuate appropriate circuitry for
visual md1cations.
Also, some _telem~try systems include an out-of-range indication facility. This condition is
cause~ by a?aaen~1!.1:1'1g.~~ the leads or the patient getting out of range from the receiver cap abili .
For this, the RF earner signal from the transmitter is continuously monitored Wh th" · tyl
level falls below the limit set, the alarm will turn on. · en 15 sign a
 Biomedical Telemetry and Telemedicine 303

prevent high frequency line noise is used. The main component of each receiver channel is a
phase-locked loop (PLL) used as a_frequency demo~~lator. The PLLsare set to lock at frequencies
of 750, 1750 and 2750 Hz for the first, second and third charu\~ls respectively. The Signetics NE
565, was selected as the PLL. After low-pass filtering the multiplexed signals, filters are used as
band-reject notch filters, followed by PLL detectors in each channel. Finally, low-pass filtering of
each output channel is needed to remove carrier ripple noise.
The channels were found to be identical in response to within ± 1 dB, cross-talk better than
-45 dB and total harmonic distortion. The system was used over a 40 kms distance on normal
telephone lines.

mm> 9.7 TELEMEDICINE

Telemedicine is the application of telecommunications and computer technology to deliver
healJh..carelrom one.location to another. In other words, telemedicine involves the use of modern
information technology to deliver timely health services to those in need by the electronic
transmission of the necessary expertize and information among geographically dispersed parties,
including physicians and patients, to result in improved patient care and management, resource
distribution efficiency and potentially cost effectiveness (Bashshur, 1995).
Advanced information technology and improved information infrastructure the world over
have made telemedicine an increasingly viable health care service delivery alternative, measured
in clinical, technical and economic terms. However, most ·existing telemedidne-programs, at
present, are operating in an investigational settings. Issues such as telemedicine technology
management and other barriers such as professional, legal and financial are still under debate.
From a technology stand point, the telemedicine technology includes hardware, software,
medical equipment and communications link. The technology infrastructure is a telecommunication
network with input and output devices at each connected location.

9.7.1 Telemedicine Applications

Although telemedicine can poterttially affect all medical specialities, the greatest current
applications are found in radiology, pathology, cardiology and medical education.
Teleradiology: Radiblogical images such as X-ray, CT or MRI images can be transferred from one
location to another}ocation for expert interpretation and consultation. The process involves image
acquisition and _digitization. . .
Telepath~logy: To obtain an expert opinion on the microscopic images of pathology slides and
biopsy reports from specialists.
Telecardiology: Telecardiology relates to the transmission of ECG, echocardiography, colour
-Doppler, ~tc. ·
In addition, telemedicine is being advantageously used for:
Tele-education: Delivery of medical education programmes to the physicians and the paramedics
located at smaller towns who are professionally isolated from major medical centres.
 304 Handbook of Biomedical Instrumentation
------------,'~-- --
Teleconsultation: Specialist doctors can be consulted either by a patient directly or by the local
medical staff througn·t~emedicine technology. In the latter case, the patient is substituted by his/
her electronic patient record (EPR) which has complete information on the physical and clinical
aspects of the patient.
Depending on the level of interaction required, the telecommunication infrastructure requirement
also varies: from a normal telephone, low-bit rate image transmission, real-time video transfer to
video conferencing.

9.7.2 Telemedicine Concepts

Store and Forward concept involves compilation and storing of information relating to audio,
video images and clips, ECG, etc. The stored information in the digital form is sent to the expert
for_ i:e'f iew, interpretation and advice at his/her convenience. The expert's opinion can be trans-
i_hitted back without any immediate compulsion on the consultant's time during his/her busy
professional schedule.
Real Time telemedicine involves real-time exchange o[ information between the two centres
simultaneously and communicating interactively. It may include·video conferencing, interviewing
and examining the patients, transmission of images of various anatomic sites, auscultation of the
heart and lung sounds and a continuous review of various images.

9.7.3 Essential Parameters for TeJemedicine

relemedicine systems are based on multi-media computing, which not only support live multi-
Nay conversations between physicians, patients and specialists but can also facilitate off-line
:onsultations among health-care team members. It is however, advisable to create a detailed
~lectronic patient record so that necessary information can be accessed, when desired. The
ollowing components relating to a patient are considered essential from the point of view of
2lemedicine:
• Primary Patient Data:Name, age, occupation, sex, address, telephone number, registration
number, etc. . ·
• Patient History: Personal and family history and diagnostic reports.
• Clinical infonnation: Signs and symptoms are interpretations of dpta obtained from direct
and in~ect patient observations. Direct observations include data obtained from the
senses ~sight, so~~, t~uch, smell, etc.) and through mental and physical interaction with
the patient, while mdirect observations include data obtained from diagnostic instru-
ments such as temperature, pulse rate, blood pressure.
• In~estigatio~s: C:omplete analysis reports of haemotology and biochemistry tests st00l d
~ e exanunaq()IJ.. , an

