J Med Syst (2007) 31:237–246
DOI 10.1007/s10916-007-9061-4
Pervasive E-health Services Using the DVB-RCS
Communication Technology
Demosthenes Vouyioukas & Ilias Maglogiannis &
Vasilios Pasias
Received: 9 January 2007 / Accepted: 28 February 2007 / Published online: 19 April 2007
# Springer Science + Business Media, LLC 2007
Abstract Two-way satellite broadband communication
technologies, such as the Digital Video Broadcasting with
Return Channel via Satellite (DVB-RCS) technology,
endeavour to offer attractive wide-area broadband connec-
tivity for telemedicine applications, taking into consider-
ation the available data rates, Quality of Service (QoS)
provision, survivability, flexibility and operational costs,
even in remote areas and isolated regions where the terres-
trial technologies suffer. This paper describes a wide-area
tele-medicine platform, specially suited for homecare
services, based on the DVB-RCS and Wi-Fi communica-
tion technologies. The presented platform combines med-
ical data acquisition and transfer, patient remote monitoring
and teleconference services. Possible operational scenarios
concerning this platform and experimental results regarding
tele-monitoring, videoconference and medical data transfer
are also provided and discussed in the paper.
D. Vouyioukas (*) : I. Maglogiannis
Department of Information and Communication Systems
Engineering, University of the Aegean,
Karlovassi, 83200 Samos, Greece
e-mail: dvouyiou@aegean.gr
I. Maglogiannis
e-mail: imaglo@aegean.gr
V. Pasias
Department of Electronic and Computer Engineering,
University of Portsmouth, PO1 3DJ Portsmouth, UK
e-mail: pasiasv@hotmail.com
V. Pasias
Hellenic Aerospace Industry S.A.,
Schimatari, Greece
Keywords Pervasive tele-medicine . Digital video
broadcasting . Satellite communications . WiFi .
Regional access point . Patient telemonitoring
Introduction
Broadband connectivity is rapidly evolving around the
globe using a diversity of means involving wire-line (e.g.
Asynchronous Digital Subscriber Line—ADSL), wireless
(e.g. Wi-Fi, WiMax) and satellite interconnections. Multi-
media-rich services provided via broadband connections
can potentially change the way of communicating ideas,
doing business, or acting in the modern digital world. In
this framework, European Space Agency (ESA) has
initiated the Digital Video Broadcasting with Return
Channel via Satellite (DVB-RCS) technology enabling
almost all potential locations—even the most geographical-
ly dispersed and isolated ones—to gain access to broadband
services using low-cost Satellite Interactive Terminals
(SITs). Nowadays, the DVB-RCS technology is a mature
broadband communications technology with comparable
implementation and operational costs to the other broad-
band terrestrial technologies, effectively satisfying the
Quality of Service (QoS) requirements of high demanding
applications in electronic healthcare.
In the era of mobile computing the trend in medical in-
formatics is towards achieving two goals: the availability of
software applications and medical information anywhere
and anytime and the invisibility of computing; computing
modules are hidden in multimedia information appliances.
The DVB-RCS technology seems capable of providing
such pervasive e-health services. DVB-RCS [1, 2] is an
ETSI (European Telecommunications Standards Institute)
[3] standard that specifies the provision of the interaction
238
channel for interactive (two-way) satellite networks using
Return Channel Satellite Terminals referred to as RCST or
simply SITs. The DVB-RCS Hub is vital for the operation
of the DVB-RCS satellite communications network and
essentially manages the network operation; it enables SIT
access to the satellite network, assigns bandwidth to SITs,
relays traffic between SITs inside the satellite network and
between the SITs and other networks (e.g. Internet) and also
monitors the operation of the SITs.
The topology of a typical interactive satellite network is
star with the central gateway, known simply as DVB-RCS
Hub, at its center and the SITs around the DVB-RCS Hub.
The DVB-RCS Hub is vital for the operation of the DVB-
RCS satellite communications network and essentially
manages the network operation; it enables SIT access to
the satellite network, assigns bandwidth to SITs, relays
traffic between SITs inside the satellite network and
between the SITs and other networks (e.g. Internet) and
also monitors the operation of the SITs. Note that data
communication between two SITs can only take place
through the DVB-RCS Hub, thus effectively being a two-
hop communication. For the sake of simplicity in this paper
from this point forward, the transmission from the DVB-
RCS Hub towards all SITs will be referred to as Forward
Link (FL) and the transmission from each SIT towards the
DVB-RCS Hub will be referred to as Return Link (RL).
