WIRELESS ATM AS A BASE FOR
MEDICAL MULTIMEDIA APPLICATIONS AND TELEMEDICINE
P. DUDZIK, M. SCHOETTNER, A. KASSLER, A. LUPPER, P. SCHULTHESS
University of Ulm, Department of Distributed Systems, 89069 Ulm, Germany
{ schoettner | kassler | lupper | schulthess}@informatik.uni-ulm.de
Phone / Fax: +49 (0)731-502-4138 / 4142
ABSTRACT
Wireless ATM technology provides mobility, high band-
width, and quality of service (QoS) which is a promising
base for medical applications. In this paper the archi-
tecture of the European WAND (Wireless ATM Network
Demonstrator) System is presented which will be evalu-
ated in a medical environment. The doctoral needs are
access to patient databases, video-conferencing (VC) and
telemedicine (collaborative groupwork) wherever they are
in the hospital. Doctors are not willing to use special ap-
plications for groupwork, instead they want to continue
using their familiar programs. Therefore, we establish an
Application Sharing (AS) tool which extends standard
applications with multiple user capabilities. We describe
two different AS architectures including performance
evaluation. We also review QoS issues for transmitting
videos over wireless ATM connections. Such mobile
CSCW applications increase quality and efficiency of
treatment but require high bandwidth and low latency
which can be guaranted by a wireless ATM network. Be-
side these benefits this paper discusses possible radio
interference with medical equipment.
1. INTRODUCTION
During the last years a lot of special applications for
medical environments have been developed. These medi-
cal multimedia applications support doctors at their daily
work and therefore improve the treatment of patients.
Most of these programs are only designed for a single user
usage and don’t support collaborative groupwork. Espe-
cially collaboration in medical fields can gain synergistic
effects (e.g. discuss x-ray images with experts). For this
purpose we propose telemedicine (medical CSCW appli-
cations), which encompass video-conferencing (VC) and
groupware multimedia applications. However, doctors are
not willing to use special groupware toolkits. Instead they
want to keep their well known single user applications.
This can be realized by establishing the concept of Appli-
cation Sharing (AS). AS is an operating system extension
which enhances standard single user applications by
groupwork capabilities. Typically doctors are seldom at
their office but instead moving around in the hospital.
Availability of expert knowledge can be increased by
adding mobility to medical applications. Currently avail-
able high end notebooks satisfy the requirements of such
programs. This does not apply for available wireless net-
works (DECT, WaveLAN, etc.). Technologies like Wire-
less ATM developed within the Magic WAND, with
transmission rates up to 20 Mbit/s and Quality of Service
(QoS) provide a solid base for medical multimedia appli-
cations.
The first section of this paper is composed describes
the requirements of a medical environments. Section 3
unfolds the benefits of wirless ATM for medical applica-
tions. Afterwards, in section 4 an overview of the Magic
WAND Demonstrator is presented. In the following sec-
tion 5 we present the architecture and performance
evaluation of the medical software developed in WAND.
Section 6 focuses on QoS aspects for wireless video
transmission. The conclusion includes measurements of
possible risks caused by wireless networks in hospitals
and deals with questions of data protection.
2. REQUIREMENT PROFLE FOR A MEDICAL
ENVIRONMENT
The Magic WAND project, will evaluate the wireless
ATM technology in two user trials in hospitals. The intro-
duction of mobility offers new possibilities: a doctor has
full access to medical data (e.g. x-rays) while visiting pa-
tients at their bedside (see fig.-1). Furthermore expert con-
sultation is available everywhere, e.g. during a surgery.
The new developed applications meet the requirements of
the physicans evaluated by a questionaire. Various inter-
views (38) with doctors at Germany, Finland and Swit-
zerland revealed the following requirements (see [1]):
• office software for daily work
• access to patient databases
• viewing of x-rays images and ultrasonic videos
• collaboration supported by computers (video-
conferencing and application sharing)
Furthermore there was a great accordance for the imple-
mentation of wireless communication in hospitals. Wire-
less networks make all above services available independ-
ent of doctors location.
