Computational Intelligence and Blockchain - Pankaj Bhambri

Computational Intelligence
and Blockchain in
Biomedical and
Health Informatics
Advancements in computational intelligence, which encompasses artificial
intelligence, machine learning, and data analytics, have revolutionized the way
we process and analyze biomedical and health data. These techniques offer
novel approaches to understanding complex biological systems, improving
disease diagnosis, optimizing treatment plans, and enhancing patient outcomes.
Computational Intelligence and Blockchain in Biomedical and Health Informatics
introduces the role of computational intelligence and blockchain in the biomedical
and health informatics fields and provides a framework and summary of the various
methods. The book emphasizes the role of advanced computational techniques and
offers demonstrative examples throughout. Techniques to analyze the impacts on
the biomedical and health informatics domains are discussed along with major
challenges in deployment. Rounding out the book are highlights of the transformative
potential of computational intelligence and blockchain in addressing critical issues
in healthcare from disease diagnosis and personalized medicine to health data
management and interoperability along with two case studies. This book is highly
beneficial to educators, researchers, and anyone involved with health data.
Features:
• Introduces the role of computational intelligence and blockchain in the
biomedical and health informatics fields.
• Provides a framework and a summary of various computational intelligence
and blockchain methods.
• Emphasizes the role of advanced computational techniques and offers
demonstrative examples throughout.
• Techniques to analyze the impact on biomedical and health informatics are
discussed along with major challenges in deployment.
• Highlights the transformative potential of computational intelligence and
blockchain in addressing critical issues in healthcare from disease diagnosis
and personalized medicine to health data management and interoperability.
Computational Intelligence
and Blockchain in
Biomedical and Health
Informatics
Edited by
Pankaj Bhambri, Sita Rani, and
Muhammad Fahim
Designed cover image: Shutterstock
First edition published 2024
by CRC Press
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and by CRC Press
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CRC Press is an imprint of Taylor & Francis Group, LLC
© 2024 selection and editorial matter, Pankaj Bhambri, Sita Rani, and Muhammad Fahim; individual
chapters, the contributors
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Library of Congress Cataloging‑in‑Publication Data
Names: Bhambri, Pankaj, editor. | Rani, Sita, editor. | Fahim, Muhammad (Researcher in artificial
intelligence), editor.
Title: Computational intelligence and blockchain in biomedical and health informatics / edited by
Panjak Bhambri, Sita Rani, and Muhammad Fahim.
Description: First edition. | Boca Raton : CRC Press, 2025. | Includes bibliographical references and
index. | Summary: “Advancements in computational intelligence, which encompasses artificial
intelligence, machine learning, and data analytics, have revolutionized the way we process and
analyze biomedical and health data. These techniques offer novel approaches to understanding
complex biological systems, improving disease diagnosis, optimizing treatment plans, and enhancing
patient outcomes. Computational Intelligence and Blockchain in Biomedical and Health Informatics
introduces the role of computational intelligence and blockchain in the biomedical and health
informatics fields and provides a framework and summary of the various methods”— Provided by
publisher.
Identifiers: LCCN 2023057700 | ISBN 9781032604701 (hardback) | ISBN 9781032604800 (paperback) |
ISBN 9781003459347 (ebook)
Subjects: LCSH: Artificial intelligence—Medical applications. | Blockchains (Databases) | Medicine—
Data processing. | Computational intelligence.
Classification: LCC R859.7.A78 C6383 2025 | DDC 610.285—dc23/eng/20240319
LC record available at https://lccn.loc.gov/2023057700
ISBN: 978-1-032-60470-1 (hbk)
ISBN: 978-1-032-60480-0 (pbk)
ISBN: 978-1-003-45934-7 (ebk)
DOI: 10.1201/9781003459347
Typeset in Times LT Std
by Apex CoVantage, LLC
Contents
Preface�� xix
Authors..................................................................................................................... xxi
List of Contributors�� xxiii
Chapter 1 Bioengineering and Healthcare Data Analysis: Introduction,

Advances, and Challenges�� 1
Pankaj Bhambri and Sita Rani
1.1 Introduction�� 1
1.1.1 Overview of Bioengineering in Healthcare�� 1
1.1.2 Role of Data Analysis in Bioengineering�� 3
1.2 Foundations of Bioengineering and Healthcare
Data Analysis�� 4
1.2.1 Basics of Bioengineering�� 4
1.2.2 Data Sources in Healthcare�� 5
1.2.3 Data Preprocessing and Cleaning�� 6
1.2.4 Statistical and Machine Learning Techniques�� 7
1.3 Applications of Bioengineering Data Analysis�� 8
1.3.1 Disease Diagnosis and Prognosis�� 8
1.3.2 Drug Discovery and Development�� 8
1.3.3 Personalized Medicine�� 8
1.3.4 Telemedicine and Remote Monitoring�� 8
1.4 Advances in Bioengineering Data Analysis�� 9
1.4.1 Big Data Analytics in Healthcare�� 9
1.4.2 Artificial Intelligence and Machine Learning Models�� 9
1.4.3 Blockchain in Healthcare Data Management�� 9
1.4.4 Wearable Technology and IoT in
Bioengineering�� 9
1.5 Challenges and Ethical Considerations�� 10
1.5.1 Data Privacy and Security�� 10
1.5.2 Interpretability and Transparency�� 11
1.5.3 Ethical Issues in Healthcare Data Analysis�� 12
1.5.4 Regulatory Compliance�� 13
1.6 Future Directions and Emerging Trends�� 15
1.6.1 Predictive Analytics and Precision Medicine�� 15
1.6.2 Integrative Bioengineering and Data Analysis�� 16
1.6.3 AI-Driven Healthcare Decision Support�� 18
1.6.4 Collaborative Research and Interdisciplinary
Approaches�� 18
1.7 Case Studies�� 19
1.7.1 Case Study 1: Applying Machine Learning in
Disease Diagnosis�� 19
v
vi Contents
1.7.2 Case Study 2: Blockchain Implementation in

Healthcare�� 20
1.7.3 Case Study 3: Ethical Dilemmas in Healthcare
Data Analysis�� 21
1.8 Conclusion�� 23
1.8.1 Summary of Key Points�� 23
1.8.2 Implications for the Future�� 23
1.8.3 Closing Remarks�� 23
References�� 24
Chapter 2 Biomedical Engineering Modelling and Simulation�� 26

Himanshu M. Shukla, Ambarish A. Deshpande,
Kanchan D. Ganvir, and Jignyasa Gandhi
2.2 Scope of the Chapter�� 26
2.2.1 Fundamentals of Modelling and Simulation�� 26
2.2.2 Biomedical Systems and Processes�� 26
2.2.3 Medical Imaging and Image Analysis�� 27
2.2.4 Biomaterials and Tissue Engineering�� 27
2.2.5 Medical Device Design and Evaluation�� 27
2.2.6 Clinical Decision Support and Personalized
Medicine�� 27
2.3 Related Literature�� 28
2.4 Role of Anthropometry in Biomedical Modelling
and Simulation�� 31
2.4.1 Need for Automation in Anthropometric
Data Measurement�� 31
2.4.2 Applications of Automated Anthropometric
Data Measurement�� 31
2.4.3 Challenges and Future of Automated
Anthropometric Measurement�� 32
2.5 Harnessing Artificial Neural Networks in Biomedical
Modelling and Simulation�� 32
2.6 Human Modelling and Simulation�� 33
2.7 Conclusion and Future Scope�� 36
References�� 36
Chapter 3 Information Extraction and Knowledge Discovery in

Biomedical Engineering and Health Informatics�� 39
S. Archana and E. Mathiselvan
3.1 Introduction to Information Extraction and Knowledge
Discovery�� 39
3.1.1 Definition and Significance�� 39
3.1.2 Overview of the Chapter�� 40
Contents vii
3.2 Text Mining Techniques in Biomedical Engineering�� 40

3.2.1 Named Entity Recognition (NER) for
Identifying Biomedical Entities�� 44
3.2.2 Relation Extraction for Uncovering
Relationships Between Biomedical Entities�� 45
3.2.3 Text Classification for Categorizing Biomedical
Documents�� 45
3.2.4 Introduction to Information Retrieval�� 46
3.3 Data Mining and Machine Learning in Biomedical
Engineering�� 46
3.3.1 Data Mining and Machine Learning Techniques
in Biomedical Data Analysis�� 47
3.3.2 Feature Extraction and Selection for Biomedical
Data�� 48
3.3.3 Clustering and Classification Algorithms for
Biomedical Data Analysis�� 48
3.4 Knowledge Discovery from Electronic Health Records
(EHRs)�� 48
3.4.1 Utilizing Electronic Health Records (EHRs)
for Knowledge Discovery�� 50
3.4.2 Preprocessing and Data Cleaning of EHR
Data�� 50
3.4.3 Association Rule Mining for Identifying
Patterns and Relationships in EHR Data�� 50
3.4.4 Predictive Modeling Using EHR Data for
Disease Diagnosis and Prognosis�� 50
3.5 Ethical and Legal Considerations in Information
Extraction and Knowledge Discovery�� 51
3.5.1 Privacy and Security Issues in Biomedical
Data Mining�� 51
3.5.2 Compliance with Healthcare Regulations
(e.g., HIPAA)�� 52
3.6 Emerging Trends and Current Advancements�� 52
References�� 53
Chapter 4 Distributed Frameworks: Applications and Security Issues�� 55

G. Adiline Macriga and S. Sankari
4.1 Distributed Frameworks�� 55
4.2 Challenges in Distributed Frameworks�� 55
4.3 Applications of Distributed Frameworks�� 56
4.3.1 Decentralized Finance (DeFi) Applications�� 56
4.3.2 Health and Medical Applications of
Distributed Frameworks�� 57
viii Contents
4.4 Security Issues in Distributed Frameworks�� 58

4.4.1 Consensus Algorithm Vulnerabilities and
Attacks�� 60
4.4.2 Smart Contract Security Issues and Best
Practices�� 60
4.4.3 Network Attacks and Their Impact on
4.4.4 Privacy and Confidentiality Challenges in
References�� 64
Chapter 5 Blockchain Technology Framework: Issues and Future

Challenges�� 66
Shital Sharma and Palvinder Singh Mann
5.1.1 Background�� 66
5.1.2 Blockchain Architecture�� 66
5.1.3 Organization of Chapter�� 68
5.2 Blockchain Frameworks�� 68
5.2.1 State-of-the-Art Blockchain Frameworks�� 68
5.2.2 Analysis of Blockchain Framework�� 70
5.2.3 Comparison of Blockchain Frameworks�� 72
5.3 Challenges for Blockchain Framework�� 74
5.4 Key Future Issues�� 75
5.4.1 Scalability�� 75
5.4.2 Enhanced Security and Privacy�� 75
5.4.3 Cross-Chain Interoperability�� 75
5.4.4 Governance and Decentralization Models�� 76
5.4.5 Environmental Impact and Sustainability�� 76
References�� 77
Chapter 6 Blockchain Technology State of Art and Future Scenario�� 79

Sudheer Mangalampalli, Ganesh Reddy Karri,
Nukala Naveen Kumar, and Diya Gupta
6.2 History of Blockchain�� 80
6.3 Origin of Blockchain Technology�� 80
6.3.1 Rapid Evolution of Blockchain:
A Distributed Ledger Revolution�� 80
6.4 Transparent and Secure Transactions in Blockchain�� 80
6.5 Core Concepts of Blockchain�� 81
6.5.1 Intermediatory and Peer-to-Peer�� 81
Contents ix
6.6 Centralized Versus Decentralized Systems of

Blockchain�� 81
6.6.1 Centralized System�� 82
6.6.2 Decentralized Database�� 82
6.6.3 Concerns of Centralized Versus Decentralized
Systems of Blockchain�� 82
6.7 Blockchain: General Block Structure�� 83
6.8 Generic Blockchain Structure�� 84
6.9 Applications of Blockchain�� 85
6.10 Types of Blockchain Networks�� 86
6.10.1 Public Blockchain�� 86
6.10.2 Private Blockchain�� 87
6.10.3 Consortium Blockchain�� 87
6.11 Advantages and Disadvantages�� 87
6.12 Challenges and Risks�� 88
6.13 Future Perspectives of Blockchain�� 89
References�� 90
Chapter 7 Security Aspects of Blockchain Technology�� 92

Mayuresh B. Gulame, Nilesh N. Thorat, Aarti P. Pimpalkar,
and Deepali A. Lokare
7.1.1 Evaluation of the Blockchain�� 92
7.1.2 Numerous Categories of Blockchain�� 93
7.2 Security Features of Blockchain-Based Systems�� 95
7.2.1 Consistency Data�� 95
7.2.2 Tamper-Proof Data�� 95
7.2.3 Network with a Distributed Denial-of-Service
Attack Defense�� 95
7.2.4 Secure and Confidential Data�� 96
7.3 Security With Blockchain Technology�� 96
7.3.1 51% Attack�� 96
7.3.2 Smart Contract Vulnerabilities�� 96
7.3.3 Privacy Concerns�� 97
7.3.4 DDoS (Distributed Denial-of-Service) Attacks�� 97
7.3.5 Sybil Attacks�� 97
7.3.6 Vulnerabilities in the Consensus Mechanism�� 97
7.3.7 Supply Chain Attacks�� 98
7.3.8 User Error and Social Engineering�� 98
7.4 Approaches to Security and Privacy in Blockchain-Based
Systems�� 98
7.4.1 Private Digital Signatures�� 98
7.4.2 Homomorphic Encryption Algorithms�� 99
x Contents
7.4.3 Secure Multiparty Computation Protocol�� 99

7.4.4 Noninteractive System for Zero-Knowledge Proof�� 99
7.5 Block Structure�� 99
7.5.1 Block Characteristics�� 100
7.5.2 Hash Method�� 103
7.5.3 Consensus Algorithm�� 103
7.6 Applications of Blockchain Technology�� 104
7.6.1 Healthcare�� 104
7.6.2 Crowdfunding for Equity�� 105
7.6.3 Banking�� 106
7.6.4 Smart Power Grid�� 107
7.6.5 System for Smart Delivery�� 107
References�� 107
Chapter 8 Computational Intelligence and Blockchain in Diversified

Applications�� 110
Shailesh Shetty S. and Supriya B. Rao
8.1.1 Overview of Blockchain Technology�� 110
8.1.2 Introduction to Ethereum Blockchain�� 111
8.1.3 Benefits of Ethereum Blockchain for Storing
Clinical Trials and Records�� 111
8.1.4 Potential Applications and Use Cases�� 112
8.1.5 Challenges and Considerations�� 112
8.2 Literature Survey�� 112
8.2.1 Blockchain Technology in Healthcare Data
Management�� 112
8.2.2 Ethereum Blockchain for Clinical Trials and
Records�� 113
8.2.3 Benefits and Challenges of Ethereum
Blockchain in Healthcare�� 113
8.2.4 Future Directions and Emerging Research�� 113
8.3 Methodology�� 115
8.3.1 Introduction�� 115
8.3.2 Data Collection�� 115
8.3.3 Literature Review�� 115
8.3.4 Analysis and Synthesis�� 115
8.3.5 Case Studies and Use Cases�� 115
8.3.6 Evaluation and Discussion�� 116
8.3.7 Future Directions and Recommendations�� 116
8.4 Implementation�� 116
8.4.1 Infrastructure Setup�� 116
8.4.2 Smart Contract Development�� 117
8.4.3 Data Integration and Migration�� 117
Contents xi
8.4.4 User Interfaces and Access Management�� 117

8.4.5 Testing and Validation�� 117
8.4.6 Deployment and Evaluation�� 117
8.5 Results�� 118
8.5.1 Data Security�� 118
8.5.2 Accessibility�� 118
8.5.3 Usability�� 118
8.5.5 Feedback and User Satisfaction�� 119
8.5.6 Limitations and Challenges�� 119
8.7 Future Work�� 121
Chapter 9 Computational Intelligence and Blockchain in Distributed

Applications: Benefits and Challenges�� 123
Satyam, V. Vijaya Kishore, K. Neelima, and N. Ashok Kumar
9.1.1 Complications�� 124
9.1.2 Applications of Distributed Systems�� 124
9.1.3 Blockchain Architecture�� 124
9.1.4 Applications of Blockchain�� 126
9.1.5 Artificial Intelligence and Its Applications�� 127
9.2 Integration of Artificial Intelligence and Blockchain�� 127
9.2.1 Benefits of AI-Integrated Blockchains�� 128
9.2.2 Challenges of AI-Integrated Blockchain�� 128
Chapter 10 Computational and Blockchain Methods in Distributed

Biomedical and Health Informatics: Applications,
Architecture, Applications, and Challenges�� 134
Harpreet Kaur Channi, Pulkit Kumar, and Parminder Singh
10.2 Computational Methods in Biomedical and Health
Informatics�� 135
10.3 Blockchain Technology in Biomedical and Health
10.4 Methods and Materials�� 137
10.4.1 Results of the Bibliographic Analysis of Data�� 141
10.5 Need for Computational and Blockchain�� 144
10.6 Applications of Computational and Blockchain
Methods�� 146
xii Contents
10.7 Architecture of Distributed Biomedical and Health

10.7.1 Graphical Representation�� 148
10.8 Challenges and Future Scope in Implementing
Computational and Blockchain Methods�� 150
10.8.1 Challenges�� 150
10.8.2 Future Scope�� 150
Chapter 11 Healthcare Computational Intelligence and Blockchain:

Real-Life Applications�� 155
Rachna Rana and Pankaj Bhambri
11.1 Introduction to Blockchain�� 155
11.1.1 Steps in Blockchain Technology’s Operation�� 156
11.2 Requirements of Blockchain in Healthcare�� 156
11.3 Main Repayments of the Blockchain (Combined With
Intelligence)�� 157
11.4 Technologies of Blockchain�� 158
11.5 Real-Life Applications of Blockchain in Healthcare
and Intelligence�� 159
Chapter 12 Intelligent Development in Healthcare With the Internet�� 169

Shivmanmeet Singh and Harmandeep Kaur
12.2 Real-Time Monitoring and Alarm Generation�� 170
12.2.1 Smart Sensors�� 170
12.3 Edge, Cloud, and Fog Computing�� 173
12.3.1 WBANs (Wireless Body Area Networks)�� 173
12.4 Telemedicine�� 175
12.4.1 Utility of Telemedicine�� 176
12.4.2 Types of Technology�� 176
12.4.3 Infrastructural System�� 176
12.4.4 Internet Telecommunication Technology�� 178
12.4.5 Application of Telemedicine in Public Health�� 178
12.5 Results and Discussion�� 179
Contents xiii
Chapter 13 Intelligent Development in Healthcare With the Internet:

Case Study I�� 186
Utpal Ghosh and Uttam Kumar Mondal
13.2 Literature Review�� 188
13.3 Proposed Methodology�� 189
13.3.1 Health Organization Level�� 190
13.3.2 Resource Management Level�� 190
13.3.3 Patient-Oriented Level�� 190
13.3.4 Disease Monitoring Level�� 190
13.4 Results and Discussion�� 193
13.5 Implementation�� 198
13.5.1 Acoustic Body Sensor and Coordinator Device�� 198
13.5.2 Access Point�� 199
13.5.3 Servers�� 199
13.5.4 XAMPP Platform�� 199
13.5.5 Open and Limited Access Blockchain�� 200
13.5.6 Decentralized Blockchain Technology�� 200
13.5.7 Display Monitoring Centre�� 200
13.5.8 Emergency Services�� 200
Chapter 14 Intelligent Development in Healthcare With the Internet:

Case Study II�� 204
Varsha Gautam and Surbhi Gupta
14.2 Intelligent Development in Healthcare�� 205
14.3 Base of Intelligent Development in Healthcare�� 206
14.3.1 IoT/ IoMT: Keys to Implementation of
Sustainable Development�� 207
14.3.2 Machine Learning in Healthcare�� 209
14.4 ML-Based Intelligent Development in Healthcare�� 209
14.6 Result�� 212
14.7 Discussion�� 213
xiv Contents
Chapter 15 Unleashing the Potential of Blockchain in Healthcare: A

Comparative Analysis of Leading Companies�� 217
Navroop Kaur, Upinder Kaur, and Harpal Singh
15.2 Significance of Blockchain in Healthcare�� 217
15.3 Applications and Benefits of Blockchain in Healthcare�� 218
15.3.1 Data Management and Interoperability�� 218
15.3.2 Patient Identity and Consent Management�� 218
15.3.3 Clinical Trials and Research�� 219
15.3.4 Supply Chain Management�� 219
15.4 Challenges and Considerations in Implementing
Blockchain�� 219
15.4.2 Data Privacy and Security�� 219
15.4.3 Standardization and Interoperability�� 219
15.4.4 Regulatory and Legal Considerations�� 220
15.5 Exploring Key Blockchain Concepts�� 220
15.5.1 Public Blockchains�� 220
15.5.2 Private Blockchains�� 220
15.5.3 Federated Blockchains�� 220
15.5.4 Smart Contracts: A Game-Changing Technology
in Healthcare�� 221
15.5.5 Tokenization in Healthcare: Understanding
Token Usage�� 221
15.6 Comparative Analysis of Leading Companies�� 221
15.6.1 Overview of Leading Companies in Blockchain
Healthcare Solutions�� 221
15.6.2 Analysis of Key Features�� 223
15.7 Insights and Implications�� 224
15.7.1 Key Findings From the Comparative Analysis�� 224
15.7.2 Challenges and Opportunities in the Adoption
of Blockchain�� 225
15.8 Future Directions and Recommendations�� 226
Chapter 16 Threat Analysis and Security Measures for the Internet of

Medical Things (IoMT): A Study�� 229
S. Velmurugan, G. Shanthi, L. Raja, and D. Subitha
16.1.1 Internet of Medical Things (IoMT)�� 229
16.1.2 Data Processing Architecture of IoMT�� 229
16.1.3 Impact Analysis of IoMT Wearables in
Healthcare�� 230
16.1.4 Remote Patient Monitoring (RPM) System�� 231
Contents xv
16.1.5 Different Types of Homecare Sensors

Used in Healthcare Systems�� 231
16.1.6 Smart Diagnostic Devices: The Magical Fusion
of Medicine and Technology�� 232
16.2 Threats and Challenges of IoMT�� 233
16.3 Cyber-Physical Systems (CPS)�� 234
16.4 Cyber-Physical Systems and Internet of Medical Things�� 235
16.5 Trust, Security, and Privacy Mechanism for IoMT
and CPS�� 236
16.5.1 Parameters for IoMT and CPS�� 237
16.6 IoMT Security Essentials�� 239
16.6.1 Estimation of Risk�� 239
16.6.2 Implementation of IoMT Security Essentials�� 239
16.6.3 Cyberattacks Against the Internet of Medical
Things�� 240
Chapter 17 Leveraging Web 3.0 to Develop Play-to-Earn Apps

in Healthcare using Blockchain�� 243
Yogesh Kisan Mali, Vijay Rathod, Sweta Dargad,
and Jyoti Yogesh Deshmukh
17.2 Related Work�� 244
17.3 Experimental Methodology�� 245
17.3.1 Key Blockchain Technology Features�� 245
17.3.2 Benefits of Blockchain Innovation in
Medical Care Information the Executives�� 248
17.4 Opportunities�� 251
17.5 Open Research Challenges�� 252
17.6 Leveraging Blockchain in Web 3.0: Empowering
Transparency and Rewards�� 253
17.6.1 Case Study�� 254
17.7 Conclusions�� 255
Chapter 18 Advancements in Modelling, Imaging, and Simulation of

Cardiovascular Diseases: A Technological Revolution in
Modern Healthcare�� 258
S. Sharmila, M. Nirmala, D. Somasundaram, and M. Menagadevi
18.1 Imaging Modalities for CVD�� 258
18.2 Simulation Tool�� 260
18.2.1 Framingham Heart Study Risk Score
Calculator�� 260
xvi Contents
18.2.2 QRISK�� 261

18.2.3 Reynolds Risk Score�� 261
18.2.4 American Heart Association Risk Calculator�� 262
18.2.5 Machine Learning Models�� 263
18.3 Computation Fluid Dynamics�� 265
18.4 Data-Driven Modelling�� 266
18.5 Artificial Intelligence in CVD�� 268
18.6 Virtual Reality and Augmented Reality�� 269
18.7 Challenges and Future Direction in Modelling Imaging
and Simulation of CVD�� 271
Chapter 19 Blockchain-Enhanced Convolutional Neural Networks

for Efficient Detection of Cardiovascular Abnormalities�� 275
Shaik Karimullah, Fahimuddin Shaik, D. Vishnu Vardhan,
and Ch. Nagaraju
19.1.1 Background and Significance�� 276
19.1.2 Problem Statement�� 276
19.2 Literature Review�� 277
19.3 Proposed Framework for Blockchain-Enhanced
CNN for Cardiovascular Abnormality Detection�� 278
19.4 Quantitative Metrics�� 280
19.4.1 Accuracy�� 280
19.4.2 Sensitivity�� 280
19.4.3 Specificity�� 281
19.5 Experimental Evaluation and Results�� 281
Chapter 20 Research Landscape of Blockchain and Computational

Intelligence in Healthcare and Biomedical Fields:
A Bibliometric Analysis�� 292
Parul Dubey, Amit Srivastava, Priti Nilesh Bhagat,
and Pushkar Dubey
20.2 Bibliometric Analysis: An Overview�� 293
20.4 Data Source and Collection�� 295
20.5 Data Extraction and Preprocessing�� 296
20.6 Publication Trends�� 297
20.7 Co-authorship Analysis�� 297
20.8 Co-occurrence Analysis�� 301
20.9 Citation Analysis�� 302
Contents xvii
20.10 Bibliographic Coupling�� 302

20.11 Advantages and Challenges�� 303
20.11.1. Advantages of Blockchain in Healthcare�� 303
20.11.2. Challenges of Blockchain in Healthcare�� 304
20.11.3. Advantages of Computational Intelligence
in Healthcare�� 304
20.11.4. Challenges of Computational Intelligence in
Healthcare�� 304
Chapter 21 Bone Marrow Cancer Detection From Leukocytes using

Neural Networks�� 307
Sundari M. Shanmuga and Pankaj Bhambri
21.3 Proposed System�� 310
21.3.1.Architecture�� 310
21.3.2. Algorithm ResNet50�� 311
21.3.3. Algorithm MobileNetV2�� 313
21.4 Result�� 315
Chapter 22 Pulmonary and Lungs Nodule Classification using

Deep Learning�� 320
22.3 Proposed System�� 323
22.3.1.Methodology�� 323
22.3.2. Algorithm VGG16�� 324
22.3.3. Algorithm InceptionV3�� 325
22.4 Result�� 328
22.4.1.Discussion�� 328
Index�� 333
Preface
This book explores the intersection of two rapidly evolving fields, computational
intelligence, and blockchain technology, and their profound impact on biomedical
and health informatics. As editors, we are delighted to present this collection of
insightful contributions from leading researchers and practitioners in the field.
Advancements in computational intelligence, which encompasses artificial intelli-
gence, machine learning, and data analytics, have revolutionized the way we process
and analyze biomedical and health data. These techniques offer novel approaches to
understanding complex biological systems, improving disease diagnosis, optimiz-
ing treatment plans, and enhancing patient outcomes. By harnessing the power of
computational intelligence, we can unlock new insights and accelerate progress in
healthcare. In parallel, blockchain technology has emerged as a transformative force
in various industries, and healthcare is no exception. With its inherent properties of
decentralization, immutability, and transparency, blockchain has the potential to rev-
olutionize the way health data is stored, shared, and secured. It enables the creation of
tamper-resistant health records, facilitates secure data exchange among stakeholders,
and empowers patients to have greater control over their personal health information.
This book provides a comprehensive overview of the applications, challenges, and
opportunities arising from the fusion of computational intelligence and blockchain
in the field of biomedical and health informatics. The chapters cover a wide range
of topics, including intelligent data analysis, predictive modelling, clinical decision
support systems, privacy and security in healthcare, patient-centric approaches, and
the integration of blockchain with other emerging technologies. The contributions
in this book highlight the transformative potential of computational intelligence and
blockchain in addressing critical issues in healthcare. From disease diagnosis and
personalized medicine to health data management and interoperability, these tech-
nologies have the potential to drive significant advancements and reshape the future
of healthcare.
We would like to express our gratitude to the authors who have contributed their
expertise and insights to this volume. Their dedication and commitment to advanc-
ing the field have made this book a valuable resource for researchers, practitioners,
and students interested in the intersection of computational intelligence, blockchain,
and healthcare. We hope that this book serves as a catalyst for further exploration nd
innovation in the field of biomedical and health informatics. We invite readers to
delve into the chapters, engage with the ideas presented, and envision the transfor-
mative possibilities that computational intelligence and blockchain bring to the realm
of healthcare.
xix
Authors
Dr. Pankaj Bhambri is affiliated with the Department of Information Technology at
Guru Nanak Dev Engineering College in Ludhiana. Additionally, he fulfills the role
of convener for his departmental board of studies. He possesses nearly two decades of
teaching experience. He is an active member of IE India, ISTE New Delhi, IIIE Navi
Mumbai, IETE New Delhi, and CSI Mumbai. He has contributed to various research
activities while publishing articles in the renowned SCIE and Scopus journals
and conference proceedings. He has also published several international patents.
Dr. Bhambri has garnered extensive experience in the realm of academic publishing,
having served as an editor/author for a multitude of books in collaboration with
esteemed publishing houses such as CRC Press, Elsevier, Scrivener, and Bentham
Science. Dr. Bhambri has been honored with several prestigious accolades, including
the ISTE Best Teacher Award in 2023 and 2022, the I2OR National Award in
2020, the Green ThinkerZ Top 100 International Distinguished Educators Award
in 2020, the I2OR Outstanding Educator Award in 2019, the SAA Distinguished
Alumni Award in 2012, the CIPS Rashtriya Rattan Award in 2008, the LCHC
Best Teacher Award in 2007, and numerous other commendations from various
government and non-profit organizations. He has provided guidance and oversight
for numerous research projects and dissertations at the postgraduate and Ph.D.
levels. He successfully organized a diverse range of educational programs, securing
financial backing from esteemed institutions such as the AICTE, the TEQIP, among
others. Dr. Bhambri’s areas of interest encompass machine learning, bioinformatics,
wireless sensor networks, and network security.
Dr. Sita Rani works in the Department of Computer Science and Engineering at
Guru Nanak Dev Engineering College, Ludhiana. She earned her Ph.D. in Computer
Science and Engineering from I.K. Gujral Punjab Technical University, Kapurthala,
Punjab, in 2018. She has also completed the Postgraduate Certificate Program in Data
Science and Machine Learning from the Indian Institute of Technology, Roorkee, in
2023. She completed her postdoc from the Big Data Mining and Machine Learning
Lab, South Ural State University, Russia, in August 2023. She has more than 20 years
of teaching experience. She is an active member of ISTE, IEEE, and IAEngg. She
is the recipient of the ISTE Section Best Teacher Award-2020 and the International
Young Scientist Award-2021. She has contributed to various research activities
while publishing articles in the renowned SCI and Scopus journals and conference
proceedings. She has published several international patents and authored/edited/
coedited eight books. Dr. Rani has delivered many expert talks in A.I.C.T.E.-
sponsored faculty development programs and keynote talks at many national and
international conferences. She has also organized many international conferences
during her 20 years of teaching experience. She is a member of the editorial board
and a reviewer of many international journals of repute. She has also been the vice
president of SME and MSME (UT Council) and the Women Indian Chamber of
xxi
xxii Authors
Commerce and Industry (WICCI) for the last 3 years. Her research interests include
parallel and distributed computing, data science, machine learning, the Internet of
Things (IoT), and smart healthcare.
Dr. Muhammad Fahim is Lecturer (Assistant Professor) in AI theme at the School

of Electronics, Electrical Engineering and Computer Science (EEECS), Queen’s
University Belfast, and a member of the Centre for Data Sciences and Scalable
Computing (DSSC), and he holds a fellowship Global Institute for Innovation.
Dr. Fahim worked as Assistant Professor at the Institute of Data Science and Artificial
Intelligence, Innopolis University, Russia from September 2017 to June 2021. He also
served as Assistant Professor in the Department of Computer Engineering at Istanbul
Sabahattin Zaim University, Istanbul, Turkey, and led a machine learning research
lab for three years (i.e., September 2014 to August 2017). Fahim earned his PhD in
artificial intelligence and made a significant contribution to the ubiquitous life care
research center in Seoul, South Korea. His contributions to this field are based on
the design and development of novel machine learning models to process the sensory
data streams collected in smart environments including smart homes, buildings, and
wearables.
Contributors
S. Archana Jignyasa Gandhi
Dr. N.G.P. Institute of Technology GLS University
Coimbatore, Tamil Nadu, India Ahmedabad, Gujarat, India
Priti Nilesh Bhagat Kanchan D. Ganvir

G.H. Raisoni University Priyadarshani Bhagwati College of
Amravati, Maharashtra, India Engineering
Nagpur, Maharashtra, India
Pankaj Bhambri
Guru Nanak Dev Engineering College Varsha Gautam
Ludhiana, Punjab, India Galgotias University
Greater Noida, Uttar Pradesh, India
Harpreet Kaur Channi
Chandigarh University Utpal Ghosh
Mohali, Punjab, India Vidyasagar University
Medinipore, West Bengal, India
Sweta Dargad
Symbiosis Skills and Professional Mayuresh B. Gulame
University MIT Art, Design and Technology
Pune, Maharashtra, India University
Pune, Maharashtra, India
Jyoti Yogesh Deshmukh
G.H. Raisoni College of Engineering Diya Gupta
and Management VIT-AP University
Pune, Maharashtra, India Amaravati, Andhra Pradesh, India
Ambarish A. Deshpande Surbhi Gupta

Shri Ramdeobaba College of Amity University
Engineering Noida, Uttar Pradesh, India
Shaik Karimullah
Parul Dubey Annamacharya Institute of Technology
G.H. Raisoni College of Engineering and Sciences
Nagpur, Maharashtra, India New Boyanapalli, Andhra Pradesh,
India
Pushkar Dubey
Pandit Sundarlal Sharma (Open) Ganesh Reddy Karri
University VIT-AP University
Bilaspur, Chhattisgarh, India Amaravati, Andhra Pradesh, India
xxiii
xxiv Contributors
Harmandeep Kaur Palvinder Singh Mann

Guru Nanak Dev Engineering Gujarat Technological University
College Ahmedabad, Gujarat, India
Ludhiana, Punjab, India
E. Mathiselvan
Navroop Kaur Dr. N.G.P. Institute of Technology
Akal University Coimbatore, Tamil Nadu, India
Talwandi Sabo, Punjab, India
M. Menagadevi
Upinder Kaur Malla Reddy University
Akal University Hyderabad, Telangana, India
Talwandi Sabo, Punjab, India
Uttam Kumar Mondal
V. Vijaya Kishore Vidyasagar University
Mohan Babu University Midnapore, West Bengal, India
Tirupati, Andhra Pradesh, India
Ch. Nagaraju
N. Ashok Kumar Annamacharya Institute of Technology
Mohan Babu University and Sciences
Tirupati, Andhra Pradesh, India New Boyanapalli, Andhra Pradesh,
India
Nukala Naveen Kumar
VIT-AP University K. Neelima
Amaravati, Andhra Pradesh, India Mohan Babu University
Tirupati, Andhra Pradesh, India
Pulkit Kumar
Chandigarh University M. Nirmala
Mohali, Punjab, India Dr. N.G.P. Institute of Technology
Coimbatore, Tamil Nadu, India
Deepali A. Lokare
MIT Art, Design and Technology Aarti P. Pimpalkar
University MIT Art, Design and Technology
Pune, Maharashtra, India University
Pune, Maharashtra, India
G. Adiline Macriga
Sri Sai Ram Engineering College L. Raja
Chennai, Tamil Nadu, India Sri Eshwar College of Engineering
Coimbatore, Tamil Nadu, India
Yogesh Kisan Mali
G.H. Raisoni College of Engineering Rachna Rana
and Management Ludhiana Group of Colleges
Pune, Maharashtra, India Ludhiana, Punjab, India
Sudheer Mangalampalli Sita Rani

VIT-AP University Guru Nanak Dev Engineering College
Amaravati, Andhra Pradesh, India Ludhiana, Punjab, India
Contributors xxv
Supriya B. Rao Himanshu M. Shukla

New Horizon College of Engineering Shri Ramdeobaba College of
Bengaluru, Karnataka, India Engineering
Vijay Rathod
G.H. Raisoni College of Engineering Harpal Singh
and Management Akal University
Pune, Maharashtra, India Talwandi Sabo, Punjab, India
Shailesh Shetty S. Parminder Singh

Srinivas Institute of Technology Chandigarh University
Mangalore, Karnataka, India Mohali, Punjab, India
Satyam Shivmanmeet Singh

Birla Institute of Technology and Guru Nanak Dev Engineering College
Science Ludhiana, Punjab, India
Pilani, Rajasthan, India
D. Somasundaram
S. Sankari Vellore Institute of Technology
Sri Sai Ram Engineering College Vellore, Tamil Nadu, India
Chennai, Tamil Nadu, India
Amit Srivastava
Fahimuddin Shaik Shri Shankaracharya Institute of
Annamacharya Institute of Professional Management &
Technology and Sciences Technology
New Boyanapalli, Andhra Pradesh, India Raipur, Chhattisgarh, India
Sundari M. Shanmuga D. Subitha

BVRIT HYDERABAD College of Vellore Institute of Technology
Engineering for Women Chennai, Tamil Nadu, India
Hyderabad, Telangana, India
Nilesh N. Thorat
G. Shanthi MIT Art, Design and Technology
Sri Krishna College of Technology University
Coimbatore, Tamil Nadu, India Pune, Maharashtra, India
Shital Sharma D. Vishnu Vardhan

Gujarat Technological University JNT University Anantapur
Ahmedabad, Gujarat, India Ananthapuramu, Andhra Pradesh, India
S. Sharmila S. Velmurugan
Dr. N.G.P. Institute of Technology Dr. N.G.P. Institute of Technology
Coimbatore, Tamil Nadu, India Coimbatore, Tamil Nadu, India
1 Bioengineering and
Healthcare Data Analysis
Introduction, Advances,
and Challenges
Pankaj Bhambri and Sita Rani
1.1 INTRODUCTION
Bioengineering, commonly known as biomedical engineering, is a multidisciplinary
field that integrates principles of engineering and biological sciences to generate
creative solutions for healthcare, medicine, and the betterment of human life. This
ever-expanding field of study is essential to the solution of difficult problems in
healthcare and biotechnology. Bioengineers are scientists and engineers who apply
their knowledge of biology, chemistry, physics, and engineering to the development
of new technologies. They put their knowledge to use in creating innovative med-
ications, medical equipment, tissue engineering strategies, and diagnostic instru-
ments. These developments have a significant effect on patient care by increasing the
precision of medical diagnosis and the efficacy of therapies. The creation of useful
medical tools is an important application of bioengineering. Bioengineers improve
people’s lives by developing medical technologies including pacemakers, prosthetic
limbs, and artificial organs (Kaur, Singh, & Rani, 2023). As for regenerative medi-
cine, they were the first to investigate methods of growing and transplanting tissues
and organs. Bioengineers are crucial to the pharmaceutical industry, both in drug
development and distribution. To minimize unwanted effects and maximize thera-
peutic gains, they develop drug delivery methods that zero in on specific tissues or
cells. They also create novel treatments like gene therapies and personalized medi-
cine that are specifically designed for the patient. The field of bioengineering also has
a major effect on how we see biological systems. Advances in biotechnology, such as
the creation of biofuels, bio-based products, and more sustainably implemented agri-
cultural practices, rely on bioengineers’ ability to alter and comprehend biological
processes at the molecular level through the use of tools like genomics and synthetic
biology (Kataria, Puri, Pareek, & Rani, 2023, July).
1.1.1 Overview of Bioengineering in Healthcare

The field of bioengineering, which lies at the crossroads of biology, medicine, and
engineering, is crucial to healthcare because it propels innovation, enhances patient
outcomes, and solves difficult medical problems (Kumar, Banerjee, Singhal, Kumar,
DOI: 10.1201/9781003459347-1 1
2 Computational Intelligence in Biomedical and Health Informatics
Rani, Kumar, & Lavinia, 2022). The discipline has far-reaching implications, affect-
ing many areas of healthcare delivery.
Medical Device Development: Bioengineering plays a significant role in creat-

ing, developing, and upgrading medical devices that are essential for health-
care. Devices such as blood glucose monitors, medical imaging equipment,
pacemakers, and artificial organs are examples of diagnostic tools; devices
such as prosthetics and orthopedic implants are examples of life-saving
gadgets. Bioengineers work to improve patient care and health outcomes by
making these devices more accurate, reliable, and easily accessible.
Tissue Engineering and Regenerative Medicine: Tissue engineering and
regenerative medicine are two of bioengineering’s most exciting frontiers.
Scientists and engineers are working together to develop methods for engi-
neering human organs and tissues. Patients with organ failure may find new
hope in these created tissues, which may one day solve the problem of an
inadequate supply of donor organs and completely transform transplantation.
Biomedical Imaging: The field of bioengineering has allowed for major
developments in the field of biomedical imaging. These include magnetic
resonance imaging (MRI), computed tomography (CT) scans, ultrasonog-
raphy, and endoscopy. To aid in early disease detection, diagnosis, and
minimally invasive surgical treatments, these technologies provide excep-
tionally detailed visualizations of the body’s internal architecture to medi-
cal specialists.
Drug Discovery and Delivery: By creating high-throughput screening tools,
computational modelling, and tailored drug delivery devices, bioengi-
neering has sped up the drug development process. These breakthroughs
pave the way for the creation of novel medications and therapies, which in
turn improve the efficacy of existing treatments for a plethora of disorders.
Improved patient outcomes with reduced adverse effects are another benefit
of controlled drug delivery systems.
Biomaterials and Implants: Bioengineers create biocompatible materials
for use in artificial organs, prosthetics, and other healthcare technology.
To ensure that artificial joints, dental implants, cardiovascular stents, and
other implants integrate properly with the body and improve patients’ qual-
ity of life, these materials are crucial in their development (Rani, Kaur, &
Bhambri, 2023).
Personalized Medicine: Personalized medicine is made possible by bioengi-
neering via genomes and molecular diagnostics. Healthcare practitioners
can better serve their patients by customizing treatment plans, predicting
illness susceptibility, and optimizing medicines based on each person’s
unique genetic and molecular profile. The diagnosis and treatment of dis-
eases are being transformed by this patient-centered approach.
Rehabilitation and Assistive Technologies: Bioengineers create cutting-edge
methods for aiding recovery and mobility. Wheelchairs, walking aids
like exoskeletons, and periprosthetics that replace lost functions are all
Bioengineering and Healthcare Data Analysis 3
examples. Disabled people’s lives are greatly enhanced by these technolog-

ical advancements.
Telemedicine and Remote Monitoring: Bioengineering is crucial in the
expansion of telemedicine and remote healthcare monitoring. Wearable
sensors and smartphone apps are two examples of remote monitoring gad-
gets that enable patients to keep tabs on their health and have open lines of
communication with their doctors to improve preventative medicine and the
management of chronic conditions. Healthcare equality is enhanced by the
use of telemedicine since it makes medical care available to people in rural
or underdeveloped areas.
Bioinformatics and Computational Biology: Engineers in the field of bio-
technology develop complex software for studying biological systems.
These resources are crucial for studying diseases, finding new drugs, and
developing more effective treatments. Because of the sheer volume of bio-
logical data produced in modern healthcare and research, bioinformatics
has become indispensable for its management and interpretation.
Environment and Public Health: When applied to environmental and pub-
lic health issues, bioengineering goes far beyond the confines of a hospi-
tal or doctor’s office. Biofuels and sustainable materials also contribute to
environmentally friendly solutions, while bioremediation technologies help
clear up pollutants and contaminated locations. Clean water, high air qual-
ity, and effective waste management are all issues that bioengineers aim to
improve.
Biomedical Research: Bioengineers play a key role in the advancement of
medical science by studying cellular and molecular processes and creating
cutting-edge gene-editing tools like CRISPR-Cas9. In the long run, these
initiatives lead to new discoveries in genetics, biotechnology, and the mech-
anisms underlying various diseases.
Bioengineering is an ever-changing discipline that has a profound effect on health-

care and other facets of human existence. When it comes to detecting, treating, and
preventing diseases, bioengineers continue to pave the way for the future of health-
care and play an essential role in tackling global health and environmental concerns.
Bioengineering will play an increasingly important role as technology develops,
opening the door to novel solutions and advancements in healthcare and beyond.
1.1.2 Role of Data Analysis in Bioengineering

Bioengineering relies heavily on research, diagnosis, and the creation of new tech-
nologies, all of which rely heavily on data analysis (Kataria, Agrawal, Rani, Karar, &
Chauhan, 2022). The goal of data analysis in bioengineering is to provide useful
insights from biological and biomedical data in order to aid in making well-informed
decisions. Patients can receive optimal therapy with minimal adverse effects thanks
to specific treatment plans made possible by genetic and molecular data analysis in
the field of personalized medicine. To better understand disease causes and direct the
development of novel therapies, bioengineers use computational methods to handle

and evaluate enormous datasets. As a result, the process of developing new medi-
cines moves along more quickly, which benefits patients.
Furthermore, data analysis is crucial in biomedical imaging, as it improves the
accuracy and value of diagnostic tools like MRI and CT scans. Analyzing data helps
ensure the quality and viability of manufactured tissues during their creation pro-
cess in the field of tissue engineering. Consequently, data analysis is fundamental to
bioengineering, allowing for the development of cutting-edge methods and products
that have far-reaching effects in healthcare and the life sciences. It enables scientists
and engineers to gain useful insights from large biological datasets, which in turn
improves our knowledge of diseases, speeds the creation of novel medical tools, and
eventually benefits patients.
1.2 FOUNDATIONS OF BIOENGINEERING AND

HEALTHCARE DATA ANALYSIS
The field of bioengineering combines biological and engineering concepts to
improve healthcare. Biomedical imaging, biomechanics, materials science, and
engineering fundamentals, as well as other areas of biology and engineering, are
also required. Bioengineers must be well-versed in the intersection of law, ethics,
and patient care.
Healthcare data analysis involves gathering, analyzing, and interpreting health-
care data for informed decision-making. It is crucial to have skills in data science,
machine learning, and statistics. Having a clinical background helps with analyzing
results. It is crucial to understand healthcare informatics and privacy laws. In order
to successfully communicate their findings, data analysts should also be skilled data
visualizers. Public health data analysis benefits from epidemiology ideas.
Technology and data science are playing greater roles and fostering more inter-
disciplinary collaborations in both sectors. Improving healthcare and bioengineering
requires keeping abreast of new developments.
1.2.1 Basics of Bioengineering
Bioengineering is the practice of creating medical solutions by combining engi-
neering with biological sciences, making artificial limbs and other prostheses, as
well as investigating tissue engineering for regenerative medicine (Puri, Kataria,
Rani, & Pareek, 2023, September). It is essential to have knowledge of biomateri-
als and their acceptability by the human body. Biomechanics is used to study the
effects of mechanical forces on living things. Engineers with a focus on biology
and medicine work to advance diagnostic imaging tools. To guarantee the efficacy
and safety of new medical developments, it is essential to adhere to all applicable
regulations and ethical standards. Collaboration with healthcare practitioners and
scientists is prevalent, contributing to the continuing progress of healthcare and
the quality of life. Bioengineering comprises the various subdomains shown in
Figure 1.1.
FIGURE 1.1 Bioengineering subdomains.
1.2.2 Data Sources in Healthcare

Healthcare relies on a range of data sources to provide successful patient care,
stimulate medical research, and enhance overall healthcare systems. The insights,
improved decision-making, and new discoveries made possible by these data sources
are essential to the field of medicine. The following is a brief overview of several
significant healthcare data sources.
Electronic Health Records (EHRs): Electronic health records (EHRs) are

electronic versions of paper medical charts that include a patient’s vital
statistics, diagnoses, prescriptions, treatment plans, immunization dates,
allergy information, X-rays, and lab results. These records allow for the
smooth transfer of data across different medical facilities, which improves
communication and efficiency.
Health Information Exchange (HIE): Health information exchanges facil-
itate the transfer of patient records between facilities. In times of crisis or
when a patient is seeing numerous doctors, they are essential for better coor-
dinating care. HIEs promote communication and reduce the risk of medical
errors by ensuring that healthcare personnel have access to up-to-date and
accurate patient data (Rani, Kumar, Kataria, & Min, 2023).
Wearable Devices and Remote Monitoring: There has been a rise in the use
of remote monitoring technologies that are integrated with wearable devices.
Health data, such as heart rate, physical activity, sleep habits, and more,
may be tracked in real time with the use of gadgets like fitness trackers and
smart watches. Individuals are better able to take control of their health with
the use of this data, and healthcare providers are able to remotely monitor
patients, which results in prompt interventions and individualized care plans
(Rani, Kataria, Kumar, & Tiwari, 2023).
Health Apps and Patient Portals: The rise of patient portals and mobile
health apps has empowered individuals to take an active role in their health-
care management. These online tools allow patients to coordinate their treat-
ment, receive their test results, and have direct dialogue with their doctors.
Patient preferences, treatment plan adherence, and broader health trends can
all be better understood with the information gleaned from these exchanges.
Clinical Trials and Research Databases: Medical advancements can be attrib-
uted, in part, to the information gathered by research databases and clinical
trial repositories. These sources help researchers spot patterns, measure
treatment efficacy, and uncover new remedies. For medical research to pro-
gress and evidence-based procedures to be developed, easy access to large
and varied datasets is essential (Bali, Bali, Gaur, Rani, & Kumar, 2023).
Public Health Surveillance Systems: Public health agencies rely on surveil-
lance systems to track the spread of diseases and take appropriate action
when necessary. Hospitals, labs, and community health centers are just
some of the places from which these systems gather and analyze data. In
order to identify outbreaks, adopt preventative measures, and shape public
health policy, timely and reliable information is essential.
Pharmacy and Claims Data: Patient compliance and treatment efficacy can
be gleaned from pharmacy data, such as drug dispensing and adherence
information. Insurance companies’ claim records provide a more compre-
hensive picture of healthcare consumption, expenditures, and trends. This
information is useful for managing the health of a population by revealing
ways to cut costs without sacrificing quality.
Improved patient outcomes, streamlined healthcare delivery, and scientific dis-

coveries are all possible thanks to the abundance of data sources in the healthcare
sector. For reasons of privacy, security, and the development of healthcare systems
everywhere, it is crucial that these data sources be used in a responsible and ethical
manner.
1.2.3 Data Preprocessing and Cleaning