•~;::~::;!~1:;;!:e~~~~~~:,~;:;::d nuclear medicine images and

·n addition, there is a need to have video-conferencing facility for onl. .
•igure 9.17 shows the principle and various sub-systems used . t ;ne cdo~~'Ultations.
ma e eme 1cme set-up.
 Transmitting centre Receiving centre

+ Satellite ~

t C:=:J
□c::::::::J
~
/ ~
12 Lead ECG
Satellite
machine

1
Patient /
Documents video clips
dish/pot/internet/ISDN
/
Online ECG Dish/ISDN/pot/internet
moving images
X'RAY - - - - - , video

Stored
ECG - - 1I
II
,....._ ____...,..... camera
conferencing
audio
message
Printer ·
Application
software
1.. r==:J 1

I ' 0 ,
ECG - - -
I
I
= Ser:ver at
Pathologicar-report Printer T· · I., .. · Archiving
Analysis receiving .centre
[ECG me,dical image
CT scan - - i_ ' ., .-=s: tool
MRI - - ~ I and DATA display]
Report
(Trans'~lttlng centre) generation
Patient [ECG _and _image display]
DATA - - - , ~Sca
- n~n~e~r

> Fig. 9.17 Block diagram of a typical telemedicine·system

 Handbook of Biomedical Instrumentation

re,e, medicine Tec.hoology

.
l~:n
10
. sfon of Medical Images: One of the most important aspect of telemedicine is the
and transmission of medical images such as X-rays, CT, MRI, histopathology slides,
i JJ5 e unages are first required to be converted into digital form. The usual types of diagnostic
~- J1i~sed in telemedicine include:
i 11ag:Images stored on traditional film or print media (e.g. X-ray film) and converted into digital
format by direct imaging or scanning in a raster sequence under controlled lighting condi-
tions. CCD (charge coupled devices) and laser-based scanners are commercially available
for digitizing the film recorded X-ray images. A typical 11-by-17 inch chest film requires
atleast 2000 by 2000 pixels and an optical dynamic range of at least 4000 to 1 (12-bits) to
represent the image adequately.
• Computer-generated images (e.g. ultrasound, CT) available in standard video format
(NTSC), computer format (SVGA), or computer-file format (TIP). In modem digital radiog-
raphy systems, the X-ray image is stored in the computer in the digital format. Being a
filmless system, it does not require any further digitization.
The American College of Radiologists and the National Electrical Manufacturers Association
jointly developed a 13-part Digital Imaging and Communications in Medicine (DICOM) standard
(ACR-NEMA, 1993) for the, interconnection of medkal imaging devices, particularly for
radiological imaging equipment such as digital radiography, CT (Computed Tomography), MRI
(Magnetic Resonance Imaging) and PAE:S (Picture.Archiving and Communication Systems). In
addition, ACR, 1994 is another standard, which deals with the transmission of radiological images
from one location to another for the purposes of interpretation and consultation. The standard
includes equipment guidelines for digitization of matrix images digitized in arrarys of 0.5 k x 0.5
k x 8-bits and large matrix images digitized in arrarys of 2 k x 2 k x 12-bits.
At the transmitting end, there is usually a requirement for the local storage of image data,
particularly wh~ the storage and forward concept is adopted in the telemedicine system. The
number of images that may be stored depends upon the size of the storage facility (Hard disk) and
the amount of data compre§sion_applied to the images before storage. The storage requirements for
various imaging modalitie_s are given in Table 9.1.
Transmission of Video Images: Telemedicine applications generally require video and ind· 'd
· f - • • . 1v1 ua 1
st ill -f rame images or ~ teractive v1sua1 communication and medical diagnosis. N f 1
Television System Committee (NTSC) adopted, in 1953, the analog signal format used in ;s:~a
0
the broadcast and cable transmission of television. The NTSC format consists of 30 ima e fr ;

s. Ea_ch frame is_an ~ t: rl~ced raster scan of 512 horiz~ntal lines sized to obtain a 4:3 a;pec::~o.
Vertical resolution IS hIDited by the number of scan Imes and horizontal resolution is limited b
the specified bandwidth of the signal-4.2 MHz. An alternative expression of resolution is th~
term television-ltne1,·(TVL), the number of alternating light and dark bars an observer can resolve
in the vertical d imens ion or along 75% of the horizontal dimension. NTSC luminance resolution
is 336 TVL.
At the resolution and frame rate associated with NTSC video, digital data are produced at a rate
Jf over 100 Mbps (Mega bits per seconds). Obviously, communication and storage limitations and