Data rates on the FL can reach 45 Mbps and data rates on
Fig. 1 Electronic healthcare
satellite network in the north
Aegean region
J Med Syst (2007) 31:237–246
the RL can reach 2 Mbps. Bandwidth allocations on both
FL and RL can be guaranteed (constant rate) or dynamic,
depending on the available bandwidth at certain time
periods.
Tele-medicine applications span the areas of emergency
healthcare, homecare, patient tele-monitoring, tele-cardiol-
ogy, tele-radiology, tele-pathology, tele-dermatology, tele-
ophthalmology, tele-psychiatry and tele-surgery [4, 5].
These applications enable the provision of prompt and
expert medical services in underserved locations, like rural
health centers, ambulances, ships, trains, airplanes as well
as at homes (homecare) [6–9]. The combination of the
medical profession's advanced procedures and equipment
with regional healthcare communication networks, may
offer complete, integrated healthcare delivery systems made
up of hospitals, outpatient services, pharmacies and large
rural home health operation. From the patient’s perspective,
that means not only having the necessary technology at
hand, but also a centralized environment that is comfort-
able, convenient and dedicated to the care of their specific
condition.
Tele-medicine provided via satellite communications is
an evolving area of healthcare services and provision of
medical information, which utilizes the new developments
in satellite networks such as DVB-RCS. In fact, satellite
communication systems are considered an attractive net-
working solution for telemedicine platforms, since they
J Med Syst (2007) 31:237–246
have the advantage of worldwide coverage and offer a
variety of data transfer rates, even though satellite links
involve high operating costs [10–12]. However, with the
application of the DVB-RCS technology, the operating
costs of satellite links tend to be significantly reduced.
In the context of this paper, an integrated wide-area
tele-medicine platform for the provision of homecare
services, based on the DVB-RCS and Wi-Fi communica-
tion technologies, is presented and evaluated for the Re-
gion of North Aegean in Greece (see Fig. 1). The platform
can support all or a number of the following e-health
services:
1. Videoconference or only VoIP communication between
patients at home and medical personnel, such as doctors
and nurses, located at a remote hospital or a medical
center.
2. Video Based Tele-monitoring of patients at home with
or without movement problems and
3. Biosignal Based Tele-monitoring; Acquisition of vital
medical data (biosignals), (i.e. Electrocardiogram
(ECG), NIBD (Non Invasive Blood Pressure) and
related physical data such as temperature, oxygen
saturation, (in-blood) glucose level measurements,
heart pulse measurements, weight measurements, etc.)
and transmission of them to a hospital or medical center
for further process and/or archiving.
The topology of the proposed tele-medicine platform
and its functional operation are described in “Description
Fig. 2 Topology of the
proposed tele-medicine
platform
239
of the integrated satellite tele-medicine platform” section. In
“The platform in practice—two typical operational scenar-
ios,” section two possible operational scenarios are pre-
sented, while in “Experimental setup and results,” section
experimental results regarding patient tele-monitoring,
videoconference and medical data transfer are presented.
The objective of these experiments is the validation of the
transmitted video quality, considering various data rates and
combinations of satellite capacity allocation, involving
guaranteed and dynamically allocated bandwidth. Finally,
“Discussion and conclusions” section discuss the findings
and concludes the paper.
Description of the integrated satellite
tele-medicine platform
The general topology of the proposed tele-medicine
platform is depicted in Fig. 2. The platform’s architecture
is hierarchical, involving an access network based on the
Wi-Fi technology and a core network based on DVB-RCS.
The core DVB-RCS network can be provided by any
company or organization that has purchased, invested and
operates, like the one that Hellenic Aerospace Industry S.A.
owns and operates at its premises in Greece [13]. The
DVB-RCS satellite core network can gain access by any
satellite provider using the expensive but necessary satellite
bandwidth (satellite transponder) in order to provide SIT
and DVB-RCS Hub interconnection. The only limitation of
240
the network is the satellite coverage footprint (coverage
map) [14, 15].
The platform may consist of one or more Remote Sites
(RSs) placed in several remote areas. Every RS can be
equipped with appropriate communication devices (i.e.
videoconference units, videophones, patient tele-monitoring
unit, IP phones etc). Optionally, the communication device