When it comes to healthcare data, its accuracy and dependability are critical for
making educated decisions, enhancing patient outcomes, and advancing medical
research. Electronic health records (EHRs), medical imaging, wearable devices, and
research studies are just few of the many places data can be found in the healthcare
industry. Errors, inconsistencies, and missing values are common in these datasets;
hence thorough preparation and cleaning methods are required.
Preprocessing missing values is a significant obstacle when working with health-
care data. It is possible to draw incorrect conclusions from incomplete data studies. To
solve this problem, statisticians might use methods like imputation, in which missing
values are filled in using preexisting information. However, imputation approaches

must be carefully chosen to prevent introducing new biases.
Data normalization and standardization are other important factors. Measurements
in healthcare datasets may be gathered using a wide variety of tools and technolo-
gies, each of which may employ a unique scale and set of units. The data can be more
easily analyzed and interpreted if the variables are all on the same scale, which is
achieved through standardization. By standardizing the data and minimizing the
influence of outliers and extreme values, normalization improves data quality even
more.
Whether it’s free-form writing in clinical notes or an image of a patient, unstruc-
tured data is commonplace in the healthcare industry. Textual data can be integrated
into structured databases through the use of natural language processing (NLP) tech-
niques, which are employed to extract useful information from unstructured text.
Image denoising, normalization, and segmentation are all examples of preprocessing
operations that are performed on medical pictures to make them acceptable for anal-
ysis and interpretation (Rani, Mishra, Kataria, Mallik,& Qin, 2023).
Keeping patient information private and secure is of utmost importance. In order
to protect the privacy of their patients, healthcare providers should anonymize or
pseudonymize patient data before using it. Protecting patients’ privacy while still
enabling useful analysis requires the removal or encryption of sensitive data.
Identifying and fixing outliers is just as important as fixing missing values and
normalizing data in healthcare data preprocessing. Statistics can be heavily influ-
enced by outliers, that is, extremely uncommon data. The correct handling of outliers
can be aided by the use of robust statistical approaches and visualization tools.
Data cleaning also includes finding and fixing mistakes in the data. This involves
checking for errors, eliminating duplicates, and making sure the data is correct. The
quality and dependability of healthcare data relies on the elimination of errors, which
can result from human error, technical issues, and other causes.
The use of healthcare data for decision-making, research, and better patient out-
comes requires the preprocessing and cleaning of the data. High-quality, reliable
healthcare datasets can be created by addressing missing values, standardizing data,
handling unstructured information, protecting data privacy, managing outliers, and
correcting errors. Effective data pretreatment and cleansing are becoming increas-
ingly vital as the healthcare business adopts data-driven techniques, laying the
groundwork for valuable insights and scientific progress in the medical field.
1.2.4 Statistical and Machine Learning Techniques

In order to draw conclusions and make forecasts from data, statistical and machine
learning methods are crucial. Analysis of data patterns to draw conclusions about
populations or associations is at the heart of statistical approaches, which have their
origins in probability theory. They offer a sturdy foundation for conducting statistical
analyses including p-values, confidence intervals, and regression.
Machine learning, on the other hand, takes advantage of methods that allow
computers to discover patterns and make predictions without being explicitly pro-
grammed to do so. Models are trained using labelled data in supervised learning,
while unlabelled data is used in unsupervised learning. Decision trees, support vec-
tor machines, and neural networks are all examples of common machine learning
methods.
Data-driven decision-making is essential in many fields, including healthcare,
finance, and technology, and both statistical and machine learning approaches play
important roles in this process. The statistical approaches’ rigor in inference and
interpretation is complemented by the versatility of machine learning in processing
high-dimensional data for applications like image recognition and NLP. Integrating
these methods furthers the development of AI and data science by improving our
capacity to analyze and draw conclusions from a wide variety of information.
1.3 APPLICATIONS OF BIOENGINEERING DATA ANALYSIS

Bioengineering data analysis plays a significant role in personalized medicine, drug
development, and synthetic biology. It facilitates the use of genomic, proteomic, and
metabolomic data in the analysis of disease (Tanwar, Chhabra, Rattan, & Rani, 2022,
September). The development of bioengineering for healthcare and biotechnology
has been aided by bioinformatics tools such as those used in the design of novel bio-
materials and the optimization of bioprocesses.
1.3.1 Disease Diagnosis and Prognosis

Genomic, proteomic, and clinical data interpretation is at the heart of bioengineer-
ing’s role in disease diagnosis and prognosis, allowing for the identification of bio-
markers, risk assessment, and individualized treatment. This individualized method
revolutionizes cancer treatment and genetic problem care by facilitating early diag-
nosis, better patient outcomes, and precision medicine.
1.3.2 Drug Discovery and Development

Bioengineering data analysis accelerates drug discovery by analyzing genetic, pro-
teomic, and structural data to find new therapeutic targets. The drug development
process is simplified with its help in areas such as new compound discovery, drug
interaction prediction, and formulation optimization. The process of bringing novel
medications to market is facilitated and enhanced by this method.
1.3.3 Personalized Medicine
Bioengineering data analysis deciphers patient-specific genetic, proteomic, and clin-
ical information to personalize healthcare to each person. This method allows for
more precise and individualized treatment plans by enhancing disease detection,
optimizing therapeutic approaches, and reducing unwanted side effects.
1.3.4 Telemedicine and Remote Monitoring

Interpreting patient data remotely for continuous health monitoring is a key use
of bioengineering in telemedicine data analysis. It allows for the monitoring and
analysis of vital signs and other physiological parameters, allowing for timely inter-
ventions. By allowing for constant monitoring and the early discovery of health
issues, this application improves patient outcomes across the board but especially in
underserved and rural areas.
1.4 ADVANCES IN BIOENGINEERING DATA ANALYSIS

Integrating AI, ML, and big data analytics has been a recent development in the
study of bioengineering data. Precision medicine, faster medication development,
and a deeper knowledge of complex biological processes are all made possible by
these advances in technology, leading to better healthcare for everybody.
1.4.1 Big Data Analytics in Healthcare

Extracting useful information from large and varied healthcare datasets is the goal
of big data analytics. It helps doctors make better decisions, has a positive effect on
patients’ health, and makes better use of available resources. Patient health, demo-
graphic patterns, and the efficacy of medical therapies can all be better understood
thanks to the wealth of information provided by big data, which has a significant
impact on the healthcare industry at large, from predictive analytics for disease pre-
vention to individualized treatment plans.
1.4.2 Artificial Intelligence and Machine Learning Models

Many sectors are undergoing radical change because of AI and ML models, which
have improved healthcare by facilitating diagnoses, forecasting outcomes, and refining
treatment strategies. They analyze enormous databases to uncover patterns, enhancing
decision-making. These models improve financial crime monitoring and risk analysis.
Automation fueled by AI also simplifies production procedures. The efficient, data-
driven solutions offered by these technologies continue to change other fields.
1.4.3 Blockchain in Healthcare Data Management

When applied to healthcare data management, blockchain technology guarantees
safe, transparent, and interoperable data storage for patient records. It improves the
reliability of data, facilitates sharing of that data among interested parties, and pre-
vents unwanted access. By facilitating automation, smart contracts simplify admin-
istrative tasks. This technology creates confidence among patients and healthcare
providers, boosting data accuracy and permitting innovative applications like pre-
cision medicine. Blockchain has the potential to dramatically alter the healthcare
industry by solving problems with data security and boosting the effectiveness of
healthcare data management.
1.4.4 Wearable Technology and IoT in Bioengineering

In bioengineering, real-time health data from individuals is collected through the use
of wearable technology and the IoT. Smart watches and other wearable technology as
well as medical sensors are among the gadgets that track health and wellness metrics.
Personalized healthcare insights are made possible by the seamless data exchange
made possible by IoT integration. This convergence of technologies allows for con-
stant tracking of health, early identification of disease, and remote patient monitor-
ing, all of which contribute to progress in preventative and individualized treatment.
1.5 CHALLENGES AND ETHICAL CONSIDERATIONS

One primary challenge involves ensuring the accuracy and reliability of bioengi-
neering data, as errors or biases can have significant consequences in healthcare
decision-making (Bhambri & Gupta, 2018). Additionally, the ethical considerations
involve issues such as data privacy, consent, and the responsible use of patient infor-
mation. Striking a balance between the potential benefits of advanced data analysis
in bioengineering and healthcare and protecting individual privacy rights is crucial.
It also involves addressing issues of equity in access to healthcare technologies and
ensuring that the benefits of bioengineering innovations are distributed fairly across
diverse populations (Bhambri & Gupta, 2016). Moreover, ethical considerations
extend to transparency in data analysis methodologies, avoiding discrimination, and
safeguarding against unintended consequences. The integration of bioengineering
and healthcare data analysis necessitates a thoughtful approach that acknowledges
and addresses these challenges and ethical dimensions to foster responsible innova-
tion in the healthcare landscape.
1.5.1 Data Privacy and Security

The field of bioengineering involves the integration of engineering principles with
biological and medical sciences, often requiring the analysis of vast amounts of per-
sonal and health-related information (Brown & Patel, 2018). Here are the details of
the challenges and ethical considerations related to data privacy and security in this
domain:
Sensitive Nature of Healthcare Data: Healthcare data frequently encompasses

exceedingly sensitive and personal information, encompassing genetic data,
medical histories, and treatment records. Ensuring the safeguarding of
this data is of utmost importance in upholding patient trust and preserving
confidentiality.
Legal and Regulatory Compliance: It is crucial to adhere to data protection
laws and healthcare standards, such as the Health Insurance Portability and
Accountability Act (HIPAA) in the United States or the General Data Pro-
tection Regulation (GDPR) in Europe. Noncompliance may lead to legal
ramifications and harm to one’s reputation (Chen & Wang, 2019).
Data Encryption and Access Controls: The utilization of powerful encryp-
tion methodologies and the enforcement of stringent access controls serve
to guarantee that only authorized individuals are able to access and manage
healthcare data. This measure aids in mitigating unauthorized access and
potential data breaches.
Data Anonymization and De-Identification: Bioengineering and health-

care data analysts must consider methods like anonymization and de-
identification to strip personally identifiable information from datasets
while retaining their utility for analysis. This balances the need for data
privacy with the requirement for meaningful research.
Secure Data Storage and Transmission: Ensuring the secure storage and
transmission of healthcare data is essential. Cloud-based solutions should
employ encryption, and data transfer mechanisms must adhere to secure pro-
tocols to prevent interception or unauthorized access during transmission.
Ethical Handling of Genetic Information: With the rise of genomics and
personalized medicine, bioengineering often involves working with genetic
information. Ethical considerations include informed consent, ensuring
individuals understand the implications of sharing genetic data, and protect-
ing against potential misuse (Johnson & Brown, 2016).
Data Lifecycle Management: Implementing proper data lifecycle manage-
ment practices involves securely handling data from its creation, through
processing and analysis, to its eventual deletion. This minimizes the risk of
data breaches or unauthorized access at any stage.
Cybersecurity Measures: Given the increasing frequency and sophistication
of cyber threats, incorporating robust cybersecurity measures is crucial. This
includes regular security audits, intrusion detection systems, and staying
abreast of emerging threats to healthcare data.
Patient Consent and Informed Decision-Making: The ethical principle of
patient autonomy necessitates the acquisition of informed consent prior to
utilizing their data for research purposes (Kaur & Bhambri, 2015). Providing
clear information about how data will be used, ensuring voluntary participa-
tion, and allowing individuals to withdraw consent are ethical imperatives.
Continuous Ethical Oversight: Establishing ethics committees or review
boards to provide ongoing oversight ensures that bioengineering and
healthcare data analysis activities adhere to evolving ethical standards and
guidelines.
1.5.2 Interpretability and Transparency

Interpretability refers to the ability to understand and explain the decisions or out-
comes generated by data-driven models, while transparency involves openness and
clarity in the processes and methodologies employed in data analysis.
One of the primary challenges in bioengineering and healthcare data analysis is
the complexity of the models used, such as machine learning algorithms, which often
operate as so-called black boxes. These models can provide accurate predictions, but
their lack of interpretability raises concerns about the rationale behind their decisions.
The interpretability of models plays a major role in healthcare, where decisions can
have significant and life-altering implications. This factor is essential for establishing
confidence among healthcare workers and patients (Kim & Kim, 2019). Interpretability
ensures that stakeholders can comprehend how a model arrives at a specific diagnosis
or treatment recommendation, facilitating better informed decision-making.
Transparency, on the other hand, is essential for establishing the ethical foun-
dation of bioengineering and healthcare data analysis. Transparent methodologies
allow researchers, practitioners, and regulatory bodies to scrutinize the data sources,
algorithms, and validation processes. This openness is crucial for identifying biases,
errors, or ethical concerns that may arise during data analysis. Furthermore, trans-
parent data analysis practices foster accountability, ensuring that the results and deci-
sions made based on the analysis are trustworthy and align with ethical standards
(O’Reilly & Smith, 2021).
In the context of healthcare, ensuring interpretability and transparency is not only
an ethical consideration but also a legal requirement. Regulatory entities frequently
need comprehensive documentation of the procedures and methodologies employed
in the analysis of healthcare data to ensure the protection of patient confidentiality,
safeguarding of data integrity, and adherence to prevailing legislation.
To overcome these challenges, researchers and practitioners in bioengineering
and healthcare data analysis are increasingly focusing on developing interpretable
machine learning models and adopting transparent methodologies. The objective of
techniques such as explainable artificial intelligence (XAI) is to offer elucidation into
the decision-making mechanisms employed by intricate models. Additionally, there
is a growing emphasis on incorporating domain expertise, collaborating with health-
care professionals, and adopting clear documentation practices to enhance interpret-
ability and transparency in the analysis of healthcare data (Tondon &Bhambri, 2017).
These efforts are crucial for building trust among stakeholders, ensuring the ethical
use of data, and ultimately advancing the application of data-driven approaches in
bioengineering and healthcare.
1.5.3 Ethical Issues in Healthcare Data Analysis

The discipline of bioengineering and healthcare data analysis encompasses the utili-
zation of sophisticated technology and procedures to extract valuable insights from
extensive datasets, with the objective of enhancing patient care, optimizing health-
care systems, and advancing medical research. However, this process is fraught with
ethical challenges that require careful consideration to ensure the responsible and
respectful handling of sensitive health information (Wang &Faloutsos, 2021).
Privacy Concerns: One of the primary ethical issues in healthcare data analy-
sis is the protection of patient privacy. As datasets become larger and more
interconnected, there is an increased risk of re-identification of individu-
als. Researchers and analysts must implement robust de-identification tech-
niques to safeguard the anonymity of patients and prevent the misuse of
their health information.
Informed Consent: Obtaining informed consent is a critical ethical consider-
ation. Patients should be fully informed about how their data will be used,
who will have access to it, and for what purposes. Ensuring that individuals
have the option to opt in or opt out of data analysis is essential in respecting
their autonomy and right to control their personal health information.
Data Security and Integrity: Maintaining the security and integrity of

healthcare data is paramount. The occurrence of data breaches gives rise
to ethical problems due to the potential exposure of sensitive information to
unauthorized parties. It is imperative to implement resilient cybersecurity
protocols in order to safeguard against unauthorized access and guarantee
the integrity and reliability of the data under analysis.
Bias and Fairness: Bias in healthcare data analysis can lead to unfair and
discriminatory outcomes, particularly if certain demographic groups are
underrepresented or if historical biases are embedded in the data. Ethical
data analysis requires a commitment to identifying and mitigating biases
to ensure that the insights derived are applicable and fair across diverse
populations.
Transparency and Accountability: Ethical healthcare data analysis demands
transparency in methodologies and results. Researchers should be transpar-
ent about their data sources, analysis techniques, and any potential conflicts
of interest. This transparency fosters accountability and allows for scrutiny
by the scientific community and the public.
Data Ownership and Access: Determining who owns healthcare data and
who should have access to it raises ethical questions. The task of achiev-
ing a harmonious equilibrium between the facilitation of relevant research
and the safeguarding of individual rights presents a formidable challenge
(Kaur & Bhambri, 2016). The ethical consideration of ensuring equal access
to data for research purposes, while also protecting the rights and interests
of patients, is of paramount importance.
Dual-Use Concerns: Healthcare data, when used for research, has the poten-
tial for dual use—meaning it could be employed for both beneficial and
harmful purposes. Ethical guidelines should address the responsible use of
data to prevent unintended consequences, such as the development of tech-
nologies that could be used for malicious purposes.
Impact on Vulnerable Populations: Vulnerable populations, such as those
with limited access to healthcare or marginalized groups, may be dispro-
portionately affected by data analysis outcomes. Ethical considerations
involve ensuring that the benefits of research are equitably distributed and
that vulnerable populations are not exploited or harmed by the analysis.
1.5.4 Regulatory Compliance
The fields of bioengineering and healthcare data analysis pose a multitude of
obstacles and ethical considerations as a result of the inherently sensitive nature
of health-related information. Compliance with regulations is crucial to safeguard
patient privacy, maintain data integrity, and uphold ethical standards. Here’s a
detailed exploration of regulatory compliance in the realm of ethical issues in health-
care data analysis (Gupta & Singh, 2020):
HIPAA Compliance: The privacy and security requirements established by

the HIPAA govern the handling of healthcare data in the United States. The
maintenance of HIPAA compliance is of the utmost importance in safe-

guarding the confidentiality of patients’ personal health information (PHI).
This entails the implementation of stringent access restrictions, encryption
mechanisms, and measures to prevent unauthorized disclosures.
GDPR (General Data Protection Regulation) Compliance: The GDPR
inside the European Union (EU) sets down a framework of rules govern-
ing the legitimate handling of personal data, encompassing health-related
information. In the realm of healthcare data analysis, it is imperative for
researchers and organizations to adhere to the regulations set forth by the
GDPR. These regulations encompass several key aspects, such as the obli-
gation to seek explicit agreement from individuals, guaranteeing the prin-
ciple of data minimization, and granting individuals the right to view and
exert control over their personal health data.
Informed Consent and Institutional Review Board (IRB) Approval:
Ethical healthcare data analysis requires obtaining informed consent from
individuals whose data is being used. This consent process should transpar-
ently communicate the purpose of data analysis, potential risks, and ben-
efits. Furthermore, it is imperative to acquire approval from an IRB while
undertaking research with human beings in order to guarantee adherence
to ethical norms.
Data Anonymization and De-Identification: To comply with regulations
and ethical considerations, healthcare data should undergo a rigorous ano-
nymization and de-identification process. The process entails the elimina-
tion or encryption of personally identifiable information (PII) in order to
safeguard patient confidentiality while enabling substantial analysis.
Data Security and Integrity: Regulatory compliance extends to ensuring
the security and integrity of healthcare data. The implementation of robust
cybersecurity protocols, including encryption, access controls, and periodic
security audits, plays a pivotal role in mitigating the risks associated with
unauthorized access, data breaches, and manipulation.
Adherence to Ethical Guidelines and Professional Codes: Healthcare data
analysts should follow ethical guidelines and professional codes of conduct
established by the relevant organizations and associations. This includes
commitments to honesty, transparency, and the responsible use of data for
the betterment of patient outcomes and public health.
Audit Trails and Documentation: Keeping detailed audit trails and docu-
mentation of data handling processes is essential for regulatory compliance
(Miller & Wilson, 2017). This documentation not only facilitates internal
accountability but also serves as evidence of adherence to regulations in the
event of audits or inquiries.
Continuous Monitoring and Updating: The regulatory landscape is dynamic,
and healthcare data analysts must stay informed about changes in laws
and guidelines. Regularly updating data management practices and anal-
ysis protocols to align with evolving regulations is crucial for maintaining
compliance.
1.6 FUTURE DIRECTIONS AND EMERGING TRENDS

The field of bioengineering and healthcare data analysis is undergoing significant
advancements that have the potential to reshape medical research and patient treatment
in the future (Bhambri & Gupta, 2017). The incorporation of cutting-edge technology,
such as artificial intelligence, machine learning, and big data analytics, presents the
potential to profoundly transform the field of healthcare by revolutionizing the processes
involved in diagnosing, treating, and managing diseases. The increasing prevalence of
precision medicine, facilitated by the individualized examination of genomic and health
data, is expected to become increasingly prevalent, hence enabling customized and
focused treatment approaches. Furthermore, the emergence of wearable devices and the
IoT is anticipated to make a significant contribution to the production of uninterrupted
flows of patient data, thereby offering immediate and valuable observations into health
patterns. Ethical considerations, privacy safeguards, and the establishment of robust
data governance frameworks will be pivotal as the field progresses (Harris & Patel,
2018). The synergy between bioengineering and healthcare data analysis is indicative
of a future where technological advancements enhance medical decision-making pro-
cesses and ultimately lead to more effective, patient-centric healthcare solutions.
1.6.1 Predictive Analytics and Precision Medicine

Predictive analytics and precision medicine represent cutting-edge approaches in
bioengineering and healthcare data analysis, offering transformative insights and
personalized solutions for patient care and treatment.
Predictive Analytics: Predictive analytics encompasses the use of statistical

algorithms and machine learning methodologies to scrutinize past data
and generate forecasts pertaining to forthcoming occurrences. Within the
healthcare domain, predictive analytics utilizes data derived from diverse
sources like electronic health records (EHRs), medical imaging, and genetic
information in order to anticipate future results, detect potential dangers,
and enhance the process of decision-making. Through the examination of
patterns and trends within extensive datasets, predictive analytics has the
potential to aid healthcare practitioners in foreseeing the advancement of
diseases, forecasting patient outcomes, and customizing treatment strate-
gies to enhance effectiveness (Davis & Jones, 2021).
In the field of bioengineering and healthcare, the utilization of predictive
analytics has the potential to foresee the occurrence of disease outbreaks,
optimize the allocation of resources within hospitals, and improve the man-
agement of patients. One illustration of the utility of predictive models is
their ability to identify individuals who are more susceptible to acquiring
particular ailments. This identification facilitates the implementation of
proactive interventions and preventive measures.
Precision Medicine: Precision medicine, on the other hand, revolves around
tailoring medical treatment and healthcare strategies to the individual
characteristics of each patient. This approach considers genetic, environ-

mental, and lifestyle factors to customize prevention, diagnosis, and treat-
ment plans. The objective of precision medicine is to depart from the
conventional paradigm of uniform healthcare provision and instead adopt a
more focused and individualized approach.
In the context of bioengineering, precision medicine integrates advanced
technologies like genomics, proteomics, and other “omics” data to under-
stand the unique genetic makeup of an individual. This detailed understand-
ing enables clinicians to prescribe treatments that are not only effective but
also minimize adverse effects (Fong & Wu, 2019).
Integration of Predictive Analytics and Precision Medicine: The integra-
tion of predictive analytics with precision medicine is a potent combination.
Predictive analytics can be employed to identify patterns and relationships
within large datasets, helping predict how an individual patient might
respond to a specific treatment based on their unique characteristics. This,
in turn, supports the principles of precision medicine by providing clinicians
with actionable insights that contribute to more informed decision-making.
For instance, predictive analytics can assist in predicting a patient’s
response to a particular drug or therapy, allowing clinicians to choose the
most effective treatment from the outset. Moreover, it can aid in the early
detection of diseases, potentially enabling preventive measures or early
intervention strategies in precision medicine.
Future Directions and Emerging Trends: As we look to the future, the syn-
ergy between predictive analytics and precision medicine is likely to lead
to more sophisticated and individualized healthcare solutions. Advanced
machine learning algorithms will be applied to increasingly diverse data-
sets, including genomics, lifestyle factors, environmental data, and real-
time patient monitoring. The goal is to create highly accurate predictive
models that can guide clinicians in developing personalized treatment plans
based on a comprehensive understanding of each patient’s unique biological
and clinical profile.
Additionally, the integration of artificial intelligence (AI) and deep learn-
ing methodologies will augment the predictive capacities of analytics, facil-
itating the identification of intricate patterns and connections that may not
be readily discernible (Adams & Smith, 2020). Additionally, the ongoing
advancements in wearable devices and remote monitoring technologies will
contribute to the continuous generation of patient data, facilitating real-time
predictive analytics for timely interventions and adjustments in precision
medicine strategies.
1.6.2 Integrative Bioengineering and Data Analysis

This integrated approach seeks to synergize the expertise of bioengineering, which
involves the application of engineering principles to biological and medical prob-
lems, with sophisticated data analysis methods to extract meaningful insights from
large and diverse datasets. Here’s a detailed discussion of the key aspects of integra-
tive bioengineering and data analysis:
Multidisciplinary Collaboration: Integrative bioengineering and data anal-

ysis foster collaboration among experts from diverse fields such as biol-
ogy, engineering, computer science, and healthcare. The convergence of
these disciplines enables a holistic understanding of biological systems and
health-related issues.
Biomedical Signal Processing: Bioengineering involves the development of
innovative technologies for acquiring and processing biomedical signals.
Integrating advanced signal processing techniques with bioengineering allows
for the extraction of valuable information from signals such as EEG, ECG, or
genomic data, contributing to diagnostic and therapeutic advancements.
Biomechanics and Computational Modelling: Bioengineering often involves
studying the mechanics of biological systems. Integrating computational mod-
elling techniques with bioengineering data allows for simulations and predic-
tions of physiological responses. This is crucial for understanding the impact
of interventions, designing medical devices, and optimizing treatment plans.
Biological Data Integration: Sophisticated data integration approaches
are necessary to handle the extensive biological data derived from many
sources, including genomics, proteomics, and metabolomics (Anand &
Bhambri, 2018). Integrative bioengineering and data analysis aim to develop
approaches that seamlessly combine and analyze diverse biological datasets
to reveal comprehensive insights into complex biological processes.
Machine Learning and Predictive Analytics: Data analysis techniques,
including machine learning algorithms and predictive analytics, play a
pivotal role in identifying patterns, correlations, and predictive models
from large healthcare datasets. Integrating these tools into bioengineering
research enhances the understanding of disease mechanisms, patient vari-
ability, and treatment responses.
Personalized Medicine: Integrative bioengineering and data analysis contrib-
ute to the advancement of personalized medicine by considering individual
variations in genetics, lifestyle, and environmental factors. This approach
enables the tailoring of medical treatments to specific patient characteris-
tics, improving overall healthcare outcomes.
Data Security and Ethical Considerations: As the integration of bioengi-
neering and data analysis involves handling sensitive healthcare informa-
tion, attention to data security and ethical considerations is paramount.
Integrative approaches should prioritize patient privacy, consent, and com-
pliance with ethical standards in research and healthcare practice.
Emerging Technologies: The field of integrative bioengineering and data
analysis continually evolves with the integration of emerging technologies,
such as bioinformatics, nanotechnology, and digital health. These technol-
ogies contribute to the development of novel diagnostic tools, therapeutic
approaches, and healthcare management systems.
1.6.3 AI-Driven Healthcare Decision Support

In healthcare, the volume and complexity of data generated, including patient
records, medical imaging, genomics, and other health-related information, have
grown significantly. AI-driven decision support systems leverage advanced algo-
rithms, machine learning models, and data analytics to sift through this vast amount
of data (Bhambri, Sinha, Dhanoa, & Kaur, 2019). The goal is to extract meaningful
patterns, trends, and correlations that can aid healthcare professionals in making
informed decisions regarding patient care, treatment plans, and overall healthcare
management.
Key components of AI-driven healthcare decision support may include predic-
tive modelling to anticipate disease outcomes, personalized treatment recommenda-
tions based on individual patient data, and the integration of AI tools in diagnostic
processes. These applications have the potential to optimize resource allocation,
improve patient outcomes, and contribute to more efficient and effective healthcare
delivery (Edwards & White, 2017).
1.6.4 Collaborative Research and Interdisciplinary Approaches

This approach recognizes that advancements in these domains often require insights
and expertise from multiple disciplines, including but not limited to biology, engi-
neering, data science, medicine, and informatics (Lee & Kim, 2018).
Integration of Expertise: Collaborative research involves bringing together

researchers with expertise in bioengineering and healthcare data analysis.
The integration of different domains enables a more thorough comprehen-
sion of the issues and opportunities that arise at their junction. Bioengineers
may bring expertise in designing medical devices or developing novel
biomaterials, while data analysts may contribute skills in processing and
extracting meaningful insights from vast healthcare datasets.
Holistic Problem-Solving: Interdisciplinary approaches enable a holistic view
of complex problems in bioengineering and healthcare data analysis. For
example, addressing challenges in personalized medicine may require not
only technological advancements in bioengineering but also sophisticated
data analysis techniques to interpret individual patient data for tailored
treatment plans.
Innovation through Diversity: Collaboration among experts from diverse
backgrounds fosters innovation. Different perspectives and methodologies
from various disciplines can lead to novel solutions that might not be appar-
ent when approached from a single disciplinary perspective. For example,
the integration of bioengineering advancements with sophisticated machine
learning algorithms has the potential to improve the precision and effective-
ness of healthcare data processing.
Translation of Research Findings: Collaborative research facilitates the
translation of research findings into practical applications. For instance,
a collaboration between bioengineers developing a new medical imaging
technology and data scientists working on predictive modelling can result in

the creation of diagnostic tools that improve patient outcomes.
Addressing Complex Healthcare Challenges: Many healthcare challenges
today are multifaceted and cannot be adequately addressed by isolated disci-
plines. For example, understanding the genetic basis of diseases and developing
targeted therapies require a combination of genetic research, bioengineering
innovations, and advanced data analytics (Quinlan & Feldman, 2017).
Educational Opportunities: Collaborative and interdisciplinary research
also provides valuable educational opportunities. Researchers from dif-
ferent disciplines can learn from one another, fostering a new generation
of professionals with a broader skill set and a more holistic approach to
problem-solving.
Ethical and Social Considerations: Collaborative research also allows for the
integration of ethical and social considerations. When developing technol-
ogies or analyzing healthcare data, interdisciplinary teams can ensure that
the solutions are not only scientifically sound but also ethically responsible
and considerate of social implications.
1.7 CASE STUDIES
A case study of the particular topic elaborates the practicality of the domain con-
cerned and thus offers the expert exposure needed for greater understanding. The
following case studies are elaborated on and shared for the purpose of deep coverage
of bioengineering and healthcare data analysis:
1.7.1 Case Study 1: Applying Machine Learning in Disease Diagnosis

This case study focuses on the application of machine learning in cardiology, where
early and accurate diagnosis is critical for effective intervention and treatment. The
study aims to demonstrate the feasibility and efficacy of employing machine learning
algorithms to analyze diverse datasets, including medical imaging, patient history,
and genetic information, in order to enhance diagnostic capabilities in cardiological
conditions (Smith & Jones, 2016).
Objective: The primary objective is to develop a machine learning model capa-
ble of accurately diagnosing cardiac conditions such as arrhythmias and heart fail-
ure using a multimodal dataset. The study seeks to assess the model’s performance
against traditional diagnostic methods, emphasizing the potential for improved accu-
racy and efficiency in disease identification.
Methodology:
Dataset Compilation: Collect a comprehensive dataset comprising electro-
cardiogram (ECG) recordings, medical imaging (e.g., MRI and CT scans),
patient electronic health records (EHRs), and genetic information.
Data Preprocessing: The data should be subjected to cleaning and prepro-
cessing in order to assure consistency and remove any noise present. The
pertinent characteristics from various modalities should be extracted, and

the data formats should be standardized to ensure interoperability.
Model Development: Utilize machine learning technologies, including deep
neural networks and ensemble approaches, in order to construct a resilient
diagnostic model. Train the model on a labelled dataset, fine-tuning param-
eters for optimal performance.
Validation: Validate the model using a separate set of data not used during
the training phase. Assess the model’s accuracy, sensitivity, specificity, and
other relevant metrics.
Comparison: Compare the performance of the machine learning model with
traditional diagnostic methods, evaluating factors such as speed, accuracy,
and resource efficiency.
Results: The machine learning model exhibits superior diagnostic accuracy com-
pared to traditional methods, showcasing its ability to analyze complex, multimodal
datasets. The model’s predictive capabilities demonstrate potential improvements in
early detection, allowing for proactive medical interventions.
Conclusion: This case study serves as an illustration of the profound influence
that the use of machine learning techniques has had on disease diagnosis in the
domain of cardiology. The results highlight the potential for enhanced accuracy and
efficiency in identifying cardiac conditions, paving the way for more personalized
and timely patient care. As machine learning continues to advance, its integration
into healthcare data analysis holds immense promise for improving diagnostic preci-
sion and ultimately transforming patient outcomes.
1.7.2 Case Study 2: Blockchain Implementation in Healthcare

This case study explores the implementation of blockchain technology in the health-
care sector, specifically within the context of bioengineering and healthcare data
analysis (Turner & Miller, 2018). The integration of blockchain in healthcare is
driven by the need for enhanced security, transparency, and interoperability in man-
aging sensitive patient data, ensuring data integrity, and streamlining complex data
analysis processes.
The healthcare industry faces significant challenges in managing patient data effi-
ciently, ensuring data security, and facilitating seamless data sharing among stake-
holders (Reddy & Raj, 2019). Blockchain technology, known for its decentralized
and tamper-resistant nature, presents a promising solution to address these chal-
lenges. This case study delves into a real-world implementation of blockchain in a
bioengineering and healthcare data analysis setting.
Objectives:
To enhance data security and integrity in the storage and sharing of patient
health records.
To establish a transparent and auditable system for tracking the provenance of
healthcare data.
To streamline the data analysis process, ensuring efficient and secure access to
bioengineering and healthcare datasets.
Implementation Steps:
System Architecture Design: Define the blockchain network architecture,
including nodes, consensus mechanisms, and smart contract functionalities.
Integrate the blockchain system with existing healthcare databases and bio-
engineering data repositories.
Patient Data Onboarding: Implement a secure and user-friendly process for
onboarding patient health records onto the blockchain. To ensure adherence
to data privacy standards, such as the HIPAA, it is imperative to use encryp-
tion protocols and establish permission-based access controls.
Smart Contracts for Data Access and Analysis: Develop smart contracts to
govern data access based on predefined permissions. Implement automated,
blockchain-based data analysis processes to enhance efficiency.
Interoperability and Integration: Establish interoperability standards to ena-
ble seamless integration with other healthcare systems. Ensure compatibil-
ity with existing bioengineering and healthcare data analysis tools.
User Training and Adoption: Conduct training sessions for healthcare pro-
fessionals, bioengineers, and data analysts on using the blockchain system.
Implement user-friendly interfaces to encourage adoption and adherence to
best practices.
Results and Impact: The implementation of blockchain technology in this bioengi-

neering and healthcare data analysis case study resulted in several positive outcomes:
Enhanced Data Security: The decentralized and cryptographic nature of the block-
chain ensured robust protection against unauthorized access and tampering.
Improved Data Transparency: Stakeholders could trace the entire lifecycle
of healthcare data, promoting transparency and accountability.
Streamlined Data Analysis: Smart contracts facilitated automated and secure
data analysis processes, reducing the time required for insights generation.
Conclusion: This case study provides valuable insights into the successful integra-
tion of blockchain in the healthcare domain, emphasizing its potential to revolu-
tionize bioengineering and healthcare data analysis. The outcomes highlight the
importance of blockchain in addressing longstanding challenges, fostering a more
secure, transparent, and efficient healthcare ecosystem. As the industry continues
to explore innovative solutions, the adoption of blockchain technology stands as a
promising step toward the future of healthcare data management and analysis.
1.7.3 Case Study 3: Ethical Dilemmas in Healthcare Data Analysis

In a cutting-edge bioengineering research institution, a team of data scientists and
bioengineers is working on a groundbreaking project aimed at developing person-
alized treatment plans for patients with a rare genetic disorder. The project involves
extensive analysis of genomic data, patient medical records, and real-time health
monitoring through wearable devices (Patel & Chandrasekaran, 2020). The goal is
to tailor treatment strategies based on individual genetic profiles, optimizing efficacy
while minimizing potential side effects.
The Ethical Dilemma: As research progresses, the team encounters an ethical

dilemma related to the use of patient data (Nguyen & Hui, 2018). While the project is
built on the principles of improving patient outcomes and advancing medical science,
concerns arise regarding the privacy and informed consent of the patients involved.
The team has access to a vast dataset comprising highly sensitive information, and
the question arises: To what extent can the data be utilized without compromising
individual privacy and autonomy?
Key Considerations:
Informed Consent: The team must assess whether the initial consent pro-
vided by patients adequately covers the extensive data analysis and poten-
tial long-term use of their information. Are patients aware of the full scope
of the research, and do they have the option to withdraw their consent at
any stage?
Data Security: Given the escalating occurrence of cyberattacks and data
breaches, the team is confronted with the task of implementing robust
security measures in order to protect patient information effectively. What
measures may be used to ensure the preservation of data integrity and confi-
dentiality during the entirety of the study procedure?
Transparency: The ethical responsibility of the research team includes main-
taining transparency about the goals, methods, and potential implications of
the study. How can the team effectively communicate these aspects to the
patients, ensuring that they understand the purpose and potential impact of
the research?
Beneficence vs. Autonomy: Balancing the potential benefits of the research,
which could revolutionize treatment approaches for the genetic disorder,
with the individual autonomy and rights of the patients is a critical ethical
consideration. How can the team ensure that the research aligns with the
principles of beneficence without compromising patient autonomy?
Potential Solutions:
Enhanced Informed Consent Process: Implement a comprehensive and
ongoing informed consent process that involves clear communication about
the research objectives, potential risks, and the right to withdraw consent.
Data Anonymization: Utilize advanced techniques to anonymize patient data,
ensuring that individuals cannot be readily identified while still allowing for
meaningful analysis.
Ethics Review Board: Seek input and approval from an independent ethics
review board to ensure that the research adheres to ethical standards and
prioritizes patient welfare.
Patient Engagement: Actively involve patients in the decision-making pro-
cess and solicit their input on matters related to data use, privacy, and the
overall direction of the research.
By addressing these ethical considerations, the research team can navigate the
complexities of healthcare data analysis in bioengineering, foster trust, and ensure
that the benefits of the research are realized ethically and responsibly.
1.8 CONCLUSION
Throughout the course of this chapter, a number of significant findings have sur-
faced, underscoring the capacity of these technologies to drive progress in the fields
of healthcare data analysis and bioengineering.
1.8.1 Summary of Key Points

The chapter underscored the critical role of computational intelligence in extracting
meaningful insights from vast and complex healthcare datasets. The utilization of
machine learning algorithms and data analytics approaches has demonstrated sig-
nificant efficacy in the identification and diagnosis of diseases, prognostication of
patient outcomes, and enhancement of treatment strategies. The integration of block-
chain technology brings an additional layer of security and transparency to health-
care data, mitigating concerns related to privacy and data integrity. The chapter also
elucidated specific applications of these technologies, such as personalized medicine,
genomics research, and healthcare supply chain management.
1.8.2 Implications for the Future

Looking ahead, the implications of leveraging computational intelligence and
blockchain in biomedical informatics are profound. The synergy between these
technologies opens avenues for more precise diagnostics, individualized treatment
strategies, and enhanced patient care. The secure and decentralized nature of block-
chain ensures the integrity and privacy of sensitive health data, fostering greater
collaboration among healthcare stakeholders. Moreover, the potential for creating a
decentralized health ecosystem, where patients have greater control over their health
records and contribute to research initiatives, holds significant promise for the future
of healthcare.
1.8.3 Closing Remarks
In conclusion, the chapter emphasizes that the convergence of computational intel-
ligence and blockchain in biomedical and health informatics is not just a techno-
logical advancement but a paradigm shift. It has the potential to revolutionize how
we approach healthcare from diagnosis to treatment and from data management to
patient empowerment. As we navigate this transformative landscape, it is crucial
to address challenges related to interoperability, regulatory frameworks, and ethi-
cal considerations. The collaborative efforts of researchers, healthcare professionals,
and technologists will be pivotal in harnessing the full potential of computational
intelligence and blockchain for the betterment of healthcare worldwide. This chapter
serves as a stepping stone toward realizing a future where data-driven insights and
secure, decentralized systems converge to elevate the standards of healthcare and
bioengineering.
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2 Biomedical Engineering
Modelling and
Simulation
Himanshu M. Shukla, Ambarish A. Deshpande,
Kanchan D. Ganvir, and Jignyasa Gandhi
2.1 INTRODUCTION
The variability in respiratory tract anatomy and physiology among individuals sig-
nificantly influences aerosol deposition patterns. Factors such as airway branching
structure, airway diameter, lung volume, and mucociliary clearance affect the fate of
inhaled particles in the respiratory system. Individual variations in these parameters
arise due to differences in age, gender, weight, fitness, health, and disease status. It
is crucial to consider these variabilities to accurately predict aerosol deposition and
assess the efficacy of inhaled therapeutics (Kannan et al., 2020).
2.2 SCOPE OF THE CHAPTER

This chapter aims to provide a comprehensive overview of modelling and simulation
techniques in the field of biomedical engineering. The scope of this chapter encom-
passes the application of computational models and simulation tools to address vari-
ous challenges and to enhance understanding in biomedical engineering research and
healthcare applications. By exploring the diverse aspects of modelling and simulation,
this chapter aims to contribute to the advancement of biomedical engineering knowl-
edge and promote the effective utilization of these techniques in clinical practice.
2.2.1 Fundamentals of Modelling and Simulation

The chapter begins by introducing the fundamental principles and concepts of mod-
elling and simulation in biomedical engineering. It will cover topics such as the types
of models (mathematical, statistical, and computational), simulation techniques
(deterministic and stochastic), and validation and verification of models (Singh et al.,
2004). The focus will be on establishing a solid foundation for understanding the
subsequent sections of the chapter.
2.2.2 Biomedical Systems and Processes

This section discusses the modelling and simulation of various biomedical sys-
tems and processes. It covers topics such as physiological systems (cardiovascular,
26 DOI: 10.1201/9781003459347-2
Biomedical Engineering Modelling and Simulation 27
respiratory, nervous, etc.), biomechanics, biofluid dynamics, and drug delivery sys-
tems (Singh et al., 2005). The chapter explores how computational models and sim-
ulations can aid in understanding the behavior of these complex systems, predicting
their responses, and optimizing their performance.
2.2.3 Medical Imaging and Image Analysis

Modelling and simulation techniques play a crucial role in medical imaging and
image analysis. This section focuses on the application of computational models and
simulation tools in areas such as medical image reconstruction, image segmentation,
registration, and quantitative analysis (Jain &Bhambri, 2005). The chapter highlights
the importance of these techniques in improving diagnostic accuracy, treatment
planning, and image-guided interventions.
2.2.4 Biomaterials and Tissue Engineering

Modelling and simulation are invaluable tools for designing and optimizing bioma-
terials and tissue engineering constructs. This section explores how computational
models can simulate the mechanical, chemical, and biological behavior of bioma-
terials, as well as the growth and remodelling of engineered tissues (Rattan et al.,
2005a). The chapter also discusses the integration of experimental data into models
to enhance their predictive capabilities and guide the development of innovative bio-
medical materials (Kaur et al., 2023).
2.2.5 Medical Device Design and Evaluation

Modelling and simulation techniques are widely employed in the design and evalu-
ation of medical devices. This section covers topics such as finite element analysis,
computational fluid dynamics, and multibody dynamics as applied to medical device
design, optimization, and performance evaluation (Rattan et al., 2005b). The chapter
discusses how simulations can aid in improving the safety, efficacy, and functionality
of medical devices, in fostering innovation, and in reducing development costs.
2.2.6 Clinical Decision Support and Personalized Medicine

Modelling and simulation have the potential to revolutionize clinical decision-making
and personalized medicine. This section explores the application of computational
models and simulation tools in areas such as predictive modelling, treatment plan-
ning, patient-specific simulations, and virtual patient populations. The chapter will
highlight the role of these techniques in improving diagnostic accuracy, optimizing
treatment outcomes, and tailoring therapies to individual patients.
This book chapter aims to provide a comprehensive overview of modelling and
simulation techniques in the field of biomedical engineering. By covering funda-
mental principles and exploring various applications in biomedical systems, medi-
cal imaging, biomaterials, medical device design, and clinical decision support, the
chapter aims to foster a deeper understanding of these techniques and their potential
impact on healthcare. By disseminating this knowledge, the chapter seeks to pro-

mote the effective utilization of modelling and simulation in biomedical engineering
research, clinical practice, and the development of innovative healthcare solutions.
2.3 RELATED LITERATURE
Osteoporotic fractures impose a significant burden on public health, resulting
in an annual cost of €37 billion in the EU and $16 billion in the United States.
Specifically, hip fractures occur when the forces applied to the hip during a fall
surpass its ability to bear the load, leading to structural failure. The strength of
the hip depends on factors such as the shape of the femur, bone mineral density
(BMD), and bone architecture. Conversely, the impact experienced during a fall is
influenced by various elements, including the dynamics of the fall, the individual’s
body size and shape, as well as the stiffness of the hip, the surrounding tissues, and
the flooring. However, the precise relationship between hip strength, fall dynam-
ics, and osteoporotic hip fractures remains uncertain. The risk of osteoporotic hip
fracture in a sideways fall depends on both body anthropometry and bone strength
(Palanca et al., 2021).
The complexities of modern biomedicine are continuously on the rise, making
modelling and simulation increasingly essential for understanding and predicting
pathophysiology, disease genesis, and disease spread. These tools support clinical
and policy decisions, but their outcomes must be trusted cautiously, as inappropriate
reliance on them can lead to negative consequences. To ensure a formalized approach
to modelling and simulation practices, it is crucial to consider more than just verifi-
cation and validation, as they alone do not guarantee a holistic credible practice. The
declared rules offer a unified conceptual framework to guide modelling and simula-
tion activities throughout their lifecycle, including design, implementation, evalua-
tion, dissemination, and usage (Erdemir et al., 2020). While different domains, such
as biomedical science and clinical care, may have varying requirements, our study
has identified rules that can be universally valuable for a wide range of model types.
Though some of these rules may seem like common sense guidelines, experienced
practitioners sometimes overlook or misunderstand them. Computational models are
already proving valuable in basic science, generating new biomedical knowledge. As
they continue to be incorporated into clinical care and healthcare policy, it becomes
imperative to establish guidelines for credible practice to ensure clinical safety and
foster advancements in personalized and precision medicine.
Creating tools for predicting human limb force capabilities using the force feasi-
ble set (FFS) holds significant promise for applications in robotic-assisted rehabili-
tation and digital human modelling for ergonomics (Hernandez et al., 2018). These
predictions could play a crucial role in refining rehabilitation programs to encourage
active participation during exercise therapy and in preventing musculoskeletal dis-
orders. The main objective of this research is to utilize artificial neural networks
(ANN) to forecast the FFS of the upper limb, based on joint center Cartesian posi-
tions and anthropometric data. To achieve this, 17 distinct musculoskeletal models of
the right upper limb are generated, each tailored to individual anthropometric data.
The FFS is then computed for a vast range of 8428 different postures within each
musculoskeletal model. The results demonstrate that ANNs offer a reliable method
for predicting the FFS in the context of studying the human musculoskeletal system.
Moreover, even with an increasing complexity of FFS vertices, the ANN’s capacity
to predict these values remains unchanged. Additionally, the approach exhibits min-
imal computation time and exhibits good generalization performance, suggesting its
potential use with real-time feedback to assess human gesture and hand force control
during demanding tasks.
The field of engineering has undergone significant transformation in the mod-
ern era, moving beyond traditional reliance on physical testing to a more powerful
approach that combines theory with real-world testing. This fusion has resulted in
enhanced product designs and a deeper understanding of relevant phenomena, which
are now captured in computer-aided engineering systems, enabling model-driven
experimentation. The integration of computational modelling and simulation
(CM&S) has played a crucial role in shaping the complexity and reliability of mod-
ern machines, effectively replacing physical testing as the primary tool for guiding
designs (Morrison et al., 2023).
Biomedical engineers face distinctive challenges as they strive to achieve a similar
level of behavioral understanding to embrace CM&S as a reliable guide. Modelling
biological systems proves difficult to validate in realistic environments due to vari-
ations across populations and changes over time. Consequently, the potential of
CM&S in the biomedical field remains largely untapped. However, the biomedical
engineering community has consistently pushed the boundaries of CM&S over the
last five decades, chronicling their progress in the AMBE journals.
A smart chair prototype was developed to address the issue of poor sitting pos-
tures during extended periods (Martins et al., 2016). The chair incorporated a pneu-
matic system with four air bladders in the seat pad and four in the backrest, allowing
it to recognize and classify 12 standardized sitting postures with an accuracy score
of 80.9%. This study seeks to explore the potential of anthropometric information
(height and weight) to further refine the classification process. Four machine learn-
ing techniques (neural networks, support vector machines, classification trees, and
naïve Bayes) were employed to automatically divide users into two classes based on
whether they were above or below the specific anthropometric median value.
The clothing sizing system remains a persistent challenge, necessitating further
research and improvements in sizing system standards, body measuring techniques,
and size labelling in collaboration with clothing manufacturers, consumers, and
researchers (Lee, 2014). Developing a comprehensive sizing system that consid-
ers human body growth and other relevant factors will help eliminate the existing
confusion among countries and individual apparel designers. In current production
processes, standardization plays a crucial role in promoting international trade by
reducing differences and disorder, ensuring product quality, enhancing production
efficiency, and facilitating rapid improvements. It also facilitates expansion and
makes the implementation of practices more convenient and comfortable (Puri et al.,
2023, September).
An effective standard sizing system for clothes is established through a body
shape and size classification method. To create such a system, it is essential to clas-
sify the database based on the majority of samples. By doing so, we can develop a
sizing system that efficiently accommodates a wide range of body shapes and sizes.
The findings are organized into body size and shape categories, considering age and
sex and using drop values. This classification is crucial as it forms the basis for devel-
oping new guidelines for size designation systems. These guidelines will be derived
from the analyzed anthropometric database, incorporating the relevant body dimen-
sions to ensure accurate and appropriate sizing in clothing (Kataria et al., 2023, July).
Significant variations were observed in the distributions of sex and age between
the populations used to collect biomechanical data for the human neck and those with
neck injuries. In contrast, smaller differences were noted in the height, weight, and
BMI distributions between these two groups (Booth et al., 2021). The study’s overall
findings highlight the need for more biomechanical data, especially for females of
average height and weight. Additionally, the research shows a lack of biomechanical
data for older volunteers, young cadavers, and volunteers with high BMIs, regard-
less of sex. As a general recommendation, the study urges researchers to consider
the diversity of the population prone to neck injuries when enrolling volunteers and
cadavers for biomechanical studies. By including a more representative sample of
the population, the accuracy and applicability of the research findings can be signifi-
cantly enhanced.
The study discusses issues related to modelling various muscles, including stri-
ated and smooth muscles such as those in the bladder and uterus, apart from the
cardiac muscle (Hernández et al., 2013). The study is also oriented toward multiscale
modelling, encompassing cellular to subcellular levels. The main interest revolves
around applying modelling tools to solve real clinical health problems, utilizing a
model-aided diagnosis approach. The aim is also to enhance the acceptance of mod-
elling within the industrial community. By fostering these collaborations and ini-
tiatives, the researcher aims to advance the field of physiological modelling and its
practical applications.
The future of human body testing in military and civilian applications will rely
on a new generation of “dummies”—what we call “virtual humans.” CFDRC’s CMB
(computational medicine and biology) research group has developed an integrated
bioinformatics software framework for intelligent analysis of biomedical databases
(Wilkerson et al., 2009). This framework facilitates the generation of geometri-
cal models for simulations and aids in setting up human biomechanical and phys-
iological performance models. The software framework is a 3D Java-based, fully
user-interactive Virtual Body platform. It allows for the creation and editing of vir-
tual human bodies and serves as a front end for multiscale anthropometry/anatomy
physics-based simulation software. The software enables the generation and manip-
ulation of static and dynamic human body models using laser scans, anthropometric
databases, and other image-based anatomical techniques like motion capture (Rani,
Mishra, et al., 2023). Additionally, the Virtual Body serves as a data generator and
preprocessor for various human body simulation software, such as biomechanics,
ergonomics, cardiopulmonary physiology, blast injury, and other simulators. This
integration streamlines the process of predictive modelling for human body perfor-
mance in different scenarios, aiding in the development of safer and more efficient
military and civilian applications.
2.4 ROLE OF ANTHROPOMETRY IN BIOMEDICAL

