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Telemedicine Systems DiViSy TM21

A telemedicine system of DiViSy TM21 model stands for the third generation of telemedicine systems, which incorporate the operating experience of two previous versions DiViSy PM1and DiViSy TM2000. These systems are meant for remote medical tutorials on various kinds of diagnostics and treatment, in the real time mode along with deferred mode with application of any available communication channels. 

Principal features of the systems are as follows:
1. Transmission and receiving of medical data simultaneously via five channels: two parallel channels for medical video data, one channel for transmission of medical telemetric information and command signals for administration of local and remote medical instruments, duplex sound channel and transceiving channel for text-type data. The number of channels can be increased on the customers request. 
1.1. Two parallel channels of medical video data transmission secure input, digitalizing, representation and transfer of medical video images with resolution of up to 768х576 dots (for analogue video cameras) and up to the maximum resolution possible for digital video and photo cameras (see next Figure 1).


Two parallel channels for transmission and imaging of medical video data are required so that a remote-based consulting physician in course of telemedicine tutorial or a remote-based physician cadet in the framework of remote medical education system could see basic and auxiliary information. For instance, in course of different types of operations such as endoscopic, abdominal, neuro-surgical, ophthalmologic, otolaryngology, dental etc. it would be possible to view not only the image of surgical intervention target, but the general picture of operating room along with the actions taken by members of operating crew. On the other hand, in the process of ultrasonic examination, a remote-based physician would be able not only to see a medical image transferred from ultrasound examination apparatus (UEA), but the picture showing position of ultrasonic sensor fixed on the body of a patient as well, thus permitting the consulting physician to render his advice along with correcting of the entire diagnostics procedure. Besides, in the framework of remote medical education in case one channel of medical video data transfer plays back a previously recorded video film on some unique procedure of diagnostics or operation, the other channel can transmit the picture of a physician, who is commenting on the broadcast film. In addition to the film transmitted over the second channel, the latter can transfer documentary texts or presentation materials along with any other graphic or illustrative data. Therefore, at a transfer of primary and auxiliary medical information, a remote-based physician receives almost the identical amount of data, as does the doctor, who stays in a direct contact with the patient. Both channels are equal in regard to their respective technical parameters and secure input and digitalizing of medical images with resolution of up to 768х576 dots (for analogue sources of medical video images) and up to maximum resolution feasible in respect to digital sources of medical video images. Compression standards for medical video images can be selected from the menu that contains the following algorithms: MJPEG, H.263, MPEG-4 and MPEG-2.

1.2. Transceiving channel for medical telemetric information and command signals for administration of remote medical equipment is meant for connection of medical devices and techniques possessing digital outputs for telemetric data (digital electrocardiographs, encephalographs, etc.) as well as management of local and remote medical equipment (controlled video cameras, robotized microscopes in course of pathomorphology diagnostics and in the future outlook robots destined for remote performance of surgical operations). Typical supply of a telemedicine system incorporates a channel for management and control over a video camera. Algorithms in regards to administration of other medical instruments can be included upon agreement with customers. 

1.3. Duplex acoustic channel is meant for audio exchange between remote participants of telemedicine tutorials or for remote medical education. High quality sound is secured due to incorporation of the acoustic compression standards set included into telemedicine systems. Such compression standards are as follows: G.711, G.728, G.723 etc.

1.4. Channel for text exchange is destined to procure text dialogue in the real time mode among the participants of telemedicine sessions. 

2. DiViSy TM21 telemedicine system incorporates the feature of a desktop by means of which a joint analysis is carried on along with combined work with medical images (Fig.2). 