at the RS may have the capability to connect to medical
data acquisition units collecting various biosignals and
physical data. Each RS has access (Ethernet IP connection)
to a wireless access point that utilizes the Wi-Fi technology
(IEEE 802.11 g), through which the RS is wirelessly
connected to a Regional Access Point (RAP). The range of
communication between a RS and a RAP is generally less
than 1 km. The RAP concentrates video/voice/data from a
number of RSs and communicates through the cor-
responding (located at the site) DVB-RCS SIT, the utilized
communication satellite and the available DVB-RCS Hub
of the satellite network, with the Center Node (CN),
essentially being a hospital or a medical center. Naturally,
the equipment of the CN, among others, includes a SIT for
communication with the satellite network. The medical
personnel (physicians and nurses) at the CN can commu-
nicate and provide help to the patients with health incidents
as well as potentially realize regular and irregular medical
examinations from distance using the platform. The
locations of the RSs, RAPs and CN are assumed to be
random. Considering the characteristics of the equipment
used in the framework of the proposed tele-medicine
platform, teleconference/VoIP communication with the
patients, tele-monitoring, glucose level and blood pressure
measurements, supervision of injuries, monitoring and/or
Table 1 Required infrastructure of the proposed platform at
each node
Location Required infrastructure
Remote Site (RS) Communication Unit (VoIP, Videophone
or Special Videoconference/Medical
Data Collector Unit)
IP Camera or a Video Server Unit
Wireless Access Point
Regional Access Satellite Interactive Terminal (SIT)
Point (RAP) Wireless Access Point
Center Node (CN) Data Collector Personal Computer (C-PC)
Database Computer (DB-PC)
Multipoint Conference Unit (MCU)
Videoconference Units (VCUs)
IP phones
TV monitors
Ethernet Hub or Switch
Satellite Interactive Terminal (SIT)
J Med Syst (2007) 31:237–246
confrontation of hypoglycemia or hyperglycemia symp-
toms, confrontation of possible heart attack incidents as
well as monitoring of the respiratory system of patients can
be efficiently performed using the tele-medicine platform
described in this paper.
Each Remote Site (RS) is equipped with a communica-
tion unit that utilizes a VoIP, a special integrated videocon-
ference and/or a medical data acquisition unit [16]. The
medical personnel, through the embedded teleconference
capability of the device, is able to communicate with the
patients using VoIP, real-time video, as with a simple
videophone, even permitting the realization of regular and
irregular medical examinations from distance.
The required infrastructure at the Center Node (CN)
consists of one data Collector Personal Computer (C-PC),
one Database Computer (DB-PC), one Multipoint Confer-
ence Unit (MCU), two or more Videoconference Units
(VCUs), two or more IP phones, two or more TV monitors,
one Ethernet Hub or Switch and one SIT to communicate
with the RAPs. The C-PC is used for the communication
with the special videoconference/medical data collector
units located at the RSs. Special software consolidate and
process all the medical data coming from the aforemen-
tioned units and it will update the medical records of the
patients. The DB-PC is used to facilitate the communication
to the C-PC and support the database, where the medical
history data of the patients will be contained. The VCU
gives the opportunity to the doctor at the CN to
communicate with his patient (or patients) using real-time
video. The required infrastructure of the anticipated
platform is depicted in Table 1.
The platform in practice—Two typical
operational scenarios
In this section we discuss some indicative operational
scenarios, which reveal the functionality of the proposed
platform.
Operational scenario 1
The first scenario concerns a patient, who recently was
discharged from hospital after some form of intervention,
for instance, after a cardiac episode, cardiac surgery or a
diabetic comma. These types of patients are less secure and
require enhanced care even at home. However, the home
offers a considerably different environment than a hospital
or a health unit. The patient or elder will mainly require
except video surveillance, also monitoring of his vital
signals (i.e., ECG, blood pressure, heart rate, breath rate,
oxygen saturation and perspiration).
J Med Syst (2007) 31:237–246
Operational scenario 2
The second scenario concerns a patient, who suffers from
saccharoid diabetes and he exhibits hypoglycemia symp-
toms (e.g. abstractness and ephidrosis). Supposing the
patient is located at the RS X2, equipped with a
videoconference/medical data collector unit, connected to
a glucose meter, allowing a direct connection with a