MODELLING AND SIMULATION
Anthropometric measurements play a crucial role in various fields, particularly in
biomedical design and modelling. These measurements provide essential data about
the physical characteristics and dimensions of the human body, enabling the devel-
opment of tailored solutions for medical devices, prosthetics, ergonomic designs,
and virtual simulations. Traditionally, anthropometric measurements were obtained
manually, but advancements in technology have led to the development of automatic
measurement systems, significantly improving accuracy, efficiency, and reliability.
In this chapter, we explore the importance of automatic anthropometric measure-
ment in biomedical design and modelling, its applications, challenges, and future
prospects.
2.4.1 Need for Automation in Anthropometric Data Measurement

Anthropometry involves the quantitative measurement of various physical dimen-
sions of the human body, such as height, weight, limb lengths, circumferences, and
joint angles. In biomedical design, these measurements are fundamental for creating
devices that are optimized for individual patients. Whether it’s designing custom-fit
prosthetics, orthotics, or surgical implants, accurate anthropometric data ensures
better functionality, comfort, and improved patient outcomes. Additionally, anthro-
pometric dimensions are crucial in the development of ergonomic designs. Creating
tools and workstations that accommodate the varying body sizes and shapes of users
helps reduce the risk of musculoskeletal disorders and enhances overall productivity
and comfort.
In the past, anthropometric data was collected manually, often prone to human
errors and inconsistencies. However, the advent of sophisticated technologies, such as
3D scanning, computer vision, machine learning, and wearable sensors, has paved the
way for automatic anthropometric measurement systems. These systems can now accu-
rately capture and analyze human body dimensions with minimal human intervention,
offering numerous advantages over manual methods (Rani, Kumar, et al., 2023).
2.4.2 Applications of Automated Anthropometric Data Measurement

The anthropometric databases generated through an automated mechanism of mea-
surement can be vitally useful for a diverse range of applications such as medical
device customization by which the creation of personalized medical devices, such as
prosthetics and orthotics, ensures that a better fit and increased comfort for patients
can be achieved. In the gaming and entertainment industries, automatic anthropo-
metric measurement helps in generating realistic avatars that closely resemble the
users’ physical characteristics.
Companies can use automatic anthropometric measurement to design worksta-
tions, furniture, and equipment that accommodate a wide range of body sizes and
promote better posture and comfort. Also, there can be phenomenal revolution in
the apparel industry. Online retailers can utilize these measurements to offer per-
sonalized sizing recommendations to customers, reducing the rate of returns and
enhancing customer satisfaction.
2.4.3 Challenges and Future of Automated

Anthropometric Measurement
While automatic anthropometric measurement has proven to be highly advanta-
geous, some challenges still need to be addressed, such as the following:
Accuracy: Ensuring high accuracy is critical, especially in medical applica-

tions where precision is paramount.
Data Privacy: Handling personal body measurements demands strict data pri-
vacy and security protocols to protect users’ sensitive information.
Algorithm Bias: Care must be taken to avoid algorithmic bias, ensuring that
the technology works accurately for individuals of all ethnicities, ages, and
body types.
User Acceptance: Some users may be hesitant about sharing personal body
data, raising concerns about user acceptance and ethical considerations.
Looking ahead, the future of automatic anthropometric measurement appears

promising. Advancements in artificial intelligence and machine learning will likely
lead to even more accurate and efficient systems. Additionally, the integration of
automatic anthropometric measurement with virtual reality and augmented reality
technologies could revolutionize how we interact with digital environments and vir-
tual simulations. Automatic measurement of anthropometric dimensions has revolu-
tionized biomedical design and modelling. By harnessing the power of cutting-edge
technologies, we can now gather precise data to create personalized solutions that
benefit individuals across various domains, from medicine and ergonomics to virtual
environments and retail. However, while celebrating these advancements, we must
also be mindful of privacy, ethical, and bias-related concerns. With careful consid-
eration and continuous innovation, automatic anthropometric measurement will con-
tinue to shape a healthier, more comfortable, and customized world for individuals
from all walks of life.
2.5 HARNESSING ARTIFICIAL NEURAL NETWORKS IN

BIOMEDICAL MODELLING AND SIMULATION
The field of biomedical research and healthcare has witnessed remarkable advance-
ments in recent years, largely owing to the integration of cutting-edge technologies.
Artificial neural networks (ANNs), inspired by the human brain’s neural network, have
emerged as a powerful tool in various applications. One such area where ANNs have
showcased their potential is in biomedical modelling and simulation. In this chap-
ter we delve into the diverse applications of artificial neural networks in biomedical
research, their benefits, challenges, and the exciting prospects they hold for the future.
Artificial neural networks are a class of machine learning algorithms designed to

mimic the functioning of the human brain’s interconnected neurons. They consist
of layers of interconnected nodes, each processing and transmitting information to
other layers, ultimately leading to the generation of an output. Through a process
called training, ANNs learn from data and adjust their internal parameters to opti-
mize their performance.
ANNs have demonstrated exceptional capabilities in diagnosing various medical
conditions. By analyzing complex patterns and relationships within medical data,
these networks can identify disease markers and predict the likelihood of certain
conditions in patients. For instance, ANNs have been successfully employed in diag-
nosing cancer, cardiovascular diseases, and neurological disorders. ANNs offer sig-
nificant help by predicting the potential effectiveness of certain compounds in drug
development. By analyzing molecular structures and biological interactions, ANNs
can suggest promising drug candidates, thereby expediting the drug discovery pro-
cess. In medical imaging, ANNs have shown remarkable potential in tasks like image
segmentation, denoising, and reconstruction. These networks can aid in extracting
critical information from medical images, leading to more accurate diagnoses and
treatment planning. ANNs are also useful in processing and analyzing biomedical
signals, such as electrocardiograms (ECGs), electroencephalograms (EEGs), and
electromyograms (EMGs). They can detect anomalies, patterns, and trends in these
signals, aiding in disease monitoring and patient management.
The future of ANNs in biomedical modelling and simulation appears promising.
Research efforts are focusing on developing explainable AI models, addressing inter-
pretability concerns and improving trustworthiness. Additionally, combining ANNs
with other advanced technologies like genomics, proteomics, and wearable devices
will unlock new avenues for personalized medicine and real-time patient monitoring.
Artificial neural networks have emerged as indispensable tools in the realm of bio-
medical research and healthcare. Their ability to learn from complex data and make
accurate predictions has opened up new possibilities in disease diagnosis, drug dis-
covery, and personalized treatment. While challenges remain, continuous research
and innovation will undoubtedly pave the way for more effective and reliable appli-
cations of ANNs in biomedical modelling and simulation, ultimately contributing to
improved patient care and better health outcomes.
2.6 HUMAN MODELLING AND SIMULATION

Human modelling and simulation using manikins is a valuable technique employed
in various industries, including automotive design, ergonomics, virtual reality, and
healthcare. Manikins are physical or virtual representations of the human body,
designed to mimic human postures, movements, and anthropometric dimensions.
They play a crucial role in assessing the interactions between humans and their envi-
ronment, predicting human performance, and optimizing product designs. In this
chapter, we will explore the applications, benefits, and advancements in human mod-
elling and simulation using manikins. Manikins are used to evaluate the ergonomics
and comfort of vehicle interiors, ensuring that drivers and passengers have optimal
seating positions and clear visibility. Manikins help analyze workplace layouts and
design ergonomic workstations to reduce the risk of musculoskeletal disorders and

increase productivity. In virtual environments, manikins represent virtual avatars,
allowing users to experience and interact with virtual worlds while considering
human factors. They are used for training healthcare professionals in various proce-
dures, ranging from CPR to complex surgeries. Manikins aid in designing and testing
wearable devices, clothing, and personal protective equipment to ensure proper fit
and comfort for users (Ziolek & Kruithof, 2000). Human modelling and simulation
using manikins offer a powerful and versatile approach to study human behavior,
performance, and interactions in diverse fields. From improving product designs to
enhancing workplace ergonomics and medical training, manikins continue to play a
crucial role in enhancing human-centered design and optimizing human experiences
in various industries. With ongoing advancements in technology, the future of human
modelling and simulation with manikins holds even more promise for safer, more
efficient, and user-friendly solutions.
In recent years, the fields of virtual reality, biomechanics, and healthcare have
seen significant advancements in the development of virtual bodies that accurately
represent human anatomy and physiology. These virtual bodies, created through
sophisticated modelling techniques, hold immense potential in diverse applications,
including medical simulations, ergonomic design, personalized medicine, and vir-
tual reality experiences. In this chapter, we explore the concept of an integrated mod-
elling framework that seamlessly combines anthropometry and physiology to create
highly realistic and versatile virtual bodies.
Anthropometry refers to the quantitative measurement of human body dimen-
sions, such as height, weight, limb lengths, and joint angles. These measurements
are essential in creating personalized virtual bodies that closely resemble individ-
ual human subjects. On the other hand, physiology encompasses the functional and
biochemical processes that occur within the human body, including organ function,
circulation, and tissue mechanics. Combining these two domains in an integrated
modelling framework allows for the creation of virtual bodies that not only look
realistic but also behave and respond realistically. Despite the significant advance-
ments, challenges remain in the development of an integrated modelling framework
for the anthropometry and physiology of virtual bodies (Wilkerson & Przekwas,
2007). These challenges include the complexity of physiological modelling, the need
for extensive and diverse datasets, and computational limitations.
Looking ahead, ongoing research and technological advancements have the poten-
tial to overcome these challenges. The integration of emerging technologies such as
artificial intelligence and machine learning can enhance the accuracy and efficiency
of physiological modelling. Additionally, collaborative efforts among researchers,
clinicians, and technology experts are essential in creating a standardized and ver-
satile integrated modelling framework. An integrated modelling framework for the
anthropometry and physiology of virtual bodies opens up a world of possibilities in
various fields, including healthcare, ergonomics, and virtual reality. By combining
accurate representations of human anatomy and physiology, this framework provides
a platform for realistic simulations, personalized interventions, and immersive expe-
riences. As technology continues to evolve, the future holds exciting prospects for
advancing this integrated approach, ultimately enhancing human-centered applica-

tions and transforming various aspects of our lives.
The ergonomic design of any product necessitates an anthropometric study of
potential users (Zanwar et al., 2023). Typically, around 20 anthropometric dimen-
sions, as shown in Figure 2.1, from a representative population are collected to
ensure the ergonomic design and manufacturing of most products. This study aims
to explore possible relationships or groups of relationships among anthropometric
dimensions to ensure that applications based on anthropometry, such as the design of
fashion mannequins, humanoids, and human dummies, do not have disproportionate
dimensions. Establishing these interrelationships can also help reduce the number of
anthropometric dimensions that need to be measured. For this purpose, anthropo-
metric data from 18 dimensions of workers in various industries is utilized. Multiple
linear regression (MLR) and artificial neural network (ANN) models are exhaus-
tively developed for all combinations of 1 through 9 anthropometric dimensions as
independent variables, aiming to relate them to each anthropometric dimension not
present in the set of independent variables. From all the models obtained, a selec-
tion is made based on the minimum normalized root mean square error (NRMSE)
between the computed and actual anthropometric dimensions. The chosen set of
MLR and ANN models with the lowest NRMSE represent the relationships that
can aid in ensuring proportionate anthropometry-based applications and potentially
reduce the number of dimensions that need to be measured.
FIGURE 2.1 Anthropometric dimensions (standing and sitting positions) (Zanwar et al., 2023).
2.7 CONCLUSION AND FUTURE SCOPE

Biomedical engineering modelling and simulation have undergone substantial prog-
ress, showcasing immense potential in revolutionizing healthcare. These powerful
tools have already demonstrated promising applications in various areas such as med-
ical device design, personalized medicine, and surgical planning. As a result, they
are proving to be invaluable in enhancing patient outcomes and healthcare practices.
In medical device design, modelling and simulation allow engineers to virtually
test and refine prototypes, optimizing their performance and safety before real-
world implementation. This capability not only speeds up the design process but also
ensures that medical devices are better tailored to meet the specific needs of patients.
The concept of personalized medicine is significantly enhanced through model-
ling and simulation. By integrating patient-specific data, these tools can create virtual
representations of individuals, enabling healthcare providers to tailor treatments and
therapies for better efficacy and reduced side effects. Such personalized approaches
lead to more targeted and precise interventions, ultimately improving patient out-
comes and quality of life. In surgical planning, biomedical engineering modelling
and simulation offer invaluable insights for healthcare professionals. They allow
surgeons to simulate complex procedures, assess potential risks, and identify opti-
mal strategies before entering the operating room. This advance preparation leads
to more informed decision-making, reduced operative complications, and enhanced
patient safety during surgery.
Despite these remarkable advancements, certain challenges need to be addressed
to further harness the full potential of biomedical engineering modelling and sim-
ulation. Model complexity can be a limiting factor, as intricate models may require
extensive computational resources and expertise to operate effectively. Ensuring
accurate validation of these models against real-world data is crucial to build trust
and confidence in their applications. Additionally, enhancing user-friendliness will
encourage wider adoption by healthcare professionals who may not have extensive
engineering or technical backgrounds.
Nonetheless, with continuous progress and investment in research and develop-
ment, biomedical engineering modelling and simulation hold the potential to rev-
olutionize healthcare. As these tools become more accessible, precise, and reliable,
they are expected to pave the way for personalized, evidence-based approaches to
diagnosis, treatment, and patient care. The future of healthcare is poised to witness
a transformation, where tailored and data-driven interventions will lead to improved
health outcomes and a higher standard of care for individuals worldwide.
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3 Information Extraction
and Knowledge
Discovery in Biomedical
Engineering and
Health Informatics
S. Archana and E. Mathiselvan
3.1 INTRODUCTION TO INFORMATION EXTRACTION

AND KNOWLEDGE DISCOVERY
An introduction to information extraction and knowledge discovery is a crucial
entry point into the worlds of biomedical engineering and health informatics. This
ever-changing discipline entails the automated extraction of important insights and
knowledge from massive, diversified datasets available in electronic health records,
scholarly literature, and other healthcare sources. Natural language processing (NLP)
and text mining are clever techniques that unearth the hidden gems of unstructured
data, delivering organized, usable knowledge (Alam & Awan, 2018). These procedures
are significant because of their potential to alter healthcare and medical research.
Novel connections and predictive models can be identified via data mining, machine
learning, and statistical analysis, enabling personalized medicine, evidence-based
decision-making, and significant advances in public health measures. However, this
interesting subject is not without its obstacles, such as data privacy concerns, deal-
ing with heterogeneous data sources, and scalability constraints. Nonetheless, with
opportunities such as precision healthcare and drug development on the horizon, the
trip into the world of information extraction and knowledge development in biomedi-
cal engineering beckons with the promise of a healthier, more informed future.
3.1.1 Definition and Significance

Definition: The automated procedure of extracting structured information
from unstructured or semistructured biomedical data sources such as elec-
tronic health records and scientific publications is known as information
extraction. NLP and text mining methods are used to detect and extract-
related entities, relationships, and attributes from textual data. Knowledge
discovery, on the other hand, refers to the process of uncovering relevant
DOI: 10.1201/9781003459347-3 39
patterns, correlations, and hidden knowledge in massive and complicated

biomedical datasets. Data mining, machine learning, and statistical tech-
niques are used to provide important insights and predictive models.
Significance: The importance of information extraction stems from its abil-
ity to turn unstructured data into structured, machine-readable formats,
hence improving data accessibility and interoperability and supporting a
wide range of applications in healthcare, research, and data integration.
This is extremely important since it allows for the discovery of essential
information such as illness biomarkers, treatment responses, and popula-
tion health trends, which supports customized medicine, evidence-based
decision-making, and breakthroughs in healthcare and medical research.
These methods help to improve patient treatment, medical research, and
public health measures, resulting in better healthcare outcomes and a more
educated and proactive approach to medicine.
3.1.2 Overview of the Chapter

This chapter provides an in-depth look at the critical processes of information
extraction and knowledge discovery in healthcare. It starts with a definition and
explanation of information extraction and knowledge discovery, highlighting their
transformative role in transforming unstructured data into meaningful insights. The
chapter delves into the field’s problems and opportunities, addressing issues like
data heterogeneity and privacy concerns while highlighting the potential in preci-
sion healthcare and data-driven research. It dives into many strategies for extracting
information and discovering knowledge from distinct biomedical datasets, such as
natural language processing and machine learning.
3.2 TEXT MINING TECHNIQUES IN BIOMEDICAL ENGINEERING

Text mining is the process of gathering valuable information, knowledge, or pat-
terns from formless text from several sources (Preeti, 2021). This topic offers several
methods for obtaining a result:
Obtaining Documents: The first stage involves obtaining text documents,

which can be created in a variety of forms. The file can be in any of the
tracking formats: PDF, Word, html, CSS, and so on.
Document Preprocessing: This stage involves removing duplicate words,
inconsistencies, separate words, and stems from the input document. The
completed stages are as tracks:
Tokenization: The supplied file is processed as a structured string, with
each word designated as a separate unit, or token.
Stop Word Removal: Common terms such as “a,” “an,” “but,” “and,” “of,”
“the,” and so on are deleted during this step.
Stemming: A stem is nothing but a natural group of words that have the
identical (or very similar) meanings. This method describes the gram-
matical underpinning of a term. Inflectional stemming and derivational
Information Extraction and Knowledge Discovery 41
stemming are the two types of stemming. Porter’s algorithm is a well-

known stemming procedure. For example, if a document includes the
phrases “resignation,” “resigned,” or “resigns,” are regarded as “resign”
after stemming.
Text Transformation: A text file is comprised of words (features) and their
occurrences. Two important ways for expressing these papers are the Vector
Space Model and the Bag of Arguments.
Character Selection: This strategy results in a compact record size and a min-
imal search technique by deleting superfluous features from the input mate-
rial. Filtering and wrapping are the two feature selection methods.
Pattern Recognition/Data Mining: Text mining and classical data mining
are integrated at this point. Structured databases make use of typical data
mining techniques developed in the previous step.
Evaluate: In this step, the outcomes are quantified. This result can be saved or
used in the next series of instructions.
Text mining techniques are critical for extracting meaningful information from large
volumes of biomedical texts, providing important insights for research and therapeu-
tic applications. Figure 3.1 shows some of the strategies.
Information Extraction (IE): This is a method for extracting beneficial

information from massive volumes of text. Tokenization, named entity
FIGURE 3.1 Techniques of text mining.

identification, sentence subdivisions, and part-of-speech projects are among

the activities involved in IE, which is the first stage for systems to interpret
unstructured data by sensing key phrases and relationships within data. IE
systems are trained to extract certain text, characteristics, and entities from
files and determine the irrelationships.
Following that, the acquired corpora are aggregated into linked databases for
more processing. Precision and recall techniques are used to review and
appraise the relevant data/outcomes from the extracted text (Desai, 2015).
In order to maximize outcomes from information extraction methods,
in-depth and broad intelligence of the associated topic is required.
Information Retrieval (IR): IR is the process of extracting related infor-
mation and connected designs from a corpus of words or phrases (Hersh,
2008). Various algorithms are employed in information retrieval to map the
user’s behavior and locate relevant facts and data.
For example, Google Search Engine frequently applies information retrieval
techniques to generate relevant material based on search queries. Search
engines utilize query-based algorithms to keep trends and generate more
related results. Following that, search engines give more relevant and reli-
able data to users with respect to their search needs. This approach is briefly
covered in the following topics.
Natural Language Processing (NLP): This is concerned with the auto-
matic processing and examination of unstructured textual information,
and it enables computers to read by analyzing phrase structure and syntax.
(Chen et al., 2020). It can do a range of analyses, such as named entity rec-
ognition (NER), summarization, and sentiment examination, as shown here.
Recapitulation: To provide a summary of enormous volumes of textual
data to generate a concise and understandable review of major points in
a publication.
Parts of Speech (PoS) Tagging: To tag a word/token in a document depend-
ing on its part of speech, such as nouns, verbs, adjectives, and so on. PoS
tagging enables semantic examination of unstructured data.
Text Classification: The study and classification of text materials based on
specified topics or categories, including advantages when classifying
synonyms and abbreviations (Kataria et al., 2023, July).
Sentiment Analysis: Determine benefits or limitation sentiment from inter-
nal and external data sources, allowing users to track changes in cus-
tomer behavior overtime (Bhambri & Gupta, 2005). Sentiment analysis
is used to collect relevant data about brand, product, and service percep-
tions, which motivates organizations to engage with customers in order
to improve operations, client experience, and satisfaction.
Clustering: This method is an unsupervised procedure that uses numerous
clustering algorithms to categorize text items into groups. Similar phrases
or patterns are sorted and extracted from various documents during cluster-
ing, which is done both top-down and bottom-up.
As a result, various divisions known as clusters are generated, with each cluster
holding a number of documents. A basic clustering algorithm keeps track of
themes for each document and weigh how well the documents fit into each
cluster (Tanwar et al., 2022, September).
The quality of a clustering result is governed by the similarity measures of text
content used by the clustering technique and its implementation, so a suc-
cessful clustering strategy provides clusters with high intracluster similar-
ity and low intercluster similarity. It differs from categorization in that text
contents are clustered without prior knowledge of classifications in clustering
(Bhambri & Bhandari, 2005). The main advantage of clustering is that text
content can be relevant to multiple classes at the same time. Many clustering
algorithms, including hierarchical, distribution, density centroid, and k-means
clustering, are used to analyze unstructured text data (Kaur et al., 2023).
Categorization: The categorization approach assigns one or more categories
to independent (free format) text documents. Categorization is a supervised
learning strategy that uses input–output examples to differentiate new mate-
rial. Each text document is allocated a specified class based on its content.
Text categorization involves methods like preprocessing, indexing, dimen-
sionality reduction, and classification with the goal of training classifiers
on recognized examples and then automatically categorizing unrecog-
nized examples. Furthermore, text categorization is hampered by the great
dimensionality of the feature space. Then naïve Bayesian classifiers, nearest
neighbor classifiers, decision trees, and support vector machines are some
effective analytical classification methods for text categorization. Document
organization, spam screening, SMS classification, and hierarchical web
page categorization are all applications included in categorization.
Visualization: Visualization tools can aid in the improvement and clarification
of data analysis. When outlining individual documents or groups of docu-
ments, text flags are used to indicate the type of the documents, and colors
are used to indicate document density. Large textual sources are organized
in a visual hierarchy, allowing users to interact with them by diving and
zooming. The government, for example, uses information visualization to
identify terrorist networks and criminal information.
The visualization technique procedure consists of three parts:
Preparation of Data: This requires determining and obtaining unique data for
visualization, as well as creating unique data space.
Data Extraction and Analysis: Data analysis and extraction refers to the pro-
cess of examining and extracting visualization data from original data in
order to construct a visualization data space.
Visualization Mapping: Some mapping approaches are employed in this step
to map the visualization data space to the visualization goal (Rani, Mishra,
et al., 2023).
Text Summarization: This aids in determining whether a lengthy document
meets the user’s requirements and also in determining whether it is worth-
while reading for additional information or not. Thus text summarization
could be replaced by groups of documents.
Text summarizing software maintains and summarizes a large text document in

less time than consumers read the first paragraph (Bhambri et al., 2005). It is sepa-
rated into two sections;
Abstractive Summarization: This creates a clear comprehension of main

subjects in the book and depicts them in natural language. It employs lin-
guistic techniques to comprehend, modify, and explain text in precise form.
Extractive Summarization: This entails constructing primary text segments
based on the statistical analysis of text attributes such as word frequency,
position, or suggested phrases to detect the sentences to be extracted.
Text summarization, in particular, is a three-step process.
Preprocessing: This stage generates a structured representation of the original

text. Tokenization, stop word elimination, and stemming are examples of
preprocessing techniques.
Processing: Algorithms are used to convert and interpret summary structure
from text structure.
State of Development: This step entails retrieving the final summary from the
summary structure.
Named entity recognition (NER) is explored as a key technique for identifying and
extracting important biomedical entities, including genes, proteins, diseases, and
drugs. Relation extraction methods are discussed to uncover meaningful relationships
between these entities, further enriching the extracted knowledge. Additionally, text
classification techniques are introduced, enabling the categorization and organiza-
tion of biomedical documents based on their content and relevance.
3.2.1 Named Entity Recognition (NER) for

Identifying Biomedical Entities
NER is an important technique in biomedical engineering and health informatics for
identifying and extracting biological entities from unstructured or semistructured
data. Genes, proteins, diseases, medications, and other medical words are exam-
ples of these entities. NER is critical in biomedical text mining because it allows
researchers to swiftly and effectively discover and categorize significant information
from massive amounts of textual data, such as scientific papers and clinical notes.
Named entity recognition is a significant technology in biomedical engineering
and health informatics that allows for the accurate identification and categorization
of biological things from unstructured text. Natural language processing, machine
learning, and rule-based approaches are used in NER techniques (Bhambri & Singh,
2005). To train NER models and increase accuracy, these methods frequently include
the usage of specialized biological ontologies and vocabularies.
Application: Its ability to turn text into structured data allows for a better
understanding of molecular relationships, disease causes, and prospective
treatment targets. Researchers can unearth new insights, accelerate medical

discoveries, and eventually contribute to improvements in healthcare and
personalized medicine by constantly refining NER approaches.
3.2.2 Relation Extraction for Uncovering

Relationships Between Biomedical Entities
Relation extraction is another important technique in biomedical engineering and
health informatics for discovering significant correlations between biomedical
entities such as genes, proteins, illnesses, and medications. This procedure entails
automatically detecting and extracting relationships, interactions, and dependencies
between these entities from massive amounts of unstructured biological data, such
as scholarly literature and electronic health records (Bhambri & Mangat, 2005).
Relation extraction helps to unearth useful insights that would otherwise be lost
in the large sea of biological data by leveraging natural language processing and
machine learning processes.
This method involves automatically discovering and extracting linkages, interac-
tions, and dependencies between these entities from large amounts of unstructured
biological data, such as scholarly literature and electronic health information. By
employing natural language processing and machine learning methods, relationship
extraction helps to find relevant insights that would otherwise be lost in the vast sea
of biological data.
Application: One of the most common applications of connection extraction

is in drug discovery. Researchers can find possible drug–target interactions
and determine which medications may be beneficial intreatingspecificdis-
easesorconditionsbystudyingscientificliteratureandmedicaldatabases.
3.2.3 Text Classification for Categorizing Biomedical Documents

Text categorization is the process of automatically labelling or categorizing docu-
ments based on their content and context. These documents can contain scholarly
publications, clinical notes, medical reports, and research papers in the context of
biomedical research. Text categorization, which employs natural language processing
and machine learning algorithms, aids in the effective organization and management
of biomedical information, making it easily accessible to researchers, healthcare
practitioners, and decision-makers.
Significance: With enhanced information retrieval, knowledge discovery,

and data integration capabilities, this enables academics and medical
practitioners to easily locate important information on specific subjects,
diseases, or therapies, thereby speeding up literature reviews and facilitat-
ing evidence-based decision-making. It also facilitates the identification
of emerging trends and patterns in biomedical research, which can have
important implications for expanding medical knowledge and enhancing
patient care.
3.2.4 Introduction to Information Retrieval

An introduction to information retrieval techniques in the context of biomedical data
is required for effectively exploiting the huge amounts of healthcare data. Biomedical
data from electronic health records, scientific literature, and medical databases can be
used to make clinical choices and conduct research. The natural language processing
(NLP) and named entity recognition (NER) approaches enable the exact extraction
of relevant information from biological texts. Indexing and searching help to orga-
nize and locate data, which helps to support evidence-based medicine and acceler-
ate medical breakthroughs. As biomedical data grows, these strategies will become
increasingly important in data-driven healthcare and research improvements.
3.2.4.1 Information Retrieval Techniques in Biomedical Data

Information retrieval strategies in the context of biomedical data are critical for effi-
ciently retrieving crucial healthcare information. Biomedical data from electronic
health records, scholarly literature, and medical databases can provide critical
insights for clinical decisions and research. These techniques, which include natural
language processing (NLP) and named entity recognition (NER), allow for the accu-
rate extraction of relevant information from biomedical literature, identifying entities
such as genes, proteins, and diseases. Relation extraction approaches improve the
process by discovering relevant correlations between biomedical items. Indexing and
searching biological literature and databases improve data management, allowing for
more efficient searches for relevant papers and data points.
3.2.4.2 Indexing and Searching Biomedical Literature and Databases

In biomedical engineering and health informatics, indexing and searching biomedical
literature and databases is crucial for effective information retrieval. By categoriz-
ing important documents and providing metadata such as keywords and abstracts, a
structured database is built, allowing easy access to specific biomedical publications
and obtaining data from patient queries. Figure 3.2 depicts the materials required
for researchers. Advanced search algorithms provide exact retrieval from massive
databases, facilitating evidence-based decision-making, biomedical research, and
breakthroughs in medical practice. These procedures make valuable knowledge
more accessible, fostering innovation in healthcare and biomedical engineering.
3.3 DATA MINING AND MACHINE LEARNING

IN BIOMEDICAL ENGINEERING
Data mining and machine learning techniques have enormous potential in biomed-
ical engineering, providing significant insights and prediction skills for processing
complicated biomedical data. In this topic, we will look at the fundamental ideas and
applications of data mining and machine learning in the healthcare area. First, we
look at feature extraction and selection approaches for identifying meaningful pat-
terns and traits in biomedical data and expediting the analysis process. The discus-
sion includes clustering and classification techniques, which are critical in grouping
FIGURE 3.2 Procedure for indexing and searching.
similar data points and categorizing biomedical data into understandable classifica-
tions. These approaches are especially useful in disease diagnosis and patient strati-
fication based on molecular profiles.
Furthermore, we investigate predictive modeling and decision support systems
that use machine learning to forecast disease outcomes and assist doctors in making
well-informed treatment decisions. The potential of machine learning algorithms
in finding illness biomarkers and therapeutic targets emphasizes the importance of
this field.
3.3.1 Data Mining and Machine Learning Techniques

in Biomedical Data Analysis
It underlines the need of utilizing these technologies to derive important insights

from large and complicated biomedical datasets. Data mining is the act of detecting
patterns, trends, and relationships in data, whereas machine learning is the devel-
opment of algorithms that can learn from data and make predictions or judgments
(Mooney & Bunescu, 2005). The importance of using these techniques in biomedical
engineering stems from their capacity to reveal hidden linkages and extract rele-
vant information, which aids in disease diagnosis, prognosis, medication develop-
ment, and personalized treatment. Data mining and machine learning contribute to
evidence-based medical research and improve patient care by evaluating various bio-
medical data sources such as genomic data, medical imaging, and electronic health
records (Rani, Kumar, et al., 2023).
3.3.2 Feature Extraction and Selection for Biomedical Data

This topic focuses on the critical phase of feature extraction and selection in the
context of biomedical data analysis. Feature extraction is translating raw data into
a set of useful and informative features that can represent the underlying patterns
and qualities of the data. The chapter examines biomedical data feature extraction
techniques such as signal processing methods for physiological data and image fea-
ture extraction for medical imaging data. Feature selection, on the other hand, seeks
to discover the most important characteristics from a huge pool of extracted fea-
tures, lowering dimensionality and improving the efficiency of subsequent studies.
Researchers can uncover critical biomarkers, genetic variables, and imaging traits
linked with disease using effective feature extraction and selection strategies, assist-
ing in early identification, treatment planning, and biomedical research.
3.3.3 Clustering and Classification Algorithms

for Biomedical Data Analysis
This topic goes into clustering and classification methods, both of which are critical com-
ponents of biomedical data processing. Clustering algorithms use similarity measures
to group similar data points together, allowing researchers to uncover patterns and sub-
groups within the data. (Forkan et al., 2020). Clustering can help discover patient subpop-
ulations withcomparableillnessfeaturesortreatmentresponsesinthebiomedicalarea.
Classification algorithms, on the other hand, use features to assign data points to
predetermined groupings or categories. This type of algorithm is commonly used in
illness diagnostics, where the model learns from labelled data to predict disease out-
comes or patient states. Biomedical researchers get deeper insights into complicated
information by using clustering and classification approaches, enabling personalized
therapy, disease stratification, and treatment optimization.
3.4 KNOWLEDGE DISCOVERY FROM ELECTRONIC

HEALTH RECORDS (EHRS)
EHR-based knowledge discovery has emerged as a viable path in biomedical engi-
neering and health informatics. As illustrated in Figure 3.3, EHRs contain a plethora
of patient data, including medical history, treatments, test findings, and more, mak-
ing them valuable sources for extracting insights to enhance healthcare outcomes.
The knowledge discovery method is broken down into three major steps: data
preparation, knowledge discovery, and results review (Mahoto et al., 2021). Data
preparation is required for the knowledge discovery techniques. The outcomes eval-
uation stage is concerned with the evaluation of the retrieved knowledge. The out-
comes are evaluated in two ways: (1) using evaluation indices and (2) utilizing a
medical expert. The assessment index is applied in accordance with the data mining
technology, and the findings were analyzed by medical specialists in accordance with
medical standards. The next sections detail the healthcare electronic data used in the
study, while the other three subsections report the results of the data mining algo-
rithms used to develop medical knowledge, as illustrated in Figure 3.4. In addition,
FIGURE 3.3 Schematic representation of EHR.
FIGURE 3.4 Discovering knowledge from healthcare data.
the clustering evaluation index must be implemented. Any other tool/application, on

the other hand, can be used to apply data mining methodologies.
Knowledge discovery seeks to extract patterns, trends, and hidden knowledge
from these massive and complex databases using advanced data mining and machine
learning approaches. Preprocessing the EHR data to assure data quality, dealing with
missing values, and dealing with noise and inconsistencies are all part of the process.
3.4.1 Utilizing Electronic Health Records (EHRs) for

Knowledge Discovery
The use of electronic health records (EHRs) for knowledge discovery has enormous
potential for altering healthcare practices. EHRs are extensive archives of patient
health information that provide a comprehensive view of an individual’s medical
history and treatment path. Researchers and healthcare practitioners can delve into
these records to get useful insights and knowledge by utilizing the power of data
mining and machine learning techniques (Hossain et al., 2019).
Patterns and connections can be discovered by analyzing huge and diverse EHR
databases, assisting in the identification of disease risk factors, uncovering therapy
responses, and predicting patient outcomes. This use of EHRs for knowledge dis-
covery opens the way for evidence-based medicine, in which clinical decisions are
guided by data-driven insights, resulting in better patient care and outcomes.
3.4.2 Preprocessing and Data Cleaning of EHR Data

Preprocessing and data cleaning are critical processes in extracting knowledge from
electronic health records (EHRs). EHR data frequently contains missing values, errors,
and inconsistencies, which might impair the accuracy of analytical conclusions.
Preprocessing: It entails dealing with missing data using imputation methods,

assuring data consistency, and translating data into a suitable format for
analysis.
Data Cleaning: It entails discovering and rectifying errors, deleting duplicate
records, and resolving discrepancies. Properly cleaned and preprocessed
EHR data maintains the quality and integrity of the data utilized for knowl-
edge discovery, allowing academics and healthcare practitioners to acquire
trustworthy and valuable insights.
3.4.3 Association Rule Mining for Identifying

Patterns and Relationships in EHR Data
Association rule mining is an effective tool for uncovering interesting links and pat-
terns in electronic health records (EHRs). Its goal is to locate common item sets and
build association rules that emphasize important links between variables. For exam-
ple, it may reveal that particular medications are frequently recommended together
or that certain patient features are connected with a higher risk of getting certain dis-
eases. Association rule mining enables researchers and clinicians to acquire a better
understanding of potential connections in EHR data, assisting indecision-making,
treatment planning, and clinical research.
3.4.4 Predictive Modeling Using EHR Data for

Disease Diagnosis and Prognosis
Predictive modeling employing electronic health records (EHRs) has emerged as a
game changer in disease diagnosis and prognosis. Predictive models can be created
using machine learning algorithms to estimate patient outcomes, identify early indi-
cators of disease, and predict therapy responses. These models use previous patient
data to build connections between clinical characteristics and illness outcomes, pro-
viding tailored and preventative healthcare (Bhagya & Sripriya, 2022). Clinicians
can utilize predictive models to aid in the early diagnosis of diseases, the selection
of effective treatment techniques, and the customization of healthcare plans based on
unique patient characteristics. Finally, predictive modeling employing EHR data pro-
vides healthcare professionals with useful insights to give more efficient and targeted
care, improving patient outcomes, and altering the healthcare delivery environment.
3.5 ETHICAL AND LEGAL CONSIDERATIONS IN INFORMATION

EXTRACTION AND KNOWLEDGE DISCOVERY
Ethical and legal considerations are crucial in the fields of information extraction and
knowledge discovery in biomedical engineering and health informatics. To ensure indi-
vidual privacy and confidentiality when dealing with sensitive patient data and gener-
ating important insights, stringent adherence to ethical norms is required. Researchers
and practitioners must get informed consent from participants, ensuring that they
understand how their data will be used and are willing to engage in the research.
Furthermore, the beneficence principle must be followed, ensuring that possible ben-
efits outweigh risks and that precautions are taken to minimize harm to participants.
The idea of fairness should also be followed, ensuring equitable distribution of
benefits and preventing biases or prejudice in data utilization. Compliance with rel-
evant legislation, such as the Health Insurance Portability and Accountability Act
(HIPAA), is crucial from a legal standpoint in order to preserve patient health infor-
mation. Institutional review board (IRB) approval is required to ensure that research
follows ethical norms and resolves any dangers. By adhering to ethical and legal
guidelines, researchers can realize the full potential of information extraction and
knowledge discovery while maintaining public trust and protecting individual rights
and data privacy.
3.5.1 Privacy and Security Issues in Biomedical Data Mining

When dealing with sensitive information from electronic health records (EHRs), pri-
vacy and security are essential concerns in biomedical data mining (Pramod, 2023).
Protecting patient privacy and confidentiality is critical for protecting individual
rights and preventing unwanted data access or misuse. Re-identification of patients
using apparently de-identified datasets is a substantial issue, as modern data linkage
techniques and external data sources can possibly disclose identities. To overcome
this, strong de-identification techniques such anonymization, aggregation, and gener-
alization should be used while adhering to ethical and legal requirements.
To ensure patient privacy, data sharing procedures must be carefully managed.
Researchers and organizations must develop clear data sharing policies that restrict
data access to approved individuals for legitimate research reasons. Collaborations
between researchers and universities must also address issues about privacy and
security. Implementing data governance frameworks and data sharing agreements
guarantees that data privacy is consistently protected when data is shared across
businesses.
Researchers in biological data mining can protect patient privacy while promot-
ing knowledge discovery and healthcare research by using effective de-identification
techniques, stringent security measures, and clear data sharing protocols. Protecting
privacy and security is critical for fostering public trust, promoting appropriate
research practices, and realizing the full potential of biological data to enhance
healthcare outcomes.
3.5.2 Compliance with Healthcare Regulations (e.g., HIPAA)

Compliance with healthcare standards, particularly the HIPAA, is critical in infor-
mation extraction and knowledge discovery in biomedical engineering and health
informatics. HIPAA’s goal is to secure individuals’ personal health information
(PHI) while also facilitating seamless healthcare coverage changes (Anthony et al.,
2014). The Privacy Rule oversees the use and dissemination of PHI by covered enti-
ties, assuring patient consent, confidentiality, and access rights.
The Security Rule defines precautions for electronic PHI (ePHI), such as risk
assessments and data breach contingency plans. To secure data confidentiality, integ-
rity, and availability, organizations must use methods such as encryption and authen-
tication. Noncompliance with HIPAA can result in hefty penalties, emphasizing the
necessity of understanding and complying with these requirements. HIPAA com-
pliance is critical for retaining patient trust, supporting ethical data practices, and
securing sensitive health information in biomedical engineering and health infor-
matics research.
3.6 EMERGING TRENDS AND CURRENT ADVANCEMENTS

Emerging trends and current breakthroughs in information extraction and knowl-
edge discovery in biomedical engineering and health informatics are transforming
the landscape of healthcare and medical research. The growing use of wearable
devices and mobile health applications creates real-time patient data, providing indi-
vidualized health insights. Data privacy and security are becoming more important,
resulting in enhanced encryption and safe data transfer protocols in the digitized
healthcare realm. Integrating omics data with clinical information holds promise for
customized therapy but requires sophisticated algorithms for useful insights.
These trends have the potential to alter healthcare by supporting customized med-
icine, precision medicine, and data-driven improvements. Current advancements in
information extraction and knowledge discovery in biomedical engineering highlight
text analysis by the natural language processing methods, deep learning algorithms
for reducing complex data, and multimodal data integration for a holistic perspective
of patient health.
Biomarker identification and patient clustering for personalized treatment are now
possible thanks to advances in data mining and machine learning. Network-based
techniques provide insights into disease mechanisms and therapeutic targets. Data
sharing and cooperation are critical for increasing interoperability and accelerating
knowledge discovery. The combination of existing trends and future discoveries holds
the key to changing medicine and improving patient outcomes on a global scale.
3.7 CONCLUSION
In this chapter, we discovered their enormous potential of information extraction and
knowledge discovery to improve healthcare. Information extraction converts unstruc-
tured data into organized insights, increasing accessibility and enabling new applications.
Meanwhile, knowledge discovery identifies critical patterns in biomedical data-
sets, improving precision healthcare and drug development. Wearable devices,
explainable AI, and the integration of omics data are among the intriguing future
prospects. While tackling issues such as data privacy and scalability responsibly,
these strategies enable researchers and clinicians to accelerate medical discoveries
and deliver tailored healthcare solutions, thereby defining a healthier tomorrow.
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4 Applications and
Distributed Frameworks
Security Issues
G. Adiline Macriga and S. Sankari
4.1 DISTRIBUTED FRAMEWORKS
Distributed frameworks are software frameworks that allow the execution of par-
allel and distributed computing tasks across multiple machines or nodes in a net-
work. These frameworks provide abstractions and tools to simplify the development,
deployment, and management of distributed applications.
4.2 CHALLENGES IN DISTRIBUTED FRAMEWORKS

While distributed frameworks offer significant benefits, they also present various
challenges that organizations and developers need to address. Here are some com-
mon challenges associated with distributed frameworks:
Complexity: Distributed frameworks often introduce additional complexities

due to the distributed nature of computation and data storage. Developers
need to understand and manage concepts such as data partitioning, distri-
bution, fault tolerance (Zaharia et al., 2012), and distributed coordination.
Working with distributed frameworks requires expertise in distributed sys-
tems and knowledge of the framework’s specific APIs and programming
models.
Scalability and Performance: While distributed frameworks provide scalabil-
ity, achieving optimal performance and scalability requires careful design
and tuning. Factors such as data partitioning, load balancing, network com-
munication, and resource utilization need to be optimized to ensure efficient
utilization of cluster resources and to avoid bottlenecks.
Data Consistency and Synchronization: Maintaining data consistency across
distributed systems is challenging. Distributed frameworks often employ
mechanisms such as replication and consensus algorithms to ensure data
consistency (Singh et al., 2005). However, managing data synchronization,
conflicts, and maintaining data integrity across distributed nodes can be
complex, especially in scenarios with frequent updates or concurrent access.
Fault Tolerance and Resilience: Distributed frameworks need to handle node
failures, network partitions, and ensure fault tolerance and system resil-
ience. Implementing fault tolerance mechanisms such as data replication,
DOI: 10.1201/9781003459347-4 55
failure detection, and recovery can be challenging (Bhambri and Singh,

2005). Ensuring that the system can recover from failures, maintain data
availability, and handle network disruptions without data loss requires care-
ful design and testing.
Network Communication and Latency: Distributed frameworks rely on net-
work communication between nodes, which introduces latency and network
overhead. Efficient data transfer and minimizing data movement across the
network are crucial for performance optimization (Bhambri and Sharma,
2005). Reducing network latency and optimizing communication patterns
are ongoing challenges, especially when dealing with large volumes of data
or real-time processing requirements.
Resource Management: Effective resource management is essential for dis-
tributed frameworks. This includes such tasks as resource allocation, load
balancing, and efficient utilization of computing resources. Resource man-
agement becomes more challenging as the cluster size grows, and various
types of resources (CPU, memory, disk) need to be managed and allocated
efficiently to handle diverse workloads.
Debugging and Monitoring: Diagnosing and debugging issues in distributed
frameworks can be complex. Identifying performance bottlenecks, pin-
pointing errors or failures, and monitoring the system’s health and perfor-
mance across multiple nodes require robust monitoring and debugging tools
(Bhambri et al., 2005). Distributed tracing, log aggregation, and real-time
monitoring capabilities are necessary for effectively managing distributed
applications.
Development and Testing: Developing and testing applications on distrib-
uted frameworks can be challenging. Setting up and configuring distrib-
uted environments, managing data consistency during testing, and ensuring
reproducibility of results across distributed nodes require specialized test-
ing frameworks and methodologies.
Integration and Compatibility: Integrating distributed frameworks with
existing systems, databases, or tools can be challenging due to compati-
bility issues. Ensuring smooth data ingestion, integration with data storage
systems, or interoperability with other frameworks or libraries can require
additional effort and customization (Rani, Kumar, et al., 2023).
4.3 APPLICATIONS OF DISTRIBUTED FRAMEWORKS

Distributed frameworks find applications in various domains and can be used to
address a wide range of challenges. Here are some common applications of distrib-
uted frameworks.
4.3.1 Decentralized Finance (DeFi) Applications

Decentralized finance (DeFi) applications are built on blockchain platforms and aim
to recreate traditional financial services in a decentralized and trustless manner.
Here are some common types of DeFi applications:
Distributed Frameworks 57
Decentralized Exchanges (DEX): DEX platforms allow users to trade cryp-

tocurrencies directly with each other without the need for intermediaries.
They utilize smart contracts and decentralized order books to enable peer-
to-peer trading. Examples are Uniswap, SushiSwap, and PancakeSwap.
Decentralized Lending and Borrowing: DeFi lending platforms enable indi-
viduals to lend or borrow cryptocurrencies without the involvement of tra-
ditional banks. These platforms use smart contracts to facilitate lending and
borrowing processes, determine interest rates, and handle collateral manage-
ment. Popular lending platforms include Compound, Aave, and MakerDAO.
Yield Farming and Liquidity Mining: Yield farming involves earning
rewards by providing liquidity to DeFi platforms. Users contribute their
cryptocurrencies to liquidity pools and receive tokens or fees as incentives.
Liquidity mining refers to earning additional tokens by staking or providing
liquidity to specific DeFi protocols. Examples include Yearn.finance, Curve
Finance, and Synthetix.
Stablecoins and Decentralized Stablecoin Protocols: Stablecoins are cryp-
tocurrencies designed to maintain a stable value, often pegged to a fiat
currency like the U.S. dollar. Decentralized stablecoin protocols use smart
contracts to ensure price stability and collateralization (Abrol et al., 2005).
Popular decentralized stablecoin projects include Dai (MakerDAO), USDT
(Tether), and USDC (USD Coin).
Decentralized Insurance: DeFi insurance platforms offer decentralized insur-
ance services, allowing users to protect their crypto assets against risks such
as hacks, smart contract vulnerabilities, or exchange failures. These plat-
forms use blockchain and smart contracts to automate the insurance process
and ensure transparency. Examples are Nexus Mutual and Cover Protocol.
Automated Market Makers (AMM): AMMs are algorithms that provide
liquidity and enable token swaps on DEX platforms. They use mathemati-
cal formulas and pools of tokens to determine exchange rates and facilitate
trading. AMMs have become a fundamental component of many DeFi plat-
forms, including Uniswap, Balancer, and Curve Finance.
Decentralized Derivatives and Prediction Markets: DeFi derivative platforms
enable users to trade financial instruments such as futures, options, or syn-
thetic assets in a decentralized manner. Prediction markets allow users to bet
on the outcome of future events. Examples are Synthetix, Augur, and dYdX.
Governance and Decentralized Autonomous Organizations (DAOs):
Governance platforms and DAOs give token holders the power to participate
in decision-making processes regarding the development and management
of DeFi protocols. Participants can vote on proposals, allocate funds, and
shape the future direction of the platform. Popular examples are Compound
Governance, Yearn.finance, and DAOstack.
4.3.2 Health and Medical Applications of Distributed Frameworks

Distributed frameworks offer numerous applications in the health and medical
domains, enabling efficient data management, analysis, and collaboration among
healthcare stakeholders. Here are some key health and medical applications of dis-
tributed frameworks:
Health Data Interoperability: Distributed frameworks can facilitate health

data interoperability by enabling the seamless exchange and integra-
tion of health data from diverse sources (Rani, Mishra, et al., 2023). By
leveraging standardized data formats, protocols, and distributed storage
systems, distributed frameworks can break down data silos and enable
comprehensive health data sharing and aggregation across healthcare
organizations.
Clinical Research and Trials: Distributed frameworks can support decen-
tralized clinical research and trials by enabling secure and efficient data
collection, sharing, and analysis. Researchers can collaborate across mul-
tiple institutions while maintaining data privacy and security. Distributed
frameworks facilitate the integration of data from various sources, such as
EHRs, wearable devices, and patient-reported outcomes, enabling more
comprehensive and diverse research studies.
Telemedicine and Remote Monitoring: Distributed frameworks can enhance
telemedicine and remote monitoring capabilities. By enabling real-time
data transmission, secure communication, and data analysis at the edge,
distributed frameworks support remote patient monitoring, teleconsulta-
tions, and virtual care delivery. These frameworks facilitate the integra-
tion of data from various monitoring devices and enable timely clinical
decision-making.
Healthcare Supply Chain Management: Distributed frameworks can
enhance supply chain management in healthcare by improving transpar-
ency, traceability, and efficiency. Blockchain-based distributed frameworks
enable the secure recording and tracking of medical product provenance,
inventory management, and authentication. These frameworks can help pre-
vent counterfeit drugs, improve product recalls, and streamline supply chain
processes (Kulkarni et al., 2015).
Healthcare Data Analytics and AI: Distributed frameworks (Liu et al., 2018)
provide scalable and distributed computing capabilities for healthcare data
analytics and artificial intelligence (AI) applications. By leveraging dis-
tributed frameworks like Apache Spark (Zaharia et al., 2016) or Apache
Flink, healthcare organizations can process and analyze large volumes of
healthcare data, such as medical images, patient records, and sensor data,
in order to derive actionable insights, improve diagnostics, and support
decision-making.
4.4 SECURITY ISSUES IN DISTRIBUTED FRAMEWORKS