At the initiative of any telemedicine session participant, an image, which in a particular moment of time holds the utmost interest, is placed on the desktop. For example, as it is demonstrated in the corresponding Figure, such image placed on the desktop depicts the data from endoscope in course of performance of bronchoscope. Session participants can use different-color marking pens (each participant selects a separate color) in order to indicate precise parts of the image where in their respective opinions a biopsy shall be taken. Moreover, with assistance of integrated drawing options on top of the image, a consulting physician can show boundaries of a tumor or the curve along which resection shall be made. Further on that image with all remarks rendered can be saved and stored by every participant of telemedicine session under a specifically created data format, designated as *.tmi. This format is brand new as the above listed features are not present in any other types of medical systems. Incorporation of those functions of analysis and work with medical images allows remote-based physicians concentrating their attention on precise and most informational sectors, whereas the option of saving and storing of images along with all remarks made, permits to rapidly restore later on the course of discussion held, along with the logic of decision making. 

3. Telemedicine system has an integrated local database for instant saving of images while holding telemedicine sessions. 

4. In order to process and improve the quality of medical images, telemedicine system incorporates as an option the DiViSy IP21 (Image Processing) software package that permits to perform the following operations: 
· to scale image with positive zooming of 2, 4, 8 and 16 times, along with negative zooming of 2, 4 and 8 times.
· to integrate frame sequence for the purpose of noise attenuation and , possibly, image contrast improving. Number of integrated frames can vary within the range from 2 to 300.
· to alter brightness and contrast of the input video signal. 
· to alter brightness and contrast of a frozen image, inclusive of images received due to integration. 
· to convert stilled image with assistance of single or several consecutive mathematical filter-operations. Filtration can be applied to entire image or to an arbitrarily chosen rectangular area of the same. Filters composition can be varied in accordance with customers requests. 
· to calculate and depict a bar chart of image dots brightness distribution or that of selected rectangular area of the image. 
· to normalize entire image or its selected rectangular area. 
· to measure linear sizes of the images elements. 
· to calibrate following measurement. 
· to save images in form of files pertaining to certain graphic format. 
· to copy images to the systems clipboard for their following processing by means of other programs and applications. 
· to load images from a graphic file or from the systems clipboard. 

The following photo depicts user interface in regard to the program of medical images processing and their quality improvement DiViSy IP21 (Fig3).

In addition to the above-mentioned program, telemedicine systems can incorporate other software programs and applications meant for processing of images, in conformity with customers requests. 

5. DiViSy TM21 telemedicine systems permit to carry out consulting and remote medical education sessions not only with a single remote-based physician or patient, but with many of them, including the option of video conference holding. To achieve this goal a telemedicine server DiViSy TM21VS has been designed. With assistance of this server it has become feasible to combine local telemedicine networks of medical institutions into one global network (wide area network) by means of servers cascading method. More to that, within the framework of such global telemedicine network it is possible to simultaneously hold several independent telemedicine sessions. Telemedicine server performs control and administration of the data streams in course of sessions, as well as performs multipoint telecouncils. 

6. DiViSy TM21 telemedicine systems are meant for operation with application of virtually any available channels of communication, in particular: telephone, radio, cellular, fiber optic, satellite and so on, inclusive of the channels secured by certified means of data protection. Transfer rate for medical information is limited by the data effective transmission speed in regards to certain applied communication channels. Minimum rate passed in course of testing of DiViSy TM21 telemedicine systems equals to 9,600 bits per second (GSM cellular channels), while the maximum rate reached the mark of up to 8 megabits per second. Technological settings are incorporated to the system through which it is feasible to select parameters of video and audio information quality, depending on actual rate of data transfer within the channel, in particular: alteration of images resolution within a wide range, modification of number of frames transferred per second, changing of algorithm and ratio of compression in respect to video images, etc. 

7. On request of customers DiViSy TM21 telemedicine systems can hold integrated standard means of user authentication on the basis of, for example, individual USB key, biometrical devices that scan a fingerprint, and so forth. Besides, detachable memory disks can be used that in the absence of user can be stored in a safe box. 

8. In compliance with customers request, the information received in course of holding of telemedicine tutorials can be transferred over to pre-existing medical data systems of running medical institutions. To reach this target, after analysis of formats of databases operating within medical informational systems of a customer has been complete, a specialized program module is being designed, by means of which telemedicine information is directed to the databases and as well similar information can be requested from other databases in course of telemedicine tutorials with the purpose of comparative analysis.