physician at a Center Node (CN), upon his request. The
attached glucose meter measures the level of blood glucose
and sends the results to the CN. The doctor gains access to
these medical data and he also retrieves the patient's
medical history from an EHR (Electronic Health Record)
relational database system. According to the examination
results, the symptoms described by the patient following to
the doctor's questions and the patient’s medical history, the
doctor decides if further medical attention is needed (i.e. if
an ambulance has to be sent to the patent’s home or not)
and then provides appropriate advise in order to address his
uncomfortable condition.
Experimental setup and results
The implemented testbed used for our experiments con-
sisted of two SITs, communicating with each other (Sites X
and Y) through the DVB-RCS Hub that the Hellenic
Aerospace Industry (in Tanagra, Greece) owns and oper-
ates. The HellasSat-2 satellite was used to provide SIT and
DVB-RCS Hub interconnection. Site X simulates the CN,
while Site Y simulates a combination of RS and RAP. The
experiments presented in this paper essentially involve tele-
monitoring, videoconference and medical/physical data
transfer. Actually, two set of tests took place. The first set
involved (video) monitoring of the patients and medical
data transfer, where the SIT at Site X was connected to a
PC, while the SIT at Site Y was connected to the output of a
video server device. The second set involved videoconfer-
ence between the two Sites jointly with medical data
transmission from Site Y towards Site X. Note that two
strict priority queues were defined in both SITs; the one had
high priority weight and served video/voice transmission
while the other one had low priority weight and served
medical data transmission.
Regarding the medical data transfer in all the set of tests,
the SIT at Site Y was connected to a PC, which produced a
continuous data stream, essentially simulating blood pres-
sure, ECG and audio stethoscope and vital numerical data
transmission, towards the PC at Site X. The total simulated
medical data stream rate was 20 kbps. The utilized numbers
are also displayed in Table 2, which present typical data
rates. With reference to the tests, the client version of the
Iperf testing software [17] was running to the PC at Site Y,
241
Table 2 Typical medical data transmission rates
Medical data type Data rate required
Digital Blood Pressure Monitor <10 kbps
Vital Data Monitor (Digital thermometer, <10 kbps
Oxygen Saturation Measurement, etc)
Digital audio stethoscope & integrated ECG ∼10 kbps
Compressed and full motion video 384 kbps to
1.544 Mb/s (speed)
while to the PC at Site X the server version of the Iperf
software was running. The client version of Iperf was
sending a constant User Datagram Protocol (UDP) data
stream, which simulated a medical data stream (see
above), to the server version of Iperf. The server version
of Iperf was recording packet loss for the transmitted data
stream and also the utilized bandwidth by the stream. In
the next sub-sections the two set of tests are analytically
described.
First set of tests: Tele-monitoring and medical data transfer
According to the formerly described scenario 1 at
“Operational scenario 1” section, Site X simulates the CN,
while Site Y simulates a combination of RS and RAP. The
input of the video server at Site Y was connected to one
Close Circuit TV (CCTV) analogue camera. The video server
device transforms the analogue TV signal at its input(s),
coming from one or more tele-monitoring cameras, to one
or more IP packet video streams, which are subsequently
sent to a LAN. Basically, the video quality provided by a
video server depends on the utilized video compression
format (e.g. MPEG-2, MPEG-4) and frame size/resolution
(e.g. 4CIF—768×576 pixels, 2CIF—640×480 pixels, CIF
—380×240 pixels, QCIF—176×144 pixels). Note that
during the tests, the video server was connected to one
CCTV camera only. The test topology is illustrated in
Fig. 3.
The basic objective of the tests was to validate the video
quality perceived at Site X, while sending both video and
simulated medical data (biosignals) from Site Y. The
experiments consider various transmission data rates and
combinations of satellite capacity allocation, involving
guaranteed and dynamically allocated bandwidth for the
SIT at Site Y. The packet loss for the data stream and the
utilized bandwidth by the stream were continuously
monitored during all tests. The video quality is defined
considering the quality of illustration. Actually, the quality
of the video is not good when the image is not sharp
enough, squares and/or blurred areas appear inside the
image frame, the sequence of video frames is not constant
but stops and starts again, the colors are not properly
242 J Med Syst (2007) 31:237–246