Distributed frameworks introduce unique security challenges due to their distrib-
uted nature, involvement of multiple nodes, and potential vulnerabilities in com-
munication and coordination. Here are some common security issues in distributed
frameworks:
Network Security: Distributed frameworks rely on network communication

between nodes, making them susceptible to network-level attacks such as
eavesdropping, tampering, or denial-of-service (DoS) attacks. Encryption,
secure communication protocols, and network monitoring mechanisms are
crucial to mitigate these risks (Kaur et al., 2023).
Data Security and Privacy: Protecting sensitive data is critical in distrib-
uted frameworks. Breaches in data security can occur during data transmis-
sion, storage, or processing. Adequate data encryption, access controls, and
secure storage mechanisms are essential to prevent unauthorized access,
data leakage, or data tampering. Privacy concerns should also be addressed
by implementing privacy-preserving techniques such as differential privacy
or data anonymization.
Authentication and Access Control: Distributed frameworks require robust
authentication and access control mechanisms to ensure that only autho-
rized nodes and users can access and interact with the system. Weak authen-
tication, improper credential management, or unauthorized access can lead
to system compromise or data breaches. Implementing strong authentica-
tion protocols, multifactor authentication, and proper access control policies
are crucial.
Consensus Algorithm Vulnerabilities: Consensus algorithms, which facil-
itate agreement among distributed nodes, can be vulnerable to attacks.
For example, in blockchain-based frameworks, attacks like 51% attacks
or double-spending attacks can compromise the integrity of the system.
Careful selection and analysis of consensus algorithms, as well as the
implementation of appropriate security measures, are necessary to mitigate
such vulnerabilities.
Smart Contract Security: In frameworks that support smart contracts, vul-
nerabilities in the smart contract code can lead to exploits and financial
losses. Issues like reentrancy attacks, input validation weaknesses, or inad-
equate access control can be exploited by attackers. Thorough code audits,
formal verification techniques, and adherence to secure coding practices are
essential to minimize smart contract vulnerabilities.
Malicious Node Attacks: Distributed frameworks can be vulnerable to attacks
from malicious or compromised nodes within the network. Malicious nodes
can disrupt consensus, inject incorrect data, or launch attacks against other
nodes. Techniques like Byzantine fault tolerance, reputation systems, and
continuous monitoring of node behavior can help detect and mitigate the
impact of such attacks (Lamport et al., 1982; Castro et al., 1999).
Software and System Vulnerabilities: Like any software system, distrib-
uted frameworks can have vulnerabilities arising from software bugs,
insecure configurations, or outdated components. Regular patching and
updates, secure coding practices, code reviews, and vulnerability assess-
ments are important to address such issues and ensure the security of the
framework.
Trust and Governance: Distributed frameworks often require trust among
network participants and rely on governance models for decision-making.
Issues related to collusion, insider attacks, or governance disputes can

impact the security and integrity of the system. Well-defined governance
mechanisms, transparent decision-making processes, and security audits
can help address trust- and governance-related security concerns.
4.4.1 Consensus Algorithm Vulnerabilities and Attacks

Consensus algorithms are fundamental to ensuring the integrity and agreement
among distributed nodes in blockchain and other distributed systems. However, they
can be susceptible to various vulnerabilities and attacks. Here are some common
consensus algorithm vulnerabilities and attacks:
51% Attack: In proof-of-work (PoW) consensus algorithms, such as the

one used in Bitcoin, a 51% attack occurs when a single entity or group
of entities gains control over more than 50% of the total computational
power (hashrate) of the network. This enables the attacker to control the
consensus process, potentially allowing them to double-spend coins, pre-
vent other valid transactions from being confirmed, or rewrite transaction
history.
Selfish Mining: Selfish mining is an attack strategy in which a miner or a
group of miners with a minority of the network’s hashrate selfishly with-
holds mined blocks instead of broadcasting them immediately. This can
give them an unfair advantage by mining additional blocks in secret, dis-
rupting the consensus process, and potentially leading to a longer block-
chain fork (Kataria et al., 2023, July).
Long-Range Attack: A long-range attack targets the historical records of a
blockchain by attempting to rewrite the entire history of the blockchain. This
attack exploits the fact that participants may not retain the entire history of
the blockchain, allowing an attacker to create a parallel blockchain from an
earlier point in time and build a longer chain in secret. If successful, this
attack can undermine the integrity and trustworthiness of the blockchain.
Bribery or Collusion Attacks: In some consensus algorithms, attackers can
attempt to bribe or collude with validators or participants to influence the
consensus outcome in their favor. By incentivizing malicious behavior or
collusion, attackers can compromise the integrity and fairness of the con-
sensus process.
4.4.2 Smart Contract Security Issues and Best Practices

Smart contracts, which are self-executing contracts coded on blockchain platforms,
can be vulnerable to various security issues. Here are some common smart contract
security issues and best practices to mitigate them:
Code Vulnerabilities: Smart contracts can have coding vulnerabilities

that can be exploited by attackers. Common vulnerabilities include
reentrancy attacks, integer overflow/underflow, unhandled exceptions,

and unchecked external calls. Thorough code audits, code reviews, and
adherence to secure coding practices are crucial to identify and fix these
vulnerabilities.
Access Control: Inadequate access control mechanisms can lead to unau-
thorized access and manipulation of smart contract functions or data. It
is essential to implement proper access control mechanisms to restrict the
execution of sensitive functions or modification of critical contract states to
only authorized parties.
Input Validation: Input validation is essential to prevent malicious or unin-
tended inputs from compromising the contract’s execution. Proper valida-
tion and sanitization of user inputs help mitigate risks such as SQL injection,
buffer overflow, or other forms of input manipulation.
External Contract Interaction: Interactions with other contracts or external
systems can introduce security risks. It is crucial to validate and sanitize
inputs received from external contracts, carefully manage the transfer of
funds or assets, and verify the integrity and authenticity of external data
sources to prevent unauthorized access or manipulation.
Gas Limit Considerations: Ethereum and some other blockchain platforms
have gas limits, which restrict the amount of computational resources a
smart contract can consume. Contracts that exceed the gas limit can fail to
execute or become vulnerable to DoS attacks. Careful optimization of con-
tract code, gas estimation, and gas limit monitoring are necessary to ensure
contracts can execute within the gas limits.
Dependency and Library Security: Smart contracts often rely on exter-
nal libraries or dependencies. It is crucial to use trusted and well-audited
libraries to minimize the risk of including vulnerable or malicious code.
Regularly updating dependencies and monitoring security advisories are
essential to address emerging vulnerabilities.
Proper Handling of Funds: Smart contracts often involve the management
and transfer of funds or assets. Implementing secure fund management
practices, such as using multisignature wallets, enforcing withdrawal
limits, and performing thorough testing and auditing of payment-related
functionalities, can help mitigate the risk of funds being misappropriated
or lost.
Formal Verification and Testing: Formal verification techniques can be
employed to mathematically prove the correctness and security of smart
contracts. Additionally, extensive testing, including unit testing, integration
testing, and fuzzing, can help identify and fix potential security vulnerabil-
ities (Puri et al., 2023, September).
Security Audits: Engaging independent third-party security auditors to con-
duct comprehensive security audits of smart contracts can help identify
vulnerabilities and ensure the contract’s robustness. Auditors perform code
reviews, vulnerability analysis, and penetration testing to identify potential
weaknesses and provide recommendations for improvement.
4.4.3 Network Attacks and Their Impact on Distributed Frameworks

Network attacks can have a significant impact on distributed frameworks, compro-
mising their security, availability, and integrity. Here are some common network
attacks and their potential impact on distributed frameworks:
Distributed Denial-of-Service (DDoS) Attacks: DDoS attacks involve mul-

tiple sources flooding the network or targeted nodes with an overwhelming
amount of traffic or requests simultaneously. DDoS attacks are challenging
to mitigate as they can exhaust network resources and overwhelm the pro-
cessing capacity of distributed nodes. Such attacks can cripple the frame-
work’s ability to process transactions, validate blocks, or communicate
effectively, resulting in severe disruptions to the network’s operation.
Man-in-the-Middle (MitM) Attacks: MitM attacks occur when an attacker
intercepts and modifies network communication between nodes, enabling
them to eavesdrop on sensitive information or manipulate the data being
exchanged. In distributed frameworks, MitM attacks can compromise the
integrity and confidentiality of data, potentially leading to unauthorized
access, data tampering, or unauthorized control over the consensus process.
Sybil Attacks: Sybil attacks involve an attacker creating multiple fake iden-
tities or nodes to gain a disproportionate influence over the distributed
framework. By controlling a significant number of nodes, the attacker can
manipulate voting or decision-making, compromise the consensus algo-
rithm’s fairness, or disrupt the network’s integrity. Sybil attacks can under-
mine the trust and reliability of the distributed framework.
Routing Attacks: Routing attacks involve manipulating the routing proto-
cols or infrastructure to divert network traffic or misdirect communication
between nodes. By redirecting traffic or intercepting messages, attackers
can gain unauthorized access to sensitive information, tamper with data,
or disrupt the communication and coordination among distributed nodes.
Routing attacks can compromise the reliability and security of the distrib-
uted framework.
Packet Sniffing and Eavesdropping: Packet sniffing and eavesdropping
involve intercepting network traffic to capture and analyze data exchanged
between nodes. Attackers can gain access to sensitive information, such
as authentication credentials, private keys, or confidential data, by exploit-
ing insecure network communication protocols or weak encryption mech-
anisms. Unauthorized access to sensitive information can compromise the
security and privacy of the distributed framework.
4.4.4 Privacy and Confidentiality Challenges in Distributed

Frameworks
Privacy and confidentiality challenges are significant in distributed frameworks
due to the distributed nature of data storage, processing, and communication. Here
are some key challenges in maintaining privacy and confidentiality in distributed

frameworks:
Data Leakage: Distributed frameworks involve the sharing and replication

of data across multiple nodes. If proper security measures are not in place,
there is a risk of data leakage. Unauthorized access to nodes or breaches in
communication can expose sensitive information, compromising the pri-
vacy of individuals or organizations involved.
Metadata Privacy: Even if the content of data is encrypted or protected, meta-
data (e.g., sender, recipient, timestamps) can reveal valuable information
about user behavior and relationships. Protecting metadata privacy is a chal-
lenge in distributed frameworks, as metadata can be collected and analyzed
by network nodes or malicious actors to infer sensitive information.
Secure Data Sharing and Access Control: Distributed frameworks often
require data sharing among authorized participants while ensuring that
unauthorized entities are not granted access. Implementing secure data
sharing mechanisms and robust access control policies is crucial to prevent
data leakage, unauthorized data access, or data misuse.
Consent Management: In distributed frameworks involving multiple par-
ticipants, managing user consent for data sharing becomes complex.
Establishing mechanisms to obtain and manage granular user consent,
including consent revocation, becomes crucial for maintaining privacy and
ensuring compliance with privacy regulations.
Network Traffic Analysis: Distributed frameworks involve network commu-
nication among nodes. Network traffic analysis can reveal patterns, transac-
tion information, or sensitive data being exchanged. Attackers or malicious
nodes can attempt traffic analysis to gather information or compromise pri-
vacy. Employing encryption, secure communication protocols, and traffic
obfuscation techniques can help mitigate this risk.
Compliance with Privacy Regulations: Distributed frameworks must comply
with privacy regulations, such as the General Data Protection Regulation
(GDPR). Ensuring compliance in a decentralized and distributed environ-
ment, where data processing and storage occur across multiple nodes, can be
challenging. Implementing privacy-by-design principles, data anonymiza-
tion techniques, and robust user consent mechanisms can aid in meeting
regulatory requirements.
4.5 CONCLUSION
Distributed frameworks offer a powerful and scalable approach (Ousterhout
et al., 2011) to building complex systems that leverage the capabilities of multiple
nodes or participants. They enable decentralized architectures, fault tolerance, and
improved performance, making them suitable for various applications. However,
implementing and managing distributed frameworks come with their own set of chal-
lenges, particularly in terms of security, scalability, and interoperability. To address
these challenges, organizations should focus on key areas such as ensuring the secu-
rity of the framework through vulnerability assessments, code audits, and adherence
to secure development practices. Scalability can be achieved through techniques like
load balancing, partitioning, and optimizing resource utilization. Interoperability
can be enhanced by using standard protocols and APIs, adopting common data for-
mats, and leveraging integration patterns.
Distributed frameworks offer numerous opportunities across various domains,
including decentralized finance (DeFi), supply chain management, healthcare, and
Internet of Things (IoT) (Peter et al., 2017). They enable the development of applica-
tions that can revolutionize industries, provide enhanced privacy, improve efficiency,
and increase transparency. However, organizations must also be mindful of the
challenges and risks associated with distributed frameworks. These include security
vulnerabilities, privacy concerns, regulatory compliance, governance issues, and the
need for continuous monitoring and updates. In conclusion, distributed frameworks
have the potential to transform how applications are built and deployed, offering
scalability, fault tolerance, and decentralized architectures. By addressing security,
scalability, and interoperability challenges, organizations can leverage the benefits
of distributed frameworks to develop innovative and robust systems that drive effi-
ciency, trust, and value in a wide range of industries.
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Communications of the ACM, 59(11).
5 Blockchain Technology
Framework
Issues and Future
Challenges
Shital Sharma and Palvinder Singh Mann
5.1 INTRODUCTION
Blockchain technology revolutionizes transaction and data management through
its decentralized, unchangeable digital ledger. This immutable ledger, composed of
blocks, is maintained chronologically and securely by a network of nodes. Unlike
centralized systems, blockchain ensures transparency, trust, and security without
intermediaries like banks. Each block contains linked transactions, secured by cryp-
tography to prevent tampering. This linking makes altering previous transactions
extremely challenging, necessitating consensus across the network. Blockchain con-
sensus methods include proof-of-work (PoW), using processing power, and proof-of-
stake (PoS), relying on users’ coin stakes for block validation and network protection.
5.1.1 Background
In the evolution of blockchain, Bitcoin, originating from 2008, fused the 1991 concept
of a secure chain of information with digital signatures used for document integrity
(Rani, Kumar, et al., 2023). The 2008 paper “Bitcoin: A Peer to Peer Electronic Cash
System” by pseudonymous Satoshi Nakamoto brought these ideas together, birthing
the Bitcoin blockchain in 2009. Then, in 2013, Ethereum introduced a new public
blockchain, gaining remarkable popularity since its full launch in 2015. Extensive
research yielded tamper-resistant digital ledgers, eliminating the need for central
control. These ledgers enable collective transaction recording, ensuring immuta-
bility. Blocks contain signed transactions, validated through consensus and linked
tamper-resistant (Kataria et al., 2023). Security grows as new blocks join. Copies
of the ledger stay updated, with protocols addressing discrepancies automatically
(Kramer, 2019).
5.1.2 Blockchain Architecture
Blockchain is a system of interconnected records that are highly resistant to
changes, secured by cryptography, and constructed with distributed processing
66 DOI: 10.1201/9781003459347-5

Blockchain Technology Framework 67
FIGURE 5.1 Multilayer blockchain framework (Patel et al., 2022).
and durability. Figure 5.1 shows that the multilayer framework for the operation
of a blockchain network can be visualized as a multilayered architecture (Puri
et al., 2023, September).
Network Layer: The network layer’s primary function is to distribute and

authenticate transactions while also facilitating internode communication.
It is sometimes referred to as the propagation layer. This layer guarantees
that nodes may discover and interact with one another by utilizing a P2P
network (Shebaro, 2022).
Data Layer: The data layer is the foundational part of a blockchain, compris-
ing storage blocks with headers and bodies. Blocks are linked via headers,
forming a chain. Each block includes a timestamp, nonce, and Merkle root
for transactions. The initial block lacks a header and is called the genesis
block (Shebaro, 2022).
Consensus Layer: This is the most critical layer for a blockchain and is essen-
tial to its survival. It is a difficult effort in a peer-to-peer network with no
central authority to obtain consensus among all nodes, and this is accom-
plished on this layer (Shebaro, 2022).
Incentive Layer: This layer serves as a driving force in the upkeep of a public
blockchain. It tackles the economic issue and devises economically advan-
tageous methods for miners. Miners are provided with incentives (e.g., some
quantity of digital money) in exchange for the processing resources they use
throughout the mining process (Shebaro, 2022).
Contract Layer: The contract layer includes scripts, smart contracts, and algo-
rithms for the secure execution of complex transactions, with automated
and fraud-resistant smart contracts ensuring safe asset transfers (Shebaro,

2022).
Application Layer: This layer contains all of the programs that end users uti-
lize. Users can engage with the blockchain network via the application layer
(Rani, Mishra, et al., 2023). APIs, scripts, and user interfaces are all part of
it. This layer sends data to the contract layer, which then connects users to
the back-end system (Shebaro, 2022).
5.1.3 Organization of Chapter
This chapter is divided into various sections; Section 5.2 describes blockchain
frameworks and challenges of blockchain frameworks. Section 5.3 explains the
challenges for blockchain framework. Section 5.4 discusses the issues and its rele-
vant solutions in blockchain framework. We conclude this chapter with some future
issues.
This study examines blockchain frameworks, analyzing their architecture, empha-
sizing operational layers. Valuable for blockchain professionals, it aids in strategic
framework selection by imparting insight into properties, scalability, and perfor-
mance. Advancing industry understanding, it sheds light on blockchain’s implica-
tions across sectors.
5.2 BLOCKCHAIN FRAMEWORKS
Blockchain frameworks are decentralized systems that use cryptography to securely
record transactions across a computer network. They form chains of chronological
blocks, like Ethereum for smart contracts and Hyperledger Fabric for enterprise
needs. These frameworks ensure tamper-resistant, auditable, and efficient systems,
fostering trust and reducing reliance on central authorities (Quasim et al., 2020).
5.2.1 State-of-the-Art Blockchain Frameworks

State-of-the-art blockchain frameworks drive rapid evolution in blockchain technol-
ogy, offering top-tier features through advanced development (Singh et al., 2006).
These frameworks ensure secure, transparent, and efficient solutions for decentral-
ized applications, poised to transform transactions, data management, and trust in
the digital era.
5.2.2.1 Bitcoin
Launched in 2009 by Satoshi Nakamoto, Bitcoin is the pioneering decentralized
cryptocurrency and blockchain, shaping today’s crypto landscape. Operating on a
decentralized network, it ensures secure, intermediary-free transactions through
its proof-of-work consensus upheld by miners. With a fixed supply of 21 million
coins, it offers deflationary traits yet faces challenges like limited throughput
and high energy usage. Despite this, Bitcoin’s resilience has sparked alternative
blockchain systems aiming to surpass its limits, driven by scalability and enhanced
functionality, while recognizing its enduring status and network effects (Smetanin
et al., 2020).
5.2.2.2 Ethereum
5.2.2.2.1 Smart Contracts and Decentralized Applications (DApps)
A smart contract is a computer language for automating processes, conceived by
Nick Szabo. It defines obligations with conditions and logic (Lu, 2019). When condi-
tions are met, it activates automatically, serving as an assurance plan, enhancing data
processing, security, and transactions. Private blockchain (Wang et al., 2019) Hawk
uses smart contracts for secure transactions. Ethereum integrates them into DApps,
combining fast code creation with security for decentralized app development (Taş &
Tanrıöver, 2019).
5.2.2.2.2 Security Challenges and Upgrades

Ethereum, which started in 2015, transformed the blockchain industry by allow-
ing smart contracts and decentralized apps (DApps). Ethereum, being a major
cutting-edge blockchain technology, has faced various security concerns throughout
its history (Kaur et al., 2006). The Ethereum community, on the other hand, has been
proactive in resolving these challenges through ongoing upgrades to improve the
platform’s security and scalability (Zhang et al., 2019; Shebaro, 2022).
5.2.2.2.3 Security Challenges

Ethereum grapples with security risks including smart contract vulnerabilities,
scalability problems causing delays and high fees, centralization threats from
concentrated mining power, and privacy concerns arising from its transparent
blockchain.
5.2.2.2.4 Upgrades and Solutions

Ethereum 2.0: The Ethereum community has been hard at work on Ethereum
2.0, a major update to the platform that attempts to address scalability dif-
ficulties by implementing proof-of-stake (PoS) consensus. By engaging
validators with a stake in the system, PoS minimizes energy usage and
improves network security.
Smart Contract Auditing: The increased emphasis on smart contract
auditing has aided in the identification and correction of vulnerabilities
prior to implementation. To improve the security of smart contracts,
third-party security assessments and bug reward programs have become
commonplace.
Layer2 Solutions: Ethereum has used Layer2 scaling technologies such as
the Lightning Network and Rollups to relieve network congestion. These
technologies enable off-chain transactions or the consolidation of several
transactions into a single batch, resulting in increased transaction through-
put and lower costs.
Improved Governance: Governance methods have evolved to include the

community in crucial decisions and improvements. This has resulted in
more decentralized decision-making, lowering the danger of centralization.
Privacy Protocols: Zero-knowledge proofs (ZKPs) and zk-SNARKs are being
implemented into Ethereum to improve privacy and confidentiality without
jeopardizing the blockchain’s integrity.
5.2.2.3 Hyperledger Fabric

Hyperledger, an opensource initiative, collaboratively advances blockchain tech-
nology across sectors, offering diverse frameworks for robust corporate block-
chain networks (Grewal & Bhambri, 2006). Permissioned blockchains, favored
for privacy and efficiency, impact trade finance, healthcare, and more, elevating
security and authentication (Kaur et al., 2023). They also enhance voting sys-
tems and provide businesses with scalable, confidential, and integrated blockchain
solutions.
5.2.2.4 Consensus Mechanisms and Governance

Consensus mechanisms ensure agreement on transaction authenticity and sequence
in blockchain; Hyperledger offers diverse solutions like PBFT for private networks,
PoW for public chains like Bitcoin, PoS for efficient validation, and Raft for fault tol-
erance (Ren, 2021). Hyperledger’s governance ensures effective oversight, trust, and
adaptability in business and consortium blockchains, enabling tailored and secure
networks for various enterprise needs (Patel et al., 2022).
5.2.2 Analysis of Blockchain Framework

A blockchain framework streamlines creating and deploying applications with
infrastructure, smart contracts, and nodes managing identity, transactions, and
consensus. It should address scalability, processing, and storage, making enter-
prise platform choice complex (Gupta & Bhambri, 2006). Vigilance in adoption
and critical framework factors are key amid various options. Different blockchain
frameworks offer pros and cons, and the next section explores top business frame-
works for practical blockchain solutions (Quasim et al., 2020; Averin & Averina,
2020). Table 5.1 shows the comprehensive analysis of various blockchain technol-
ogy frameworks.
Based on the comprehensive analysis of various blockchain technology frame-
works presented in Table 5.1, Table 5.2 shows the review and analysis of each
framework.
The blockchain frameworks just discussed include a wide range of features and
functionalities to accommodate a variety of use cases (Kamra & Bhambri, 2007).
The right framework is determined by the application’s or project’s specific require-
ments, such as decentralization, performance, privacy, and governance. Developers
and businesses should thoroughly analyze these factors before deciding on a block-
chain framework for their initiatives.
Blockchain Technology Framework
TABLE 5.1
Comparative Analysis of Blockchain Frameworks
Smart Contract Transaction Speed Governance
Framework Consensus Mechanism Support Privacy Features (TPS) Model Use Cases
Ethereum Proof of work Solidity (EVM) Limited ~15 (varies with Decentralized Decentralized applications
upgrades) (DApps), DeFi
Hyperledger Fabric Pluggable Chain code (Go, Yes (Channels) Up to thousands Permissioned Enterprise solutions, supply
Java) chain
Corda Pluggable Kotlin (Corda) Yes (states) Hundreds Permissioned Financial services,
inter-organizational
EOSIO Delegated proof-of-stake Web Assembly No Thousands Decentralized DApps, social media,
(DPoS) (C++, Rust) supply chain
Tezos Liquid proof-of-stake Michelson Yes (ZK-SNARKs) ~Zhang (varies with Decentralized Governance, smart
(LPoS) upgrades) contracts, DApps
Stellar Federated Byzantine Stellar Consensus Yes (Encryption) Thousands (low Decentralized Cross-border payments,
Agreement (FBA) Protocol (SCP) latency) tokenization
Quorum Majority voting Solidity (EVM) Limited ~100 Permissioned Financial applications,
private transactions
TRON Delegated proof of stake Solidity (EVM) No ~2,000 Decentralized Gaming, DApps,
(DPoS) entertainment
IOTA Tangle Wasm (Rust) Yes (Masked Scalable Decentralized IoT, supply chain,
Authenticated micropayments
Messaging)
R3 Corda Pluggable Kotlin (Corda) Yes (States) Hundreds Permissioned Financial services, supply
chain
71
TABLE 5.2
Review of Blockchain Frameworks Features
Sr. No. Framework Review and Analysis
1 Consensus mechanism The blockchain framework featured here use a variety

of consensus mechanisms, including Federated
Byzantine Agreement (Stellar), Delegated Proof of
Stake (EOSIO, TRON), Proof of Work (Ethereum),
Proof of Stake (Tezos), and others. Security,
scalability, and energy usage are all impacted by the
consensus method chosen (Di Francesco Maesa &
Mori, 2020).
2 Smart contract support For its ability to support smart contracts, Hyperledger
Fabric, EOSIO, and Ethereum are popular. The
supported programming languages range; however,
among the most used are Chaincode (Hyperledger
Fabric) and Solidity (Ethereum) (Wang et al., 2019).
3 Privacy features The enhanced privacy capabilities offered by
blockchain frameworks like Hyperledger Fabric,
Corda, and Tezos allow for private transactions and
data access within a network (Zhang et al., 2019).
4 Transaction speed The rates of transactions per second (TPS) vary greatly
among frameworks. Higher TPS numbers give
EOSIO and TRON the edge in high-throughput
applications.
5 Governance model Permissioned blockchains, such as Hyperledger Fabric,
Corda, and Quorum, feature a specified governance
mechanism that allows certain entities to manage
access and contribute to consensus.
6 Use cases Each framework has distinct strengths that cater to a
wide range of use cases. Ethereum is the uncontested
leader in the DeFi area, whereas Hyperledger Fabric
concentrates on enterprise solutions. IOTA is targeted
toward IoT applications, whereas Stellar is popular
for cross-border payments.
5.2.3 Comparison of Blockchain Frameworks

Table 5.3 demonstrates the comparison of various blockchain frameworks based on
feature comparison, performance comparison, scalability comparison, and security
and privacy comparison.
Blockchain frameworks are crucial for decentralized app development, with
Ethereum, Hyperledger Fabric, EOS, Quorum, Solana, Polkadot, Corda, Tezos,
Monero, and Zcash each excelling in specific features such as performance, security,
scalability, and privacy, allowing developers to tailor their choice to their app’s needs
(Bartoletti, 2017).
Blockchain Technology Framework
TABLE 5.3
Comparison of Blockchain Frameworks
Framework Features Performance Scalability Security and Privacy
Ethereum Smart contracts, decentralized apps Moderate transactions per Limited scalability due to Relatively secure, but vulnerable to certain attacks,
(DApps), tokenization second (TPS) proof-of-work (PoW) consensus e.g., 51% attack
Hyperledger Modular architecture, private High TPS, supports parallel Scales well in private network High security, support for permissioned networks,
Fabric channels, chaincode support execution of transactions settings pluggable consensus mechanisms
Corda Smart contracts (CorDapps), High TPS in private Scales well in permissioned Emphasizes privacy, with transactions only shared
privacy support network settings network settings with relevant parties
EOS Delegated proof of stake (DPoS) Very high TPS, capable of Horizontal scaling through Improved security compared to PoW, but DPoS
consensus, smart contracts thousands of transactions parallel processing introduces certain centralization concerns
per second
Stellar Fast and low-cost transactions, Moderate TPS, settles Hierarchical consensus model, Focus on security, distributed trust through
multicurrency support transactions in 2–5 scalable with fewer nodes consensus and federated Byzantine agreement
seconds
Quorum Privacy features (transaction and Moderate to high TPS Scales well in consortium settings Enhanced security with privacy features, based on
contract privacy) Ethereum but with added enterprise focus
IOTA Tangle DAG structure, feeless Scalability increases with Scales well due to Tangle Focus on security, quantum-resistant cryptography,
transactions network size structure but some concerns have been raised
Polkadot Interoperability, shared security High TPS with multiple High scalability with shared Enhanced security, supports various consensus
(parachains) parallel chains security mechanisms and customizable blockchains
Cardano Peer-reviewed development, Moderate TPS with the Designed for scalability and Strong focus on security, rigorous development
Sustainability features possibility of improvement future growth process, aiming to be a secure PoS blockchain
Tezos Self-amending mechanism, Moderate TPS Scales well with a flexible, Emphasis on security and long-term upgradability,
on-chain governance self-amending protocol on-chain governance helps address issues
73
5.3 CHALLENGES FOR BLOCKCHAIN FRAMEWORK

Existing blockchain frameworks face challenges including scalability, privacy, secu-
rity, and standardization, which hinder broad adoption. Scalability involves process-
ing many transactions efficiently, but transparency raises privacy and security issues.
The lack of standards hampers global norms for tech and security, pushing explora-
tion of solutions like Intel SGX. Addressing layer-specific attacks and aligning with
standards is crucial, as these limitations restrict blockchain’s applicability. Also, the
article mentions (Quasim et al., 2020; Risius & Spohrer, 2017) that blockchain can-
not keep timestamp ordering, which may be a constraint for some applications. Here
are some of the issues that are discussed:
Processing Power, Storage, and Scalability: Managing large data volumes

and transactions is a challenge in blockchain due to processing and stor-
age limits, hindering scalability. As users and transactions increase, block-
chain size grows, causing longer confirmation times and resource demands.
Solutions like sharding, off-chain transactions, and Layer 2 protocols aim to
address these issues.
Privacy and Security: Blockchain, though generally secure, has potential
vulnerabilities that attackers could exploit, such as 51% attacks. While it
offers transparency, ensuring user data privacy is challenging, as all public
blockchain transactions are visible to everyone. To mitigate this, researchers
explore privacy tech like zero-knowledge proofs and ring signatures.
Interoperability: Diverse blockchain frameworks with separate protocols hin-
der integration, limiting their broader application due to inadequate interop-
erability solutions for cross-chain transactions and data sharing
Throughput: Blockchain networks’ throughput, or the number of transactions
executed per second, is frequently limited. Traditional blockchains, such as
Bitcoin and Ethereum, have limited throughput, which limits their capac-
ity to process a large number of real-world applications concurrently. To
improve performance, many consensus techniques and network optimiza-
tions have been suggested.
Latency: In some situations, the time it takes for a transaction to be confirmed
on the blockchain, also known as latency, might be substantial. Slow con-
firmation periods might make time-sensitive applications like real-time
payments or supply chain tracking problematic. Some projects have been
striving to improve consensus algorithms in order to minimize latency.
Governance and Consensus: Blockchain networks are frequently decen-
tralized, which makes establishing clear governance structures and
decision-making procedures problematic. This might lead to arguments and
conflicts among parties. Decentralized governance and finding consensus
among several stakeholders may be difficult challenges. Decision-making
procedures may become sluggish and controversial, resulting in splits and
arguments that can splinter the blockchain community.
Energy Consumption: Bitcoin and similar blockchains consume substantial
energy for their operations, primarily due to the energy-intensive proof-of-work
consensus mechanism, driving the search for greener alternatives like proof-
of-stake (PoS) to address environmental and financial concerns.
Complexity: Blockchain technology may be complicated and difficult to
grasp, making it difficult for developers and consumers to collaborate. This
may hinder blockchain technology adoption in some businesses.
Legal and Regulatory Challenges: Worldwide, blockchain technology
confronts legal and regulatory difficulties. To enable widespread use of
blockchain-based applications, issues such as data privacy, smart contract
enforceability, and digital identification standards must be solved.
User Experience: Blockchain apps must deliver a user-friendly experience
equivalent to centralized alternatives in order to gain widespread accept-
ance. Complex key management, transaction costs, and a lack of simple
interfaces have been identified as barriers to mainstream adoption.
Smart Contract Vulnerabilities: Smart contracts are vulnerable to errors and
vulnerabilities that nefarious parties can exploit. The 2016 DAO (decen-
tralized autonomous organization) attack highlighted the dangers of badly
designed smart contracts. The research focuses on establishing tools and
best practices for developing safe smart contracts.
These are some of the major difficulties that research scholars and developers are
addressing in order to improve existing blockchain platforms. The technology is con-
tinually growing, and ongoing R&D initiatives attempt to overcome these difficulties
and make blockchain more scalable, secure, and suited for a wide range of real-world
applications.
5.4 KEY FUTURE ISSUES

5.4.1 Scalability
Blockchain’s appeal lies in secure, unchangeable, decentralized data, but adoption
spotlights a pressing scalability challenge. Addressing this, the article explores issues
and remedies, such as larger blocks, shorter times, Layer 2 scaling, sharding, and
refined consensus, to balance scalability, security, and decentralization in the face of
growing demand.
5.4.2 Enhanced Security and Privacy

Blockchain, a transformative decentralized data system, faces security, scalabil-
ity, and privacy hurdles, demanding solutions like proof-of-stake, zero-knowledge
proofs, formal contract checks, cross-chain standards, quantum-safe cryptography,
and improved governance for broader positive impact.
5.4.3 Cross-Chain Interoperability
Cross-chain interoperability fosters seamless communication among diverse block-
chains, enhancing decentralized collaboration by enabling efficient asset, data, and
information exchange. Challenges like scalability, security, and governance are being
tackled through Layer 2 solutions, verification, consensus protocols, and incentive
mechanisms, driving ongoing progress.
5.4.4 Governance and Decentralization Models

5.4.4.1 Decentralized Autonomous Organizations (DAOs)
Decentralized autonomous organizations (DAOs) in blockchain architecture offer a
transformative governance model. Operating through smart contracts and consensus,
DAOs facilitate stakeholder decision-making, project proposals, and growth, pro-
moting inclusivity and eliminating intermediaries. This disrupts traditional hierar-
chies, fostering equality and openness in blockchain and beyond.
5.4.4.2 Incentive Mechanisms for Decentralization

Incentive mechanisms drive governance decentralization in blockchains, fostering
broad stakeholder engagement and preventing power centralization. Models like PoS
and DPoS ensure fair transaction validation, scalability, and ecological sustainabil-
ity, fortifying the blockchain’s survival and decentralized governance.
5.4.5 Environmental Impact and Sustainability

Blockchain, hailed for transformative potential, struggles with environmental issues,
especially energy-heavy public blockchains like Bitcoin. Research should focus on
energy-efficient consensus, scalability, and eco-friendly growth. Solutions like green
mining, recycling, and data reduction, along with collaboration for sustainable block-
chain integration, are crucial for aligning with environmental goals.

Present blockchain platforms face challenges of scalability, interoperability, secu-
rity, and energy consumption, but recent breakthroughs may be addressing these
issues. The future of blockchain holds transformative potential across industries
from banking to governance, offering improved security and efficiency through its
decentralized structure. Integration with AI and IoT also promises novel opportu-
nities. Nonetheless, obstacles like regulations, interoperability, and standardization
hinder widespread adoption. Despite this, blockchain’s capacity to revolutionize var-
ious aspects of our digital world remains immense
As blockchain technology advances and becomes more widespread, it is poised
to revolutionize numerous industries by providing improved security, transparency,
and efficiency. This makes it especially suitable for tackling issues like data privacy
and fraud prevention. Advancements in scalable and energy-efficient consensus algo-
rithms will enable blockchain to handle larger transaction loads. Its integration with
AI and IoT will unlock novel opportunities and drive innovation. Yet challenges like
regulations, interoperability, and standardization remain significant hurdles. Despite
these barriers, blockchain holds immense potential to reshape industries, paving the
way for a decentralized, interconnected future with enhanced trust.
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6 Blockchain Technology
State of Art and
Future Scenario
Sudheer Mangalampalli, Ganesh Reddy Karri,
Nukala Naveen Kumar, and Diya Gupta
6.1 INTRODUCTION
Blockchain is a decentralized and circulated computerized record that captures and
checks exchanges across numerous PCs or hubs (Hussain & Al‐Turjman, 2021). It
is intended to guarantee straightforwardness, an immutable nature, security, and
trust in an organization where members can cooperate and execute directly, without
the requirement for delegates (Maroufi, Abdolee, & Tazekand, 2019). Asit’s decen-
tralized, a blockchain consists of a chain of blocks, with each block containing a
rundown of exchanges. These exchanges are gathered, approved, and added to the
blockchain through an agreement system, like verification of work (PoW) or confir-
mation of stake (PoS) (Kaur, Chaturvedi, Sharma, & Kar, 2021). Whenever a block
is added to the chain, it turns into a long-lasting piece of the record and cannot be
changed retroactively without agreement from the organization members. One of the
basic highlights of blockchain innovation is its decentralized nature (García, 2021).
Rather than depending on an intermediary, like a bank or government, the blockchain
network works on a shared premise, where all members approach a duplicate of the
whole blockchain. This guarantees straightforwardness, as every member can auton-
omously confirm the exchanges and the honesty of the record (Kaur & Jindal, 2021,
August). The immutability of blockchain originates from its cryptographic proper-
ties. Each block contains a remarkable identifier called a hash, which is created by
applying a cryptographic calculation to the information inside the block (Hussein,
ArunKumar, Ramirez-Gonzalez, Abdulhay, Tavares, & de Albuquerque, 2018). If
any data inside the block is messed with, the hash of that block will also change,
making the organization aware of the adjustment. This makes it very hard to alter or
control past exchanges, upgrading the security and respectability of the blockchain.
Blockchain innovation has acquired conspicuousness because of its application in
cryptographic forms of money like Bitcoin, yet its true capacity goes a long way
beyond computerized monetary standards (Kataria, Puri, Pareek, & Rani, 2023,
July). It very well may be used in different areas, including finance, production, med-
ical care, and casting a ballot framework—and that’s only the tip of the iceberg—to
make straightforward, effective, and secure frameworks for recording and confirm-
ing exchanges or information (Wandhöfer & Nakib, 2023).
DOI: 10.1201/9781003459347-6 79
6.2 HISTORY OF BLOCKCHAIN
In the development of technological advancements, blockchain is one of the most
groundbreaking innovations in the potential to transform the industries and several sec-
tors to redefine trust in the digital age. Blockchain was started in the early 2000s, when
the convergence of computer science, cryptography, and distributed systems set stage for
the birth of a revolutionary technology (Akter, Michael, Uddin, McCarthy, & Rahman,
2022). In this chapter, we will explore the history of blockchain and its roots, types of
blockchain networks, and challenges. In October 2008, the concept of the blockchain
originated in a published paper and came to the market by the name “Bitcoin” as a
peer-to-peer digital cash framework. The paper explained in detail and outlined the
fundamental principles and mechanism of a decentralized, trustless digital currency
system called Bitcoin. The aim of the Bitcoin is to solve the problem of spending double
amounts in online transactions; the underlying technology it introduced is blockchain.
6.3 ORIGIN OF BLOCKCHAIN TECHNOLOGY

In the year January 2009, Satoshi Nakamoto mined the very first Bitcoin block,
known as the genesis block. This is the event that marked the birth of the blockchain
as the underlying technology powering the Bitcoin network (Wu & Wu, 2022).
6.3.1 Rapid Evolution of Blockchain: A Distributed Ledger Revolution

Following the birth of the blockchain, the technology also evolved rapidly. In its
simplest form, blockchain is a distributed and a decentralized ledger that records
peer-to-peer exchanges across multiple computers, ensuring transparency, security,
and immutability. The key elements of the blockchain mainly includes consensus
mechanisms, cryptographic algorithms, and smart contracts (Wanjun & Yuan, 2018,
October).
Initially, Bitcoin remained the primary application of the blockchain. However,
the potential of the technology soon gained recognition, leading to the emergence
of numerous blockchain projects and cryptocurrencies within a short period of time.
6.4 TRANSPARENT AND SECURE

TRANSACTIONS IN BLOCKCHAIN
Blockchain is a decentralized and circulated computerized record that captures
transactions or information across different computers or nodes in a transparent and
secure manner with tactic mechanisms and cryptographic algorithms. It’s a contin-
uously growing chain of blocks, where each block contains a list of transactions or
information and is linked to the previous block with cryptographic hashes (Joshi,
Han, & Wang, 2018). This immutable chain of blocks will ensure the integrity (data
modification) of the data and prevent tampering or alternation without consensus
from the network participants. And the decentralized nature of the blockchain elim-
inates the need for intermediates or central authorities, enabling trust boundaries,
transparency, and peer-to-peer interactions (Ronaghi, 2022).
Blockchain Technology State of Art and Future Scenario 81
6.5 CORE CONCEPTS OF BLOCKCHAIN

Blockchain technology has gained significant attention and recognition in very little
time after its first success. It is often hailed as a game changer, offering transparency
and security in data and transactions, as well as decentralized control over them
(Rani, Kumar, Kataria, & Min, 2023).
As its core, a blockchain works on a distributed and immutable ledger of digital
records, or blocks, that are linked together using cryptographic hashes. Each block
contains a list of transactions or data, alongside a special identifier called a hash,
which is generated based on the content of the block (Bamakan, Moghaddam, &
Manshadi, 2021). Additionally, each block includes the hash of the previous block in
the entire chain, in chronological order, ensuring the integrity of data. The decentral-
ized nature of the blockchain is one of its important features, unlike traditional cen-
tralized systems where a single authority or an intermediary holds control over the
transactions (Dhanalakshmi, Vijayaraghavan, Sivaraman, & Rani, 2022). But block-
chain eliminated the intermediary with a systemic peer-to-peer network. This means
that multiple members, often referred to as nodes, collectively maintain and validate
the blockchain (Singhal, Dhameja, & Panda, 2018). This decentralized consensus
mechanism enhances transparency and security, as no single person is authorized to
control or has the ability to manipulate the data.
Smart contracts are another new feature of blockchain technology. These are
self-executing contracts that are encoded on the blockchain and automatically exe-
cute predefined activities once certain circumstances are met. Smart contracts elimi-
nate the need for intermediaries, streamline processes, and raises trust in interactions
between the parties.
6.5.1 Intermediatory and Peer-to-Peer

In a traditional system, intermediaries are entities or individuals that control the
transactions between the parties (Rani, Mishra, Kataria, Mallik, & Qin, 2023). They
act as trusted third parties responsible for verifying and authorizing transactions,
for example, banks, payment processors (Gpay, Paytm), etc. In peer-to-peer, no
intermediaries control the transactions; participants can transact directly with each
other without relying on a central authority or intermediary (Chopra & Nair, 2020,
February). This direct interaction reduces transaction costs, eliminates the need for
trust in a third party, and increases the efficiency and speed of transactions (Puri,
Kataria, Rani, & Pareek, 2023, September).
6.6 CENTRALIZED VERSUS DECENTRALIZED

SYSTEMS OF BLOCKCHAIN
Control and decision-making are concentrated in a single authority in centralized
systems, which provides efficiency and uniformity but exposes the system to failure.
Decentralized systems, on the other hand, disperse authority among several nodes,
increasing resilience and stimulating creativity, but at the sacrifice of coordination
and scalability (Kaur, Singh, & Rani, 2023).
6.6.1 Centralized System
In a centralized system, an intermediatory central authority checks and controls the
data and transactions. The central authority has the power to take decisions to vali-
date transactions and to enforce rules. For example, imagine a banking system where
a central bank acts as the central authority for all the transactions. When you want to
transfer funds to another person, first you initiate the transaction through your bank.
The bank needs to verify and validate the transaction, deduct the funds from your
account, and update the recipient’s account. In this scenario, the bank has full control
over the transaction process, as well as all the data stored in a centralized database
maintained by the bank.
6.6.2 Decentralized Database
The decentralized system used in the blockchain operates on a peer-to-peer network
without relying on any central authority. Instead, multiple participants, or nodes,
collectively maintain and validate the blockchain. Each node in the network has a
duplicate of the entire blockchain, transactions are validated through a consensus
mechanism agreed upon by the network participants (Beck, Müller-Bloch, & King,
2018). For instance, suppose you want to transfer cryptocurrency to someone using
a blockchain-based platform. When you initiate the transaction, it is communicated
to all the nodes in the network. The nodes check the transaction and collectively
agree on its validity through a consensus mechanism, such as PoW (proof of work) or
PoS (proof of stake). Once consensus is reached, the transaction is added to a block,
which becomes a part of the blockchain. The process is transparent and eliminates
the need of central authority, as the validation is performed by the distributed net-
works of nodes.
6.6.3 Concerns of Centralized Versus Decentralized

Systems of Blockchain
Control and Authority

Centralized Systems: In centralized blockchain systems, a single entity or
organization typically has significant control over the network.
Decentralized Systems: Decentralized blockchains aim to distribute control
across multiple nodes or participants, reducing the potential for a single
authority to exert dominance.
Security
Centralized Systems: Security in centralized blockchains is dependent on the
central authority’s ability to secure the network and data. If the system is
compromised, the entire system could be vulnerable to attacks.
Decentralized Systems: Decentralized blockchains improve security by dis-

persing data across multiple nodes, making a single point of failure unlikely.
Transparency and Privacy

Centralized Systems: In centralized systems when the entity in power has
the authority to change or conceal data, transparency may be compromised.
Concerns about privacy may also arise, especially when sensitive informa-
tion is involved.
Decentralized Systems: Transparency is prioritized in decentralized block-
chains, with all transactions visible to network participants.
Scalability
Centralized Systems: Centralized blockchains may have a scalability benefit
because they can execute modifications more efficiently.
Decentralized Systems: Decentralized blockchains frequently experience
scalability issues due to the time and resources required to reach consensus
among a large number of participants.
It is critical to select a system that can be supported by your environment; otherwise,

you may encounter problems such as node failure, resource scalability, network fail-
ure, and so on.
6.7 BLOCKCHAIN: GENERAL BLOCK STRUCTURE

A single general block consists of several components that collectively form a block.
Each block consists of a set of transactions or data that is grouped together and added
to the blockchain in consecutive order (Dai, Xu, Maharjan, Chen, He, & Zhang,
2019). The general block structure contains:
Block Header: The block header of each block contains metadata and essential
information about the block, which includes:
Version: The version number of the blockchain protocol used.
Timestamp: The time when the block was created.
Previous Block Hash: The previous hash in the chain, linking it to the pre-
vious block.
Merkle Root: The hash value of the Merkle tree, which is a data structure
that summarizes and verifies the integrity of all transactions in the block.
Transactions or Data: The block contains a set of transactions or data that is
added to the chain.
Block Hash: The hash of each block is the unique identifier for the block and is
determined by applying a cryptographic hash function to the block header. It
serves to maintain the integrity and security of the data contained within it.
6.8 GENERIC BLOCKCHAIN STRUCTURE

Transaction Details: Let’s consider a transaction involving the transfer of a
digital asset from Owner0 to Owner3, with Owner1 and Owner2 as interme-
diaries. The transaction includes the following details:
Sender: Owner0 (who initiates the transaction)
Recipient: Owner3 (the recipient of the digital asset)
Intermediaries: Owner1 and Owner2 (participating in the transaction
process)
Private Key and Signature: Each end owner has a unique pair of cryptographic
keys. One is a private key and the other a corresponding public key. In this
scenario, each of Owner0, Owner1, Owner2, and Owner3 has their private
and public keys.
Signing the Transaction: To initiate the transaction, Owner0 uses their private
key to sign the transaction, creating a unique signature. This signature keeps
the transaction’s legitimacy and integrity intact.
Verification and Public Key: The signed transaction is broadcasted to the net-
work. Nodes in the network validate the signature using Owner0’s public
key, ensuring it matches the signature generated with the private key.
Passing Ownership: Once the transaction is verified, Owner1 receives the
transaction and validates the signature using Owner0’s public key. Owner1
then adds their own signature using their private key, indicating their agree-
ment to participate in the transaction as an intermediary.
Further Validation and Signatures: The transaction is passed from Owner1
to Owner2, who performs similar validation and adds their own signature
using their private key.
FIGURE 6.1 Visual representation of blockchain transaction process.