Nevertheless data protection (e.g. encryption on the wire-
less link) and avoidance of interferences with medical
equipment is a strict requirement.
Medical Consulting
over wireless ATM
AP
20 Mbit/s
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3. BENEFITS OF WIRLESS ATM FOR MEDICAL
APPLICATIONS
Wireless devices are only accepted if they provide data
fast and with high reliability. For example a typically x-
ray image consumes 1-3MB memory and transmitting it
requires high bandwidth. Additional VC necessitates a
guaranted quality of service for the transmission. Wireless
ATM can satisfy all these needs. Today, most hospitals
don’t have area-wide coverage with classical wired net-
works. Hence, wireless ATM is predestinated for closing
this gap. Furthermore one base station can serve multiple
mobile clients within an range of 50m. This can be a po-
tential saving of costs if compared to an area-wide instal-
lation of fixed networks.
4. OVERVIEW OF THE MAGIC WAND SYSTEM
The Magic WAND project brings the ATM technology to
wireless networks (see [2] and [3]), while all existing
services and applications currently available for fixed
ATM networks are supported. Applications developed in
the Magic WAND project run under Windows NT 4.0 and
use the WinSock 2.0 interface. They can either use native
ATM services or TCP/IP over LAN emulation. The
Magic WAND system is composed of four main compo-
nents:
• Mobile ATM Terminal (MT)
• Access Point (AP)
• Mobility enhanced ATM switch
• Control Station
The MT is the user device (e.g. notebook) with a built-in
radio interface card offering a wireless connection (20
MBit/s) to an AP. The MT is composed of two PCs. The
user PC runs Windows NT 4.0 with the terminal signaling
software (implemented below WinSock 2.0). The wireless
link is controlled by a second PC which compromises the
DLC layer and the WAND radio modem. The mobile ter-
minals are connected back-to-back with STM-1 ATM
connection. The APs are wired to the mobility enhanced
switch and create cells of approx. 50m diameter with ra-
dio-links in the 5 GHz band. The switch is a standard
customer premises ATM switch connected (via ATM) to a
Control Station
The Control Station provides support for mobility only in
software. Due to the till on-going implementation phase it
is impossible to present any performance evaluation for
the Magic WAND hardware at this point of time.
Control Station
Network
Server
Wireless ATM
5 GHz
20 Mbit/s Switch API
Access
Point
UNI
ATM network
ATM
switch
Mobile
Terminal Access
Point
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5. TELEMEDICINE SOFTWARE FOR WIRELESS
MEDICAL CONSULTATION
Typically, doctors use standard applications for their daily
work. These word processors or image-viewers are single
user applications which don’t support collaborative work.
However, telemedicine requires collaboration aware ap-
plications. There are different options for CSCW applica-
tions:
• develop special co-operation aware applications
È doctors can’t use standard applications
• screen sharing
È typically used for administration purposes
• application sharing tools
È share windows of standard applications
The Joint Viewing and Tele Operating System (JVTOS)
was developed within the CIO project (see [4]) allows
sharing of applications and video streams. With respect to
the wireless ATM and Windows NT as an OS basis a
complete redesign became necessary. We give now an
overview of the WAND JVTOS architecture and perform-
ance evaluation (see [5] and [1]). It consists of two main
parts (see figure-3): application sharing (white parts) and
audio/video subsystem (gray parts).
Because Windows NT doesn’t support displaying appli-
cations on remote machines, an OS extension, so called
Interceptor, was introduced. This module intercepts sys-
tem-calls of applications (e.g. drawing commands). These
system-calls are transformed to a network protocol and
passed to a remote display server called GDI-Server. The
shared application must only be installed on the exporting
machine. Every participant of a sharing conference only
needs the GDI-Server on his machine. Application Shar-
ing can be implemented in several ways:
• transmission of screen contents based on compressed
raster graphics (optional compressed)
• transmission of drawing commands (graphic primi-
tives including attributes)
0HG'%
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Interface to open video windows or to disconnect whole
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connection should be established. Since the user is not
concerned with network QoS parameters like cell loss
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ratio, the QoSC is a kind of wizard for fine-tuning the
quality of the connections and the system behaviour to the
specified user related parameters like expected visual
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quality.