Fig. 3 Topology of the experi-

mental network for the first set
of tests

displayed etc. The transmitted data rate from a SIT can be
guaranteed (Constant Rate Assignment—CRA) or dynamic
(Volume Based Dynamic Capacity—VBDC), depending on
the available bandwidth, or combination of the above two
bandwidth allocation schemes.
During the tests, video and medical data transfer from
the video server and the PC at Site Y towards the PC at Site
X took place considering different Return Links (RL) rates
for the SIT at Site Y. The Forward Link (FL) rate for the
SIT at Site X was 2 Mbps in all tests. In the experiments,
the video resolution was CIF (380×240 pixels) and the
video compression standard MPEG-4 was used resulting in
an average 5:1 compression ratio, that is the 20% of the
totally produced video data about colors and brightness was
finally sent from the video server. No restrictions to the
upper and down limits of the video rate produced by the
video server were imposed. Video viewing on the PC at
Site X took place using an ActiveX-enabled web browser
(Microsoft Internet Explorer). It should be noted also that
the total rate for the medical data transmission was 20 kbps.
The test results are depicted in Table 4. The results are
evaluated subjectively according to the recommendation of
ITU [18] especially modified for evaluation of motion
monitoring processes. Seven observers—three non-expert
and four doctors—were asked to grade the picture with
respect to the reference one (video no passing via satellite),
using the CCIR-5 point impairment scale (Best: 5, Very
Good: 4, Good: 3, Bad: 2, Very Bad: 1). A number of
parameters, depicted in Table 3, influence the viewers’
judgment of the sequence quality, according to the
information found in [19–21]. The tests were carried out
in a viewing room using a 42” LCD colored monitor with

Table 3 Viewing conditions for the subjective assessment of image quality

Item Values

Ratio of viewing distance to picture height 3

Peak luminance on the screen (cd/m2) 150–250
Ratio of luminance of inactive tube screen (beams cut off) to peak luminance ≤ 0.02
Ratio of the luminance of the screen when displaying only black level in a completely dark room, Approximately 0.01
to that corresponding to peak white
Ratio of luminance of background behind picture monitor to peak luminance of picture Approximately 0.15
Illumination from other sources low
Chromaticity of background D65
Angle subtended by that part of the background which satisfies the specification above. 53° high×83° wide
This should be preserved for all observers
Arrangement of observers Within ±30° horizontally from
the centre of the under study
Display size 1.07 m (42 in)
J Med Syst (2007) 31:237–246 243

Table 4 Test results for the

first set of tests Test Video RL rate for the SIT Frame Throughput Medical data Medical data
number qualitya at site Y (kbps) rate (kbps) stream packet stream utilized
(fps) loss (%) bandwidth
(kbps)