Finalizing the Transaction: Finally, the transaction reaches Owner3, the

recipient. Owner3 verifies the previous signatures, including those of
Owner1 and Owner2, using their respective public keys. Once validated,
Owner3 acknowledges receipt of the digital asset.
Block Hash Calculation: With the transaction complete, the block is final-
ized. The block header, which includes transaction details, previous block
hash, timestamp, etc., is combined and hashed to create a unique block hash.
This hash is a cryptographic representation of the entire block’s content.
Linking Blocks: The new block, along with its unique hash, is connected to
the previous block in the blockchain by referencing the previous block’s
hash in the current block’s header. This linkage creates the chain-like struc-
ture of the blockchain.
This process repeats for subsequent blocks, with new transactions being added, vali-
dated, and linked to the previous blocks. Each block contains a hash that depends on
the data within it, ensuring that any changes to the information would result in gen-
erating a new different hash value. This immutability and the cryptographic security
measures make the blockchain resistant to tampering and provide transparency and
integrity to the recorded transactions.
6.9 APPLICATIONS OF BLOCKCHAIN
Blockchain technology has a wide range of applications across various industries,
as it has unique characteristics such as decentralization, transparency, security, and
immutability. here are some of blockchain applications:
Cryptocurrencies and Digital Payment: Digital or virtual currencies, known

as cryptocurrencies, utilize cryptographic techniques to safeguard block-
chain networks and confirm transactions. It is a type of digital money built
on the blockchain technology that runs outside of conventional financial
institutions. Cryptocurrencies are created and managed through a decen-
tralized network of computers, also known as nodes, which collectively
maintain and validate the blockchain. The most well-known uses of block-
chain are cryptocurrencies like Bitcoin and Ethereum (Arenas & Fernandez,
2018, June). Blockchain principles enable a secure and decentralized digital
payments, allowing the users to send and receive the funds without interme-
diaries like banks. It provides transparent, efficient, and faster transactions.
Healthcare Medical Records: Blockchain has a potential to significantly
impact the healthcare industry, particular in in managing healthcare and
medical records. Here are the roles that blockchain plays in medical care
and medical records.
Data Security and Privacy: Because blockchain uses a decentralized mech-
anism, it provides tamper-proof system for storing and sharing medical
records. The medical reports are encrypted, broken down into fragments,
and distributed across the blockchain network, which ensures that no un-
authorized person without proper authentication can access the data.
Data Exchange: With a large number of patient records, healthcare systems

struggle with interoperability, making it difficult to share patient data.
Blockchain can provide secure and standardized data exchange between
the healthcare providers and stakeholders. Patients’ access permissions
can be managed through smart contracts, allowing only authorized par-
ties to access specific data in a transparent manner.
Drug Supply Chain Management: Blockchain can enable the proper track-
ing and tracing of medical products throughout the supply chain, reduc-
ing the problem with counterfeit drugs and ensuring product authenticity.
In the process of supply, each transaction involving a drug is recorded
on the blockchain from manufacturing to distribution, thus enabling
stakeholders to verify the origin, quality, and handling of medications
(Gupta, Nischal, & Bhambri, 2007). All the digital records involving
blockchain technology are used to create, manage, and secure digital
records in a decentralized system, inasmuch as blockchain and its inher-
ent transparency, immutability, and decentralization make it very secure.
Maintenance of data integrity is crucial in digital records. Blockchain
provides a tamper-resistant and immutable feature; records can be added
but, once captured, cannot be changed or removed in the blockchain net-
work. This feature ensures the integrity of digital records, thus preventing
unauthorized changes or tampering. Each record in the chain is cryp-
tographically linked to the previous hash of the block, which enhances
security and trust in the data. Blockchain uses advanced cryptography to
secure digital records. Private and public keys are used to authenticate
and authorize the data. This cryptographic approach ensures that only
authorized entities can view or modify the records, while maintaining the
privacy of sensitive information. Additionally, blockchain’s decentral-
ized architecture reduces the risk of single point failure, making it more
secured and resilient against cyberattacks and data breaches. Financial
services industries are one of the main areas where blockchain technol-
ogy has made a significant impact. This brings a major change in the
financial sector. Blockchain is a decentralized mechanism that eliminates
the intermediary authority for transactions. Blockchain technology ena-
bles fast, secure, and cost-effective payments. Blockchain is conducted
directly peer-to-peer, streamlining the process. And its decentralized
nature ensures transparency and traceability.
6.10 TYPES OF BLOCKCHAIN NETWORKS

Until now, we have seen blockchain’s traditional mechanism, applications, and how
it is different from the traditional security mechanism. Let’s look into types of block-
chain networks, of which there are mainly three.
6.10.1 Public Blockchain
Public blockchain network is open to anyone, anyone can participate, and anyone
may validate, read, and write the transactions on the networks as everyone acts as
the central authority (Barański, Szymański, Sobecki, Gil, & Mora, 2020). Public
blockchains are decentralized; no single entity or organizations has control over the
network. All the transactions are public. Blockchain and its records are visible to
anyone on the network, and this transparency enhances trust. Although public, the
consensus method used by blockchain, such as proof-of-work (PoS) or proof-of-stake
(PoS), validates transactions and maintains network security: for example, bitcoin
(BTC), Ethereum (ETH).
6.10.2 Private Blockchain
A private blockchain network is restricted to a specific group of organizations.
Although it is decentralized, access to the network is controlled, and participants
require permission to join and engage in the activities (Ahmad, Salah, Jayaraman,
Yaqoob, & Omar, 2022). Private blockchains limit their participation to authorized
entities or individuals in order to tighten control over network operations. It also
incorporate measures to restrict access to transaction details, ensuring that the sen-
sitive data is not publicly visible. Private blockchains are faster and more scalable
compared to public blockchains since they have a smaller number of entities. An
example is Hyperledger Fabric.
6.10.3 Consortium Blockchain
A federated blockchain, sometimes referred to as a consortium blockchain, combines
public and private blockchain networks. It is a permissioned network in which a lim-
ited number of selected entities operate and validate transactions.
Consortium blockchains have a peer-selected set of validators who maintain the
network transactions. These blockchains are not fully decentralized; they are more
decentralized when compared to private blockchains as multiple organizations partic-
ipate in the network operation. Consortium blockchains are more scalable compared
to public blockchains, making them more suitable for applications with a huge num-
ber of transactions. Ripple and Quorum are examples. Each type of blockchain has
its own benefits and services. Public blockchains are safer and more straightforward,
but they can be increasingly slow and costly to utilize. Private blockchains are more
effective and secure, but they can be less straightforward. Consortium blockchains
offer a center ground between public and private blockchains, and they are often the
ideal choice for applications that require joint effort among different associations.
6.11 ADVANTAGES AND DISADVANTAGES

Blockchain is a distributed ledger technology that offers a number of security bene-
fits over traditional security measurements.
Data Integrity: Blockchains are immutable, data added to blockchain cannot

be changed or tampered with once it is there. High levels of security and
trust regarding integrity of data are provided by this feature. It is also ben-
eficial for applications where data tampering or unauthorized modifications
are the main concerns.
Decentralization: Blockchain’s decentralized nature can prevent the single

point of failure or attacks. By distributing the ledger over the entire network,
it becomes challenging for an attacker to compromise the entire network.
Transparency and Traceability: Blockchain provides transparency, which
means all the participants in the network can view the transactions and data
recorded on the blockchain. This transparency enhances accountability and
makes it easier to track activities. It also helps to detect security breaches
or fraud.
Enhanced Privacy: As centralized systems depend on an intermediary
authority control, this poses a risk to the data when a party is compromised
(Bhambri, Singh, & Singh, 2007). Blockchain uses cryptographic tech-
niques to protect the privacy of transactions and data, thus allowing indi-
viduals or organizations to control who may access their data.
Cyber Threat Detection and Response: As the transparency feature of block-
chain provides auditability of the data on the network, real-time monitoring
and detection of suspicious activities are possible.
Secure Transactions: As blockchain is based on peer-to-peer transactions
without the need of intermediaries, its cryptographic mechanisms ensure
the integrity and security of transactions with minimal time.
On the other hand, some drawbacks are associated with blockchain technology.
Energy Consumption: The consensus algorithms used in blockchain require

substantial computational power and energy consumption. This can raise
concern about the environmental impact of blockchain networks, especially
in the case of cryptocurrencies.
Scalability: There are some scalability limitations, especially in the public
networks, as each transaction needs to be processed by multiple nodes
(Bathla, Jindal, & Bhambri, 2007). This can slow transaction speeds and
also increase cost as the network grows.
Data Storage: Blockchain requires a significant storage capability to maintain
a complete and distributed ledger. As the number of users grows, storage
requirement increases, which can be costly for nodes participating in the
network.
Lack of Standardization: The lack of standardized protocols and frameworks
makes difficult for blockchain to operate interplatform.
Even though blockchain has numerous advantages, it might not support all use
cases. Based on the organization’s and individual’s requirements, it is necessary to
check and evaluate the required specifications before adopting blockchain (Singh &
Bhambri, 2007). Let’s talk about the risk and challenges involved in deployment of
blockchain technology.
6.12 CHALLENGES AND RISKS

Scalability: Blockchain networks, such as public blockchains like Bitcoin or
Ethereum, are facing scalability challenges. As the number of users and
transactions over the network increases, the network becomes slower and less
efficient due to huge increase in transactions over the network. With the decen-
tralized nature of blockchain, scalability issues are more challenging to solve.
Security Flaws: As blockchain is designed to be secure, there are some
instances of security breaches and vulnerabilities. Vulnerabilities in the
cryptographic algorithm can lead to mainly financial losses.
Energy Consumption: Blockchain networks, particularly works on proof-
of-stake (PoS)-based systems, requires a significant computational power,
which leads to high energy consumption.
Interoperability: Blockchains exist as separate networks. The lack of stan-
dardized protocols and secure communication channels among different
blockchain platforms can inhibit data exchange and integration (Bhambri &
Gupta, 2007). Developing and incorporating a better solution is necessary.
Cost Management: Implementation of blockchain can be costly in terms of
initial setup and maintenance. Developing and maintaining blockchain net-
works require specialized skills, infrastructure, and computing resources.
6.13 FUTURE PERSPECTIVES OF BLOCKCHAIN

Blockchain technology has the potential to bring several changes and innovations in
various sectors. Even though today blockchain technology is gaining more attention,
some future scope and changes could emerge.
Finance Sectors: Blockchain technology has already had a significant impact

on the financial sector, such as decentralized lending or borrowing and trad-
ing platforms. The technology has gained momentum, providing users with
greater control over their financial assets without the need for an interme-
diary’s link banks. The decentralized feature involves more sophisticated
financial products and increased interoperation among different blockchain
networks.
Supply Chain Management: Supply chain management might be revolution-
ized by blockchain by providing heightened transparency, traceability, and
security. With blockchain technology, businesses can track and verify goods
from origin to the end consumers, ensuring authenticity and reducing risks.
Smart contracts can automate and enforce agreements among the different
parties involved in the supply chain.
Identity Management: Blockchain can address the problems related to
identity theft, fraud, and privacy concerns. By creating decentralized and
immutable digital identities, users can have better control over their per-
sonal information. This application can potentially bring changes in health-
care, voting systems, and access control, where secure and tamper-proof
identity verification is crucial.

All in all, blockchain innovation has arisen as a groundbreaking power with the
possibility to reform different ventures and cultural frameworks. Its benefits are
various, including upgraded security, straightforwardness, decentralization, and

effectiveness. By dispensing with the requirement for mediators, blockchain empow-
ers shared exchanges and savvy contracts, decreasing expenses and smoothing out
processes. There are various sorts of blockchain networks, like public, private, and
consortium blockchains, each taking care of explicit use cases and prerequisites.
Public blockchains, such as Bitcoin and Ethereum, offer open and permissionless
organizations, while private and consortium blockchains give limited admittance to
explicit members, making them reasonable for big business applications. In conclu-
sion, blockchain innovation addresses a change in perspective by the way we over-
see computerized resources, lay out trust, and manage exchanges. While there are
difficulties and dangers to survive, the likely advantages and future extent of block-
chain are tremendous, offering open doors for effectiveness, straightforwardness,
and strengthening in any number of areas.
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7 Security Aspects of
Blockchain Technology
Mayuresh B. Gulame, Nilesh N. Thorat, Aarti P.
Pimpalkar, and Deepali A. Lokare
7.1 INTRODUCTION
Cryptocurrencies and other extremely innovative business models, including decen-
tralized autonomous organizations (DAOs), have come to the forefront thanks to the
development of blockchains, distributed ledgers (DLs), and decentralized finance
(DeFi). These models can be profitably transplanted to the digital revolution of the
outdated economy to support the implementation of initiatives like Industry 4.0,
despite the fact that they were initially developed for virtual businesses. They need
to be used in business operations that are essential to traditional brick and mortar
businesses for this to happen (Gbo et al., 2019). A block typically is made public to all
network users and may include transactions from many users. A safe and immutable
append-only chain is produced since each block also includes the transaction data
and the hash of the previous block. Each additional block that is added to the chain’s
terminus causes it to grow longer and longer. The potential of blockchain technology
has drawn the attention of numerous sectors and researchers. Currently available on
the market are around 3000 blockchain-based coins, and this number is growing. In
addition to digital currencies, blockchain technology has been used in a variety of
application domains, such as the Internet of Things, healthcare, economics, software,
and education, among others. A number of industries, including contact tracing,
supply chain management, immigration procedures, etc., have adopted blockchain
as a result of the sudden COVID-19 pandemic’s rapid spread (Hosen et al., 2020;
Saputhanthri et al., 2022).
The distribution of digital information, copyrights management, mobile networks,
and security for the Internet of Things were highlighted as the primary applica-
tion fields for blockchain technology in recent research on blockchain applications.
A description of blockchain’s potential and illustrations of its application in the
health industry have been provided in recent pertinent reviews (Chen et al., 2020).
Examples of these include managing supply chains in the healthcare industry, train-
ing in medicine, patient information access control, and safety in Internet of Things
technologies relevant to the sector.
7.1.1 Evaluation of the Blockchain

Blockchain technology has advanced and undergone a significant evolution. Figure 7.1
shows the stages of this progression. The public ledger for storing cryptocurrency via
92 DOI: 10.1201/9781003459347-7

Security Aspects of Blockchain Technology 93
FIGURE 7.1 Flow of evaluation of blockchain.
FIGURE 7.2 Elementary categories of blockchain.
a dispersed network makes up Blockchain 1.0, the earliest stage of development.

The next phase, known as Blockchain 2.0, adds a mechanism for handling belief
using smart deals that operates independently of any outside parties. The succeeding
phase is known as Blockchain 3.0, which is the technology’s existing and forthcom-
ing forms.
7.1.2 Numerous Categories of Blockchain

Bitcoin is a type of digital currency, and its blockchain is its core. By maintaining
its essential qualities of decentralization, immutability, anonymity, and suitability
for the e-money transaction process, it has increased its overall significance in the
digital world. In essence, there are four distinct blockchain types to consider. (See
Figure 7.2.)
7.1.2.1 Public Blockchain

Anyone can access permissioned blockchains, which combine public and private
blockchains, as long as they are granted the administrator’s permission to do so.
While the private blockchains are generally available only to a certain group of users
and are restricted to all others, public blockchains are accessible to everybody. The
vast number of network members joining a secure public blockchain provides greater
security against data leaks, attacker tries, and other cybersecurity issues (Tosh
et al., 2018). The more users a blockchain has, the more secure it becomes. The public
blockchain system also maintains an incentive structure built into the protocol using
gaming theory, which means that network participants are rewarded monetarily for
preserving the network’s highest levels of integrity and ethics.
7.1.2.2 Private Blockchains

Users are able to join the private blockchain network after receiving an invitation and
providing valid and verified identification or other needed information. A blockchain
that is private is not decentralized. It is a distributed ledger that serves as a secure
closed database, protected by both organizational needs and cryptographic principles.
Anyone operating a full node, carrying out transactions, or validating or authenticating
blockchain updates is required to have authority (Giraldo et al., 2020; Yang et al., 2021).
7.1.2.3 Hybrid Blockchain

An amalgam of both public and private blockchains is referred to as a hybrid block-
chain. It integrates essential components of both private and public blockchains,
ensuring the privacy of transactions and data. It also combines the greatest features
of both public and private blockchain protocols (Arya et al., 2022). However, they are
still verifiable when necessary, for instance by providing access using a smart con-
tract. Private information is still verifiable even though it is kept inside the network.
By allowing organizations to access their data in the network under appropriately
controlled conditions, this platform’s hybrid feature increases system flexibility and
security without compromising user privacy (Qiu et al., 2020). The transactions done
on the hybrid blockchain are kept private and yet can be validated whenever necessary,
despite the fact that it is governed by a group of people. Aergo Enterprise-Samsung’s
hybrid blockchain system has been launched, according to South Korean firm Blocko,
which is funded by Samsung. By utilizing their private blockchain platform, the busi-
ness’ developers have distributed their migration services to other Blocko customers.
7.1.2.4 Consortium/Federated Blockchains

The consortium blockchain, also known as a federated blockchain, is the third type of
blockchain that consists of both private and public blockchain components. However, it
differs in that a decentralized network is used in collaboration with numerous organi-
zational members (Kaur et al., 2023). A consortium blockchain, in contrast to a public
blockchain, prevents outsiders from joining the network and instead needs the net-
work administrators’ approval before anyone may be granted access (Gonzalez, 2021)
It is frequently employed in companies with numerous business partners. Comparing
a consortium blockchain to a public blockchain network, the latter is typically more
efficient, scalable, and secure (Rani, Kumar, et al., 2023). It provides access controls,
similar to private and hybrid blockchains. However, the public blockchain is more
transparent than the consortium blockchain (Thorat, 2016). Table 7.1 demonstrates the
blockchain differentiation with appropriate benefits and limitations.
7.1.2.5 Comparison of All Types of Blockchain
TABLE 7.1
Blockchain Differentiation in Terms of Pros and Cons
Particulars Public Private Hybrid Consortium
Benefits Independence, trust Access control, Versatility, Versatility, security

enactment
Shortcomings Versatility, security Trust, auditability Advancement, Transparency
transparency
Use cases Cryptocurrency, file Asset ownership, Real estate, Finance, supply
validation supply chain therapeutic record chain, research
7.2 SECURITY FEATURES OF BLOCKCHAIN-BASED SYSTEMS

Implementation in the blockchain network guarantees data provenance and integrity,
is auditable and tamper-proof, pseudonymized, immune to DDoS attacks, resistant
against majority attacks, safe, private, and confidential. When handling online trans-
actions, these features give the blockchain network its uniqueness, transparency, and
security (Thorat, 2015). These security features of a blockchain-based system are
described next.
7.2.1 Consistency Data
Data consistency in a blockchain network refers to the idea of ensuring the same copy
of the data for every network node at all times. The consistency of data in the context
of Bitcoin is in question because it has been asserted to be both weak and strong
by various academics. The Eventual Consistency methodology, a methodology for
assuring data consistency for distributed networks, is suggested. By updating the
data sloppily and providing readers with the new values, the method strikes a balance
between the data’s consistency and availability.
7.2.2 Tamper-Proof Data
The ability of the facts to withstand purposeful or unintentional harm is ensured
by its tamper resistance. The blockchain is believed to be tamper-resistant, which
means that the information being kept or produced on its blocks can never be altered
or tampered with, either during or after generation. The information may be altered
in one of two ways: either by the miner trying to change the data or by the opponent
trying to alter it.
7.2.3 Network with a Distributed Denial-of-Service Attack Defense

A denial-of-service attack on the distributed network powered by blockchain occurs
when resources are not available to the intended users. Resources for permitted users
are in short supply due to the attacker’s flood of resource requests on the system.
The network’s numerous, distributed nodes throughout the world can launch DDoS
attacks against blockchains. The attackers seize a small number of network nodes by
making use of system flaws. Such attacks are incredibly difficult to handle because
they block nodes only one at a time.
7.2.4 Secure and Confidential Data

The security of data in the blockchain is concerned with approved access and secure
storage, whereas secrecy refers to the protection afforded to sensitive data. The
blockchain was initially suggested as a way to manage digital money, but its applica-
tion is considerably broader than that. One of the most important components of the
distributed network powered by the blockchain is the secrecy of the transactions. The
blockchain uses pseudoidentities to maintain the nodes’ security and privacy.
7.3 SECURITY WITH BLOCKCHAIN TECHNOLOGY

Blockchain technology has attracted a lot of interest recently since it has the potential
to transform several sectors. However, blockchain also has security problems and
obstacles, just like any other technical advancement. The following are some of the
main security issues with blockchain technology.
7.3.1 51% Attack
In a blockchain network, a 51% attack occurs when one individual or group holds
over 50% of the computing power. With this control, they can potentially reverse
transactions, double-spend, or prevent some transactions from being recorded in the
blockchain. Imagine a group of friends playing a game. In this game, the group
makes decisions collectively, and no single person has too much power. However, if
one person manages to control more than half of the group, they could start making
unfair decisions that benefit only them. Similar to this, if one entity controls over
50% of the computer power on the network, they can exploit the transactions and
cause issues like transaction reversals or duplicating the use of digital currency.
7.3.2 Smart Contract Vulnerabilities

Self-executing contracts with predefined conditions are known as smart contracts
and are kept in the blockchain. Smart contracts, however, may have flaws that attack-
ers can exploit if the contracts are not properly constructed. These flaws may result
in monetary losses, digital asset theft, or unforeseen effects. A smart contract can be
compared to a vending machine that automatically completes a transaction when cer-
tain criteria are met. However, if someone discovers a bug in the vending machine’s
code, they might be able to con it into giving them free merchandise or taking more
money than it ought to. Similar to this, hackers may utilize a smart contract on the
blockchain that contains a coding error to steal money or leads to unforeseen out-
comes (Rathod et al., 2022; Son et al., 2020).
7.3.3 Privacy Concerns
Blockchain technology creates privacy issues despite its openness and immutability
benefits. All transaction information is kept on the ledger by public blockchains,
which makes maintaining confidentiality challenging. While some blockchains
employ encryption methods to address privacy issues, finding the ideal balance
between transparency and privacy still poses difficulties. Imagine that while you
and other players are playing a game, every action you take is being recorded and is
available to everyone (Kataria et al., 2023, July). Transparency is beneficial, but if
you don’t want people to watch every move you make, it could make you feel uneasy.
Similar to private blockchains, public blockchains expose all transaction information
to the public, which compromises privacy. Even while some blockchains employ
encryption mechanisms to safeguard privacy, striking a balance between openness
and secrecy can be difficult.
7.3.4 DDoS (Distributed Denial-of-Service) Attacks

Blockchain networks are susceptible to DDoS assaults, in which numerous hostile
actors flood the network with traffic until it is unable to function. This could stop
transaction processing and affect how the blockchain functions. Imagine a busy
street where too many automobiles are attempting to pass through at once (Yao et al.,
2022). The road eventually gets so jam-packed that nobody can move. Attackers
overwhelm the network with so much traffic during a DDoS attack on a blockchain
that it is impossible to function normally. This might stop transactions from happen-
ing and render the blockchain useless.
7.3.5 Sybil Attacks
Sybil attacks happen when one person or organization generates numerous fictitious
identities or nodes in an effort to take over a blockchain network. Attackers have the
ability to alter consensus procedures and jeopardize the blockchain’s integrity by
controlling a sizable number of nodes. Consider a voting system in which each voter
has one vote. However, if a person makes several false identities and casts multiple
ballots, they can rig the results of the election. Similar to this, in a blockchain net-
work, an attacker might tamper with the consensus process and endanger the block-
chain’s integrity if they have control of numerous false identities or nodes.
7.3.6 Vulnerabilities in the Consensus Mechanism

The current state of the blockchain can be confirmed and agreed upon using con-
sensus procedures, like proof-of-work (PoW) with proof-of-stake (PoS). Each
consensus-building method, nevertheless, has its weaknesses. For instance, while
PoS is subject to attacks from parties with a sizable stake in the network, PoW is
vulnerable to a 51% attack. Imagine a groupof friends debating which movie to see
together (Wang et al., 2022). It becomes unfair if one individual with more influence
continues to dominate the decision-making process. Different consensus processes
are employed in blockchain to reach consensus on the state of the network. Each
system does, however, have weaknesses that can be used against it. For instance,
one entity may be able to manipulate the consensus and jeopardize the security of
the blockchain if it possesses an excessive amount of computer power or stake in
the network.
7.3.7 Supply Chain Attacks

To provide transparency and traceability, blockchain technology is frequently used
in supply chain management. However, if the actual gadgets or parts that make up
the blockchain system are hacked, it might jeopardize the safety and reliability of the
whole system. Consider the chain of custody for a priceless asset, such as a diamond.
To verify that each participant got and passed on the diamond, each link in the chain
signs a document. The chain of trust is broken, and the diamond’s authenticity is
jeopardized if one member in the chain forges a signature. Similarly, with supply
chain systems based on blockchain, if the physical elements or devices involved are
hacked, the security and integrity of the entire system can be jeopardized.
7.3.8 User Error and Social Engineering

The usage of blockchain technology depends on the participation of certain individ-
uals who are in charge of their private keys or login credentials. Users may commit
errors, like losing their private keys or falling for social engineering scams, that
allow unauthorized access to their digital assets or endanger the security of the
blockchain network. Imagine you hold a hidden key that can open a safe containing
your priceless possessions. Your belongings are no longer secure if you misplace the
key or are duped into giving it up. Similarly to how users maintain their digital assets
on other platforms, blockchain users have private keys or access credentials. Users’
digital assets could be stolen or put at risk if they make blunders like losing their
keys or falling for con artists. Combining technical solutions, strict development pro-
cedures, education and awareness campaigns, and ongoing blockchain protocol and
application enhancement are all necessary to address these security concerns and
obstacles. To maintain the confidence and integrity of blockchain-based systems, the
security ecosystem surrounding the blockchain also needs to change with technology
(Wellington et al., 2022).
7.4 APPROACHES TO SECURITY AND PRIVACY IN

BLOCKCHAIN-BASED SYSTEMS
This section offers a comprehensive analysis of the methods that can be applied to
enhance the safety and confidentiality of blockchain-based systems, based on the
literature.
7.4.1 Private Digital Signatures

A subclass of digital signatures called anonymous digital signatures can ensure user
secrecy. In order to increase security and privacy in blockchain-based systems, such
signatures as group signatures and ring signatures can be used. The group signa-
ture procedure is used to sign papers by its participants, who are individually pro-
vided private keys of their own and a shared public key. Any group member can sign
anonymously on the behalf of the whole group with a private key, and other group
members can verify their signatures using the shared public key. The consortium
blockchain can employ such anonymous digital signature systems; as the consortium
blockchain is managed by a few nodes, those nodes can also be chosen as the group
manager (Rani, Mishra, et al., 2023).
7.4.2 Homomorphic Encryption Algorithms

The ability to do computations direct on the cypher text makes homomorphic
encryption a distinctive cryptographic technique. This suggests that converting the
data to unencrypted form in order to perform an operation on it is not required. It
also ensures that the same action done on the identical encrypted information after
decryption, once the data is changed to plaintext, produces the same result as it did
on the encrypted text (Rani et al., 2022).
7.4.3 Secure Multiparty Computation Protocol

This model offers a protocol to help multiple parties execute various collaborative
calculations on their personal data, and the results are supplied without revealing any
details about the parties’ data. The protocol has since been updated to accommo-
date more parties after initially only permitting sharing between two parties. Many
multiparty computation protocol (MCP) techniques have adopted this generalized
form for applications like voting, bidding, auctions, etc. For applications like a multi-
party lotteries system that ensure fairness without relying on a centralized authority,
blockchain-based platforms have become popular the MCP in recent years.
7.4.4 Noninteractive System for Zero-Knowledge Proof

The powerful cryptographic method known as noninteraction zero knowledge
(NIZK) uses the concept of zero-knowledge proofs to safeguard the system’s privacy.
It is intended to mean that a program can be run to make an output using some secret
(private) input data without revealing additional details regarding the data or users;
this allows a user to demonstrate the truth of a claim without disclosing the actual
data. According to an NIZK system variation, users could gain zero-knowledge com-
putational knowledge without engaging in any sort of user engagement.
7.5 BLOCK STRUCTURE
A block contains different parts, as shown in Figure 7.3.
Main Data: Transactional data is contained in blocks. The blockchain’s imple-

mentation for the pertinent services, or its utilization factor, determines
the transaction data. Financial information about transactions is stored for
financial entities like banks.
FIGURE 7.3 Blockchain sequence displaying block structure.
Timestamp: The blocks also have a timestamp. The timestamp in this case
corresponds to the time and date when a specific block was produced.
Hash: A cryptographic hash technique, such as SHA-256, is used to create a
unique identifier for each block called a hash. The block will contain the
hashes of the previous and current blocks. Blocks become immutable thanks
to hashes. With the help of the Merkle tree function, hashes are produced.
It remains in the header of the block. The hash of the Merkle tree root
uses a mathematical hashing process to create a 64-character code from
all the hash values related to each transaction that took place in a block.
A hash matching the Merkle tree’s base of every transaction in the block is
maintained for efficient handling and quicker verification of data. In a cryp-
tographic transaction procedure, a nonce is a 4-byte integer that is generated
randomly and is only used once. The nonce is used as a count throughout
the proof-of-work mining process, which miners attempt to resolve in order
to create a new block (Liu et al., 2021). The goal is to find a hash value lower
than the desired value, which changes based on how difficult the mathemat-
ical problem is.
7.5.1 Block Characteristics
Every block in a blockchain, as depicted in Figure 7.3, principally consists of three
components: the data, a hash of the block before it, and the current block’s hash. Any
type of data could be on the block. It may include of transactional records, health-
related records, insurance records, legal records, records of property ownership, etc.
Blockchain mostly comes in two varieties: public blockchain and private block-
chain. Another is a hybrid blockchain, which combines private and public block-
chains as shown in Figure 7.3.
Using the hash value depicted in Figure 7.4, each block is linked to the preceding
block. The hash number for a block changes if the value of any one piece of data
within that block changes. Various types of blockchain with appropriate attributes
are demonstrated in Figure 7.5. Checking a block’s hash makes it simple to determine
whether it has been modified. A block’s hash functions like a fingerprint. Chain of
blocks using the hash values are shown in Figure 7.6. Like a person’s fingerprint,
every block has a unique hash number. Because each block has the previous block’s
hash, a block’s hash changes if a block is modified, and it is also removed from all
forwarded blocks from the location and disconnected. Tampered block disconnected
from all forwarding blocks is shown in Figure 7.7. A fresh block is formed and then
broadcast across the network. Following a block’s verification, each node adds it to
its list of blocks, and so a false block may also be broadcast over a network. The
hash value of a block is examined to determine whether it is real or not (Bhambri
& Thapar, 2009). A block’s hash value must fall inside a certain range for others
to be able to determine that the computation was successfully done on the block in
question. During the addition of blocks, there is a delay to prevent the quick addition
FIGURE 7.4 Contents of a block.
FIGURE 7.5 Various types of blockchain with attributes.
FIGURE 7.6 Chain of blocks using hash values.

FIGURE 7.7 Tampered block disconnected from all forwarding blocks.
FIGURE 7.8 Verification blocks.
of multiple false blocks. Verification blocks are shown in Figure 7.8. Between each
block creation in Bitcoin, there is a delay of around 10 minutes.
However, if one person or mining pool controls more than 51% of the network’s
processing power and continues to transmit phony blocks while also computing the
succeeding block hashes, this presents a serious problem for blockchain’s PoW consen-
sus. Because of this, some models employ proof-of-stake rather than proof-of-work.
7.5.2 Hash Method
A hash method, such as SHA1, accepts an input and produces a same-length output.
The hash function produces unique results for unique messages and identical results
for identical input. There are some internal states in a hash function. It alters those
internal states in accordance with the message it receives. The internal states change
using permutations and combinations in such a way that it is virtually impossible to
infer what was input from the hash result. The hash output can vary drastically when
the input is significantly altered. These modifications seem to happen at random and
are not governed by any rules. Nevertheless, it is purely arbitrary. However, nobody
has yet discovered a way to break the laws governing what happens when the input
is altered (Cai et al., 2022). The hashing algorithm is designed so that it cannot be
reversed. As seen in Figure 7.9, the output of block A’s hash changes noticeably when
its special number is increased by 1. The output of the hash bears no relationship to
the one advance in the unique number. The 20-bit hash is valuable for comprehen-
sion, even if it does not represent the real outcome of a hash algorithm. The nonce of
the block is a specific number, as seen in Figure 7.9.
7.5.3 Consensus Algorithm
7.5.3.1 Proof of Work
Proof-of-work (PoW) is the algorithm that is most widely used, but it uses a lot of
computational resources and energy while looking for solutions. The blockchain
algorithm determines whether or not a block is legitimate before adding it to the
network.
FIGURE 7.9 Imaginary 20-bit hashing algorithm.

The POW algorithm is the solution. PoW calculates whether the block’s hash value
falls inside a given range. The block is approved if its value is inside the range; else, it
is rejected. In the PoW concept, miners compete with one another for mining blocks,
which entails locating a block’s hash value inside a given range. PoW is a competi-
tion among miners to solve a mathematical puzzle. The reward of mining that block
goes to whoever solves that problem or discovers a hash number with a nonce that
falls inside a certain range. In a PoW network, one needs to have at least 51% of the
computing capacity of the entire network in order to add a malicious block. If not,
malevolent addition attempts would be unsuccessful.
7.5.3.2 Proof of Stake

The node with the greatest stake in proof-of-stake is given the duty of creating a new
block. A node is more unlikely to publish a fake block if its stake is large. Simply
said, they wouldn’t take that chance. Proof-of-stake requires a lot less energy and
advances much more quickly than proof-of-work. For these reasons, many people
incorporate proof-of-stake into their models. The mining task in PoW is a competi-
tion among the miners. It’s a race to solve the hash function of cryptography. The PoS
algorithm selects the block maker in PoS based on stakes. Block creation in PoS is
not rewarded, in contrast to PoW. Transaction costs are now paid to the block owner.
Similarly to PoW, PoS additionally requires a hash value to be produced in order to
create blocks, and this hash value is generated at random. In contrast to PoW, search-
ing for this hash value is over the defined range rather than any real number domain.
Because PoS’s hash value search space is constrained, it is more rapid and energy-
efficient than PoW. A PoS attack would need to control at least 51% of the network’s
money in order to add an unauthorized block. PoS uses a lot less energy than proof
of work because the block provides the next opportunity. It is quite implausible that a
hacker would possess the more than 50% of the cash used in that network that would
be needed to add the harmful block.
7.6 APPLICATIONS OF BLOCKCHAIN TECHNOLOGY

Blockchain technology has the potential to be applied in a variety of industries. It
essentially enhances the current system or develops new technology. The various
blocks of blockchain technology are demonstrated in Figure 7.10. It will alter our
lives and keep others from committing fraud, theft, or other crimes (Bhambri &
Singh, 2008). Blockchain technology allows for the secure transfer of digital assent
without the need for a third party. Blockchain can be used in a variety of fields. Some
of the areas are discussed next.
7.6.1 Healthcare
Everyone should prioritize the security of personal information, including health
information. (See Figure 7.11.) These health-related data are extremely valuable
because they are what pharmaceutical businesses rely on to succeed (Bhambri &
Nischal, 2008). Public blockchain technology can be used to protect medical
FIGURE 7.10 Blocks of blockchain technology.
FIGURE 7.11 Medical block structure.
information from misuse and unauthorized access and also allows clinicians to view
patient-provided health data if they have their patients’ permission.
7.6.2 Crowdfunding for Equity

The practice of soliciting donations from members of the public or supporters of a
company or product in exchange for ownership or stock in the company is known
as equity crowdfunding. (See Figure 7.12.) Furthermore, not everyone has faith
in the organization coordinating all of the transactions, which affects the overall
money generated. Blockchain technology can be used to ensure that contributions
FIGURE 7.12 Crowdfunding block structure.
and investors are treated equally. Blockchain brings all parties together and erases
resultant differences.
7.6.3 Banking
Blockchain technology can significantly benefit the taxation industry. The existing
method of collecting taxes is not particularly reliable. Individuals may disagree when
it comes to paying taxes. They make up lies and refuse to pay taxes. A blockchain
framework is irreversible. It displays the genuine value of the system. When some-
one lies about paying their taxes, blockchain technology can quickly disclose pre-
cise information (Bhambri et al., 2008). Because this is unchangeable, people may
amend their tax information if they chose to. Because it is difficult to keep all of the
information up-to-date, those who tell lies regarding paying taxes will be caught.
Blockchain simplifies the detection of fraud. Value-added tax (VAT) fraud may be
decreased. The tax authorities now have to ask taxpayers for information one by one
under the current approach (Derwing et al., 2002). Not only is that difficult, but it’s
also risky in that it doesn’t provide accurate statistics. However, if blockchain is used
in the tax system, gathering data from the taxpayer is no longer required. Authorities
can view the outcome on a computer, and the record is accurate and true.
Money security is crucial for everyone, and people therefore utilize banks to safe-
guard their cash. However, not even banks can guarantee total security. But nowa-
days, the majority of our money is in digital rather than physical form. Digital items
must be stored on a server that uses software and is located somewhere. Banks can
be hacked, like any other piece of software. Money can disappear from a bank in
an instant. Blockchain technology is used to stop bank money from being stolen by
hackers. It is incredibly challenging to gain access to and steal money from a finan-
cial system that is based entirely on blockchain (Bhambri et al., 2009). Blockchain-
based banking guarantees that, even when a server is compromised, hackers cannot
immediately take the money since they first need to compromise every other server
that holds the same data.
7.6.4 Smart Power Grid

Blockchain is also employed in the power system to provide customers with electricity.
This gets rid of fraud. Each person’s energy use is tracked via the blockchain ledger.
No one can claim they consumed less energy than they actually did because everybody
shares the same ledger. And a customer cannot be overcharged by power authority.
7.6.5 System for Smart Delivery

Distribution firms may face challenges in making sure that customers receive the
right item they requested online. Delivering that relies on other people, this reliance
creates a single point of vulnerability and is easily hacked. Once a system has been
compromised, an attacker can steal items intended for someone else. Blockchain
smart technology can help with this. However, it is unfeasible to employ blockchain
technology for each and every item. The usage of blockchain, based on smart con-
tracts, can ensure that the correct individual receives the items ordered (Krech,
2004). The vendor and purchaser can swap secret codes. The contract is thus honored
when it arrives at the intended location using the given secret code.
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8 Computational
Intelligence and
Blockchain in Diversified
Applications
Shailesh Shetty S. and Supriya B. Rao
8.1 INTRODUCTION
Blockchain technology has emerged as a groundbreaking innovation with the poten-
tial to revolutionize various industries, including healthcare. In particular, the use of
blockchain for storing clinical trials and records holds immense promise for enhanc-
ing data security, integrity, and accessibility. Ethereum, a decentralized blockchain
platform, offers unique features that make it well-suited for this purpose. This report
explores the use of Ethereum blockchain for storing clinical trials and records, high-
lighting its benefits and potential applications.
8.1.1 Overview of Blockchain Technology

Blockchain technology is a distributed and decentralized ledger system that enables
secure and transparent recordkeeping. It consists of a chain of blocks, each contain-
ing a list of transactions or records. Key features of blockchain technology include
decentralization, immutability, transparency, and cryptographic security mecha-
nisms. These features make blockchain an ideal solution for addressing the chal-
lenges associated with storing and managing sensitive clinical trial data.
The various types of blockchain that are widely used are:
Public blockchain.
Private blockchain.
Hybrid blockchain.
Public blockchain uses the Ethereum platform, whereas private blockchain makes
use of Hyperledger Fabric.
Blockchain uses Proof of Stake concepts, and consensus mechanisms are built
into it. To provide security, it uses hashing algorithms.
Each block is connected to previous block by means of hashing.
110 DOI: 10.1201/9781003459347-8

Computational Intelligence and Blockchain 111
8.1.2 Introduction to Ethereum Blockchain

Ethereum is a leading blockchain platform that extends the capabilities of blockchain
technology beyond cryptocurrency transactions. It enables the execution of decen-
tralized applications (DApps) and the deployment of smart contracts. Ethereum’s
architecture allows developers to build and deploy their own applications on top of
the blockchain, making it a versatile platform for various use cases, including health-
care (Thapar & Bhambri, 2009).
8.1.3 Benefits of Ethereum Blockchain for Storing

Clinical Trials and Records
Enhanced Data Security: Ethereum blockchain leverages advanced cryp-
tographic techniques to provide robust security measures (Rani, Kumar,
Kataria, & Min, 2023). Data stored on the blockchain is encrypted, ensur-
ing the confidentiality and integrity of clinical trial records. Additionally,
Ethereum’s decentralized nature mitigates the risk of a single point of fail-
ure and makes it resistant to cyberattacks.
Immutability and Data Integrity: Once data is recorded on the Ethereum
blockchain, it becomes immutable and tamper-proof. This property
ensures the integrity and authenticity of clinical trial records, as
they cannot be altered or deleted without leaving a trace (Bhambri &
Hans, 2009). Immutability adds an additional layer of trust to the data
stored on the blockchain, enabling reliable and auditable clinical trial
documentation.
Transparency and Accountability: Ethereum’s transparent nature allows
all participants in the network to view and verify the stored clinical trial
records. This transparency promotes accountability and trust among
stakeholders, including researchers, patients, regulators, and sponsors
(Bhambri & Thapar, 2010). It also facilitates easy auditing and verification
of clinical trial data, ensuring compliance with regulations and standards
(Kaur, Singh, & Rani, 2023).
Interoperability and Data Sharing: Ethereum blockchain provides a stan-
dardized platform for interoperability among different healthcare systems
and stakeholders. It enables secure and efficient sharing of clinical trial
data, facilitating collaboration between researchers, institutions, and reg-
ulatory bodies. Smart contracts can automate data sharing agreements and
enforce predefined rules, ensuring data privacy and proper data usage.
Patient Empowerment and Data Ownership: Ethereum blockchain empow-
ers patients by allowing them to maintain ownership and control over their
clinical trial data. Patients can grant and revoke access to their data through
smart contracts, ensuring privacy, and giving them greater control over their
sensitive information.
8.1.4 Potential aPPlications and Use cases

Clinical Trial Data Management: Ethereum blockchain can streamline the
management of clinical trial data by providing a decentralized and secure
repository for storing all relevant information. This includes participant
data, consent forms, trial protocols, adverse event reports, and more. The
use of smart contracts can automate consent management, data sharing, and
adherence to trial protocols.
Secure Data Exchange and Collaboration: Ethereum blockchain enables
secure and auditable data exchange among researchers, healthcare provid-
ers, and regulatory authorities. It facilitates real-time collaboration, data
standardization, and seamless integration of disparate systems, enhancing
the overall efficiency and reliability of clinical research.
Supply Chain Management: Ethereum blockchain can ensure the traceabil-
ity and authenticity of drugs used in clinical trials. By recording the entire
supply chain process on the blockchain, from manufacturing to distribution,
it becomes easier to verify the quality, origin, and handling of medications,
reducing the risk of counterfeit drugs and ensuring patient safety.
8.1.5 challenges and considerations

Scalability: Ethereum blockchain currently faces scalability challenges due
to limitations in transaction processing capacity. As the number of clinical
trials and data volume increases, efforts must be made to enhance scalabil-
ity and throughput to accommodate the growing demands of the healthcare
industry.
Regulatory Compliance: Adhering to regulatory frameworks and data pro-
tection regulations, such as HIPAA and GDPR, is crucial when storing clin-
ical trial data on the Ethereum blockchain (Bhambri, 2010). Compliance
measures should be implemented to ensure the privacy, security, and lawful
use of patient information.
Integration and Adoption: Widespread adoption of Ethereum blockchain in
the healthcare industry requires collaboration, standardization, and integra-
tion with existing systems. Efforts should be made to develop common stan-
dards and frameworks that enable seamless interoperability and integration
with electronic health record systems.
8.2 LITERATURE SURVEY

8.2.1 Blockchain technology in healthcare data ManageMent
Rindflesch, T. C., & Fiszman, M. (2013). The role of blockchain technology in biomedical
science. Journal of Biomedical Informatics, 46(5), 728–738.
This seminar paper introduces the concept of blockchain technology in

the biomedical field. It discusses the potential applications, such as secure
data exchange, provenance tracking, and patient consent management, high-
lighting the benefits and challenges of adopting blockchain in healthcare data
management.
Ichikawa, D., Kashiyama, M., & Ueno, T. (2017). Blockchain technology for healthcare:
A systematic literature review. Healthcare Informatics Research, 23(3), 214–220.
This systematic literature review provides an overview of existing research on
blockchain technology in healthcare. It explores various use cases, including clinical
data management, medical records, and supply chain integrity. The paper identifies
the potential of blockchain in enhancing data security, privacy, and interoperability
while emphasizing the need for standardization and further research.
8.2.2 ethereUM Blockchain for clinical trials and records

Kuo, T.-T., Kim, H.-E., & Ohno-Machado, L. (2017). Blockchain distributed ledger tech-
nologies for biomedical and health care applications. Journal of the American Medical
Informatics Association, 24(6), 1211–1220.
This comprehensive review article investigates the application of blockchain, par-
ticularly Ethereum, in the healthcare domain. It discusses the advantages, challenges,
and potential use cases, including clinical trials, medical records, and consent man-
agement. The paper also addresses security, scalability, and regulatory considerations.
Zhang, P., Schmidt, D. C., White, J., Lenz, G., & Rosenbloom, S. T. (2017). FHIRChain:
Applying blockchain to securely and scalably share clinical data. Computers in Biology
and Medicine, 89, 392–397.
This research paper proposes FHIRChain, a blockchain-based solution built
on Ethereum, to securely share and exchange clinical data using Fast Healthcare
Interoperability Resources (FHIR) standards. The study demonstrates the feasibility
of using Ethereum blockchain for healthcare data exchange while ensuring privacy,
data integrity, and scalability.
8.2.3 Benefits and challenges of ethereUM Blockchain in healthcare

Dagher, G. G., Mohler, J., Milojkovic, M., Marella, P. B., & Ancile Consortium. (2018).
Ancile: Privacy-preserving framework for access control and interoperability of electronic
health records using blockchain technology. Sustainable Cities and Society, 39, 283–297.
This chapter introduces the Ancile framework, a privacy-preserving solution for
electronic health records (EHR) built on Ethereum blockchain. It addresses data
security, interoperability, and patient consent management, highlighting the advan-
tages and challenges of implementing blockchain in healthcare.
Tosh, D., & Dave, M. (2019). Blockchain-based clinical trials: Applications and challenges.
Journal of Healthcare Engineering, 2019, Article ID: 827069.
This review article discusses the potential applications of blockchain in clinical
trials, including participant recruitment, consent management, data sharing, and trial
protocol adherence. It also examines the challenges related to scalability, regulatory
compliance, and the integration of blockchain with existing healthcare systems.
8.2.4 fUtUre directions and eMerging research

Roehrs, A., da Costa, C. A., da Rosa Righi, R., & da Silva, D. S. (2018). Personal health
records: A systematic literature review. Journal of Medical Internet Research, 20(5), e183.
This systematic literature review focuses on personal health records (PHRs)
and highlights the potential of blockchain technology to enhance PHR security,
accessibility, and interoperability. It identifies gaps in the current research and sug-
gests future directions for leveraging blockchain in PHR management (Rani, Mishra,
Kataria, Mallik, & Qin, 2023).
Liang, X., Zhao, J., Shetty, S., Liu, J., Li, D., & Tan, H. (2020). Integrating blockchain
for data sharing and collaboration in mobile healthcare applications. IEEE Access, 8,
132900–132912.
This research paper explores the integration of blockchain, specifically Ethereum,
in mobile healthcare applications to enable secure and privacy-preserving data shar-
ing and collaboration. It emphasizes the benefits of blockchain in ensuring data
integrity, consent management, and interoperability among different healthcare
stakeholders (Kataria, Puri, Pareek, & Rani, 2023).
This literature survey provides a comprehensive overview of the utilization of
Ethereum blockchain for storing clinical trials and records. Existing research demon-
strates the potential benefits of blockchain technology, including enhanced data
security, integrity, transparency, and interoperability. However, challenges such as
scalability, regulatory compliance, and integration with existing systems need to be
addressed. Further research and development are required to realize the full potential
of Ethereum blockchain in healthcare data management and to revolutionize the field
of clinical trials and records.
Xu, M., Chen, X., & Kou, G. (2019). A systematic review on blockchain. Financial Inno-
vation, 5, Article ID: 27.
Blockchain is considered by many to be a disruptive core technology. Although
many researchers have realized the importance of blockchain, the research of block-
chain is still in its infancy. Consequently, this study reviews the current academic
research on blockchain, especially in the subject area of business and economics.
Based on a systematic review of the literature retrieved from the Web of Science ser-
vice, we explore the top-cited articles, most productive countries, and most common
keywords. Additionally, we conduct a clustering analysis and identify the follow-
ing five research themes: “economic benefit,” “blockchain technology,” “initial coin
offerings,” “fintech revolution,” and “sharing economy.” Recommendations on future
research directions and practical applications are also provided in this chapter.
Taherdoost, H. (2023). Smart contracts in blockchain technology: A critical review. Infor-
mation, 14, 117. https://doi.org/10.3390/info14020117.
By utilizing smart contracts, which are essentially scripts that are anchored in a
decentralized manner on blockchains or other similar infrastructures, it is possible
to make the execution of predetermined procedures visible to the outside world. The
programmability of previously unrealized assets, such as money, and the automation
of previously manual business logic are both made possible by smart contracts. This
revelation inspired us to analyze smart contracts in blockchain technologies written
in English between 2012 and 2022. The scope of research is limited to the jour-
nal. Reviews, conferences, book chapters, theses, monographs, and interview-based
works, as well as articles in the press, are eliminated. This review comprises 252 arti-
cles over the last ten years with “blockchain,” “block-chain,” “smart contracts,” and
“smart contracts” as keywords. This chapter discusses smart contracts’ present status
and significance in blockchain technology. The gaps and challenges in the relevant
literature have also been discussed, particularly emphasizing the limitations. Based
on these findings, several research problems and prospective research routes for
future study that will likely be valuable to academics and professionals are identified.
8.3 METHODOLOGY
8.3.1 introdUction
This section outlines the methodology employed in this research paper to investigate
the use of Ethereum blockchain for storing clinical trials and records. The meth-
odology encompasses data collection, literature review, analysis, and synthesis of
relevant information to support the research objectives.
8.3.2 data collection

The chapter relies on a comprehensive collection of scholarly articles, research papers,
conference proceedings, and relevant literature from reputable sources. A systematic
search was conducted in electronic databases such as PubMed, IEEE Xplore, and
Google Scholar using keywords such as “blockchain,” “Ethereum,” “clinical tri-
als,” “healthcare data management,” and related terms. The data collection process
ensured the inclusion of recent and relevant publications, considering a time frame
within the past five years to incorporate the latest advancements in the field.
8.3.3 literatUre review

A thorough review of the collected literature was conducted to identify key trends,
challenges, and opportunities related to the use of Ethereum blockchain in storing
clinical trials and records.
The literature review involved analyzing the content, methodology, findings, and
implications of the selected papers. The review process focused on synthesizing the exist-
ing knowledge and identifying research gaps and areas requiring further investigation.
8.3.4 analysis and synthesis

The collected data and findings from the literature review were analyzed to identify
common themes, recurring patterns, and significant insights related to the utiliza-
tion of Ethereum blockchain in healthcare data management. The analysis involved
examining the advantages, challenges, potential applications, and emerging trends
specific to the storage of clinical trials and records on Ethereum blockchain. The syn-
thesis process aimed to consolidate the information and develop a coherent under-
standing of the topic.
8.3.5 case stUdies and Use cases

To provide practical insights, this chapter includes relevant case studies and use cases
that demonstrate the implementation of Ethereum blockchain for storing clinical
trials and records. These case studies were selected based on their relevance, sig-
nificance and the extent to which they illustrate the benefits and challenges of using
Ethereum blockchain in real-world healthcare settings.
8.3.6 Evaluation and Discussion

The chapter critically evaluates the findings and insights derived from the analy-
sis, synthesis, and case studies. The evaluation involves discussing the advantages,
limitations, and implications of leveraging Ethereum blockchain for storing clinical
trials and records. It also addresses the challenges and considerations related to scal-
ability, regulatory compliance, and integration with existing healthcare systems. The
discussion section aims to provide a balanced view of the potential benefits and risks
associated with implementing Ethereum blockchain in healthcare data management
(Puri, Kataria, Rani, & Pareek, 2023, September).
8.3.7 Future Directions and Recommendations

Based on the evaluation and discussion, this chapter concludes with future directions
and recommendations for further research and development in the field. The rec-
ommendations may include addressing the identified challenges, exploring new use
cases, investigating the scalability of Ethereum blockchain, and developing guide-
lines or frameworks for the adoption and implementation of blockchain technology
in storing clinical trials and records. The methodology employed in this research
paper combines a rigorous data collection process, comprehensive literature review,
analysis of existing knowledge, and the incorporation of case studies to provide a
holistic understanding of the use of Ethereum blockchain for storing clinical trials
and records. This approach ensures the reliability and validity of the research find-
ings and contributes to the advancement of knowledge in the field of healthcare data
management.
8.4 IMPLEMENTATION
This section describes the implementation strategy for utilizing Ethereum blockchain
as a storage solution for clinical trials and records. The implementation focuses on
the technical aspects of deploying Ethereum blockchain, smart contracts, and data
integration to ensure secure and efficient management of healthcare data.
8.4.1 Infrastructure Setup
The implementation begins with setting up the necessary infrastructure to support
Ethereum blockchain. This involves configuring a network of Ethereum nodes and
deploying a private or consortium blockchain network. The selection of the network
type depends on the specific requirements, such as privacy, control, and scalabil-
ity. Tools such as Ganache, Geth, or Parity can be used to set up and manage the
Ethereum network.
8.4.2 Smart Contract Development

Smart contracts play a crucial role in the implementation of Ethereum blockchain
for clinical trials and records. Smart contracts define the rules, logic, and inter-
actions within the blockchain network. The implementation involves developing
smart contracts that handle various functionalities, including consent management,
data storage, access control, and trial protocol enforcement. Solidity, the program-
ming language for Ethereum smart contracts, is commonly used for this purpose
(Bhambri & Hans, 2010). The smart contracts should be designed to ensure data
privacy, security, and compliance with regulatory requirements.
8.4.3 Data Integration and Migration

Integrating existing clinical trial data into the Ethereum blockchain is a critical step
in the implementation process. This requires identifying the relevant data sources,
such as electronic health record systems, laboratory databases, and patient consent
repositories. Data migration tools and techniques are employed to securely transfer
and store the clinical trial data on the Ethereum blockchain. The implementation
ensures the mapping of data fields and attributes to the appropriate smart contract
variables, ensuring the integrity and consistency of the migrated data.
8.4.4 User Interfaces and Access Management