GDI-Server
GDI-Server
The AVW compresses, distributes, serializes and
Figure-3, JVTOS architecture for WAND System mixes A/V streams. Two different operation modes are
possible depending on the side of the connection: on the
We evaluated the two application sharing architectures
distribution side, the AVW duplicates data (may be soft-
with different applications (figure-4) and measured net-
ware replicated, if different users are served with different
work output (kbit/s) and additional cpu load (1 = 100%)
compression methods or by using a multicast service) and
introduced by application sharing.
on the receiver side it merges/mixes (audio) or filters
Screen Capture Screen Capture Graphic (video) and decodes the incoming streams and forwards
with RLE Primitives them to the local PP, which displays the streams in local
Word processing 1600 / 0.3 1440 / 0.33 8 / 0.02 windows. AVW also sets up new ATM connections dy-
Shape drawing 9600 / 0.4 5520 / 0.43 960 / 0.3 namically using AAL5.
cube-animation 6240 / 0.38 1400 / 0.39 3500 / 0.1 The user is the starting point for evaluating the system.
Figure-4, comparison of different AS architectures
Without userfriendliness no success is possible. There-
(kbit/s and percentage of additional cpu load) fore, the user specifies his subjective wishes or satisfac-
tory values for the perceived quality of the A/V subsystem
Independent of the chosen implementation the network in a convenient way. The complexity to deal with QoS-
output of application sharing is very bursty. If there is no parameters is hidden by a simplified user interface [7].
user interaction, the network load is zero. However, if a This includes the acquisition of user perceived quality, the
user is scrolling large images, this requires high band- users preferences in the case the network or system cannot
widths. The following chart (figure-5) shows the through- support the old values longer (in this case the user can
put of the shape benchmark in different networks. select the category to degrade first like spatial resolution,
WaveLAN Ethernet ATM color, framerate). Based on these preferences, the system
Screen capture with RLE 960 440 5520
load and capabilities (like inbuild A/V equipment and
installed codecs) and the capabilities of the remote system
Graphic primitives 960 960 960
the network QoS parameters are calculated and negotiated
Figure 5, network throughput (in kbit/s) of the shape with the network in the following way: first the estimated
drawing application in different networks
parameters are used to set-up an ATM-connection to the
The application sharing system basing on graphic primi- remote host. If this connection is dropped or cannot be
tives represents the better solution for limited bandwidth established because it cannot be supported by the network,
(see [5] and [6]). For screen capturing solutions (like the AVWedge asks the QoSC for lower values based on
NetMeeting of Microsoft) only a fast ATM network can the users preferences and establishes a connection using
satisfy bandwidth requirements. Nevertheless, the bitmap conservative parameters and subsequently tries to increase
solution might be reasonable for heterogeneous environ- the capacity by establishing new connections based on
ments. higher values transparently to the user. [7] gives some
details in how the mapping functions between the users
6. QOS ISSUES FOR TRANSMITTING VIDEO OVER QoS wishes and the overall quality could look like.
WIRELESS ATM
A ressources controller inside the AVWedge continu-
The Audio/Video – subsystem of the WAND demonstra-
ously measures system and network behaviour for adapt-
tor consists of the following parts: Picture Phone (PP),
ing to different conditions. This is necessary for wireless
AVWedge (AVW) and QoS Controller (QoSC) and man-
transmissions, because the radio link quality can change
ages the acquisition, coding, scheduling and transport of
dramatically during a short period of time. If the BER (bit
A/V-streams. The PP serves as a front-end for the user,
error rate) on the wireless link increases, the WAND
displays and captures the audio and the video and for-
WDLC sublayer may reduce available bandwidth due to
wards the captured data to the AVW.
forward error correction (FEC) affecting negotiated QoS.
During a handover procedure, the new AP may not be
possible to support old negotiated QoS values which re-
sults in a drop of the connection. Then, the AVW has to
establish new connection transparently based on the users
preferences which may lead to quality of service re-
negotiation between all system and network layers.