1 5 1648-CRA 25 900 0 20
2 5 1024-CRA 25 900 0 20
3 4 512-CRA 25 420 0 20
4 3 384-CRA 25 310 0 20
5 2 256-CRA 25 190 0 20
6 1 128-CRA 10 90 0 20
7 1 64-CRA, 64-VBDC 10 60 0 ∼20
8 1 64-CRA, 192-VBDC 10 70 0 20
9 2 64-CRA, 448-VBDC 12 140 0 20
10 2 128-CRA, 128-VBDC 12 100 0 20
11 2 128-CRA, 256-VBDC 12 120 0 20
12 2 128-CRA, 384-VBDC 12 140 0 20
13 3 256-CRA, 256-VBDC 12 230 0 20
a
14 3 256-CRA, 768-VBDC 13 240 0 20
Best: 5, Very Good: 4, 15 4 512-CRA, 512-VBDC 25 450 0 20
Good: 3, Bad: 2, Very Bad: 1.

best resolution. The monitor was positioned in front of a
grey wall on a grey stand, while the ambient light level in
the test room was low. The observers' viewing distance was
three times the picture high, during the whole test series.
The rest of the viewing conditions, which they are
compliant to the ITU recommendations are specified in
Table 3.
The results are shown in Table 4; best video quality, with
also best frame rate and throughput, were acquired when
the RL rate was 1,024 kbps (or more) and it was all CRA.
However, this value for the RL rate is not realistic and
affordable, especially when networks with many RSs are
considered, since the satellite capacity (and thus the RL
rate/bandwidth) is expensive and its availability is usually
limited. So, lower RL rates are required in real conditions.
As it can be extracted by Table 4, satisfactory video quality,
with also acceptable frame rate and throughput, were
acquired when the RL rate was 384 kbps and it was all
CRA. This value of RL rate is much more affordable and
realistic. It is obvious from the tests that the throughput
basically depends on the value of CRA; decrease of CRA
eventually caused lower throughput, worse video quality
and smaller frame rate. Even when large values of VBDC
(above 512 kbps) were available during the tests, but the

Fig. 4 Topology of the experi-

mental network for the second
set of tests
244 J Med Syst (2007) 31:237–246

CRA was less than 256 kbps, the video quality and
particularly the frame rate were not satisfactory.
For the transmitted data stream that simulates the transfer
of biosignals, no packet loss appeared and the utilized
bandwidth was constant, basically reaching 20 kbps, in all
tests as shown in Table 4. Even when the RL allocated
capacity was small (e.g. Test 7) the medical data transfer
was normal and stable, without packet losses. So, video
transmission did not affect medical data transmission at any
case. Besides, medical data transmission was not affected
by the different values of CRA and VBDC, for the SIT at
Site Y, considering all tests. So, medical data transfer can
be well served using dynamic capacity allocation schemes,
that is VBDC, without the need for, rather expensive and
limited, guaranteed capacity (CRA).
Second set of tests: Videoconference and medical
data transfer
According to the previously described scenario 2 in
“Operational scenario 2” section, videoconference proce-
dure and data transmission of the glucose meter will be
evaluated considering various transmission rates and combi-
nations of satellite capacity allocation, involving guaranteed
and dynamically allocated bandwidth for both SITs.
The network topology used in this set of tests is illustrated
in Fig. 4. At both Sites, except the two PCs, two VCUs
were used; one at Site X and the other in Site Y. The VCUs
are ViewStation EX from Polycom [22]. Both VCUs were
connected to TV monitors. Note that the VCUs automati-
cally adjust the utilized bandwidth during videoconferen-
ces. In fact, the user adjusts the nominal allocated
bandwidth (dial speed) shown at videoconference session
setup, e.g. 384 kbps, which is the initially utilized
bandwidth for the videoconference; during the videocon-
ference the allocated bandwidth changes (slightly increases
or decreases) depending on video reception characteristics,
such as brightness, movement of the subjects included in
the video frames etc [23]. As it was shown through tests,
most of the times the allocated bandwidth during video-
conferences is lower than the nominal allocated bandwidth
at the beginning of the videoconference session. As it was
also shown through tests, the actual available bandwidth
must be at least 20% greater than the nominal value at
videoconference session setup for satisfactory video quality.
Actually, if the dial speed at videoconference session setup
is 256 kbps then the channel bandwidth (RL rate) must be
about 320 kbps.