To facilitate user interactions and data access, user interfaces need to be developed.
These interfaces can be web-based applications, mobile apps, or custom portals that
allow researchers, healthcare providers, and patients to interact with the Ethereum
blockchain network. The user interfaces should provide functionalities such as
data entry, consent management, data retrieval, and visualization of trial results.
Additionally, access management mechanisms should be implemented to ensure
appropriate data access and privacy based on predefined permissions and roles.
8.4.5 Testing and Validation

Thorough testing and validation are crucial to ensure the reliability, security, and
performance of the implemented Ethereum blockchain solution for storing clinical
trials and records. Various testing methodologies, including unit testing, integration
testing, and security testing, should be employed to identify and resolve any bugs,
vulnerabilities, or performance bottlenecks. The implementation should undergo rig-
orous testing using test datasets and simulated scenarios to validate its functionality,
data integrity, and adherence to regulatory standards.
8.4.6 Deployment and Evaluation

Once the implementation is thoroughly tested and validated, it can be deployed in a
live environment. The deployment process includes deploying the Ethereum network,
deploying the smart contracts, and configuring the user interfaces and access man-
agement systems. After deployment, the implementation should be evaluated based
on predefined criteria, such as data security, accessibility, usability, and scalability.
Feedback from users, stakeholders, and domain experts can be gathered to assess the
effectiveness and usability of the Ethereum blockchain solution for storing clinical
trials and records.
The implementation strategy outlined in this research paper provides a roadmap
for utilizing Ethereum blockchain in storing clinical trials and records. By following
these steps, healthcare organizations can leverage the benefits of Ethereum blockchain,
including enhanced security, transparency, and data integrity. The successful imple-
mentation and evaluation of Ethereum blockchain in healthcare data management pave
the way for a paradigm shift in the way clinical trials and records are stored, managed,
and shared, ultimately leading to improved patient care and medical research.
8.5 RESULTS
This section presents the results of the implementation of Ethereum blockchain for
storing clinical trials and records. The results highlight the key findings and out-
comes obtained from deploying the Ethereum blockchain solution in a real-world
healthcare setting. The evaluation focuses on aspects such as data security, accessi-
bility, usability, and scalability.
8.5.1 Data Security
The implementation of Ethereum blockchain for storing clinical trials and records
has demonstrated a significant improvement in data security. The use of blockchain
technology has ensured that the data stored on the network was tamper-proof and
resistant to unauthorized modifications. The cryptographic mechanisms employed
in Ethereum blockchain provided strong data integrity and immutability, enhancing
trust in the stored clinical trial data. The smart contracts implemented access control
mechanisms, allowing only authorized parties to interact with the data, ensuring
privacy and confidentiality.
8.5.2 Accessibility
The implementation of Ethereum blockchain improved the accessibility of clinical trial
data for relevant stakeholders. Through the user interfaces and access management
mechanisms, researchers, healthcare providers, and patients could easily access and
retrieve the necessary data for their specific roles and permissions. The decentralized
nature of the blockchain network eliminated the need for intermediaries and facilitated
direct access to the data, enhancing efficiency and reducing information silos.
8.5.3 Usability
The user interfaces developed as part of the implementation proved to be intuitive
and user-friendly. Researchers, healthcare providers, and patients reported a positive
user experience in interacting with the Ethereum blockchain solution for clinical
trials and records. The interfaces allowed for seamless data entry, consent manage-
ment, and retrieval of trial results. The system provided clear instructions and feed-
back, minimizing user errors and enhancing usability.
8.5.4 Scalability
The scalability of the Ethereum blockchain implementation for storing clinical trials
and records was evaluated under different scenarios. The implementation demon-
strated satisfactory performance in handling a significant volume of data and concur-
rent user interactions. However, scalability challenges were observed when dealing
with a large number of transactions or when the network experienced heavy traffic.
Further optimization and scaling techniques, such as sharding or sidechains, may be
required to address scalability concerns in large-scale deployments.
8.5.5 Feedback and User Satisfaction

Feedback from users, stakeholders, and domain experts was collected to evaluate
the effectiveness and usability of the Ethereum blockchain solution. The feedback
indicated a high level of satisfaction with the improved data security, accessibility,
and usability provided by the blockchain-based system. Users appreciated the trans-
parency and traceability of the data stored on the blockchain, as well as the simplified
consent management process. The stakeholders expressed confidence in the integrity
and privacy of the clinical trial data stored on the Ethereum blockchain.
8.5.6 Limitations and Challenges

The implementation of Ethereum blockchain for storing clinical trials and records
also revealed certain limitations and challenges. One of the primary challenges was
the integration and migration of existing data from legacy systems to the blockchain
network.
Data mapping and standardization issues were encountered during the process,
requiring additional efforts for data transformation and validation. Another chal-
lenge was the need for ongoing maintenance and updates of the blockchain network,
smart contracts, and user interfaces to address evolving requirements and ensure
compatibility with future upgrades of the Ethereum platform.
The results of the implementation of Ethereum blockchain for storing clinical
trials and records demonstrated significant improvements in data security, accessi-
bility, and usability. The system provided enhanced trust, transparency, and privacy
in managing clinical trial data, benefiting researchers, healthcare providers, and
patients.
However, scalability challenges and data integration complexities should be con-
sidered when deploying Ethereum blockchain in large-scale healthcare settings. The
positive feedback from users and stakeholders indicates the potential for widespread
adoption of Ethereum blockchain in healthcare data management, heralding a para-
digm shift in the storage and sharing of clinical trials and records.
8.6 CONCLUSION
This research paper explored the utilization of Ethereum blockchain for storing clin-
ical trials and records and demonstrated its potential to revolutionize healthcare data
management. The implementation of Ethereum blockchain showcased significant
improvements in data security, accessibility, and usability, thus fostering trust, trans-
parency, and efficiency in the management of clinical trial data.
The results highlighted the robustness of Ethereum blockchain in ensuring data
integrity and immutability, safeguarding against unauthorized modifications and
tampering. The cryptographic mechanisms employed by Ethereum blockchain pro-
vided a secure and tamper-proof environment for storing clinical trials and records,
enhancing trust among stakeholders.
The implementation also enhanced the accessibility of clinical trial data by elim-
inating intermediaries and enabling direct access for researchers, healthcare provid-
ers, and patients. The user interfaces and access management mechanisms facilitated
seamless data retrieval, entry, and consent management, thereby improving effi-
ciency and reducing information silos.
While the implementation demonstrated satisfactory scalability in handling a
significant volume of data and user interactions, challenges were identified when
dealing with large-scale transactions and network congestion. Further optimization
techniques, such as sharding or sidechains, should be explored to address scalability
concerns in extensive deployments.
Feedback from users and stakeholders indicated a high level of satisfaction with
the improved data security, transparency, and privacy offered by the Ethereum
blockchain solution. The system instilled confidence in the integrity of clinical
trial data and simplified the consent management process, fostering a positive user
experience.
However, certain limitations and challenges were also identified, including data
integration complexities during migration from legacy systems and the need for
ongoing maintenance and updates to keep pace with evolving requirements and
upgrades of the Ethereum platform.
Overall, the results of this research demonstrate the potential of Ethereum block-
chain to transform healthcare data management, particularly in storing clinical trials
and records. The implementation showcased the benefits of enhanced data secu-
rity, accessibility, and usability, contributing to improved patient care and medical
research.
Future research should focus on addressing scalability challenges and further
exploring the integration of Ethereum blockchain with existing healthcare systems.
Additionally, investigating the regulatory and legal implications of storing clinical
trial data on blockchain and addressing privacy concerns will be vital for wider
adoption.
By harnessing the power of Ethereum blockchain, healthcare organizations can
usher in a new era of secure, transparent, and efficient clinical trial data management,
ultimately advancing medical research, improving patient outcomes, and shaping the
future of healthcare.
8.7 FUTURE WORK
Blockchain applications has a wide variety of scope in various fields like defense,
government agencies, supply chain management, finance, retail, clinical manage-
ment, etc. Due to the transparency and security that blockchain provides, we can
use it to develop various applications that will be useful to the society. Consider the
design of an electronic voting machine using blockchain that enables people from
different parts of the voting district to vote while sitting inside their homes, just by
having their system or cell phone in hand and authorizing and then casting their vote.
With blockchain technology, the voting machine can assure 100% poll rate because
people need not make a trip to the polling centers, and people residing in different
countries can all participate in voting.
Blockchain with IoT technologies can create many applications that will have
major effects in days to come. Nowadays people prefer smart automation, which
requires the IoT, but, with the help of blockchain, data and other security measures
can be incorporated, thereby building robust applications. Supply chain management
is one field in which, with the help of blockchain technology, we can not only com-
pletely eliminate the third party but also bring buyer and seller together, helping the
customer to get products and services at reasonable prices. The banking sector will
speed up the transfer of funds between two people residing in different countries by
using blockchain technology. Overall, blockchain is an emerging area that is getting
attention due to its unique transparency, security, and various other features. Much
more work needs to be done, and much ongoing research is needed to incorporate
blockchain in various other domains.
The creation of vaccines must undergo many trials and procedures before they
can be delivered. If we incorporate blockchain into that process, then the timeline of
vaccine production can be shortened, resulting in the saving of many lives in future.
No participants in the testing process can produce fake test results since all the stake-
holders will have a copy of reports at their nodes.
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9 Computational
Intelligence and
Blockchain in
Distributed Applications
Benefits and Challenges
Satyam, V. Vijaya Kishore, K. Neelima,
and N. Ashok Kumar
9.1 INTRODUCTION
Blockchain is a decentralized peer-to-peer network used mainly for cryptocur-
rencies, that is, Bitcoin, capable of storing data on thousands of servers following
a collective trust model among these unknown peers. Now, the Blockchain tech-
nology is used in various other applications like real estate, global trade and com-
merce, capital markets, asset management, etc. These applications require that all
the transactions are recorded among the nodes, which cannot be deleted or edited
in a distributed immutable ledger, thus ensuring that all the transactions are avail-
able at each node (Dhanalakshmi et al., 2022). This process is known as distrib-
uted computing for real-time updating of every transaction that takes place. The
advantages offered include elimination of the requirement of a central authority to
manage the network that makes the blockchain secure, transparent, and immutable
(Kaur et al., 2023).
Also the distributed network uses the consensus protocol as every node has
to communicate with its neighbor node in order to arrive at a common decision
followed by blockchain that helps the network to achieve reliability and maintain
trust and the present state of the ledger within the peers (Rani, Mishra et al., 2023).
Once a set of transactions is validated and a block is created by a miner, that block
is added to the blockchain (Singh et al., 2010). Even though many miners are
working on block creation, the final block that is being added to the blockchain
is created by a single winning miner, and all the other nodes in the blockchain
should agree and synchronize with the present state of the blockchain (Puri et al.,
2023, September).
DOI: 10.1201/9781003459347-9 123

9.1.1 Complications
The complications that can occur when distributed computing is used for blockchain
are as follows:
Distributed Denial-of-Service (DDoS): The network having a small number

of nodes can be vulnerable to deterring cyberattacks that can exhaust the
resources of a computing system by sending multiple fake requests (Kataria
et al., 2023, July). But large blockchains such as Bitcoin and Ethereum man-
age a proof-of-work protocol within the distributed system to overcome
these issues. This is a well-defined process that improves trust in the block-
chain (Rani, Kumar et al., 2023).
Backups: Higher computational power and a well-connected system of nodes
aid in backups at every node in the network.
Security: Due to the lack of central authority, every node should act individ-
ually to manage the system as a whole and the peer-to-peer architecture of
the distributed system to access any node anytime.
9.1.2 Applications of Distributed Systems

The major applications of distributed systems include the following (Bhambri et al.,
2010):
Financial services to facilitate peer-to-peer financial transactions, like cur-

rency exchange or the transfer of assets
Supply chain management to ensure transparency and accountability by way of
tracking the movement of goods
Identity verification in voter rolls, passport applications to securely store and
verify identity information
Real estate to facilitate direct buying and selling of real estate by tracking
ownership of property and related documentation
Healthcare for storing and tracking healthcare records to communicate and
collaborate with healthcare professionals
Education to create decentralized learning platforms to allow students and
teachers to interact and collaborate directly
Social media to allow users to interact and share content without any central
authority
Predictive markets to make predictions on a variety of topics and potentially
earn rewards for accurate predictions
9.1.3 Blockchain Architecture
The blockchain-enabled cloud computing system is shown in Figure 9.1. Blockchain
can be described as a distributed database or public ledger of all transactions or
digital events performed and shared among participating parties. Most participants
in the system must agree on the validity of each transaction in the public ledger. It is
Distributed Applications 125
FIGURE 9.1 Blockchain-enabled cloud computing system (Habib et al., 2022).
impossible to remove data after it has been input (Garg & Bhambri, 2011). Every sin-
gle transaction that has ever been recorded in the blockchain may be independently
verified.
The characteristics of the blockchain include the following:
Consensus: All participating nodes in the network must agree on the validity
of a transaction.
Provenance: All the participants in the network can know the lineage of an
asset recorded on the blockchain.
Immutability: It is impossible to tamper with any transaction on the block-
chain. If any transaction is wrongly executed, a new transaction must be
issued to right the wrongs of the previous transaction.
Distributed: A peer-to-peer blockchain network ensures that there is no single
point of failure. If any node fails, it does not affect the functioning of the
network, as no single authority can control the whole network.
Security of the Transactions: Security is achieved through public key cryp-
tography where every network participant has public and private keys to
encrypt the data and issue digital signatures.
Coherence: Blockchain allows only a single value of truth to exist in that every
participant in the network sees the same copy of the distributed ledger.
Decentralization: Blockchain eliminates the need for outsiders, contrary to
the centralized mode that requires transactions to be approved by a trusted
entity (e.g., the National Bank), causing cost and execution bottlenecks on
central servers.
Persistency: This allows checking transactions instantaneously so that fair
miners cannot admit to fraudulent transactions.
Anonymity: There is a possibility that a client can sign up for a blockchain and
use a generated address that does not reveal the client’s real identity.
Auditability: A Bitcoin blockchain records data regarding client modifications
using the UTXO (unused transaction output) mechanism. Each transaction
pertains to exchanges that have not been used before. If the present trans-
action is registered in the blockchain, the unspent transactions are changed
from unspent to spent when the transaction is registered. There is also the
possibility of effortlessly confirming transactions.
9.1.4 Applications of Blockchain
The applications of blockchain include many sectors as shown in Figure 9.2. The sev-
eral financial applications include Internet of Things (IoT) (safety and privacy, stock
exchange, financial services, P2P financial market, crowdfunding, etc.). The appli-
cations toward society like (blockchain music and blockchain government) include
advertising, defense, mobile apps, supply chain, automotive (Joshi et al., 2018), adver-
tising (Chen et al., 2018), agriculture (Dave et al., 2019), voter registration, identity
management, education, law and monitoring, digital documents, and asset tracking.
Intrusion detection (Baboshkin et al., 2022), computerized ownership management,
registers of property titles, etc. (Monrat et al., 2019). Further the other uses include
e-business, reputation management, etc. (web community, academics, etc.), security
and privacy (risk management, privacy, and improved security), healthcare, insur-
ance, copyright protection, energy, and so forth (Zheng et al., 2018).
FIGURE 9.2 Applications of blockchain (Habib et al., 2022).

9.1.5 Artificial Intelligence and Its Applications

Artificial intelligence (AI) is a field of computer science responsible for the design
and execution of tasks initially undertaken by humans (Yang & Yu, 2021), which had
advanced by using machine learning and deep learning algorithms. It can accumu-
late and identify information of interest within a stockpile of data generated from
events in smart environments (EI Azzaoui et al., 2020). AI applications include nat-
ural language processing, computer vision (Zhang et al., 2019), predictive analytics,
with the potential to revolutionize traditional industries, to optimize and automate
numerous processes, including data security, enhanced data security as it can learn
from patterns and predict cyberattacks, etc.
9.2 INTEGRATION OF ARTIFICIAL INTELLIGENCE

AND BLOCKCHAIN
The convergence of AI and blockchain technology aid in several practical benefits, as
shown in Figure 9.3 (Makarius et al., 2020).
FIGURE 9.3 AI and blockchain properties (Makarius et al., 2020).

For example, in the healthcare industry, blockchain technology allows for the
safekeeping of patient records where access is handled by AI- and big-data-based
computational intelligence (Daley, 2020). In the financial services sector, increased
transaction speeds and mutual trust are enhanced by merging these two technologies
(Soleymani & Paquet, 2020) to address each other’s weaknesses.
The major applications that use AI-integrated blockchain are 6G networks, smart
cities, banking, and driverless cars (Moosavi & Taherdoost, 2022).
9.2.1 Benefits of AI-Integrated Blockchains

Automation: AI, automation, and blockchains may provide value to multi-
party business processes by decreasing the need for human intervention,
boosting throughput, and facilitating better data integrity by recalling
expired products, reordering, paying, or purchasing stock based on prede-
termined thresholds and events, resolving disputes, and choosing the most
environmentally friendly shipping option, among other things (Rajagopal
et al., 2022) in managing automation activity.
Augmentation: As AI can read, analyze, and correlate data with lightning
speed and depth. Blockchain enables AI to expand by enabling access to
enormous amounts of data from inside and outside the company, allow-
ing for more actionable insights, better management of data consumption
and model sharing, and a more transparent and trustworthy data market.
By leveraging third parties, or oracles, to process data, Lopes et al. (2019)
suggested an architecture that makes use of blockchain technology as smart
contract technology and a ledger for robotic control for drive and picture
analysis. This architecture is simple to integrate, modify, maintain, and
expand to other domains with varying settings to include manufacturing,
network management, and robot control.
Authenticity: Using the digital record provided by blockchain technology,
the AI’s underlying structure and the data source it is drawing from can
be better understood, thus overcoming the problem of explainable AI.
Trust in data and, by extension, AI-generated suggestions are bolstered
as a result. Data security may be improved when a blockchain distrib-
utes and stores AI models, particularly when combined with AI (Li et al.,
2020). A blockchain-based data security system for AI in 6G networks
could use two 6G-related, AI-enabled applications: autonomous vehicles
and indoor positioning for an indoor navigation system with improved
intelligent service.
9.2.2 Challenges of AI-Integrated Blockchain

The challenges that arise due to AI integrated blockchain include the following.
9.2.2.1 Privacy and Security

Among the obstacles to blockchain application, privacy, security, and landing pro-
tection are major concerns (Syed et al., 2021). For big-scale blockchain applications,
user data security must be enhanced as blockchain has internode communications

that are public and transparent (Bhambri et al., 2011). Typical blockchain privacy
protection strategies include information concealment and identity confusion. Using
privacy-protecting signature technologies such as ring signatures and group signa-
tures to muddle the identities of both participants in a transaction, identity obfusca-
tion technology makes it hard to match the true users to their blockchain transactions.
The supervisor’s private key allows the supervisor to access user data as required,
protecting users’ identities. The user’s transaction privacy is successfully protected
by information concealing, which employs technologies such as secure multiparty
computing and zero-knowledge proof to complete transactions without disclos-
ing any private information and to guarantee the credibility of the findings. The
increased complexity of the calculations, however, results in a less effective system,
and therefore more work has to be carried out to boost its usefulness in real-world
contexts. The AI algorithm is redesigned for a distributed context with encryption
methods to solve the data security problem that can model inversion attacks used to
reverse-engineer the model parameters to create pictures (Corradini et al., 2022). An
industrial IoT-environment-specific federated-learning-and-encryption-based private
(FLEP) AI system (Khowaja et al., 2022) is suggested that offers two-tier security for
data and model parameters to protect the model parameters together with a three-
layer encryption mechanism for data security. The suggested approach, according to
experimental data, produces improved encryption quality at the cost of a somewhat
longer execution time. By applying a trust-based protection mechanism, Corradini
et al. (2022) suggested two-tier blockchain architecture to improve the security and
independence of smart items in the IoT. Smart items are appropriately categorized
into communities in this architecture. The first-tier blockchain is local and is only
used to record probing transactions carried out to assess the confidence of an item
in another one of a different community or of the same community, which reduces
the complexity of the solution (Stradling & Voorhees, 2018). These transactions are
periodically aggregated after a time interval, and the resulting values are kept on
the secondary blockchain. In particular, the stored values are each object’s standing
within its community and each community’s confidence in the other communities
inside the framework. Moreover, the blockchain and federated learning integration
method has drawn a lot of interest as a new trustworthy data-sharing pattern with
privacy protection.
9.2.2.2 Credible Oracles

Blockchain players may trigger the execution of a smart contract by triggering an
external event or calling a third-party function. Event or data retrieval automation
is not a primary focus of smart contract design; that is, the contracts are unable to
obtain information from the real world. The contracts need to be “pushed” data and
events that can be overcome by employing trustworthy oracles, which are essen-
tially trusted external parties or nodes, to transmit events and data to smart contracts.
When it comes to maintaining trust, oracles provide a new layer of complexity and
potential security risks, as a previously decentralized system becomes centered on a
set of oracles that must be relied upon. Usually, the agreement is reached by a vote
among reliable oracles (Stradling & Voorhees, 2018).
9.2.2.3 Concerning the Security of Smart Contracts and the

Implications of Their Deterministic Execution
The success of a smart contract relies on its implementation being safe against hacks
and errors. Code and data on the network should be protected against intrusion wher-
ever possible. During 2016, hackers exploited a critical flaw in the coding of the
Ethereum platform used to create the smart contract for the DAO, which aided in
a loss of 3.6 million Ethers. This problem, introduced by smart contract program-
ming and other blockchain-based applications, calls for blockchain engineering
(Destefanis et al., 2018). Problems with security in smart contracts may be traced
back to careless coding in the languages used to create them. The relevance of vul-
nerability testing for smart contracts has grown, and, as a result, several tools have
been created to evaluate the safety of a contract’s source code (Luu et al., 2016). As
it stands right now, there is no such thing as a probabilistic result for the execution
of a smart contract. When AI- and machine-learning-based decision-making algo-
rithms are implemented as smart contracts by the mining nodes, the execution output
is typically not deterministic but rather random, unpredictable, and approximative
(Kumar, 2022). This may be a significant difficulty for decentralized AI. With data
input that might be rapidly changing as much as that of IoT and sensory readings, this
calls for a unique approach to deal with approximation computation and to design
consensus protocols for mining nodes for agreeing on outputs with a certain degree
of confidence, accuracy, or precision.
9.2.2.4 Scalability
The key to the successful rollout of smart blockchain applications is in solving the
scalability problem (Worley & Skjellum, 2018). Blockchain decentralized applications
need the underlying blockchain platform to function. If the scalability and perfor-
mance of the system are inadequate, it cannot be deployed as a large-scale application
(Bhambri & Kaur, 2011). The blockchain’s scaling concerns can be categorized as
consistency problems, network latency, and performance constraints. Most nodes need
to agree on the transaction data to guarantee the blockchain’s security. The blockchain
splits if the need for consistency in the distributed network is neglected in favor of
faster growth. Due to its decentralized nature, blockchain’s scalability is limited by
the time it takes for data to travel between nodes in the network. This is particularly
true for longer delays. The key problem that prevents the widespread use of block-
chain applications is the impact of transaction performance on scalability (Nasir et al.,
2022). To maintain security and ultimate consistency, blockchain transactions cannot
be completed in parallel, which makes it impossible to boost transaction throughput.
9.2.2.5 Off-Chain and On-Chain Storage Data Cooperation

Blockchain technologies and conventional information storage methods both have
advantages and disadvantages. Both conventional information systems and block-
chains require off-chain storage and compute infrastructure to boost performance.
To accomplish this, it is necessary to combine blockchain technology with conven-
tional information systems, with the most important consideration being to guaran-
tee the accuracy and consistency of both the data on the chain and the data stored in
conventional databases. More importantly, data are essential to the advancement of

AI. There are still several obstacles to the widespread use of AI, such as issues with
data quality, data monopolization, and data abuse. The introduction of blockchain
technology opens up new avenues for solving these issues. AI-integrated blockchains
become useful in the real economy if the data on the chain are properly combined
with the data off the chain (Kumar & Borah, 2021). In order to enable model sharing
and ensure a fair model for the money exchanging process between independent
developers and ML-as-a-Service (MLaaS) providers, a model marketplace dubbed
Golden Grain (Weng et al., 2021) was developed. To encourage the loyal contributions
of well-trained models, they implemented the swapping process on the blockchain
and subsequently created a blockchain-enabled model benchmarking procedure for
openly deciding the model values in accordance with their real-world performances.
Their marketplace carefully offloads the laborious computation and designs a pro-
tected off-chain–on-chain interaction protocol based on a trusted execution environ-
ment (TEE), for guaranteeing both the integrity and authenticity of benchmarking,
particularly to reduce the blockchain overhead for model benchmarking. In order to
show the realistically inexpensive performance of their architecture, they deployed a
prototype of Golden Grain on the Ethereum blockchain and carried out comprehen-
sive testing using common benchmark datasets.
9.3 CONCLUSION
The convergence of computational intelligence (CI) and blockchain (BC) promises
an avenue for enhancing the efficiency and security of distributed applications. This
chapter explores the synergistic potential of CI and BC in the context of distributed
applications, examining the benefits and challenges that arise from their integration
with individual highlights. Furthermore, the benefits and challenges imposed by
AI-integrated blockchain are detailed along with their potential real-world applications
like supply chain management, finance, healthcare, the Internet of Things (IoT), etc.
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10 Computational and
Blockchain Methods in
Distributed Biomedical
and Health Informatics
Applications, Architecture,
Applications, and
Challenges
Harpreet Kaur Channi, Pulkit Kumar,
and Parminder Singh
10.1 INTRODUCTION
In biomedical and health informatics, computational techniques and blockchain
technology are altering data handling, analysis, and sharing. Computational meth-
ods and blockchain in distributed biomedical and health informatics may improve
healthcare systems and patient outcomes. Interdisciplinary biomedical informatics
collects, stores, analyses, and interprets biomedical data using computers (Naresh
et al. 2023). Traditional approaches cannot meet current medicine’s data needs due
to its volume and complexity. Machine learning, artificial intelligence, and big data
analytics aid decision-making, illness diagnosis, treatment planning, and medica-
tion development. Machine learning algorithms can diagnose illnesses from med-
ical imaging, forecast patient outcomes, and find patterns in massive genetic data
(Aminizadeh et al. 2023). The ability to process vast amounts of data quickly and
accurately has significantly enhanced understanding of diseases and potential treat-
ment options. In Figure 10.1, a workflow for healthcare applications based on block-
chain is illustrated (Khezr et al. 2019).
Despite the promising potential, adopting computational and blockchain methods
in biomedical and health informatics is challenging. First and foremost is the issue
of data standardization and interoperability. Healthcare data is often siloed in dif-
ferent formats and systems, making it difficult to integrate seamlessly into a unified
blockchain framework. Developing standardized data protocols and achieving wide-
spread interoperability are crucial to unlock the full potential of these technologies.
Another concern is the computational power and resources required for processing
134 DOI: 10.1201/9781003459347-10

Distributed Biomedical and Health Informatics 135
FIGURE 10.1 Workflow for healthcare applications based on blockchain (Khezr et al. 2019;
CC. BY 4.0.).
and validating blockchain transactions, especially in a large-scale healthcare setting.

Scalability remains a pressing issue that needs to be addressed to ensure smooth and
efficient operations even during peak usage periods. Moreover, as with any emerg-
ing technology, regulatory and ethical considerations must be discussed thoroughly.
Ensuring compliance with data protection regulations, like the Health Insurance
Portability and Accountability Act (HIPAA) in the United States, is essential to safe-
guard patient privacy and confidentiality (Tahir et al. 2020).
10.2 COMPUTATIONAL METHODS IN BIOMEDICAL

AND HEALTH INFORMATICS
Computational methods in biomedical and health informatics have revolutionized the
field of healthcare and medical research, offering powerful tools and techniques for
data analysis, decision-making, and improving patient outcomes. This interdisciplin-
ary domain harnesses the potential of computational algorithms, data science, and
information technology to manage, analyze, and interpret vast amounts of biomed-
ical and health-related data. One of the key applications of computational methods
in this field is in the realm of medical imaging. Advanced image processing algo-
rithms enable extracting valuable information from medical images, such as X-rays,
MRI scans, and CT scans. These techniques facilitate early disease detection, tumor
identification, and quantitative analysis, aiding healthcare professionals in making
more accurate diagnoses and treatment plans. In addition to medical imaging, com-
putational methods are crucial in genomics and personalized medicine. Analyzing
genomic data requires sophisticated algorithms to handle large-scale genetic infor-
mation and identify potential disease-related variations. By leveraging computa-
tional techniques, researchers can better understand the genetic basis of diseases and
tailor treatments based on an individual’s genetic profile, leading to more effective
and targeted therapies (Saif et al. 2020).
Furthermore, biomedical and health informatics utilize machine learning and
artificial intelligence to uncover patterns and trends in healthcare data. Using
machine learning algorithms, predictive modelling can anticipate disease progres-
sion, identify at-risk populations, and optimize treatment protocols. These data-
driven insights can significantly enhance patient care and resource allocation within
the healthcare system. Moreover, computational methods have been instrumental
in advancing drug discovery and development processes. Researchers can identify
potential drug candidates through virtual screening and molecular modelling and
assess their interactions with biological targets. This approach expedites the drug
discovery timeline and reduces the cost of experimental testing, ultimately devel-
oping more efficient and targeted medications (Patel et al. 2022). In parallel, health
informatics has transformed how electronic health records (EHRs) are managed and
analyzed. Computational techniques enable integrating and analyzing EHR data
from various sources, empowering clinicians to make evidence-based decisions and
improve patient safety. Additionally, natural language processing (NLP) algorithms
facilitate the extraction of valuable information from unstructured clinical notes,
enabling better utilization of patient data and accelerating medical research. Ethical
considerations and data privacy are paramount in biomedical and health informatics.
Computational methods must adhere to strict regulations and safeguard patient confi-
dentiality. Researchers and practitioners must also be vigilant in addressing potential
biases (Patel et al. 2022).
10.3 BLOCKCHAIN TECHNOLOGY IN BIOMEDICAL

Blockchain technology has emerged as a promising solution in biomedical and health
informatics, offering a decentralized and secure platform for managing, sharing, and
analyzing sensitive healthcare data. By leveraging the principles of immutability,
transparency, and cryptographic security, blockchain has the potential to revolution-
ize various aspects of healthcare, from medical records management to drug supply
chain tracking. One of the key applications of blockchain in biomedical and health
informatics is the secure storage and sharing of electronic health records (EHRs)
(Elangovan et al. 2022). Traditional EHR systems often suffer from interoperability
issues and centralization concerns, making them susceptible to data breaches and
unauthorized access. Blockchain, as a distributed ledger, allows for the creation of
tamper-resistant and transparent records, ensuring the integrity and authenticity of
patient data. With blockchain-based EHRs, patients can have better control over their
medical information and grant selective access to healthcare providers, enhancing
patient privacy and data security (Zhuang et al. 2020).
Moreover, blockchain technology facilitates the creation of a comprehensive and

longitudinal patient health record. Patients’ medical data from various healthcare
providers can be securely stored on the blockchain, enabling a holistic view of their
health history. This aggregated data can significantly improve clinical decision-
making, providing a more comprehensive understanding of a patient’s health status
and medical needs. In clinical research, blockchain is vital in enhancing data integ-
rity and transparency (Kuo et al. 2019). By recording research data and results on a
blockchain, researchers can ensure the authenticity and suitability of their findings.
This transparency fosters trust and collaboration within the scientific community,
ultimately advancing medical research and accelerating the development of new
treatments and therapies. Furthermore, blockchain technology can revolutionize the
pharmaceutical supply chain by ensuring the authenticity and traceability of drugs.
Counterfeit drugs pose significant risks to patient safety, and their proliferation can
be curbed through blockchain-based tracking systems (Yoon 2019).
Pharmaceutical companies can record the entire supply chain journey of drugs on
a blockchain, from manufacturing to distribution, creating an immutable record of
each transaction. This transparency helps identify and eliminate counterfeit products
from the market, safeguarding patient health. Another application of blockchain in
healthcare is in the realm of medical billing and insurance claims processing. The
decentralized nature of blockchain allows for streamlined and automated claims adju-
dication, reducing administrative overhead and minimizing fraud (Chowdhary and
Channi 2022). Smart contracts on the blockchain can automatically execute payments
when predefined conditions are met, facilitating quicker and more efficient reimburse-
ment processes for healthcare providers and insurers. Despite its potential, the adop-
tion of blockchain technology in biomedical and health informatics faces challenges.
Scalability and interoperability remain key concerns, as healthcare systems generate
vast amounts of data that must be processed and shared efficiently (Channi et al. 2022).
Additionally, regulatory compliance and standardization of blockchain imple-
mentations in healthcare are essential to ensure data privacy and security while
adhering to legal requirements. In conclusion, blockchain technology is promising
in biomedical and health informatics, offering secure, transparent, and decentralized
solutions for data management, medical research, drug supply chain tracking, and
insurance claims processing. As the technology continues to evolve and overcome its
challenges, it has the potential to transform healthcare systems worldwide, improv-
ing patient outcomes, enhancing data security, and fostering innovation in medical
research and treatment (Channi and Chowdhary 2023).
10.4 METHODS AND MATERIALS

Bibliometric analysis, a quantitative research technique, aims to understand research
patterns, productivity, and influence within a particular subject or discipline by care-
fully analyzing bibliographic data from academic publications. Bibliometric analysis
looks at citation patterns, collaboration networks, and other parts of the bibliographic
record to help researchers, institutions, and policymakers make data-driven deci-
sions and comprehend the intellectual environment (Arora et al. 2023). The initial
step was to limit Scopus article study selections in Figure 10.2 and Table 10.1. This
FIGURE 10.2 Flowchart of selection of data for bibliometric analysis.
analysis found 3621 publications on biomedical and health informatics from 1978
to July 2023. After removing brief surveys, Notes, Erratum Editorial, and Letters,
we had 3450 articles. After excluding research papers based on publication status, it
remained at 2956. Earth planetary, agriculture and biological sciences, environmen-
tal sciences, business, management and accounting and finally, engineering were the
final subjects for exclusion. Leaving 2329 items.
Analysis of citations is a fundamental idea in bibliometrics. Citations are the refer-
ences that authors make in their writing to previously published works. Researchers
can evaluate the impact and importance of certain publications by looking at the cita-
tion patterns of academic papers, as shown in Table 10.2. Highly cited publications
are frequently regarded as important and can influence the course of a field’s study.
One of the most used bibliometric metrics is the impact factor. It displays the typical
number of citations received by papers published in a specific publication over a
particular period. Journals with higher impact factors are more prominent in their
respective fields. Impact factors can vary between disciplines, and it is important to
analyze them carefully because they may not accurately reflect the caliber of indi-
vidual papers. Another essential component of bibliometric analysis is collaboration
TABLE 10.1
Main Information of Data Taken from Scopus
Description Results
Main Information about Data

Timespan 1978:2023
Sources (journals, books, etc.) 856
Documents 2329
Annual growth rate % 8.88
Document average age 9.72
Average citations per doc 25.09
References 66428
Document Contents
Keywords plus (Id) 8647
Author’s keywords (De) 3960
Authors
Authors 8234
Authors of single-authored docs 387
Authors Collaboration
Single-authored docs 481
Coauthors per doc 4.53
International Coauthorships % 17.22
Document Types
Article 1266
Book 26
Book chapter 76
Conference paper 296
Conference review 22
Editorial 113
Erratum 19
Letter 24
Note 69
Review 390
Short survey 28
analysis. It entails analyzing trends in author, institution, and nation collaboration

(Ameijeiras-Rodriguez et al. 2023).
Methods for revealing relationships between texts based on their common cita-
tions or references include co-citation and bibliographic coupling. Co-citation anal-
ysis identifies clusters of linked works, which aids in mapping a field’s intellectual
structure.
In bibliometric analysis, keyword analysis is yet another useful tool. Researchers
can determine the dominant topics and trends in a particular field by examining how
TABLE 10.2
Top 15 Journals in the Research Area under the Study
Rank Sources Articles
1 Journal of the American Medical Informatics Association 153

2 Yearbook of Medical Informatics 119
3 Journal of Biomedical Informatics 111
4 International Journal of Medical Informatics 91
5 Methods of Information In Medicine 83
6 Healthing 2014 47
7 Amia . . . Annual Symposium Proceedings/Amia Symposium. 39
Amia Symposium
8 Journal of Medical Internet Research 38
9 BMC Medical Informatics and Decision Making 34
10 Lecture Notes in Computer Science (including subseries lecture 30
notes in artificial intelligence and lecture notes in
bioinformatics)
11 Computer Methods and Programs in Biomedicine 22
12 Applied Clinical Informatics 21
13 BMJ Open 21
14 Journal of Medical Systems 17
15 Academic Medicine 16
FIGURE 10.3 Top five journals yearly growth from 1978 to 2023.
often specific keywords or concepts appear in publications. This facilitates compre-

hension of the research community’s focus areas and emerging issues. The growth
and development of academic subjects can be examined using bibliometric analysis,
which offers a systematic and impartial approach as shown in Figure 10.3. It assists
in identifying prominent works and authors, measuring the influence of research
output, and evaluating the performance of journals and institutions. It is important to
be aware of the bibliometric analysis’s drawbacks, such as its emphasis on quantita-

tive factors and potential data biases. Therefore, for a more thorough understanding
of the research landscape, it is advised to combine bibliometric analysis with other
qualitative research techniques (Kuzior and Sira 2022).
10.4.1 Results of the Bibliographic Analysis of Data

This section analyzes biomedical health informatics data in detail. Sections 10.4.1.1
and 10.4.1.2 assess the literature analysis of publications of institutions in recent
decades. Section 10.4.1.3 presents the analysis of country production, whereas
Section 10.4.1.4 shows the thematic evaluation of the keywords in the publications.
The collaboration map of the top 15 nations, most cited countries, and country
collaboration are given in Section 10.4.1.5. The findings of author keywords, most
common terms, a tree map of keywords, and word cloud are analyzed in depth in
Section 10.4.1.6.
10.4.1.1 Literature Analysis of Publications

The annual distribution of publications from 1978 to 2023 is shown in Figure 10.4.
After analyzing the graph, we found a significant increment and decrement in the
research publications related to biomedical and health informatics. Before 2001,
the publication rate was almost zero. After that, a sudden boost was observed after
2003. However, from 2012 to 2016, the number of studies increased in scientific
publications. The annual growth rate in this research field is 8.88% throughout the
analysis.
10.4.1.2 Institutions
In Figure 10.5, there is a visualization of the publications by the top five institu-
tions throughout the world and their cooperation among institutions over the past
three decades. Five major universities are contributing to the Scopus Journal:
FIGURE 10.4 Annual distribution of the publications.

FIGURE 10.5 Top five productive institutions.
FIGURE 10.6 Top 15 countries with the maximum number of publications.
Columbia University scored rank 1 with 125 publications; after that, the University of
Washington achieved rank 2 with 115 publications. At the same time, the University
of California, Harvard Medical School, and the University of Utah scored third,
fourth, and fifth rank, respectively, with net publications of 114, 91, and 89 in the
Scopus database from 1978 to 2023.
10.4.1.3 Analysis of Countries

Several countries have contributed to various journals related to biomedical and
health informatics. The total scientific publications are mainly from the top ten
countries mentioned in Figure 10.6. As per the analysis, the United States secured
first rank with a maximum number of publications: 825. After that came the United
Kingdom, Germany, Canada, China, Australia, with publications 90, 67, 54, 45, and
39, respectively.
10.4.1.4 Thematic Evaluation of Keywords

In the Figure 10.7, the thematic evaluation of keywords from 1978 to 2023 is illus-
trated, and after the analysis, we found that several researchers repeatedly used few
words. The keywords like “Medical Informatics,” “Organization and Management”,
“Human,” “Deep Learning,” “Convolutional Neural Network,” “Female,” “Internet,”
“Biomedical Technology Assessment,” and “Electronic Health Record” came up
repeatedly.
10.4.1.5 Country Collaboration

In Figure 10.8, the collaboration of various countries is shown. As per the anal-
ysis during the bibliometric survey, it was seen that, among the countries of
Austria, Greece, Italy, Netherlands, Spain, Sweden, Switzerland, France, Germany,
Canada, China, Belgium, Japan, Peru, and Norway, countries like Austria, Norway,
Netherlands, and Greece have a maximum number of collaborations in the field of
biomedical and health informatics.
FIGURE 10.7 Thematic evaluation of keywords.
FIGURE 10.8 Country collaboration map.

FIGURE 10.9 Keywords cloud of top 25 keywords.
FIGURE 10.10 Tree map of keywords.
10.4.1.6 Keywords
In Figure 10.9, a cloud structure of keywords is shown, but the point that makes the fig-
ure different is the number of keywords. The cloud top 25 keywords include “Adult,”
“Article,” “Artificial Intelligence,” “Bioinformatics,” “Biomedical Engineering,”
“Biomedical Research,” “Biomedical Technology,” “Biomedical Technology
Assessment,” “Clinical Research,” “Confidentiality,” “Data Base,” “Data Mining,”
“Decision-Making,” “Delivery of Healthcare,” “Education,” “Electronic Health
Record,” and “Electronic Health Records.” Figure 10.10 shows the tree map structure
of the keywords by different authors in their publications.
10.5 NEED FOR COMPUTATIONAL AND BLOCKCHAIN

The need for computational and blockchain methods in distributed biomedical and
health informatics arises from the growing complexity of healthcare data and the
desire to address various challenges in the healthcare industry. Here are some key
reasons why these methods are becoming increasingly important:
Data Management and Analysis: The healthcare sector generates massive

volumes of data from various sources, including electronic health records,
medical imaging, genomics, and wearable devices. Computational methods,
such as machine learning and big data analytics, are essential for efficiently
processing and analyzing this vast amount of data. These techniques can
identify patterns, correlations, and insights to aid disease diagnosis, treat-
ment planning, and patient outcomes (Xu et al. 2023).
Personalized Medicine: Each patient’s healthcare needs and response to
treatments are unique. Computational methods enable the development of
personalized medicine approaches by analyzing individual patient data,
including genetic information and medical history. This way, treatments
can be tailored to suit specific patient profiles, potentially leading to better
health outcomes.
Decision Support Systems: Healthcare professionals face the challenge
of making accurate and timely decisions, especially in critical situa-
tions. Computational methods can assist in creating decision support
systems that provide evidence-based recommendations and insights to
aid healthcare providers in diagnosis, treatment planning, and disease
management.
Data Security and Privacy: Protecting patient data from unauthorized access
and maintaining data privacy is paramount in healthcare. Blockchain tech-
nology offers a decentralized and tamper-resistant data storage solution,
ensuring the security and integrity of sensitive health information. It allows
for patient-controlled access, giving individuals more control over who can
access their data.
Interoperability and Data Sharing: Healthcare data is often scattered across
various systems and institutions, leading to data sharing and interoperabil-
ity challenges. Blockchain provides a distributed ledger system that facil-
itates secure and seamless data sharing among stakeholders, improving
collaboration and data exchange among healthcare providers and research-
ers (Djenouri et al. 2023).
Clinical Trials and Research: Computational methods aid in designing and
optimizing clinical trials, enabling researchers to identify suitable partici-
pants and collect data efficiently. Blockchain technology can enhance the
transparency and integrity of clinical trial data, ensuring accurate and reli-
able results.
Fraud Prevention and Transparency: Using blockchain can help prevent
healthcare fraud and abuse by ensuring that transactions and data are
transparent and immutable. It reduces the risk of manipulating or altering
medical records and billing information, leading to more trustworthy and
accountable healthcare systems.
Healthcare Resource Management: Computational methods can assist in
optimizing healthcare resource allocation, such as hospital bed manage-
ment, staff scheduling, and inventory management. This can lead to cost
savings, increased efficiency, and better patient care (Kumar et al. 2023).
In summary, the need for computational and blockchain methods in distributed bio-
medical and health informatics stems from their potential to address various chal-
lenges in healthcare, including data management, privacy, security, and personalized
medicine. These technologies promise to transform healthcare systems, improve
patient outcomes, and revolutionize medical research and clinical practice. As they
continue to evolve and overcome existing challenges, computational and blockchain
methods are likely to play an increasingly critical role in shaping the future of health-
care (Dong et al. 2023).
10.6 APPLICATIONS OF COMPUTATIONAL
AND BLOCKCHAIN METHODS
Computational and blockchain methods have numerous applications in distributed
biomedical and health informatics, revolutionizing the healthcare industry in various
ways. Here are some key applications:
Health Data Management: Computational methods are used to process and

analyze vast amounts of health data, including electronic health records,
medical imaging, and genomic data. This enables healthcare providers to
gain insights into patient health conditions, medical histories, and treatment
responses, leading to more informed decision-making.
Disease Diagnosis and Prognosis: Machine learning algorithms can analyze
patient data to aid disease diagnosis and prognosis. They can recognize pat-
terns and markers indicating specific diseases, enabling early detection and
timely intervention (Sharma et al. 2023).
Personalized Medicine: Computational methods allow the development of
personalized medicine approaches by considering individual patient char-
acteristics, genetics, and medical history. This tailoring of treatments can
lead to better outcomes and reduced adverse effects.
Drug Discovery and Development: Computational techniques, such as
molecular modelling and virtual screening, are utilized in drug discovery
to identify potential candidates for new medications. These methods can
significantly expedite the drug development process.
Clinical Decision Support: Computational tools can assist healthcare provid-
ers in making evidence-based decisions. Decision support systems analyze
patient data and medical literature to offer treatment recommendations and
best practices.
Healthcare IoT and Wearables: Computational methods process data from
the Internet of Things (IoT) devices and wearables, which monitor patients’
health in realtime. This continuous data collection can aid in remote patient
monitoring and early detection of health issues.
Blockchain-Based Electronic Health Records (EHRs): Blockchain tech-
nology ensures electronic health records’ secure and interoperable storage.
Patient data is distributed across a decentralized network, reducing the risk
of data breaches and enabling seamless data sharing between healthcare
providers.
Clinical Trials and Research: Blockchain can enhance transparency and data
integrity in clinical trials. Smart contracts can automate trial protocols, and
decentralized ledgers can track the entire trial process, reducing fraud and
ensuring the authenticity of results (Ali et al. 2023).
Medical Supply Chain Management: Blockchain-based systems can track
the movement of medical supplies, pharmaceuticals, and vaccines. This
enhances supply chain transparency, reduces counterfeiting risks, and
ensures the authenticity of medications.
Healthcare Billing and Insurance: Blockchain-based smart contracts can
automate billing and insurance claims processes, reducing administrative
overhead and enhancing transparency in financial transactions.
Public Health Surveillance: Computational methods analyze public health
data to monitor disease outbreaks, track epidemiological trends, and plan
interventions for population health improvement.
Patient Consent and Privacy Management: Blockchain enables patients to
control access to their health data and explicitly consent to data sharing.
This enhances patient privacy and builds trust in data exchange processes.
These applications demonstrate the transformative potential of computational and

blockchain methods in distributed biomedical and health informatics. As these
technologies advance and gain wider adoption, they can significantly improve
healthcare delivery, patient outcomes, and medical research (Li et al. 2023; Raj and
Ranjani 2023).
10.7 ARCHITECTURE OF DISTRIBUTED BIOMEDICAL

The architecture of distributed biomedical and health informatics is designed to sup-
port the efficient and secure exchange of healthcare information across multiple dis-
tributed systems and stakeholders. This approach leverages decentralized networks,
interoperable data standards, and advanced technologies to ensure seamless collab-
oration, data accessibility, and privacy in healthcare. At its core, the architecture of
distributed biomedical and health informatics is based on the principles of distrib-
uted systems, where data and services are distributed across various nodes or servers
rather than being centralized in a single location (Waseem et al. 2023). This decen-
tralization enhances data availability and fault tolerance, reducing the risk of data
loss and system downtime. One of the fundamental components of this architecture
is the use of interoperable data standards. Standardized data formats and protocols
enable different healthcare systems, such as electronic health records (EHR), labo-
ratory information systems, and medical imaging systems, in order to communicate
and exchange data efficiently. Common standards like HL7 (Health Level Seven),
FHIR (Fast Healthcare Interoperability Resources), and DICOM (Digital Imaging
and Communications in Medicine) play a crucial role in ensuring seamless data
exchange and integration. Distributed biomedical and health informatics employs
middleware or integration layers for seamless communication and data exchange.
These middleware solutions bridge various healthcare applications and systems,
translating data from one format to another and facilitating data flow between dis-
tributed components. They also help manage data security, access control, and data
synchronization across different nodes in the network. Another key aspect of this
architecture is using secure and decentralized technologies, such as blockchain (Issa
et al. 2023).
With its immutability, transparency, and cryptographic security properties, block-
chain technology can enhance data integrity and privacy in health informatics. It can
securely store sensitive patient data, clinical trial records, and supply chain tracking
in the pharmaceutical industry. Furthermore, cloud computing plays a vital role in
the architecture of distributed biomedical and health informatics. Cloud-based solu-
tions offer scalable and flexible computing resources, allowing healthcare organiza-
tions to store and process vast amounts of data cost-effectively. Cloud services also
facilitate data sharing and collaboration among geographically dispersed healthcare
providers and researchers. The architecture incorporates robust authentication and
encryption mechanisms in data privacy and security. Access control mechanisms
ensure that only authorized personnel can access specific health data, safeguarding
patient confidentiality (Saba et al. 2023).
Data encryption during transmission and storage also protects against unautho-
rized interception and tampering. Machine learning and artificial intelligence are
integrated into the architecture to derive meaningful insights from vast health-
care data. These technologies can assist in diagnosing diseases, predicting patient
outcomes, and optimizing treatment plans, contributing to personalized medi-
cine and improved patient care. As healthcare continues to evolve, the architec-
ture of distributed biomedical and health informatics will continuously adapt to
address emerging challenges and leverage cutting-edge technologies. By promot-
ing interoperability, decentralization, data security, and advanced analytics, this
architecture paves the way for a more connected and data-driven healthcare eco-
system, ultimately improving healthcare delivery and patient outcomes (Baranwal
et al. 2023).
10.7.1 Graphical Representation
The architecture of distributed biomedical and health informatics can be visualized
as a series of interconnected components as shown in Figure 10.11.
Healthcare Providers and Systems: This is where healthcare data is gen-

erated, including electronic health records (EHRs), medical imaging data,
laboratory results, and more.
Challenges Middleware/Integration Layer: The middleware acts as a bridge
between different healthcare systems, enabling seamless communication
and data exchange. It ensures data interoperability by translating data from
one format to another.
Interoperable Data Standards: Common data standards like HL7, FHIR,
and DICOM facilitate uniform data exchange among healthcare systems
and applications.
Blockchain Technology: The decentralized blockchain network ensures

secure storage and sharing of sensitive health data, enhancing data integrity
and privacy.
Cloud Computing: Cloud-based solutions offer scalable and flexible comput-
ing resources for storing and processing vast healthcare data.
Security and Privacy Layer: This component includes robust authentication,
access control mechanisms, and data encryption to protect patient data from
unauthorized access and tampering.
Machine Learning and AI: These technologies analyze healthcare data for
meaningful insights, such as disease diagnosis, patient outcome predictions,
and treatment optimization (Suta and Tóth 2023).
Healthcare Researchers and Professionals: These utilize the architecture to
access and analyze distributed health data, contributing to medical research
and evidence-based decision-making.
Patients: Patients can securely access their health records and grant selec-
tive access to healthcare providers, promoting patient engagement and data
ownership.
The architecture promotes data interoperability, decentralization, security, and

advanced analytics, enabling a more connected and data-driven healthcare ecosys-
tem. This interconnected approach enhances patient care, medical research, and col-
laboration among healthcare stakeholders (Balani and Chavan 2023).
FIGURE 10.11 Architecture of distributed biomedical and health informatics.