9. DiViSy TM21 telemedicine systems are based on unique program software with the same name designed and worked out in course of several years by the experts of DiViSy Group of Companies. That software incorporates the experience of practical running operation of previous versions of telemedicine systems: DiViSy PM1 and DiViSy TM2000. Therefore, if so required, it would not render any trouble to integrate a docking module to the system that would secure compatible connection with telemedicine systems of other manufacturing companies, provided however, that those systems, as well as DiViSy TM21, possess an open interface of data formats. 
DiViSy TM21 telemedicine systems have friendly Russian-speaking interface. At customers request, the current interface can be supplemented with native language speaking users interface.
DiViSy TM21 telemedicine systems can be easily adapted in consideration of the purpose of holding telemedicine consultations and remote education accounting traits and peculiarities of modern and irregular methods of diagnostics, treatment and surgical intervention. 
Possibilities of DiViSy TM21 telemedicine systems can be expanded through the connection of any peripheral devices, such as printers, scanners, interactive boards, documentary cameras, audio systems, projecting systems, etc.

10. DiViSy TM21 telemedicine systems are manufactured in several constructional versions:
10.1. Manufacturing version meant for diagnostics units and operating rooms (Fig.4). 

The above listed manufacturing version stands for a 19 rack on rollers designed to shift the equipment within the medical premise. The rack comprises: Video and audio data processing unit VADPU DiViSy, integrated to the Rack Mount case, uninterruptible power supply (UPS) system to secure fail-free operation within 15 minutes in case of power supply breakdown, power supply splitter to procure connection of all components of telemedicine system, sliding drawer for storing of documents and software CDs, a 17, 19 or 20 (in accordance with customers choice) monitor, radio microphone, audio speakers or audio head set, fixed or controlled video camera, cable set for connection to local area network and to other medical equipment. The rack provides spaces for installation and connection of printer, scanner, documentary camera or other peripheral devices. Video camera can be mounted over the rack or on a special supporting bracket (of wall, floor or ceiling mounting type), depending on ergonomics of work in each office or in an operating room. 

10.2. Manufacturing version meant for offices of medical institutions heads as well as for separate departments of such establishments. The present version represents two possible variants: on the basis of a personal computer or on the basis of a notebook, depending on customers choice. Provided there are computers allotted to the heads of medical institutions or heads of medical departments of the same, these machines can be converted into telemedicine systems through installation of appropriate hardware and software expanding applications. It is worth highlighting that all personal computers functions remain intact and unimpaired. (Fig.5)

The following photo shows DiViSy TM21 telemedicine system destined for managers and heads of medical institutions of various levels. 

10.3. Mobile version of telemedicine systems meant for ambulance vehicles, field diagnostics units or mobile hospitals. Pictures of this manufacturing option are exposed below(Fig.6,7) .

The present photo depicts a mobile telemedicine system DiViSy TM21 in an extended version with self-contained power supply on the basis of UAZ vehicle. The present photo shows a mobile telemedicine system DiViSy TM21 in a portable and protected manufacturing version, fitted with R-Bgan satellite station of Inmarsat system securing data transfer rate of up to 144 kilobits per second.

Mobile telemedicine system manufactured for moving objects can be mounted over vehicles, vessels, aircrafts, helicopters and other transportation means. Therefore mobile telemedicine diagnostics units along with telemedicine ambulance vehicles have been created. Such moving offices are fitted with mobile diagnostics equipment: digital electrocardiographs, compact ultrasonic examination apparatuses, compact X-ray units, etc. In addition to that, by means of supplied cables these mobile stations can be connected to stationary equipment installed in a remote polyclinic or hospital. With assistance of such mobile telemedicine systems it would be possible to arrange field diagnostics and prophylactic raids with the purpose of examining patients in hard-to-access areas as well as to receive prompt consultations in course of leaving for emergency calls. 

Mobile telemedicine system in a portable manufacturing version can be placed as integral part of mobile hospitals, as well as used individually by a physician upon his leave for a call to hard accessible regions.

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