Table 5 Results from the

second set of tests Test Video RL rate for the SITs Frame Video Data Data stream
number qualitya at sites X and Y rate nominal stream utilized
(kbps) (fps) throughput packet loss bandwidth
(kbps) (%) (kbps)

1 5 512-CRA 25 384 0 20
2 3 16-CRA, 496-VBDC 20 384 1 ∼20
3 3 64-CRA, 448-VBDC 21 384 0 20
4 5 128-CRA, 384-VBDC 24 384 0 20
5 3 384-CRA 20 384 0 20
6 1 16-CRA, 368-VBDC 10 384 1 ∼20
7 2 64-CRA, 320-VBDC 13 384 0 20
8 3 128-CRA, 256-VBDC 18 384 0 20
9 5 384-CRA 25 256 0 20
10 3 16-CRA, 368-VBDC 21 256 0 ∼20
11 4 64-CRA, 320-VBDC 22 256 0 20
12 5 128-CRA, 256-VBDC 25 256 0 20
13 3 256-CRA 19 256 0 20
14 2 16-CRA, 240-VBDC 12 256 2 ∼20
15 2 64-CRA, 192-VBDC 14 256 0 20
16 3 128-CRA, 128-VBDC 17 256 0 20
17 4 256-CRA 22 128 0 20
18 1 16-CRA, 240-VBDC 10 128 2 ∼20
19 2 64-CRA, 192-VBDC 12 128 0 20
20 3 128-CRA, 128-VBDC 19 128 0 20
21 3 128-CRA 18 128 0 20
22 1 16-CRA, 112-VBDC 8 128 5 ∼15
23 1 32-CRA, 96-VBDC 10 128 2 ∼20
a
Best: 5, Very Good: 4, 24 2 64-CRA, 64-VBDC 14 128 1 ∼20
Good: 3, Bad: 2, Very Bad: 1.
J Med Syst (2007) 31:237–246
The basic objective of the tests was to validate the video
quality perceived at both sites, while both videoconference
and simulated medical data (biosignals) transmission from
Site Y took place. The packet loss for the data stream and
the utilized bandwidth by the stream were continuously
monitored during all tests. If the utilized bandwidth is not
equal to the anticipated value (20 kbps) and there are a lot
of packet losses, then the medical data transfer becomes
unreliable. The video quality is defined considering the
quality of illustration. Actually, the quality of the video is
not good when the image is not sharp enough, squares and/
or blurred areas appear inside the image frame, the
sequence of video frames is not constant but stops and
starts again, the colors are not properly displayed etc. Once
more, the results are evaluated subjectively according to
the recommendation of ITU, using the CCIR-5 point
impairment scale.
The transmitted data rate from a SIT can be guaranteed
(Constant Rate Assignment—CRA) or dynamic (Volume
Based Dynamic Capacity—VBDC), depending on the avail-
able bandwidth, or combination of the above two bandwidth
allocation schemes. During the tests, video and medical data
transfer took place considering different RL rates for the two
SITs at Sites X and Y. The FL rate for the two SITs at Sites X
and Y was 1 Mbps in all tests. Concerning the tests, the video
resolution was CIF (380×240 pixels); the H.263 video en-
coder and the G.711 audio encoder that produces an audio
stream of 64 kbps were used. The total rate of the medical
data transmission from Site Y was 20 kbps. The test results
are depicted in Table 5. Note that the Nominal Throughput
values refer to the initial dial speed shown at videoconfer-
ence session setup. The frame rates represent average values.
As depicted in Table 5, the best video quality with also
best frame rate and throughput was obtained when the RL
rate was 384 kbps or more. However, RL rates, for each
SIT, above 384 kbps are not realistic and affordable, in this
scenario as well. A satisfactory video quality (4) with
acceptable frame rate (22) and throughput (256 kbps) was
acquired, when the total RL rate was 384 kbps, in which
64 kbps was guaranteed capacity—CRA (see Test 11). In
this case, the results of medical data transfer were excellent
(packet losses: 0%, utilized bandwidth: 20 kbps). The
aforementioned RL rate is affordable and realistic. It is
obvious from the tests that the throughput depends on the
value of CRA; decrease of CRA causes lower throughput,
worse video quality and smaller frame rate. Generally, as it
can be understood from Table 5, CRA must be above
64 kbps for good video quality.
According to Table 5, very small packet loss appeared
and the utilized bandwidth was almost constant, generally