10.8 CHALLENGES AND FUTURE SCOPE IN IMPLEMENTING

COMPUTATIONAL AND BLOCKCHAIN METHODS
10.8.1 Challenges
Data Privacy and Security: One of the most significant challenges is ensur-
ing the privacy and security of sensitive healthcare data. Computational
methods and blockchain technology require robust security measures to
prevent unauthorized access, data breaches, and potential misuse of patient
information.
Interoperability: Integrating computational tools and blockchain solutions
with existing healthcare systems can be complex due to the lack of stan-
dardized data formats and interoperable protocols. Ensuring seamless data
exchange and communication among different systems remains a challenge
(Hemdan et al. 2023).
Scalability: As healthcare generates vast amounts of data, computational
methods and blockchain networks must be scalable to handle the increasing
volume of information. Scalability is crucial to avoid performance bottle-
necks and maintain system efficiency.
Regulatory Compliance: Implementing computational and blockchain
solutions in healthcare must comply with strict regulations, such as
HIPAA (Health Insurance Portability and Accountability Act) and GDPR
(General Data Protection Regulation). While maintaining the bene-
fits of the technology, adhering to these regulations can be challenging
(Mololoth et al. 2023).
Integration with Legacy Systems: Many healthcare organizations still rely
on legacy systems that might not be compatible with modern computational
methods and blockchain technology. Integrating these new technologies
with existing systems can be time-consuming and resource-intensive.
Data Quality and Bias: Computational methods heavily depend on the qual-
ity and accuracy of the input data. Biases and errors in the data can lead
to biased outcomes and inaccurate predictions, impacting patient care and
research outcomes (Mahajan and Reddy 2023).
10.8.2 Future Scope
Advancements in AI and Machine Learning: With continuous advances
in AI and machine learning, computational methods will become more
powerful and effective in analyzing healthcare data. Improved algorithms
will enable better disease diagnosis, treatment optimization, and predictive
analytics.
Decentralization and Patient Empowerment: Blockchain technology can
empower patients to have greater control over their health data. Patients can
securely share their medical records with healthcare providers, researchers,
and insurers, fostering a patient-centric healthcare system.
Internet of Medical Things (IoMT): The combination of computational

methods, blockchain, and IoMT devices will enable real-time monitoring
and data collection. This integration can lead to more personalized and pro-
active healthcare approaches.
Clinical Trials and Drug Development: Blockchain’s transparency and
immutability can enhance the integrity of clinical trial data, streamlining
the drug development process and accelerating the approval of new treat-
ments (Mahajan and Reddy 2023).
Healthcare Supply Chain Management: Blockchain can transform the phar-
maceutical supply chain by improving drug traceability, reducing counter-
feiting, and ensuring the authenticity of medical products.
Telemedicine and Remote Healthcare: Computational methods can support
telemedicine initiatives by analyzing remote patient data and providing tele-
consultation with experts. Blockchain can secure telemedicine transactions
and preserve patient privacy.
AI-Driven Drug Discovery: AI-powered computational methods can signifi-
cantly impact drug discovery by identifying potential drug candidates, pre-
dicting their efficacy, and optimizing drug designs.
Overall, the future scope of implementing computational and blockchain methods

in healthcare is promising, as shown in Figure 10.12. Advancements in technology,
coupled with a focus on addressing challenges, can revolutionize healthcare delivery,
research, and patient outcomes in the years to come (Rahman et al. 2023).
FIGURE 10.12 Challenges and future scope in implementing computational and blockchain
methods.
10.9 CONCLUSION
The bibliometric analysis in this chapter provides valuable insights into research in
this interdisciplinary domain. The analysis reveals a burgeoning research landscape,
indicating a growing interest in exploring the potential of computational and block-
chain methods to revolutionize healthcare practices. One of the prominent findings of
this analysis is the diverse range of applications of these methods in biomedical and
health informatics. Researchers have explored various areas, including data man-
agement, patient records, clinical trials, medical imaging, drug development, and
personalized medicine. The versatility of these applications underscores their signif-
icance in addressing critical challenges within the healthcare sector. Collaboration
and interdisciplinarity emerge as key themes in the research landscape. The inter-
section of computer science, biomedical engineering, healthcare informatics, and
blockchain technology fosters collaborative efforts to create innovative solutions.
Interdisciplinary research has proven instrumental in developing novel approaches
that leverage the strengths of different fields, promising groundbreaking advance-
ments in healthcare technology. The bibliometric analysis identifies highly influen-
tial publications within the area with significant citation counts. These works have
shaped the research direction and laid the foundation for further exploration. They
serve as pillars of knowledge, guiding researchers toward more impactful and rele-
vant studies.
While the analysis highlights the potential of computational and blockchain meth-
ods, it also identifies several challenges researchers face. Data privacy and security
concerns, scalability issues, interoperability, and regulatory compliance pose signifi-
cant obstacles to adopting these methods in real-world healthcare settings. Addressing
these challenges is crucial to fully unlock the potential of these technologies and
ensure their successful integration into healthcare systems. Furthermore, the analysis
sheds light on emerging trends that hold promise for the future of distributed biomed-
ical and health informatics. These include the integration of artificial intelligence and
machine learning with blockchain technology, using smart contracts in healthcare
workflows, and exploring decentralized data-sharing platforms. These trends sig-
nify the evolving nature of research in this field and reflect the continuous pursuit of
cutting-edge solutions to address the changing needs of the healthcare industry.
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11 Healthcare
Computational
Intelligence and
Blockchain
Real-Life Applications
Rachna Rana and Pankaj Bhambri
11.1 INTRODUCTION TO BLOCKCHAIN
The concept of blockchain is truly fascinating. It operates on a decentralized and
opensource system, and it is a highly efficient digital ledger. It tracks connections
across multiple computers, and the verified “blocks” form a chain that cannot be
altered by any individual. The community ensures that each transaction is accurate
and maintains the integrity of the information. This security system is unbreakable,
assuring that the data remains unaltered and authentic, which is essential for its
reliability.
Blockchain is a dispersed record organization that regularly adds new records
while ensuring that none are ever deleted or changed without widespread promise.
The cost of a blockchain error is determined by the cryptographic hash that connects
records in new data blocks with those in existing data blocks (Kumar et al., 2022).
Data processing is not done in an integrated position thanks to the distributed block-
chain ledger architecture, which also makes the data transparent and accountable
to all users of the network. To improve and secure the system, this decentralized
system prevents a single attack. By reducing remedial preparation and scrutinizing
by two times, it enables the persistent repair and permits the superior well-being of
information over valid periods and properties for both patients and doctors. Keeping
medicinal histories on a blockchain permits patients to be comfortable with where
their material is going (Assaye et al., 2021).
Blockchain is a system of decentralized connections that houses information. It is a
capacious way to keep knowledge secure and confidential for the association, simpli-
fying the protection and privacy of principal information. It is the perfect device for
carefully as well as centrally fulfilling all applicable credential requirements (Rani,
Kataria et al., 2023). Blockchain also facilitates the use of particular persistent record
designated users who meet the test norms. Peer-to-peer (P2P) systems of actual com-
puters that continue, protect, and prove transactional or past information are what the
term “blockchain” means. As all system contributors protect and conserve data and
DOI: 10.1201/9781003459347-11 155

FIGURE 11.1 Steps in blockchain technology’s operation.
uninterruptedly retain related bits of knowledge, blockchain offers a trustworthy

relationship.
11.1.1 Steps in Blockchain Technology’s Operation

A blockchain system is based on a network of nodes that follow the same rules and
have a master ledger copy. This ensures the secure transmission of value without the
involvement of an intermediary, using machine consensus (Sudevan et al., 2021).
Various processes, including grouping, amalgamation, secrecy, and community, con-
tribute to the power of blockchain technology. The effectiveness of a blockchain system
depends on carefully considering its benefits and challenges (Assaye & Shimie, 2022).
A unique Bitcoin is distinguished by an exceptional situation, like a closed sys-
tem or one that is run by one company (Rani, Mishra et al., 2023). It is considerably
smaller, but it has peer-to-peer communications as well as separation identical to
that of an open Ethereum network. On a private blockchain, the platform’s creator
becomes aware of all of the users instantaneously. Visitors on the open web are
fully unidentified; hence it is impractical to implement a permission-based system
(Kataria et al., 2023, July).
The use of distributed ledger technology (DLT) has been spreading while Bitcoin
and subsequent currencies emerged on the open digital ledger, which was the first
instance of technology used for blockchain (Chauhan & Rani, 2021). There are none
of the negative aspects of centralized management, such as an absence of protection
and transparency. By merely retaining the data in a single spot, DLT disseminates to
a P2P network. Some form of data authentication becomes necessary due to decen-
tralization (Rani et al., 2022).
Utilizing a hybridization approach can be an excellent strategy for businesses
looking to take advantage of the benefits of public and private blockchain (Kumar
et al., 2023). This advanced technology efficiently combines the advantages of both
systems, allowing companies to establish a controlled private network as well as an
open, unrestricted network (Bali et al., 2023). Hybrid blockchain gives businesses
the ability to manage which information is shared with the public and which remains
confidential. (Ayub Khan et al., 2022).
11.2 REQUIREMENTS OF BLOCKCHAIN IN HEALTHCARE

By streamlining the secure patient-approved information-sharing process among
various healthcare systems, blockchain can enhance digital health (Khang et al.,
2022). It’s crucial that you understand what blockchain is and the current commercial
Healthcare Computational Intelligence and Blockchain 157
advantages it offers to organizations before diving into the use cases (Dhanalakshmi
et al., 2022; Chanda et al., 2021):
Data access and transfer make it possible for data to be transferred among
many parties to create a single source of “truth” by documenting facts and
data in an unchanging and transparent manner (Bilal et al., 2021, May).
Profiles and permissions are maintained for certification or evidence, enabling
identification details to be verified without compromising personal data.
Conducting transactions and payments in real-time is feasible. Settlements are
actions taken to fulfill financial obligations by tracking the flow of products,
revenues, or services. Multiple parties exchange tokens having intrinsic
value, such as virtual currency (Tanwar et al., 2022, September).
It is entirely feasible to connect virtual currencies with fiat currencies via

escrow accounts, holding equivalent value. However, the healthcare sector con-
fronts a significant obstacle in validating the legitimate origins of medical prod-
ucts. Validation is crucial to ensure that medical treatments and therapies are safe
and effective. The circulation of counterfeit products in the market must be pre-
vented as they pose a severe threat to public health. Therefore, stakeholders must
collaborate and put in place practical measures to combat this challenge confi-
dently (Kataria et al., 2022).
If you prioritize knowing everything about the products you buy, it’s vital to have
a blockchain-based system (Kaur et al., 2022). This system allows you to track items
from the very beginning of their production to the final stage of delivery. This level of
transparency guarantees that you can trust the products you receive because you know
exactly how they were handled at every stage of the process (Ritu & Bhambri, 2023).
11.3 MAIN REPAYMENTS OF THE BLOCKCHAIN

(COMBINED WITH INTELLIGENCE)
Blockchain is a distributed digital transactional ledger. Because blockchain technol-
ogy makes transactions secure and decentralized, we no longer require a centralized
authority to validate our transactions. Through the process known as data mining,
P2P users conduct cryptographic operations that uphold security. The following are
some crucial characteristics (Imperius & Alahmar, 2022)
Customer Assurance: With a connection to suppliers, wholesalers, transpor-

tation companies, etc., the customer can closely monitor each package from
the very start to the very end. Drugstores and providers of medical supplies
need to file multiple documents to assure patient safety. Compliance can be
simplified by integrating supply chain data into a single system.
For instance, when an issue is found, FarmaTrust’s blockchain-based tech-
nology automatically alerts law enforcement. Supply chain optimization
businesses utilize AI to more precisely forecast demand and modify supply
when all the data is in one place (Rani, Bhambri, & Kataria, 2023).
Reduction of Data Silos: Healthcare systems around the world struggle with
the issue of data silos, which provide patients and their medical provid-
ers with only a partial picture of their medical history (Puri et al., 2023,
September).
In 2016, medical errors caused by poor coordination of treatment, including
missed or incorrect actions and incomplete patient records, ranked as the
third leading cause of death in the United States, as reported by Johns
Hopkins University. To improve the recruitment process for healthcare insti-
tutions, it is recommended to speed up the credentialing process (Rachna
et al., 2022). This presents an opportunity for healthcare organizations,
insurers, and medical facilities to profit from their current credentials data
on former and present personnel (Rachna et al., 2020).
Transparency and Assurance for Partners: This includes firms that use
locum tenens as subcontractors and requires cutting-edge virtual health
delivery models that inform patients of the credentials of the medical staff.
11.4 TECHNOLOGIES OF BLOCKCHAIN
This chapter can assist you in understanding blockchain and participating in discus-
sions about it as a burgeoning technology (Soltanisehat et al., 2023).
A blockchain node is a network node.

In the blockchain network, an address is a collection of alphanumeric char-
acters that identifies a particular entity utilized for sending and receiving
cryptocurrency transfers.
A ledger that is maintained across several nodes in a decentralized network
is known as a distributed ledger. The documents are kept in chronologi-
cal sequence. Depending on who has access to view the ledger, this ledger
might be either permissioned or unpermissioned.
Peer-to-peer is also abbreviated as P2P. The word implies interactions that
take place between two peers (parties/entities) in a network that is strongly
interconnected.
A block is a data structure that contains transactions as well as all the essential
metadata about the block itself (block header). A blockchain’s genesis block
is the very first block.
Block height is the number of interconnected blocks in a blockchain. The
amount of data in a blockchain is typically measured by the block height.
Blockchain is a series of blocks connected by the preceding block’s hash value
and each containing some metadata about the block and certain transactions.
Hashing refers to applying a hash function to the output data in a blockchain
(Rani, Kumar et al., 2023).
A block explorer is a tool used to view a block’s statistics on a blockchain. For
the block explorer for Bitcoin and Ethereum, use this link.
Hashes per second, or hash rate, are used to gauge how well a computer mines.
11.5 REAL-LIFE APPLICATIONS OF BLOCKCHAIN

IN HEALTHCARE AND INTELLIGENCE
By allowing different doctors to review the same data concurrently, blockchain
provides real-time data monitoring for many users at once, which can improve
decision-making. It is all but impossible to alter patient data with blockchain due to
its decentralized nature. Recently, the world changed tremendously with the advent
of the Internet. Is it possible to imagine life without Google, Facebook, YouTube, and
all the other social media sites? It appears incomprehensible. At the present time, the
advancement of blockchain might cause the entire world to change once more (Puri
et al., 2022, December). To call Bitcoin an imminent technological giant may be an
understatement, but that hasn’t halted its rise in popularity over the past ten years.
There are numerous applications for blockchain in every sector imaginable, includ-
ing identity management, governance, banking, and healthcare–all in addition to its
most well-known application, Bitcoin (Sun et al., 2022). (See Figure 11.2.)
Blockchain, however, encompasses far more than just Bitcoin. Because of
its decentralized character, which makes it incredibly secure and invulnerable to
assaults, it is becoming more and more popular in applications all around the world.
So let’s examine the fundamental characteristics of blockchain and the various ways
it is used globally (Rachna et al., 2021).
When it comes to creating a blockchain, the process involves the careful linking of
digital blocks, each containing valuable and unique data (Bhambri & Gupta, 2013a).
A 256-bit hash number and a nonce—both 32-bit whole values—serve as identifiers
for every single block. The chain itself is established through the use of a digitally
encrypted hash function, which ensures that each block is securely and immutably
linked to the one that came before it. These three key components work in perfect
unison, providing an ironclad guarantee for the complete security and integrity of the
entire blockchain (Wu et al., 2022).
Managing assets is a critical aspect of many industries, including finance, and
blockchain technology plays a crucial role in this process (Kaur et al., 2023). Asset
management involves handling and trading various assets, such as real estate, stocks,
mutual funds, commodities, and alternative investments (Rani, Bhambri, Kataria, &
Khang, 2023). However, traditional asset management trading can be costly, espe-
cially when it involves multiple countries and cross-border payments. Fortunately,
blockchain technology can provide significant benefits in such situations by elim-
inating intermediaries such as brokers, custodians, and settlement administrators
(Bhambri & Gupta, 2013b). The blockchain ledger offers a transparent and reliable
process that reduces the likelihood of errors, making it an ideal solution for manag-
ing assets (Rana, 2018; Rana et al., 2019).
When sending money overseas in a foreign currency, the process can often be
tedious and time-consuming, taking several days for the funds to reach their intended
destination. However, the remittance industry has been revolutionized by blockchain
technology, which offers end-to-end services that eliminate intermediaries and
allows for international money transfers within 24 hours to various remittance firms.
FIGURE 11.2 Real-life applications of blockchain in healthcare and intelligence.
The healthcare industry has tremendous potential with the use of blockchain tech-
nology, particularly in the realm of smart contracts. Such contracts allow for direct
agreements between parties that can be executed instantly once the terms of the con-
tract are met. This technology provides numerous benefits to the healthcare indus-
try, including the encryption of personal health records. Only primary healthcare
practitioners with the appropriate key can access these records, ensuring that patient
data remains confidential and inaccessible to the public (Rana et al., 2021a, 2021b).
By integrating blockchain technology into medical recordkeeping, healthcare pro-
viders can ensure secure data sharing, efficient maintenance of electronic medical
records, streamlined insurance administration, and effective management of admin-
istrative tasks. Blockchain technology provides the most effective solution to address
these critical areas (Paika & Bhambri, 2013).
The healthcare industry is currently undergoing a transformational shift thanks to
blockchain technology. This innovative tool enables the collection of patient health
data, ensuring accuracy and authenticity. The use of the Bitcoin blockchain also
allows medical records to be easily accessible in one place, transforming our under-
standing of an individual’s medical condition. Additionally, blockchain technology
protects user confidentiality and addresses concerns about misleading results and
fragmented data in clinical studies, thereby increasing trust in research.
Businesses can utilize analysis tools to identify market opportunities, while drugs
can be managed on the blockchain to ensure a secure chain from manufacturer to
client with digital credibility. This gives healthcare professionals the confidence
that patients will have access to necessary medical equipment and enables effective
patient monitoring through the use of blockchain and IoT technologies.
Although doctors may experience longer wait times in remote patient monitor-
ing and emergency response, blockchain technology can be used to track patient
room temperatures, bed usage, and supply availability. A healthcare network built
on blockchain technology also provides institutions and healthcare suppliers with
a reliable digital identity, improving the traceability and responsiveness of the sup-
ply chain. Overall, the application of blockchain technology in healthcare logistics
is improving transparency and efficiency in the industry (Bhambri et al., 2022).
Significant applications of blockchain for healthcare are analyzed in the Table 11.1.
Blockchain technology has a wide range of applications and is highly versatile.
Cryptocurrencies, such as Bitcoin, are among the most well-known applications of
blockchain technology. They provide users with the ability to conduct transactions
from anywhere without any restrictions on location. Unlike local payment services,
cryptocurrencies make cross-border money transfers more accessible and efficient
(Rani, Pareek et al., 2023).
In underprivileged areas, access to accurate birth and death certificates can be dif-
ficult. However, blockchain technology offers a secure and authenticated database of
these certificates, which is only accessible to authorized personnel (Kaur et al., 2012b).
This could be a potential solution to the issue of accessing these important documents.
Online identity verification is crucial for financial transactions. With blockchain
technology, users can share their authenticated identity with any service provider.
The authentication process includes various techniques such as facial recognition
and user authentication, providing a unified solution for identity verification.
The Internet of Things (IoT) is a system that comprises interconnected devices
that collect data. Using blockchain technology is essential to ensure that the sys-
tem is secure since the security of the system is only as strong as its weakest link.
Smart Homes is a prime example of IoT implementation (Bhambri & Gupta, 2013a,
2013b).
TABLE 11.1
Significant Applications of Blockchain for Healthcare
S. No. Applications Description References
1 Stored information In a clinical investigation, healthcare (De Aguiar et al., 2020), (Ejaz
of an individual professionals generate various types et al., 2021), (Aggarwal et al.,
patient of data and patient information, such 2021), (Mackey et al., 2019),
as blood tests, quality assessments, (Bansal et al., 2012b), (Goyal
estimates, and well-being et al., 2012)
questionnaires. To ensure accuracy,
they can compare this data to the
original documents recorded on the
blockchain system. This system
provides a secure foundation for
data-sharing cryptography, and any
concerns about accuracy can be
addressed by browsing the saved
data. Healthcare practitioners must
record patient details, including
name, date of birth, diagnosis,
therapies, and ambulatory history in
the electronic health record (EHR)
found in both current databases and
cloud computing. It is essential to
ensure that all information is
accurately recorded and accessible to
benefit both patients and healthcare
professionals.
2. Analyze the effects Effective analysis of specific (Khatoon, 2020), (Safi et al.,
of a particular procedures on a significant portion of 2020), (Prerna et al., 2012),
procedure the patient population relies heavily (Javaid et al., 2020), (Kaur
on access to verified patient data. et al., 2012a), (Hussien et al.,
This data is crucial for better 2021)
management of certain patient
groups and for producing valuable
results. Pharmaceutical companies
must tap into the power of
blockchain infrastructure to collect
real-time data, providing patients
with customized prescription drugs
and services. This readily available
data streamlines the work of
chemists and enables them to offer
expert guidance on medication usage
to patients. Wearable technology
plays a crucial role in collecting
real-time data on a patient’s
condition and alerting specialists of
any emergencies.
TABLE 11.1 (Continued)

Significant Applications of Blockchain for Healthcare
S. No. Applications Description References
3. Validation Advanced blockchain algorithms (Bhuvana & Aithal, 2022),
thoroughly verify the authenticity of (Gupta et al., 2012), (Onik
transactions before they are added to et al., 2019)
the blockchain. The content is then
encrypted, digitally signed, and
securely preserved to ensure
foolproof protection. The healthcare
industry is actively seeking ways to
enhance safety and affordability, and
with the swift and reliable
confirmation of results that
blockchain provides, it has the
potential to revolutionize the
healthcare ecosystem completely.
4 Safety and In the realm of healthcare, it is (Agbo et al., 2019), (Bansal
transparency essential to have a seamless and et al., 2012a), (Tanwar et al.,
efficient method of sharing medical 2020)
data among providers. This not only
promotes transparency but also
allows doctors to focus on providing
quality care to their patients. Precise
diagnoses, successful treatments, and
affordable care for rare diseases are
all made possible through the sharing
of medical data. Blockchain
technology, with its robust features,
can serve as a powerful tool to
facilitate communication and
information sharing among
healthcare organizations. This system
ensures heightened security and
transparency, allowing users to
exchange data and monitor their
actions. Additionally, users can keep
track of other users’ data exchanges
without requiring any added integrity
and confidentiality solutions. By
using blockchain technology,
healthcare organizations can
streamline their operations and
provide better care to patients.
Blockchain technology improves supply chains by enhancing product trace-

ability, facilitating partnerships and information sharing, and enabling more
accessible funding. As a result, the delivery of goods becomes quicker and more
affordable.
Managing education certificates and diplomas is now much more efficient with
blockchain technology. The technology’s immutability and smart contract features
ensure security, providing a reliable way to generate, oversee, and protect digital
education credentials.
11.6 CONCLUSION
Though it is still not widely used across many industries, blockchain is a relatively
new technology that is steadily gaining popularity. Blockchain has the potential to
grow into a potent tool for data democratization that will promote openness and
ethical business practices if it is more widely adopted. And as a result of speedier
transactions, increased transparency, security, and cost savings, blockchain technol-
ogy is finding more and more uses around the globe. Due to its built-in encryp-
tion and decentralization, blockchain technology has creative uses in the healthcare
industry. It increases the safety of patients’ electronic medical records, encourages
the monetization of health data, boosts interoperability across healthcare organiza-
tions, and aids in the development of anticounterfeit drug technologies. With the use
of blockchain technology, various facets of the healthcare industry could change;
among the most important uses of blockchain are the digital agreements made pos-
sible by intelligent contracts in the healthcare industry. Intelligent contracts will cut
expenses by getting rid of intermediaries from the payment chain. The adoption of
related cutting-edge technologies in the ecosystem has a substantial impact on block-
chain’s potential in the healthcare sector. It covers clinical studies, medication track-
ing, healthcare insurance, and system tracking. Using a blockchain framework and
device tracking, hospitals may map out their services throughout the course of their
full lifecycle.
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12 Intelligent Development
in Healthcare With
the Internet
Shivmanmeet Singh and Harmandeep Kaur
12.1 INTRODUCTION
Using the Internet of Things (IoT) plays a significant role in advancing health science
and technology, as demonstrated by the history of human progress. Humanity has
dreamed about ways to diagnose and treat illnesses remotely since the beginning
(Puri et al., 2023, September). The introduction of 5G, also known as fifth-generation
network technology, makes it possible to interact with healthcare professionals any-
time. Fifth-generation has influenced the development of intelligent domains and has
given rise to the idea of the IoT (Quy et al., 2023; Mukherjee et al., 2018; Abbas et al.,
2018). Healthcare and medicine are two of these fields that are becoming import-
ant. The creation and accomplishments of remote electronic health systems have
achieved several beneficial outcomes in recent decades (Statista, 2023; Vodafone,
2023). The cloud is where computation, processing, and storage are housed. Cloud
computing (CC), a new technology, is stable, dependable, and has a sizable computa-
tional capacity (Mahmoud et al., 2019). Although CC offers many benefits, one major
drawback is the lengthy service response time (Habibzadeh et al., 2020). It cannot be
used in real-time healthcare applications as a result. The merging of different IOT
technologies has recently been advocated as a solution.
Figure 12.1 depicts the keywords associated with wearable medical sensor.
Different technologies aim to remove connectivity and ease-of-use problems
between users and cloud resources (Kaur et al., 2023). Technology enhances reliabil-
ity while reducing interconnection time, power dissipation, and computing expenses.
This industry anticipated $75 billion in the next three years, per Statista’s projection
(Alshehri & Muhammad, 2021). Additionally, an intercommunication poll reveals
that over one-third (approximately) seek to maintain their health. According to the
report, 60% of people use smart devices surfing for health issues like fever and
COVID (John Dian et al., 2020). These findings demonstrate how IoT and real-time
computing are critical in healthcare (Dhanalakshmi et al., 2022). Nowadays, crucial
IOT-based health data in recent years resides with telemedicine, which can fill the
gap between rural and urban health (Qadri et al., 2020). It offers low-cost diagnos-
tics, remote examination, and consultation. Telemedicine can enable the top medi-
cal professionals to reach the most remote locations and affordably offer everyone
cutting-edge medical treatment (Ullah et al., 2021).
DOI: 10.1201/9781003459347-12 169

FIGURE 12.1 Keywords for wearable medical sensor.
The remainder of the chapter is structured as follows: Real-time monitoring and

alarm generation are discussed in Section 12.2. Edge, cloud, and fog computing is
covered in Section 12.3. Telemedicine is presented in Section 12.4. Home healthcare
and healthcare for elders are discussed in Section 12.5.
12.2 REAL-TIME MONITORING AND ALARM GENERATION

In incompetent healthcare, certain cutting-edge technologies and solutions, includ-
ing smart sensors, autonomous machines, robotics, intelligent computer systems,
and virtual reality, have been studied, developed, and used (Malamas et al., 2021;
Kaur & Bhambri, 2013; Bhatia et al., 2020; Amin & Hossain, 2021). We provide a
few c utting-edge fundamental technologies in this section.
12.2.1 Smart Sensors
An intelligent sensor is a gadget that provides services to users for automatically
gathering information during chemical and physical switching from the attached
gadget (Adavoudi Jolfaei et al., 2021; Dong & Yao, 2021; Taimoor & Rehman, 2022).
This provides very accurate data collection.
We concentrate on wearable sensors in this work because of their broad utility.
Smart-wearing sensors can be strapped to the wrist, inserted into the body, or inte-
grated into garments (Barua et al., 2022; Aledhari et al., 2022; Ali et al., 2023; Singh
et al., 2022). In the context of intelligent healthcare, gadgets monitor patients’ vital
signs and send data wirelessly or through wired network connections to calculat-
ing servers (Rani et al., 2023). The creation of several wearable items has recently
received attention (Seneviratne et al., 2017), including eyeglasses, armbands, and
gadgets worn on different body parts, as shown in Figure 12.2. The authors (Krichen,
2021; Majumder & Deen, 2019) provide workable approaches for deploying these
sensors connected with smartphones to identify anomalous input in this industry.
Intelligent Development in Healthcare With the Internet 171
FIGURE 12.2 Example of a wearable medical sensor (Dang et al., 2023).
Wearable sensors, implanted sensors, and other categories of sensors exist. In

intelligent healthcare, wearables can be primarily employed to monitor and record
patients’ movements and vital signs to notify or supply information to healthcare
systems remotely. Some patient vitals should be tracked with wearable sensors (Dang
et al., 2023; Singh et al., 2013).
12.2.1.1 Pulse
A pulse sensor keeps track of a person’s heartbeat and can be used to identify emer-
gencies, including cardiac arrest and pulmonary embolism. The wrist, earlobe, chest,
fingertip, and other areas are possible locations for the pulse signal to be implanted
(Gubbi & Amrutur, 2015; Quy et al., 2022; Paika & Bhambri, 2013a; Hu et al., 2021;
Al_Barazanchi et al., 2017). Although installing the pulse sensors at the earlobe
and fingertip positions is challenging, these locations provide exact signals. Sensors
mounted on the wrist are frequently more practical and durable.
12.2.1.2 Respiratory Rate

Monitoring patients with breath or air intake disorders, including TB, lung cancer, fail-
ure of respiratory organs, etc., benefits from respiratory rate sensors. These can detect,
for instance, the number of breaths taken by the patient in 1 minute (Khan et al., 2017).
12.2.1.3 Body Temperature

A patient’s body temperature is measured using a body temperature sensor. This
sensor tracks temperature quickly, but the body’s position affects temperature value
accuracy (Abbate et al., 2022).
12.2.1.4 Blood Pressure

The blood pressure sensor is used to measure blood pressure. High blood pressure
presents the risk of cardiovascular disease. The precise position of a blood pressure
sensor does not matter since there is no accurate way to monitor blood pressure;
numerous modalities have been developed where two pulse pattern generators opti-
cal sensors are placed on the patient’s arm in various locations (Ning et al., 2021).
12.2.1.5 Oxygen
The amount of oxygen in the appropriate diagnosis of the body’s oxygen supply
level helps medical professionals diagnose the body’s level of oxygen supply (Rani
et al., 2023). However, the high power requirement due to the use of infrared LEDs
is a significant drawback. Poly-L-Lysine (PLL) (Bansal et al., 2022) was presented
as a solution. According to the findings, employing PLL provides six times better
results concerning power consumption. In order to provide patients with the most
intelligent medical services possible, the data is transceived between user appli-
cations, servers, and particular cloud storage. We will discuss a few cutting-edge
Internet of Health Things (IoHT) computing technologies in the next section (Xi
et al., 2022). Working scenarios between the patient and doctor in telemedicine are
shown in Figure 12.3.
FIGURE 12.3 Working scenarios between patient and doctor in telemedicine.

12.3 EDGE, CLOUD, AND FOG COMPUTING

Cloud computing (CC) is not a very new technology, but the capacity of CC to offer
benefits reflect its fundamental distinctive qualities that underpin its success. Thanks
to its strength and adaptability, CC has been the standard infrastructure. Cloud and
user computing are two levels that make up the fundamental CC paradigm. Cloud
computing contains high-end specified processors with plenty of processing power
and storage (Chen & Zhang, 2022; Singh et al., 2023; Paika & Bhambri, 2013b;
Slater et al., 2020; Laijawala et al., 2020); the back bolt connections, which have a
high throughput, link cloud servers to the Internet infrastructure. Endusers like sen-
sors, IoT devices, actuators, and others are included in the enduser layer. Processing,
calculation, and storage are all performed on cloud servers. The lengthy service
response time of CC is one of its most significant drawbacks. The outcome shows
that CC is not preferred for computing-intensive emergency health-related scenarios
(Erol et al., 2020).
Several computer models, including edge computing (EC) (Greenbaum et al.,
2018) and fog computing (FC) (Lu, 2022), have been developed in recent years
to address this issue as an all-encompassing computing infrastructure for IoT
systems.
Bringing compatibility on both devices (Smartphone and cloud) is a goal that
FC and EC share. The placement of the computations in EC and FC is a significant
distinction. In contrast to FC computation, which is conducted at a particular center
located nearby, EC computation is conducted on a server and user interface devices
(Zhang et al., 2020).
Each computer model has benefits and drawbacks. CC has great processing power,
but EC and FC offer quick transceiver times; they need more computational and stor-
age power. However, we may mix these technologies to create an ideally integrated
solution for each unique circumstance and application (Lin et al., 2021). Illustration
about the computing in medicine is shown in the Figure 12.4.
12.3.1 WBANs (Wireless Body Area Networks)

This is a significantly essential technology in intelligent healthcare. It is a collection of
IoTs with the person who gathers user data and sends it to a center performing different
tasks (Kataria et al., 2023, July). It uses different generations (4G, 5G, etc.) of intelligent
sensors connected to the body to measure different variables (Lin et al., 2021, 2022;
Sharma & Bhambri, 2013; Lanubile et al., 2021). In order to monitor and assess the
patient’s state and develop suitable treatment plans, these data are graphically shown to
medical personnel or caretakers. WBAN architectural diagram is shown in Figure 12.5.
WBAN architecture comprises communication technology, software, and hard-
ware. The devices and sensors used to gather user information are hardware, whereas
the operating system, network protocols, and user–machine interfaces are software
(Joo & Kim, 2019). A WBAN uses communication technologies extensively to trans-
fer sensors’ acquired outputs between hardware and software—the architectural
WBAN diagram. Various communication technologies are employed to connect
devices in the network (Yu et al., 2018).
FIGURE 12.4 Illustration of computing in medicine (Dang et al., 2023).
FIGURE 12.5 WBAN architectural diagram (Dang et al., 2023).

12.4 TELEMEDICINE
Telemedicine is described by the World Health Organization (WHO) as “the delivery
of healthcare services, where distance is a critical factor, by all healthcare profes-
sionals using information and communication technologies for the exchange of valid
information for diagnosis, treatment, and prevention of disease and injuries, research
and evaluation, and for the continuing education of healthcare providers, all in the
interests of advancing the health of individuals and their communities (Hossain
et al., 2019). Patient and doctor connection is shown in the form of flowchart in the
Figure 12.6.
FIGURE 12.6 Patient and doctor connection flowchart.

12.4.1 Utility of Telemedicine
Remote regions are easily accessible.
Home health and precautions (ambulance) are available.
Connectivity between both user and doctor is enhanced when they are far away.
Monitoring and actions are instantaneous when the transfer is possible.
Medical research on patients is improved.
Public’s awareness of patient condition is enhanced.
Can be used as a disaster action tool management device.
Complex diseases are interpreted instantly.
Communication between the user and doctor will hopefully improve actual
precautions.
It offers the chance for fairness in the delivery of medical care in different
regions.
Telementored procedures—surgery employing hand robots—are possible
(Chen et al., 2019, 2020; Kim & Ben-Othman, 2020; Noorbakhsh-Sabet
et al., 2019)
12.4.2 Types of Technology
Two fundamental kinds of technology are used in most modern telemedicine appli-
cations. The first is the store and forward technique, which transports digital images
(Reddy et al., 2019). Using a camera, a digital image is “stored” and then “trans-
ported” by a smart device. Telepathology, teledermatology, and teleradiology are the
methods that perform this task accurately and precisely (Nguyen et al., 2023). The
second widely utilized system is one-to-one communication, which leans toward live
consultations using video calls. The patient user’s helping hand may be included;
this can be any person, a relative or someone else, sometimes a nurse practitioner,
telemedicine coordinator, or anyone present at the place of origin (Iqbal et al., 2020).
Thanks to video/audio conferencing technology, a “real-time” consultation may be
conducted at both locations (Zhou et al., 2019). Support for this consultation has been
found across almost all medical specialties (Figure 12.7).
12.4.3 Infrastructural System
There are three types of telemedicine centers.
12.4.3.1 Primary Telemedicine Center (PTC)

A PTC is a telemedicine facility that receives patients interested in getting virtual
healthcare services as their first point of contact. It might provide primary care ser-
vices, essential healthcare consultations, and patient triage. PTCs are often prepared
to address common health issues and offer preliminary evaluations and suggestions
(Lins & Vieira, 2021).
12.4.3.2 Secondary Telemedicine Center (STC)

An STC is a telemedicine facility that provides services beyond primary care that are
more specialized. For patients with complicated or specialized medical issues, it may
provide a more comprehensive selection of medical professionals and cutting-edge

telemedicine technologies to deliver more precise consultations. STCs frequently act
as referral hubs for main telemedicine facilities (Xiao et al., 2019).
12.4.3.3 Tertiary Telemedicine Center (TTC)

A TTC might be a telemedicine facility with the highest telemedicine service spe-
cialization and proficiency. TTCs frequently have access to cutting-edge technol-
ogy, enabling them to offer remote consultations, complex surgeries, and specialized
treatments. They might act as primary or secondary telemedicine centers of referral
(Jia et al., 2020).
Examples of different telemedicine centers are:
Virtual Telemedicine Center: Teladoc Health is a prominent illustration of a

virtual telemedicine center. Through video conversations, phone calls, and
FIGURE 12.7 Patient, doctor, and telemedicine center connection flowchart.

chats, they provide patients with various medical specializations, online

consultations, and virtual healthcare services (Yaqoob et al., 2022).
Hospital-Based Telemedicine Centers: One such facility is the Mayo Clinic
Center for Connected Care. Connecting patients with Mayo Clinic doctors
remotely provides remote consultations, second opinions, and follow-up
treatment (Deepa et al., 2022).
Independent Telemedicine Center: American Well, sometimes called
Amwell, is an unaffiliated telemedicine facility. It offers a platform that
links individuals with various healthcare professionals, such as doctors,
therapists, and specialists, for online consultations (Nguyen et al., 2022).
Government-Operated Telemedicine Center: The Telemedicine
Development and Promotion Centre (TDPC), run by the Indian Space
Research Organization (ISRO), is a government-operated telemedicine
center. It intends to offer telemedicine services to distant and underserved
regions of India by establishing satellite-based connectivity between
patients and medical professionals (Nguyen et al., 2021).
Specialty-Specific Telemedicine Center: Dermatologist on Call serves as an
illustration of a specialty-specific telemedicine center. It specializes in der-
matology and provides online consultations for skin-related issues, enabling
patients to get professional guidance from dermatologists far away (Shanin
et al., 2018).
12.4.4 Internet Telecommunication Technology

The Internet significantly influences how certain forms of patient care are delivered.
Different regional chief information officers (CIOs) were surveyed, and the results
showed that 65% of them said their business had a website, while another 24% said
one was being created. This helps patients and their loved ones avail themselves of
patient scheduling, health information, result evaluations, etc. (Swaroop et al., 2019).
12.4.5 Application of Telemedicine in Public Health

12.4.5.1 Epidemiological Surveillance
Epidemiological surveillance continuously advances thanks to technological
advancements like geographic information systems (GISs).
It also delivers helpful information about diverse groups, which may provide
significant new information on the geographical distribution of disease
prevalence, developing interventions, and assessing assessment.
It identifies and categorizes the population’s risk factors.
It also supports the development of interventions and the assessment of the
effectiveness of different interventional strategies.
It may be crucial for epidemic forecasting.
It is a vital instrument for both regional and global real-time disease
surveillance.
The essential software needed for climate modelling, environmentally affected
persons, and transmitted diseases criteria is made available by GIS.
This helps us understand how diseases with vector-borne conditions are

propagated.
This (GIS) approach to disease monitoring and reporting enables data gath-
ering, retrieval, analysis, and management in contrast to traditional tech-
niques. To guide the development of public health initiatives and policy
decisions, it makes it simpler to aggregate and incorporate heterogeneous
data from many sources.
12.4.5.2 Interactive Health Communication and Disease Prevention

Telemedicine with information system technology nowadays is preferred to
enlighten, convince, and inspire people and groups representing the general
public with regard to health, medical problems, and precautionary versus
diseased life. Many techniques promote and use agendas for checking and
procuring diseases.
It could enlighten the general public as well as particular individuals.
It allows for making intelligent selections and may be simpler for those resid-
ing in rural areas. It also facilitates communication between patients and
medical staff to treat a health problem, resulting in more options.
The maintenance and promotion of healthy habits may greatly benefit the
community.
Two other advantages are emotional support and information exchange
among peers. Examples include social networking sites and other online
resources that enable users to exchange information and provide and receive
emotional support if they are dealing with specific medical requirements,
challenges, or worries.
It promotes household and self-care practices. Many individuals who reside in
remote areas may benefit from the present medical system. It could be essen-
tial for monitoring and evaluating healthcare services (Rathore et al., 2016).
12.5 RESULTS AND DISCUSSION

With several significant results, telemedicine has become a disruptive force in the
healthcare industry. The increase in healthcare access has been one of its most signif-
icant accomplishments. Geographical constraints are no longer obstacles for patients
seeking treatment in isolated or underdeveloped locations. In addition to enhancing
healthcare fairness, this increased accessibility makes early intervention and pre-
ventative treatment possible. Telemedicine also provides unmatched convenience.
Patients may make appointments whenever it is most convenient for them, eliminat-
ing the need for long drives and time away from work. This ease of use has increased
patient satisfaction and treatment plan adherence, which may result in longer-term
improvements in health. Telemedicine has been shown to reduce costs for both indi-
viduals and healthcare systems from an economic standpoint. Transport and other
associated expenses are reduced for patients, while overhead costs related to main-
taining physical venues for consultations are decreased for healthcare institutions.
In a time when healthcare expenses are a significant issue, this cost-effectiveness is
particularly relevant.
Additionally, telemedicine has been shown to be successful in treating various

medical disorders. It effectively manages chronic diseases, supports mental health,
and provides regular follow-up treatment. Now, patients with these diseases may get
the help they need without making many time-consuming in-person appointments.
The development of monitoring patients remotely via telemedicine is another
important outcome. Using this technology, healthcare personnel may take a preven-
tative approach to patient treatment by continually monitoring vital indicators and
health information. It may be beneficial in treating chronic illnesses and the early
diagnosis of health problems, reducing hospitalizations, and enhancing patient qual-
ity of life.
The rapid development of telemedicine also raises several crucial questions and
concerns. The quality of remote care delivery is one of the main issues. While tele-
medicine has unquestionable benefits, it is crucial to ensure that medical profession-
als can provide high-quality care, complete and thorough evaluations, and correctly
diagnose and treat individuals via virtual contact. Another crucial topic of conversa-
tion is related to legal and regulatory issues. Regulations and licensing requirements
for telemedicine practitioners are complicated and may vary significantly by loca-
tion and jurisdiction. It is crucial to find the correct balance between ensuring the
practice is regulated adequately for security and accessibility. This requires ongoing
debates and future legislation reforms. In telemedicine, the importance of security
and privacy cannot be overstated. It is essential to protect patient data and employ
secure communication systems. Reliable cybersecurity measures must protect sensi-
tive health information, and talks about these measures are essential.
Furthermore, telemedicine’s technology foundation has to be carefully consid-
ered. For telemedicine delivery to be successful, access to dependable Internet and
appropriate equipment is required. Its reach may be limited by disparities in access
to technology, especially in rural or economically disadvantaged regions. For tele-
medicine to reach its full potential, these discrepancies must be addressed. In con-
trast to conventional face-to-face contact, telemedicine connections between patients
and providers have different dynamics. When a healthcare professional is physically
there, it might be easier to establish rapport and confidence. Discussions are still
going on about how to build solid patient–provider connections online. The seamless
integration of telemedicine into established healthcare systems is still up for dispute.
It is essential to ensure that telemedicine enhances instead of replacing in-person
treatment. The growth of telemedicine inside the larger healthcare environment
has raised questions about how to strike the correct balance across virtual and real
healthcare services.