This approach is very flexible and it would be possible
to obtain a desired frame rate by reducing framesize,
colordepth or imagequality. In general it would be possi-
ble with our system to select different codecs for different
users based on the system capabilities of the local and
remote hosts. But with current PCs it is not feasible to
compress one video frame more than once using different
codecs. This leads to the problem, that different users may
wish to receive the same video in different qualities si-
multaneously. The Wavevideo codec is designed scalable
and supports to extract different parts of the video stream
by using a multi-resolution representation and clever seg-
mentation of the video information into tagged network
frames (see 8]). By dropping the frames not needed for the
desired quality, the AVW (or an intermediate filter) can
extract the desired quality from the stream. The remaining
non redundant parts are then re-assembled and decoded
according to the negotiated QoS parameters allowing cli-
ents with a high bandwidth connection to display a high
quality, high resolution video-stream and simultaneously
low bandwidth clients to be served by low resolution or
greyscale frames from the high quality color video stream
without the need for transcoding.
7. CONCLUSION
The use of radio based communications devices raises the
problem of interferences with sensitive medical equipment
(Electro Magnetic Compatibility = EMC). Due to the fear
of EMC mobile telephones are forbidden in most german
hospitals. However the WAND technology has no signifi-
cant influence on medical devices (see [7]). Furthermore
WAND equipment only operate at lower power levels and
higher frequencies like GSM.
Another problem is prevention of intruders. Authori-
zation of the MT is realized by a registration mechanism
between MT and AP, when the MT enters the network.
Data security can be achieved by introducing a data en-
cryption algorithm above the link level.
Without doubt, mobility in medical environments en-
hances treatment of patients. Wireless ATM is a solid
base for a medical environment as it offers high band-
widths and guaranted QoS required by Telemedicine (VC
and AS). By sharing standard applications the acceptance
in medical environments can be greatly increased.
ACKNOWLEDGGEMENT
This work has been performed in the framework of the
project ACTS AC085 The WAND which is partly funded
by the European Commission and the Swiss Bundesamt
für Bildung und Wissenschaft. The Authors would like to
acknowledge the contributions of colleagues from Nokia
Mobile Phones, Tampere University of Technology,
Technical Research Centre of Finland, Ascom Tech AG,
Lucent Technologies WCND, University of Lancaster,
Robert BOSCH GmbH, University of Ulm, Compagnie
IBM France, IBM Zuerich Research Laboratory, ETH
Zuerich, INTRACOM Hellenic Telecommunications and
University of Athens.
REFERENCES
[1] A. Kassler, A. Lupper, Multimedia Applications in
Medical Environments over Wireless ATM, ACTS
Mobile Communication Summit ’96, 1996
[2] J. Ala-Laurila, G. Awater, The Magic WAND –
Wireless ATM Network Demonstrator System, ACTS
Mobile Communication Summit ’97, 1997
[3] J. Mikkonen, J. Kuys, The Magic WAND: A Wire-
less ATM Access System, ACTS Mobile Summit '96,
1996
[4] H. Wolf, K. Froitzheim, P. Schulthess, Multimedia
Application Sharing in a Heterogeneous Environ-
ment, ACM Multimedia '95, 1995
[5] M. Schoettner, A. Kassler, A. Lupper, P. Dudzik P.
Schulthess, Application Sharing – Architecture and
Performance Analysis, ACTS Mobile Communication
Summit ’97, 1997
[6] M. Schoettner, Application Sharing mit MS-
Windows, Diplomarbeit, University of Ulm, 1996
[7] R. Wood, G. Fankhauser, R. Kreula: Multimedia Ap-
plications and QoS support in a wireless ATM envi-
ronment, Proceedings of the ACTS Mobile Communi-
cation Summit ’97, 1997
[8] G. Frankhauser, M. Dasen, An Error Tolerant, Scal-
able Video Stream Encoding and Compression for
Mobile Computing, Proceedings of the ACTS Mobile
Communication Summit ’96
[9] P. Schelbert, U. Lott, Report on Measured Interfer-
ence Effects of Magic WAND Devices on Sensitive
Medical Equipment, Magic WAND, Deliverable 2D2,
August 1996