reaching 20 kbps, for the transmitted data stream that
simulated the transfer of biosignals. Even when the RL
allocated capacity was small (e.g. Tests 21–24), the packet
245
losses for the medical data transfer were rather small with
maximum value 5% and the utilized bandwidth never fell
below the threshold of 15 kbps. Therefore, video transmis-
sion did not seriously affect medical data transmission in
this operating scenario as well.
Discussion and conclusions
This paper presents a novel, low-cost, wide-area tele-
medicine platform, laying emphasis to patient monitoring
and homecare services. The DVB-RCS standard has been
designed to minimize the cost of scaling a broadband
access network from terminal populations as small as a few
hundred SITs to tens of thousands of SITs. With the
intention of achieving this, implementation of DVB-RCS,
utilizing dynamic assignment techniques mandated in the
DVB-RCS specification, has been specifically designed and
tuned for multimedia and high-speed data transfer.
The topology of the proposed platform is hierarchical,
involving an access network based on the Wi-Fi technology
and a core network based on the DVB-RCS satellite
communications technology. The monitored patients can
be practically anywhere, even in geographically dispersed
and isolated areas, where normally there is no terrestrial
communications infrastructure capable of supporting simi-
lar services. Considering the characteristics of the utilized
equipment in the framework of the proposed tele-medicine
platform, teleconference/VoIP communication with the
patients, tele-monitoring, glucose level and blood pressure
measurements, supervision of injuries, monitoring and/or
confrontation of hypoglycemia or hyperglycemia symp-
toms, confrontation of possible heart attack incidents as
well as monitoring of the respiratory system of patients, can
be efficiently performed using the described tele-medicine
platform.
Bearing in mind the proposed platform, two set of tests
took place. All the sets involved two locations/sites. The
operation of the CN was simulated by the one site, while
the operation of the RS and RAP together was simulated by
the other site. The first set of tests involved tele-monitoring
and medical data transfer involving both sites, while the
second set of tests was related to videoconference and
medical data (biosignals) transfer between the two sites.
Different transmission data rates and combinations of
satellite capacity allocation, involving guaranteed and
dynamically allocated bandwidth, for the two SITs were
used. The experimental results show that SIT transmission
rates at 384 kbps are enough to support tele-monitoring,
providing satisfactory video quality and frame rate. Also,
the transmission of biosignals can be performed with no
packet losses using dynamically allocated capacity, without
the need for expensive guaranteed capacity. In addition, SIT
246
transmission rates at 384 kbps (64 kbps guaranteed
bandwidth) are enough to support videoconference and
medical data transfer together, providing satisfactory video
quality. Moreover, during the tests, the medical data transfer
was not seriously affected by video transfer (approximately
zero packet losses) and it was almost constant during the
majority of the tests. Besides, it was shown that the
transmission of biosignals can be performed with generally
no packet losses using dynamically allocated bandwidth,
without the need for expensive (and limited) guaranteed
bandwidth; on the other hand, videoconference communi-
cation requires a combination of guaranteed and dynami-
cally allocated bandwidth. Future developments regarding
the proposed tele-medicine platform, involve the incorpo-
ration of more communications technologies, such as
WiMax and GSM/3G, and the incorporation of more
medical services.
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