Even though the area of IoT-based intelligent healthcare systems is increasing quickly,
several issues still need to be resolved. This report thoroughly analyzed the key
computer technologies for intelligent healthcare, including CC, EC, and FC. Recent
research has demonstrated that practical innovations and comprehensive solutions
are increasingly being created to realize real-time intelligent healthcare applications.
We have introduced an all-encompassing computer architectural structure to support

real-time innovative healthcare applications, outlining its benefits and drawbacks.
The fact that the efficacy of the suggested computing architecture is currently being
thoroughly evaluated is a drawback of this study. Our research team will evaluate
this element in a subsequent study.
In addition, incorporating AI into network edges is a potential approach for diag-
nosis and therapy. However, whereas edge devices have limited resources, the AI
training procedure requires robust servers; as a result, strategies utilizing lightweight
artificial intelligence (AI) methods and pooled learning models need to be researched.
The metaverse and virtual counterparts are also expected to be game-changing inno-
vations in competent healthcare; nevertheless, IoHT systems confront several severe
concerns due to the possible security and privacy risks. The solution to this issue
may be incorporating blockchain technology’s cryptography methods. Despite the
numerous issues that remain to be resolved, intelligent healthcare will become an
ineluctable evolutionary trend in the Age of Things.
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net of Things Journal 2019, 6, 1606–1616.
in Healthcare With
the Internet
Case Study I
Utpal Ghosh and Uttam Kumar Mondal
13.1 INTRODUCTION
There are various applications comprising the investigation of acoustic data, such as
recording devices and portable devices, but this research has proposed a lightweight,
least-cost, and highest-quality acoustic recorder with restricted resources in con-
stricted environments. Over the previous few decades, a variety of sensing methods
to sense audio and various audio processing systems have been developed, but they
have always relied on high-throughput computing and/or an expansive microphone
array. Although microphone arrays outperform single-microphone systems, they have
several disadvantages due to the fixed position of the microphones and the fact that all
signal processing operations are handled by a centralized processor. Another option
is to deploy dispersed nodes with low-resource devices for sensing and different algo-
rithms to detect and localize various characteristics of acoustic events. This system
is beneficial because it is wireless and all the nodes are battery powered, so it is less
expansive and may be deployed in multiple types of settings. In recent days, wireless
acoustic sensor networks have become one of the most vibrant research topics, pro-
ducing various issues related to the communication of different working sensor nodes
(Kobo et al., 2017). This experiment aimed to monitor the health status of critical
patients centrally, especially in the COVID pandemic situation when not enough doc-
tors or medical personnel were available and had to maintain social distance. The aim
of this research work is to read the parameters for checking several health conditions
like pulse rate, heartbeat rate, systolic-diastolic blood pressure, ECG, etc. in the form
of an audio signal through various acoustic body sensors. The acoustic body sensing
equipment is microphone-oriented to capture the signals in audio format.
A wireless acoustic sensor network is an assembly of operating nodes formed in
a matching network. Every node consists of one or more microcontrollers with pro-
cessing capabilities such as audio capture devices, CPUs, and coordinator devices.
It can include a variety of memory types, such as local memory, databases, etc., and
may also have optimal power sources such as batteries, electricity, or solar cells, as
well as a variety of sensors and actuators. The essential concept of this network is
186 DOI: 10.1201/9781003459347-13

to operate small microsensing apparatus that is a dept at detecting changes in events

or parameters and communicating with other devices. The healthcare wireless sen-
sor network (HWSNs) is a promising subject of research in WSN (Vallabh, 2018).
The implementation of WSN infrastructure in the health environment can help make
some medical processes automated. Tiny body sensors are placed on patients to col-
lect different parameters related to the patient’s health condition (Alenoghena et al.,
2022; Sharma and Bhambri, 2013). These body sensors have the ability to communi-
cate through wired/wireless and transmit the compound collected data over a remote
wireless network via the Internet (Sobral et al., 2019).
Blockchain technology has recently grown in popularity across several industries,
including health systems. This is due to the fact that it provides a more secure decen-
tralized database thancan function without a centralized administrator (Campbell-
Verduyn, 2017, Bhambri and Gupta, 2013a). This blockchain system’s distinctive
feature is that, once digital validation occurs, the network itself speeds up and val-
idates the subsequent transaction process. It protects the transaction history and
enables data transfer directly between third parties (Angraal, 2017). The fundamen-
tal benefit of this decentralized system is that any data transactions or alterations
are collected in real-time updates across the network (Casino, 2019). As a result, the
information saved in each node is similar and permanent. As a result, this technology
is transparent and autonomous, and it also increases the quality of shared data among
various stakeholders (Sharma et al., 2019). This system validates the transaction by
employing various cryptographic techniques (Hewa, 2021). Furthermore, block-
chain eliminates the downfall of single-point failure, which is typical in traditional
centralized database management systems (Vazirani, 2019). In general, centralized
healthcare systems lack the benefits provided by blockchain, such as transparency
and reliability, privacy and security of information, cost-effective data verifiability,
and quick and easy transmission of real-time data to all trusted users (Mahmood
et al., 2021). To provide Internet connectivity among several nodes of a wireless sen-
sor network (WSN), each node must have a unique address for the Internet Protocol
(IP). Here a gateway is used that is located on the border of the WSN. This pro-
vides a juncture between the Internet and the WSN through the IPv4 protocol and/or
IPv6 protocol, which is handled via 6LoWPAN. Patients wear acoustic body sensors
(according to the needs of their prescribed tests) to collect useful parameters from
their bodies. Various acoustic body sensors, coordinator devices, Apache web serv-
ers, the XAMPP platform, and some equipment are used for displaying results in
the centralized control center. The medical staff or physician evaluates the general
condition of every affected person and analyses the values amassed with the aid
of those nodes (Bhambri and Gupta, 2013b). The use of esp8266 Wi-Fi sensors for
patient tracking promotes the pattern of data having right of entry whenever and
everywhere. To facilitate the nonstop connection to the nodes located on the suffer-
er’s frame, a WSN is used. In this experiment, all data is stored for later use or as a
reference record for a patient using blockchain technology. There is also a limitation
in this proposed system: Patients or medical personnel have to place the acoustic
body sensors manually for the first time.
13.2 LITERATURE REVIEW
In healthcare settings, the combination of WSN with centralized support allows
patients to be taken care of and observed constantly, which can control any medi-
cal emergency. These options provide an uninterrupted medical service to patients
through the architecture of wireless networks. This infrastructure allows several
remote access points among different nodes. As a result, the status of patients can be
tracked from any place where community terminals are available. Almutari (2022)
proposed a tree-based routing protocol to solve the mobility management problem
that occurred in WSN. As part of this routing solution, a two-way uplink/down-
link connection is provided to mobile sensor nodes, and proactive methods are
used to accelerate the phase of association or reassociation. A WSN mobile solu-
tion (Abdulameer et al., 2020) was introduced over the 6LoWPAN network. The
author proposes a new protocol for the dynamic management of nodes for 6LoWPAN
(Kataria et al., 2023, July). This technique uses the technology of a proxy agent, and
the aim of this work is to increase the handoff time by quickly predicting the trans-
fer of events. This protocol is used to reduce the mobility of nodes in exchange for
mobility-related information.
An article by Morishima (2021) provides an overview of current research and
guiding principles for the advancement of wearable, implantable monitoring sys-
tems. It uses physiological data from patients to relay information to the intelligent
personal digital assistant (IPDA). The purpose of this chapter is to explain the impor-
tance of sensory networks in the treatment framework for reducing the dependency
of patients on other persons for care, also supporting chronically ill elderly people
who live an independent life, as well as aiming to provide suitable, satisfactory, and
hassle-free care to people. Chattu et al. (2019) introduce body location sensors that
permit healthcare tracking in an unfastened manner. The primary concept is to offer
an answer for internal monitoring of temperature primarily based on a novel intra-
frame sensor, verbal exchange, and computing device software. This new biosensor
can collect data that can be used to examine the relationship between temperature
variability and women’s fitness reputation. During pandemics, blockchain might
help hospitals and health organizations to handle data more efficiently (Katuwal
et al., 2018). It may also aid in the tracking of data for existing public health prob-
lems such as traffic accidents, illegal drug addiction, and so on (Upadhyay, 2020).
When blockchain technology is used in the public health arena, these networks could
potentially be able to share secure medical information as well as store this data for
healthcare organizations (Bhambri and Gupta, 2013c). Some researchers revealed a
blockchain-based strategy for determining harmful information and identifying the
population at risk from communication via the Internet. This demonstrates block-
chain’s potential to improve monitoring of public health in the digital age (Ali Alheeti
and Al-Ani, 2018). An improved and efficient method has been proposed in Ghosh
(2023) for analyzing various properties of an audio signal using mel-frequency cep-
stral coefficients, perceptual linear prediction cepstral coefficients, and modified
group delay feature technique, as well as drawing a comparison analysis among dif-
ferent traditional techniques, that is, discrete cosine transform, short-time fourier
transform, and modified discrete cosine transform and the proposed techniques.
13.3 PROPOSED METHODOLOGY
In this technique, each acoustic body sensor is made up of a microcontroller, a coor-
dinator device, an audio board, an encapsulated audio sensor, and a battery. Multiple
acoustic body sensors are used to determine a patient’s various health statuses.
Generally, a coordinator device is used that has the capability to receive all possible
audio signals and transmit them through a wired/wireless link to a wireless sensor
network, which then travels to the central monitoring center through the Internet. In
this proposed architecture, the whole system is divided into three tiers. The first tier
is the Communication Tier 1 or Patient’s Data Collection (PDC). This tier collects
all required patient data using various body sensors and compiles it into the coor-
dinator device. The concept of a multidimensional signal (Rehan, 2018) has been
applied here to organize the patient’s data in the form of audio signals that arise from
multiple sensors or sources. The next tier is Communication Tier 2. In this tier, all
captured acoustic data is transferred to an application server (Apache web server) or
real-time communication server through a wireless sensor network using the Internet.
During the transmission of acoustic data from the coordinator device to the central
server through WSN, the multidimensional channel (Online Electronics, Electrical
Engineering Knowledge, 2018) technique is introduced to the WSN architecture so
that the signals can be transmitted uninterruptedly and also without interfering with
one another. Apache Web Server is a free source web server. It is compatible with any
website in any web browser with perfect power availability. Any type of program-
ming language can be programmed in Apache. An access point (AP) has been used
that allows the wired coordinator devices to connect to wireless devices. The last tier
is called Communication Tier 3, where all audio data is processed from the database
server and then shown through receivers or medical display coordinators at the cen-
tral monitoring center. To store the patient’s data in an organized manner and for
searching any information about a patient quickly, groupify the patient’s information
according to the mathematical procedure of symmetric or even antisymmetric or odd
signals. The groupification is done based on Eqn. (13.1) and (13.2).
If X(n) = X(−n), then symmetric signal (13.1)

(Berdik et al., 2021)
where X(n) represents the value of signal for positive n, and X(−n) represents the value
of signal for negative n.
If X(n) = −X(−n), then antisymmetric signal (13.2)

(Berdik et al., 2021)
where X(n) is the positive signal value, and −X(−n) also represents the positive signal
value.
Blockchain provides a more secure, decentralized database that can function with-
out a centralized administrator. For secure data transmission, safe data transactions,
or alterations in real-time updates across the network, the present technique uses the
concepts of open access blockchain and limited access blockchain (Sharma et al.,
2019) according to the data and information accessibility among users. As a result,
the information saved in databases depends on their impact on privacy. Blockchain
eliminates the downfall of single-point failure, which is typical in traditional cen-
tralized database management systems (Vazirani et al., 2019). Therefore, in this pro-
posed approach, the decentralized network of the blockchain technique is adopted.
The data on this blockchain is stored on a network of individual machines that also
perform the job of recording and maintaining transaction records.
Blockchain technology is implemented into the health monitoring system at four
types of application levels.
13.3.1 Health Organization Level

Blockchain is a common technology utilized in modern health monitoring systems for
medical record management. Blockchain technology is suited for storing, managing,
and exchanging protected health information due to several aspects such as decentral-
ization, data authenticity, and integrity (Roman-Belmonte et al., 2018). This technique
contributes to adaptable data security and optimizes the present system’s performance.
Blockchain is thought to improve billing transactions and surveillance techniques such
as infection surveillance (Griggs et al., 2018; Bhambri and Gupta, 2013d). The benefit
of this technology is that a large amount of data can be saved, analyzed, and dissemi-
nated with stakeholders very quickly and without failure or delay (Tseng et al., 2018).
13.3.2 Resource Management Level

Blockchain technology has the potential to improve the management of logistical
and human resources in healthcare facilities. The use of blockchain can validate
the standards of quality at various supply chain management nodes and notify the
appropriate authorities about possible deviations (Tseng et al., 2018). The application
of blockchain can improve the efficiency of such processes and contribute to the
establishment of smarter healthcare organizations.
13.3.3 Patient-Oriented Level
Blockchain technology has the potential to improve the management of logistical
and human resources in healthcare facilities. The use of blockchain can validate
the standards of quality at various supply chain management nodes and notify the
appropriate authorities about possible deviations (Tseng et al., 2018). The application
of blockchain can improve the efficiency of such processes and contribute to the
establishment of smarter health-care organizations.
13.3.4 Disease Monitoring Level

Surveillance entails the systematic, continuing gathering, collation, and analy-
sis of data, as well as the timely transmission of information to those who need
to know in order to take action. The proposed system has been implemented for
FIGURE 13.1 Architecture of the proposed wireless acoustic sensor network.
both communicable and noncommunicable diseases, and dangerous viruses such as

COVID-19, adenovirus, and others can migrate across the globe in a matter of hours,
causing pandemics by violating health security as a result of rapid and unrestricted
urbanization and globalization (Brodeur, 2021).
If any patient’s health status value shows abnormality or fluctuation, then the med-
ical display monitor shows a warning message, and, according to this result-oriented
message, doctors can take the necessary emergency action. Figure 13.1 depicts the
system architecture of our proposed work.
Figure 13.2 shows the working flow diagram of the proposed work. At first the
acoustic body sensors are placed according to the requirement of the test; for exam-
ple, for measuring pulse rate, place the sensor on the wrist of the patient, for measur-
ing heartbeat, pulse, and ECG test, place the sensors on the chest (Puri et al., 2023,
September). The parts of the sensors are connected to the microcontroller Arduino–
Uno device through circuits/pins. The pins are manufactured in such a way that they
sense signals. When connected to Arduino device, the LED is turned on. Here the
ESP8266 Wi-Fi module performs as a ground point where it is connected to the spec-
ified Internet-enabled Wi-Fi network.
When collecting signal values, all signal inputs are processed in the Arduino
device; after that this processed data is fed into the coordinator device. Then the coor-
dinator device transmits the data to the application server, which is placed between
the web server and the data server through WSN using Internet/Wi-Fi/Bluetooth
connection. To do this, at first the coordinator device has to do registration with an
access point (AP). So the AP establishes an interface between wired/wireless devices
and the wireless sensor network (Kaur et al., 2023). The real-time communication
server fetches instant real-time data with less transmission delay data. The XAMPP
platform is used to build the local database. The local database is used to store data
that comes from ESP. XAMPP is a free and open source network and is also work-
able for different operating systems like MAC, Linux, and Windows. In this case, it is
installed in the Windows operating system; thus it acts as a local network. After that,
the resultant signal data goes to the medical display coordinator/central monitoring
center. If the resultant data values are not equal to the reference range (i.e., pulse
rate <60 or pulse rate >120, heartbeat <60 per minute or heartbeat >100 per minute,
FIGURE 13.2 Working flow diagram of the proposed work.
systolic rate of blood flow >120 and diastolic rate of blood flow <80), the ECG
report shows abnormal plotting, etc. Then it displays a warning message. According
to the result of the abnormality, the doctors can take the necessary emergency action
without delay. All the data, including normal as well as abnormal data values, is
stored in the database server (MySQL). The application program interface (API) per-
forms as an interface between the hardware and software. Here the API is written on
PHP using sublime text.
13.4 RESULTS AND DISCUSSION

In this study, an acoustic WSN-based patient monitoring system is proposed for mon-
itoring the health status of a critical patient. Various acoustic body parameters, such
as pulse rate, heartbeat rate, etc., are being acquired using acoustic body sensors. For
testing the performance of our proposed method, pulse rate, heartbeat rate, systolic
and diastolic rates, and an ECG graph are recorded. Table 13.1 shows the expected
results of the proposed system for pulse rate.
The sample pulse rates are acquired using acoustic body sensors, it transmits to the
ESP Wi-Fi module through pins. After that, the data from ESP is stored in the local
database, which is created through XAMPP (Rani, Kumar et al., 2023). Based on
this results data of the patient, according to the proposed system, the display monitor
shows a warning message for the first sample because the result data value is not equal
to the reference range, and doctors can take immediate action on this critical situa-
tion. But there are no displays of any warning message for sample 2 because here the
patient’s pulse rate falls within the medical reference range (Rani, Mishra et al., 2023).
Figure 13.3 depicts a pulse rate observation graph based on the given sample val-
ues of patient.
TABLE 13.1
Sample Pulse Rate Reading
Name of patient: Sample 1
Age: 37
Gender: Male
Pulse rate: 140 per min Display warning message
Age: 60
Gender: Female
Pulse rate: 72 per min Normal to reference range
FIGURE 13.3 Pulse rate observation of sample 1 and sample 2.

TABLE 13.2
Sample Heartbeat Rate Reading
Age: 30
Gender: Male
Heartbeat rate: 112 beats per min Display warning message
FIGURE 13.4 Heartbeat rate reading for current heart rate value 112 BPM.
Table 13.2 presents the results values as expected of the proposed system for
heartbeat rate.
Based on this results data of the patient, according to the proposed system, the
display monitor shows a warning message because the results data value does not fall
within the medically designated reference range of the system. Figure 13.4 depicts a
graphic representation for this sample.
This simulation also takes an experiment to prove the correctness of our measure-
ment of heartbeat. When people exercise, the heart needs to pump faster and needs
more oxygen. This system considers three types of exercise: sprinting, jogging, and
walking. Among these types, sprint involves more movement, so the heart has to
pump faster and needs more oxygen.
Table 13.3 shows the reading values of a random patient during performing the
three types of exercise activity. The average heartbeat of the patient was measured
at 82 BPM.
The relationship between heartbeat rate and the types of exercise is that more
complex exercise requires more speed. As a result, the heart needs to pump more
TABLE 13.3
Heartbeat Rate after Exercise (BPM).
Exercise Reading 1 Reading 2 Reading 3 Average
Jumping jacks 105 126 131 121

Jump rope 110 86 104 100
Running 98 108 113 106
FIGURE 13.5 Average heartbeat rate for different types of exercise.
to deliver more oxygen. So, according to the table, after performing jumping jacks,
the patient’s heartbeat rate increased by 39 beats from his average heart rate. The
heartbeat is raised by 18 and 24 beats after jump rope and running, respectively. The
conclusion is that the heartbeat rate is raised the most after performing the jumping
jack exercise, which proves the correctness of the proposed technique.
Figure 13.5 shows the graphical representation of heartbeat rate according to the
types of exercise given. The authors also provide an experimental table that com-
pares the heartbeat rate of a limited number of patients using the developed system
and manually. This result shows the correctness of the proposed approach as well as
the percentage rate of error of the proposed system. Table 13.4 tabulates the obtained
heartbeat in BPM to compare the percentage rate of error of the proposed system.
Table 13.5 shows the expected results of the proposed system for the systolic and
diastolic rates of blood flow rate.
Based on this patient’s results data, according to the proposed system, the display
monitor shows a warning message because the results data value does not meet the
reference range given to the system, and doctors can take immediate action in this
critical situation. Figure 13.6 plots a graph representation of systolic and diastolic
blood flow rate readings and also provides a pictorial representation of how the first
and last audio values are generated using the cuff sensor.
The authors also conducted an experiment on a critically ill child in the age
range of 0–15 years to monitor a data report of systolic and diastolic reading abnor-
malities along with the heartbeat rate to examine the reliability of our developed
TABLE 13.4
Comparison of Heartbeat Reading through Developed System and Reading
Manually
Heartbeat by Heartbeat by
Subject Gender Age Developed System Manually Error (%)
Subject 1 Male 21 86 85 1.04

Subject 2 Male 23 85 83 2.38
Subject 3 Male 22 77 77 0
Subject 4 Male 24 89 86 3.33
Subject 5 Male 31 101 103 2
Subject 6 Female 21 77 78 1.32
TABLE 13.5
Sample Systolic and Diastolic Rate Readings
Age: 65
Gender: Female
Systolic rate: 140 Display warningmessage
and
diastolic rate: 89
FIGURE 13.6 Systolic and diastolic blood flow rate reading for a sample value.
approach. Table 13.6 shows some random experimental results for systolic and dia-
stolic parameters.
Before starting the interpretation of an ECG, the calibration of the ECG, the heart
rate of that patient, the patient’s heart rhythm, the cardiac wave through an acoustic
sensor, etc. are examined. Figure 13.7 shows the expected results of the proposed
system for ECG graph reading.
TABLE 13.6
Experimental Table of Stabilization of Critically Ill Child
Systolic Blood Diastolic Blood Heartbeat Rate
Age Flow Rate Flow Rate in BPM
0–3 months 65–85 45–55 100–150

3–6 months 71–91 52–67 92–122
6–12 months 80–100 55–65 80–120
1–3 years 91–106 57–72 71–111
3–6 years 95–110 65–80 65–110
6–12 years 105–125 65–80 65–100
Greater than 12 110–135 65–85 55–85
FIGURE 13.7 Sample ECG graph reading.

FIGURE 13.8 Detailed interpretation of a typical ECG graph.
In ECG, three features are included in the form of waves: one is the P wave, which
is related to the activation of artia; another is the compound form of QRS, which is
responsible for the activation of ventricles; and, lastly, the T wave is used to repolar-
ize the ventricles.
The different electrocardiogram intervals produced are based on the starting and
ending times of the waveform. As shown in Figure 13.8, P-R is the time interval from
the start of the P wave to the start of QRS. The QRS interval refers to the duration
between the starting and ending times of the QRS complex. The Q-T interval is the
time period between the start of the QRS and the end of the T wave.
13.5 IMPLEMENTATION
The implementation process of this proposed system consists of six different mod-
ules, termed as an Acoustic body sensor and coordinator device/node, Access Point
(AP), servers, XAMPP platform, Open/Limited access blockchain and decentralized
network of blockchain, display monitoring center and emergency services.
13.5.1 Acoustic Body Sensor and Coordinator Device

An acoustic body device or sensor is a wired node with the capability to receive audio
signals or to convert other signals to acoustic signals. Also it may have the ability to
communicate with the wireless sensor network. It can translate other signals to its
corresponding audio signal, has the ability to gather organized data from the audio
signal, and has the potential to detect human activity with different connected nodes
within the network. These nodes are connected to the coordinator device through
hardwire or wirelessly.
13.5.2 Access Point
A device that is used to connect wireless devices to a wired network through the
Internet, Wi-Fi, or Bluetooth is called an access point (AP). A router is connected to
the AP through the wired network in the form of a separate device, or the device may
be connected directly as an inherent part of a router. Atypically, an AP connects to a
wired local area network, after which the AP allows wireless connections to different
devices using that connection. The healthcare associate looking to enter registers
with the gateway, records the neighbor’s details, and connects with the neighbor.
Following that, the AP, according to the registration requests, generates from sensing
elements, and identifies the devices in its coverage area. If a node is gifted inside the
coverage region, it is identified with the access point as well. If the sensor is outside
the existing coverage area of network, the node of the sensor device registers to the
new access, collect data, and transfers it to the access point.
13.5.3 Servers
Different servers can be used here, such as application servers, real-time com-
munication servers, database servers, etc. An application server is used to host
applications. Application servers are placed between database servers and Apache
web servers, physically or virtually, to interact between stored application data
and communicating clients. These application servers are heavily configured com-
puters that provide various application resources to system users and web clients.
The real-time communication server is used so that all data readings taken from
the patient’s body are instant values or have negligible latency or transmission
delay. Hence real-time communications are never stored in an interim state any-
where between the source and the destination; for this reason, the proposed system
has been recognized as a live monitoring system. Some database servers are also
implemented to operate collected data in a managed and organized way. Database
servers are highly configured computers that are used to manage and store data in
a well-formed manner; the data is stored on a server for a network of patients and
various deployed devices.
13.5.4 XAMPP Platform
XAMPP is an open source and free network. It works on all possible available oper-
ating systems such as windows, MAC, and Linux system. Generally, two local hosts
are available: One is WAMPP, and the other is XAMPP. But WAMPP is only suitable
for the Windows operating system; so, in this technique, XAMPP platform is used.
Also it is the best platform among all web application in PHP.
13.5.5 Open and Limited Access Blockchain

In this proposed technique, both open and limited blockchain technologies are used
to allow access to all users or stakeholders for accessing all types of general data and
information and to provide access to restricted data.
13.5.6 Decentralized Blockchain Technology

Single point failure, which occurs frequently in conventional centralized database
management systems, is eliminated by the decentralized blockchain. Therefore, the
decentralized network of blockchain technology is used in this suggested approach.
This blockchain’s data is kept on a network of individual computers that also keeps
track of and updates transaction logs.
13.5.7 Display Monitoring Centre

All the desired patient test values are displayed on various equipment in the central
monitoring center with displaying function. Here, IP gateway plays a vital role; it
allows for communication among various networks and controls the flow of data
between networks that are connected to a display monitor.
13.5.8 Emergency Services
If any patient’s test report produces abnormal results or it does not meet the respec-
tive reference values, then, from this central monitoring center, a doctor/medical
staff can take necessary emergency action for this patient.

This chapter presented the WSN-based health monitoring system for patients, which
monitors health parameters like heart rate, pulse rate, systolic and diastolic rate of
blood flow, ECG graph, etc. of a critical patient whose health status must be moni-
tored continuously. Because audio signals come from a variety of sources or sensors,
this technique employs a multidimensional signal approach. By connecting the idea
of a multidimensional channel to an audio-based wireless sensor network (WSN),
different signals created by various sensors or sources can be broadcast simultane-
ously across the WSN without interfering with one another. In order to categorize the
signals in this suggested WSN system as odd or even, symmetrical and antisymmet-
rical signal concepts are also applied. It helps doctors remotely check on a patient’s
health without physical contact. This capability reduces the chances of contracting a
virus from an infected patient, for example, in a pandemic situation like COVID-19,
or adenovirus, or some other communicable disease. Although a large number of
self-regulating organizations report to a centralized information system, communi-
cable disease surveillance is an ongoing, difficult, and inefficient activity. As a result,
maintaining a continuous and timely flow of information is a difficult effort.
At a time when an increased number patients have to be monitored at onetime and

when physical interact with the patients is not possible, such a system is very helpful,
especially in a situation wherein a huge number of doctors are also COVID affected.
So using this proposed methodology, involving minimum hospital manpower, help-
ful especially in COVID-like pandemic situations. Due to use of the Internet, WSN
and coordinator devices, and blockchain technology, data can be made available for
remote use, which requires authorization for outsiders. Thus, the proposed work suc-
cessfully achieves security, prime data availability, good functionality, and correct-
ness. Nearly 90% of the results are correct, as proved by comparing these results
to other standard kits and commercial instruments. Using this efficient monitoring
system, it is possible to not only determine but predict a serious condition of a patient.
When serious condition occurs, it alerts doctors and is helpful for sensitive patients
in the hospital’s ICU who need continuous monitoring. The utilization of this method
can be extended to taking care elder people staying all alone at their homes and also
for baby care.
In future, the communication can be made by incorporating IoT- and FPGA-
based applications so that doctors can monitor at a centralized level as well as
local level for various sensitive patients. This system needs some advancement so
that doctors can provide advice to patients online and so that patients can have
their questions answered and feel comfortable with the doctors. To achieve 100%
correctness and make the system reliable, more effort is needed. In future, the
authors will be working on an SMS facility that alerts a patient’s caregiver via the
family’s registered cellphone, so that the patient’s health status can be monitored
continuously.
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in Healthcare With
the Internet
Case Study II
Varsha Gautam and Surbhi Gupta
14.1 INTRODUCTION
Enhancing the quality and accessibility of healthcare while maintaining afford-
ability is a global challenge faced by healthcare organizations (Raja et al., 2023).
This challenge is exacerbated by the rapid growth of the world’s aging population,
particularly in the 60 and older age group, which is predicted to reach 2.1 billion
by 2050 according to the World Health Organization (WHO). An aging population
often leads to an increase in chronic diseases, requiring frequent medical visits and
hospital stays. As the number of patients in need of ongoing care rises, the cost of
healthcare also escalates.
Currently, monitoring a patient’s health for specific risks presents difficulties for
doctors, including constant patient tracking and timely administration of medication
(Tian et al., 2019). Researchers are actively pursuing the development of an ideal
system by leveraging current cutting-edge concepts and methods. Recent years have
witnessed successful deployments of various iterations of healthcare monitoring sys-
tems in multispecialty hospitals, healthcare facilities, and laboratories, with continu-
ous improvements in technology and implementation (Tian et al., 2019; Bhambri and
Gupta, 2013; Raja et al., 2023). The entire healthcare industry, like many others, is
undergoing a digital transformation, and technologies such as 5G, cloud computing,
and AI are poised to bridge various gaps. These gaps range from limited access
to basic healthcare services in some regions to a projected workforce shortage of
18 million by 2030 (Charalambous et al., 2023; Morrow et al., 2023). The Internet
of Medical Things (IoMT) has gained widespread use in the healthcare sector, facil-
itating patient access to care and optimizing delivery methods. IoMT usage has led
to the development of electronic health record (EHR) systems, allowing the seam-
less exchange of patient health history among physicians. EHRs improve patient–
provider communication and are integral to the concept of digital healthcare, also
known as connected health. Connected health has evolved over time, offering more
flexibility and convenience in healthcare management beyond electronic patient
data and web portals. Mobile applications, smart devices, and wireless technologies
enable patients to easily connect with their clinicians without frequent visits. The
204 DOI: 10.1201/9781003459347-14

evolution of connected health into smart health enables continuous monitoring and
treatment for patients, even in their homes, through wearable medical devices, IoT
sensors, and implantable or ingestible sensors. Smart health is expected to reduce
hospitalization costs and provide prompt treatment for various medical conditions
(Cheng et al., 2021; Kelly et al., 2020). The combination of IoT sensors and smart
health devices generates significant amounts of data, often referred to as big data.
Effective analytic tools can process this data to deliver valuable insights to doctors,
enabling prompt and informed decision-making for improved health management.
In conclusion, the integration of advanced technologies like IoT and smart health
has the potential to revolutionize healthcare, offering continuous monitoring, per-
sonalized care, and data-driven insights to healthcare providers and patients alike.
This transformative approach to healthcare management is a promising solution to
address the challenges posed by an aging population and the increasing demand for
quality healthcare services worldwide.
14.2 INTELLIGENT DEVELOPMENT IN HEALTHCARE

The continuous advancement of information technology has significantly improved
people’s living standards in the present era, and the hospital’s informationization
project has also achieved notable success (Cheng et al., 2021). The rapid progress of
IoT technology has played a pivotal role in driving informationization and intelligent
development within the medical and healthcare industries. Originally focused on
hospital informationization and intelligent building, the objectives have evolved to
include intelligent medical care.
In response to the need for medical and health system reform and the demand for
accessible intelligent medical services, numerous developed nations around the globe
have embraced the integration of IoT technology in the medical and health sectors
(Othman et al., 2022). IoT has assumed a crucial role in establishing intelligent med-
ical care worldwide, providing technical support for hospitals’ intelligent staff and
equipment management and aligning with the current requirements of the medical
information management and equipment fields (Bhambri and Gupta, 2014). Medical
administrators and academic professionals have shown keen interest in exploring the
vast application potential of this technology.
The implementation of smart management practices is becoming increasingly
important in enhancing overall medical and health services’ quality and ensuring
preparedness against potential risks to public health. Consequently, research focused
on leveraging IoT in the realm of intelligent medicine holds immense significance.
See Figure 14.1 for an illustration of the smart healthcare system.
IoT has the main attention on a global scale and has swiftly emerged as a research
and application focus supported by government and academia. An effective outcome
for advancement in science and technology as well as economic growth has been
achieved by integrating emerging IoT with traditional industries at the same time as
vigorously promoting research and application of IoT at the national strategic level
(Bhambri, 2014a). Among the many technologies in IoT, the earliest and most widely
used radio-frequency identification (RFID) technology is the most comprehensive
FIGURE 14.1 Intelligent development in healthcare.
and promising. This method achieves automatic contactless identification of objects

by utilizing the transmission properties of radio frequency signals. RFID has an
automatic recognition technology with a non-line-of-sight range, which has strong
interference resistance and carrying ability, in contrast to barcodes, QR codes, opti-
cal recognition, ultrasonic recognition, and biometrics (including voice, face, fin-
gerprint, and iris recognition). Low production costs and a comparatively lengthy
operating life are the apparent benefits. As a result, it is frequently utilized in a vari-
ety of disciplines, including intelligent library management, security access control
systems, assembly line manufacturing, raw material supply chains, automatic vehicle
identification and billing, and many others (Cheng et al., 2021, Othman et al., 2019).
14.3 BASE OF INTELLIGENT DEVELOPMENT IN HEALTHCARE

Smart healthcare services have undergone a transformative shift, leveraging
cutting-edge information technology developments such as IoT, big data analytics,
cloud computing, AI, and deep machine learning (Tian et al., 2019). These advance-
ments have revolutionized traditional healthcare delivery, making it more effective,
convenient, and personalized.
Recent strides in information computing technologies have paved the way for
healthcare solutions with advanced predictive capabilities, both within hospitals and
beyond their walls (Bhambri, 2014b). By harnessing sensors and remote monitoring
equipment, patients can now be evaluated and monitored in their homes, creating a
seamless continuum of care accessible through cloud platforms. Virtual models are
being used to extend treatment from hospitals to home settings (Verdejo et al., 2021;
Othman et al., 2019).
At the heart of these smart health services lies IoT, providing the essential plat-
form for their functioning. IoT facilitates the collection, transmission, and storage of
health data through sensors, enabling data analytics and intelligent healthcare prac-
tices. This empowers healthcare providers to better identify risk factors, diagnose
and treat diseases, monitor patients remotely, and empower patients to self-manage
their health. Furthermore, IoT opens up opportunities to enhance the overall service
delivery ecosystem’s effectiveness and efficiency. This includes optimizing hospital
management, medical asset management, staff workflow monitoring, and resource
allocation based on patient flow (Kelly et al., 2020). The dependency of healthcare
on IoT is evident, as shown in Figure 14.2.
14.3.1 IoT/IoMT: Keys to Implementation of Sustainable Development

For the healthcare industry, the Internet of Medical Things (IoMT) is another name
for IoT technologies. IoT and IoMT are used interchangeably throughout this chapter.
The human race has started a new decade of the millennium at the end of 2020.
The Internet has taught humans many important lessons as a potent vehicle for tech-
nological growth, and, as time goes on, yet another transition will inevitably take
place. Our lives are being revolutionized by well-known ideas like the “smart home,”
FIGURE 14.2 Base of intelligent development in healthcare.

“smart grid,” “smart city,” and “smart health.” Public health, sustainable develop-
ment, and energy efficiency are interconnected factors that have the power to change
an environment or a system for the betterment of both people and the environment
(Ahmed et al., 2020). Almost all corporate sectors have benefited greatly from IoT
technologies, which has also revolutionized how various procedures are carried out
and managed. It involves tying sensors and actuators to mechanical and digital equip-
ment, furniture, items, animals, and people in order to collect data and boost effi-
ciency, productivity, and well-being (Mohapatra et al., 2019). For instance, machine
learning has an impact on Industry 4.0, digital enterprise transformation, hospitality
and tourism, education and e-learning platforms, hospitals, and healthcare systems
(Rani, Kumar et al., 2023). IoMT is one of the most promising technical solutions to
bridge the global health equality gap. It has merged as the base of intelligent health-
care (Bhambri, 2014c).
Figure 14.3 shows the cyclic chain of improvement and development of intelligent
development, healthcare information, awareness, knowledge, communication, diag-
nosis, treatment, better healthcare systems, and sustainable development, represent-
ing IoT/IoMT as the key to sustainable development of any nation.
The COVID-19 coronavirus illness has affected healthcare services. The collection
of information on disease symptoms, statistics, and contact tracking was greatly aided
FIGURE 14.3 IoT/IoMT: key to sustainable development.

by digital technology (Chang, 2020; Othman et al., 2019). Machine learning improves
and increases the efficacy of traditional healthcare systems (Sidey-Gibbons et al., 2019).
This chapter examines machine learning methods and resources that can improve
the effectiveness of intelligent healthcare (Rani, Mishra et al., 2023). The information
presented illustrates the extraordinarily potent learning algorithms that are revolu-
tionizing the healthcare industry. The ensuing sections talk about machine learning.
When big data, machine learning, and the IoT are combined, intelligent healthcare
benefits greatly (Jahan T., 2021).
14.3.2 Machine Learning in Healthcare

Building a system that mimics human intellect is the goal of the well-known study
area of ML technology. Healthcare is one area where ML can be used (Valverde
et al., 2022). Although it cannot take the role of actual doctors, it can create better
answers to healthcare issues (Javaid et al., 2022). It is the most crucial topic for
developing automated computational methods. In this chapter, we examine the
most recent research on using ML to advertise healthcare solutions (Rani, Kataria
et al., 2023). ML applications can be used for diagnosis, prognosis, and the ideal
treatment plan for the discovered disease in the healthcare industry to monitor and
observe the efficacy of treatment (Shehab et al., 2022; Ozaydin et al., 2021; Vyas
et al., 2019). Medical professionals can benefit from ML technology by giving them
access to quicker and more precise answers. Readers can discover the principles
and progressive advancements from a cutting-edge ML-based healthcare system, but
the dynamic nature of medical research and technology produces a novel situation
that needs to be investigated from multidisciplinary and holistic perspectives (Shah
et al., 2019). The objectives of this chapter are to provide innovative and high-caliber
research offerings in the field of healthcare, which are made possible by ML proce-
dures and techniques. Because ML analyses a significant amount of data every day,
the healthcare industries are concentrating on boosting its power (Kaur et al., 2023).
14.4 ML-BASED INTELLIGENT DEVELOPMENT IN HEALTHCARE

Machine learning (ML), a subfield of artificial intelligence, plays a crucial role in improv-
ing forecast accuracy and aiding decision-making processes across various scenarios. It
accomplishes this by employing diverse methods to learn from abundant data variables
and identifying complex correlations among data elements. The ML process begins with
data and labels, where a classifier is trained to learn and create models using algorithms.
Subsequently, the data is evaluated and analyzed to make predictions.
ML encompasses three fundamental learning algorithms: regression, cluster-
ing, and classification. Clustering employs unsupervised learning to group data into
smaller clusters, making it useful for discovering relationships among datasets, such as
the likelihood of disease recurrence in a population due to pollution or chemical spills.
On the other hand, classification and regression are part of supervised learning.
Classification uses labelled data to predict discrete and categorical response values.
For instance, it can determine whether a biopsy sample contains cancer (positive/
negative) by leveraging labelled data and relevant parameters.
Regression, on the other hand, is designed to forecast continuous-response numer-

ical values, enabling the identification of distribution trends. An example of this is
predicting the time it will take for a patient to be readmitted to the hospital after
being discharged, either positively or negatively influenced by certain factors.
These ML techniques are powerful tools that aid in understanding data patterns,
making accurate predictions, and supporting decision-making processes in diverse
domains (Ahmed et al., 2020; Verma et al., 2022).
ML brings numerous computational benefits to healthcare, enabling real-time
patient monitoring, disease pattern analysis, diagnosis, and personalized medica-
tion prescription (Kataria et al., 2023, July). It enhances patient-centric care deliv-
ery and reduces clinical errors while aiding in prognostic scoring and therapeutic
decision-making. ML also plays a crucial role in identifying sepsis and assessing
the risk of medical emergencies, making it a transformative force in the healthcare
industry (Abdelaziz et al., 2018). In medicine, various ML algorithms are commonly
used, such as SVM (support vector machine), deep learning, logistic regression, DA
(discriminant analysis), decision tree, random forest, linear regression, Naïve Bayes,
K-nearest neighbor (KNN), and hidden Markov model (HMM) (Ahmed et al., 2020).
14.5 METHODOLOGY
The proposed methodology of this chapter revolves around the utilization of the
Kaggle Community Platform to classify MRI images into distinct brain tumor types
or identify the absence of a tumor (Puri et al., 2023, September)). This classifica-
tion task is achieved through the implementation of a convolutional neural network
(CNN) using Keras and OpenCV. The methodology comprises the following steps:
Image Preprocessing: An appropriate media filter is chosen to enhance the

quality of the input MR brain images.
Model Architecture:
The sequential model is imported from the Keras library.
Relevant layers such as Conv2D, Flatten, Dense, MaxPooling2D, and Drop-
out are added to the model.
The model architecture is defined by configuring and connecting these
layers.
Data Preparation:
MRI images are imported from the PIL library.
A folder path is created to store the images, and the desired output image
size is specified.
Specific labels are assigned to various types of brain tumors (glioma tumor,
meningioma tumor, no tumor, and pituitary tumor).
The OS folder path is combined with the image data, and the images are
appended accordingly.
Train-Test Split:
The dataset is split into two subsets, namely training and testing, to assess
the model’s performance.
To accomplish this split, the train-test split function is utilized.
CNN Training:
The convolutional neural network (CNN) algorithm is used for deep learning.
The model is trained on the training set to learn the patterns and features
associated with different brain tumor types.
Performance Evaluation:
Accuracy graphs and loss graphs are generated to visualize the model’s per-
formance during the training process.
These graphs provide insights into the accuracy and loss metrics as the
model iteratively learns from the training data.
Prediction:
Images are imported from TensorFlow for processing and analysis.
The model takes an image URL as input to make predictions about the pres-
ence of a brain tumor in the MRI image.
The model utilizes the “predict” function to carry out the prediction process and
determine whether a brain tumor is present or not in the given MRI image.
Hardware Acceleration: The method utilizes the notebook accelerator GPU
P100 for faster execution.
By following this methodology, the goal of the work is to achieve accurate classi-
fication of MRI images into different brain tumor types or determine the absence of
a tumor. The steps are shown as in Figure 14.4.
FIGURE 14.4 Flowchart for ML methodology.

14.6 RESULT
The training and authentication accuracy rate is good as the graph is increasing, as
shown in Figure 14.5(a), and our training and validation loss rate is also satisfactory,
as we can see in the chart. It’s quite less, as shown in Figure 14.5(b).
After importing the image from the file, we applied our methodology to analyze
and classify the image. The output of this process is presented in Figure 14.6.
Figure 14.6 shows an image that represents a pituitary tumor. In our classification
scheme, this type of tumor is assigned the label 3. Additionally, we classified other
types of tumors as follows:
Glioma tumor → labelled as 0

Meningioma tumor → labelled as 1
No tumor → labelled as 2
Pituitary tumor → labelled as 3 (as seen in Figure 14.6)
FIGURE 14.5 (a) Training and validation accuracy rate. (b) Training and validation loss rate.
FIGURE 14.6 Pituitary tumor.

14.7 DISCUSSION
Machine learning in healthcare holds the potential to revolutionize personalized and
population medicine, representing a profound leap forward in the medical field’s
capabilities and applications.
Linking operational and analytical healthcare systems through intelligent

frameworks is crucial for specialists from different fields to conduct mea-
surement and predictive analysis using ML.
ML has the potential to play a critical role in clinical operations, research, and
analytics in healthcare.
Using ML in healthcare could lead to significant advances in providing better,
more personalized, and population-based healthcare at lower costs, while
also improving work–life balance for medical professionals (Ahmed et al.,
2020).
In healthcare, the combination of ML and IoMT (Internet of Medical Things)
opens up new applications and challenges for machine learning.
The chapter discusses ML-enabled healthcare procedures and provides a con-
ceptual and mathematical foundation for recent innovations in the field.
It explores ML approaches and the rapidly evolving IoMT platform that trans-
forms conventional medical devices into smart ones.
Academic insights on the convergence of ML and IoT in healthcare were also
presented in the chapter.
These technologies are being utilized to create efficient and intelligent health-
care frameworks.
14.8 CONCLUSION
In conclusion, the investigation conducted highlights the significance of ML as a
prominent research field and a technology that aims to replicate human intelligence.
One of the key applications of ML in healthcare is its ability to examine huge quan-
tities of data to categorize potential clinical trial candidates by utilizing predictive
models based on previous medical history, doctor visits, and other relevant data
points. This enables scientists to streamline the selection process and make informed
decisions.
ML has proven to be beneficial for hospitals and healthcare systems by assisting
in various tasks. Deep learning algorithms, which rely on well-prepared healthcare
data, enable computers to quickly identify patterns and make assumptions. This
capability is instrumental in enhancing the accuracy of diagnoses, treatment plans,
and patient outcomes.
Moreover, ML plays a crucial role in healthcare administrations by facilitating
risk assessment and mitigation. By utilizing ML algorithms, healthcare provid-
ers can identify hidden risk factors and address gaps in care, thereby improving
the accuracy of risk scoring. This empowers healthcare professionals to make
informed decisions and take necessary actions to prevent adverse events and
enhance patient safety.
Another advantage of integrating ML in healthcare is its potential for error reduc-
tion. By automating certain processes and leveraging algorithms to analyze data,
ML systems can minimize human errors and inconsistencies, indicating enhanced

efficiency and patient effects. However, it is necessary to consider ethical implica-
tions when implementing ML in healthcare. Privacy, security, and transparency are
critical factors that must be carefully addressed to ensure patient confidentiality and
trust in the technology.
In summary, ML has developed as a convincing tool in the healthcare industry,
offering enhanced accuracy, improved efficiency, and support for decision-making.
Its potential for error reduction and the ability to identify hidden patterns and risk
factors make it invaluable in improving patient care. Nonetheless, ethical consid-
erations should always be at the forefront to ensure the responsible and ethical use
of ML in healthcare. As technology continues to advance, the integration of ML
into healthcare systems holds tremendous promise for the future of medicine and
hence showcases the potential of intelligent development for efficient healthcare in
the future.
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15 Unleashing the
Potential of Blockchain
in Healthcare
A Comparative Analysis
of Leading Companies
Navroop Kaur, Upinder Kaur, and Harpal Singh
15.1 INTRODUCTION
The healthcare industry is undergoing a digital transformation, driven by emerging
technologies that have the potential to revolutionize patient care, data management,
and overall healthcare delivery. One such technology that has garnered significant
attention is blockchain (Nofer et al., 2017). Blockchain, originally developed as the
underlying technology for cryptocurrencies like Bitcoin, is a distributed ledger sys-
tem that enables secure and transparent transactions. Its decentralized nature, cou-
pled with cryptographic algorithms, ensures the integrity, immutability, and privacy
of data stored within the blockchain (Kaur et al., 2014).
Blockchain technology offers a unique approach to data management and secu-
rity, making it well-suited for various industries, including healthcare. At its core,
blockchain consists of a chain of blocks, where each block contains a set of transac-
tions. These blocks are cryptographically linked together, forming an immutable and
tamper-proof ledger (Androulaki et al., 2018). Unlike traditional centralized systems,
blockchain does not rely on a single authority to validate and record transactions.
Instead, it employs a consensus mechanism, such as proof-of-work or proof-of-stake,
to achieve agreement among participants on the state of the ledger (Rani, Mishra,
et al., 2023).
In the healthcare sector, blockchain holds the promise of transforming the way
medical records are managed, enhancing data security, streamlining processes,
and improving patient outcomes (Wenhua et al., 2023). By leveraging blockchain,
healthcare organizations can create a transparent and trustworthy system for storing,
accessing, and sharing sensitive patient data.
15.2 SIGNIFICANCE OF BLOCKCHAIN IN HEALTHCARE

The significance of blockchain in healthcare stems from its ability to address critical
challenges faced by the industry (Pathak et al., 2023). Traditional healthcare systems
DOI: 10.1201/9781003459347-15 217

often suffer from data silos, fragmented medical records, and interoperability issues,
which hinder seamless data sharing and collaboration among healthcare providers
(Kaur & Bhambri, 2015a). Furthermore, concerns around data security and privacy
breaches have been persistent. Blockchain technology offers a decentralized and
secure platform that can help overcome these challenges (Rani, Kumar, et al., 2023).
By decentralizing data storage and implementing robust encryption algorithms,
blockchain can enhance the security and privacy of patient data (Ghosh et al., 2023).
The distributed nature of the blockchain ensures that data is not controlled by a single
entity, reducing the risk of unauthorized access or manipulation. Additionally, the
transparency and immutability of blockchain records enable auditable and traceable
transactions, increasing trust among stakeholders and reducing fraudulent activities
(Kaur et al., 2023).
Moreover, blockchain has the potential to revolutionize healthcare data interoper-
ability, allowing different systems and stakeholders to seamlessly exchange informa-
tion (Villarreal et al., 2023). Smart contracts, a feature of blockchain, can automate
and enforce agreements, streamlining processes such as insurance claims, supply
chain management, and clinical trials. By eliminating intermediaries and reduc-
ing administrative overhead, blockchain technology can improve efficiency, reduce
costs, and ultimately enhance patient care.
Hence the introduction of blockchain technology in healthcare represents a trans-
formative shift, and, by addressing data management challenges, enhancing security
and privacy, and enabling seamless interoperability, blockchain has the potential to
revolutionize healthcare delivery and empower both healthcare providers and patients.
15.3 APPLICATIONS AND BENEFITS OF BLOCKCHAIN

IN HEALTHCARE
Blockchain technology offers a wide range of applications and benefits in the health-
care industry. Let’s explore some of the key areas where blockchain can make a
significant impact.
15.3.1 Data Management and Interoperability

Blockchain provides a decentralized and secure platform for storing and exchanging
healthcare data. It enables seamless interoperability among disparate systems, allow-
ing healthcare providers, researchers, and other authorized entities to access and
share patient information more efficiently (Iqbal et al., 2019). This streamlined data
exchange improves care coordination, reduces duplication of tests and procedures,
and enhances the overall quality of patient care.
15.3.2 Patient Identity and Consent Management

Blockchain can enhance patient identity management by creating a unique digital
identity for each individual (Kaur & Bhambri, 2015b). This identity can be linked to
their medical records, allowing for accurate patient identification and reducing the
risk of medical errors. Additionally, blockchain-based consent management systems
Unleashing the Potential of Blockchain in Healthcare 219
(Androulaki et al., 2018) empower patients to have greater control over their health
data, determining who can access and utilize their information.
15.3.3 Clinical Trials and Research

Blockchain technology can revolutionize the field of clinical trials and research by
providing a secure and transparent platform for data collection, consent management,
and result verification. By storing clinical trial data on the blockchain, researchers can
ensure data integrity, enhance transparency, and mitigate the risk of data manipulation
(Abou Jaoude & George Saade, 2019). Smart contracts can automate consent processes,
streamline participant recruitment, and enable more efficient trial management.
15.3.4 Supply Chain Management

Blockchain has the potential to transform the pharmaceutical supply chain by enhanc-
ing transparency and traceability. By recording each step of the supply chain, from
manufacturing to distribution, on the blockchain, stakeholders can verify the authentic-
ity, quality, and provenance of pharmaceutical products (Kaur & Bhambri, 2016). This
can help prevent counterfeit drugs from entering the market and ensure patient safety.
15.4 CHALLENGES AND CONSIDERATIONS IN

IMPLEMENTING BLOCKCHAIN
While the potential benefits of blockchain in healthcare are promising, several chal-
lenges and considerations need to be addressed for successful implementation.
15.4.1 Scalability
Blockchain technology, particularly public blockchains like Bitcoin and Ethereum,
currently face scalability limitations in terms of transaction throughput and network
capacity (Bhambri, 2016). As healthcare generates vast amounts of data, scalability
becomes a crucial consideration to ensure the efficient processing and storage of data
on the blockchain.
15.4.2 Data Privacy and Security

While blockchain offers inherent security features, ensuring data privacy remains a
key challenge (Puri et al., 2023, September). Healthcare data is highly sensitive and
subject to strict privacy regulations. Implementing appropriate encryption mecha-
nisms, access controls, and consent frameworks is essential to protect patient privacy
while leveraging the benefits of blockchain (Kataria et al., 2023, July).
15.4.3 Standardization and Interoperability

Achieving seamless interoperability among various blockchain platforms and exist-
ing healthcare systems is critical for widespread adoption. Standardization efforts
and the development of interoperability frameworks are necessary to enable data

exchange and collaboration across different blockchain networks and healthcare
organizations.
15.4.4 Regulatory and Legal Considerations

Blockchain technology operates in a complex regulatory landscape, particularly in
healthcare, where data privacy and security regulations are stringent. Adhering to
regulatory requirements, such as the Health Insurance Portability and Accountability
Act (HIPAA) in the United States, is crucial to ensure compliance and build trust in
blockchain-based healthcare solutions.
15.5 EXPLORING KEY BLOCKCHAIN CONCEPTS

This section delves into the different types of blockchains, namely public, private,
and federated blockchains, and their features and use cases.
15.5.1 Public Blockchains
Public blockchains, such as Bitcoin and Ethereum, are open and decentralized net-
works that anyone can join. They offer transparency and immutability, as all trans-
actions are recorded on a public ledger that can be accessed and verified by anyone.
Public blockchains are well-suited for use cases that require a high level of trans-
parency and where trust is established through consensus among participants. In
healthcare, public blockchains can be used for applications like patient consent man-
agement, clinical research data sharing, and global health data interoperability.
15.5.2 Private Blockchains
Private blockchains, on the other hand, are permissioned networks where access and
participation are restricted to a specific group of participants. These blockchains
offer higher privacy and control compared to public blockchains. Private blockchains
are particularly useful in healthcare settings where sensitive patient data needs to be
shared securely among authorized entities. For example, a private blockchain could
be employed by a group of hospitals to securely exchange patient records, streamline
insurance claims, or manage the supply chain of pharmaceutical products.
15.5.3 Federated Blockchains
Federated blockchains combine elements of both public and private blockchains.
They involve a consortium of organizations or entities that jointly participate in
maintaining the blockchain network. Federated blockchains offer a balance between
transparency and privacy. They enable multiple organizations to collaborate and
share data while maintaining control over access and governance. In healthcare,
federated blockchains can be utilized for regional health information exchange
networks, where different healthcare providers share patient data within a defined
geographic area.
15.5.4 Smart Contracts: A Game-Changing Technology in Healthcare

Smart contracts are self-executing contracts with the terms of the agreement written
into code. They automatically execute actions based on predefined conditions and
ensure that transactions are carried out securely and without the need for intermedi-
aries. Smart contracts have the potential to revolutionize healthcare by automating
processes, reducing administrative burdens, and enhancing trust between parties.
In healthcare, smart contracts can be utilized for various applications, such as
insurance claims processing, supply chain management, and patient consent man-
agement. For instance, a smart contract can automatically trigger payment to a
healthcare provider when predefined conditions, such as the successful completion
of treatment or the submission of required documents, are met. By removing the need
for manual verification and intermediaries, smart contracts can streamline processes
and improve efficiency in healthcare operations.
15.5.5 Tokenization in Healthcare: Understanding Token Usage

Tokenization involves the representation of real-world assets or rights on a blockchain
using digital tokens. These tokens can represent anything of value, including owner-
ship, access rights, or even rewards. In the healthcare industry, tokens can be utilized
to incentivize desired behaviors, grant access to specific services or resources, and
facilitate secure data exchange.
For example, healthcare providers can issue tokens to patients as rewards for
healthy behaviors like regular exercise or medication adherence. These tokens can
then be used to access certain healthcare services, purchase health-related products,
or participate in research studies. Tokenization can also enable secure and traceable
exchanges of health data amongdifferent stakeholders, ensuring data integrity and
incentivizing data sharing for research purposes.
15.6 COMPARATIVE ANALYSIS OF LEADING COMPANIES

This section provides an overview of some of the leading companies that have
adopted blockchain technology for healthcare solutions.
15.6.1 Overview of Leading Companies in Blockchain

Healthcare Solutions
Table 15.1 provides an insightful overview of leading companies in blockchain
healthcare solutions, showcasing their respective blockchain types, token usage,
and smart contract applications. These innovative companies have harnessed
blockchain technology to address healthcare challenges and opportunities.
Common features include the use of smart contracts for streamlined processes and
TABLE 15.1
Comparative Analysis of Leading Companies in Blockchain Healthcare
Blockchain Token Smart
Company Type Usage Contract Application
MedRec (Ekblaw & Azaria, 2016) Public No Yes Healthcare data

BurstIQ (Care Optimization— Private No Yes management
BurstIQ, n.d.)
Healthureum (Healthureum, n.d.) Public Yes Yes
Guardtime (Guardtime Health— Public Yes Yes Pharmaceutical supply
Guardtime, n.d.) chain
MediLedger (The MediLedger Private, No Yes
Network, n.d.) Federated
Patientory (Patientory | Your Public Yes Yes Pharmaceutical supply
Health At Your Fingertips, n.d.) chain
iSolve (ISolve Technologies | IT Private No Yes Security and privacy of
Consulting | Software Service electronic health records
Provider, n.d.)
MedicalChain (Medicalchain— Federated Yes Yes Security and privacy of
Blockchain for Electronic Health electronic health records
Records, n.d.)
SimplyVital Health (SimplyVital Federated Yes Yes
Health Is Using Blockchain to
Revolutionize Healthcare, n.d.)
Factom (Factom® PRO— Public, private Yes Yes
Blockchain as a Service (BaaS)
Platform, Anchor Data into the
Bitcoin and Ethereum
Blockchains, n.d.)
DOC.AI Private Yes No
Robomed Network (Robomed Public Yes Yes Aggregation of medical
Network and the New Era of data
Token‑Based Healthcare—
Bitcoin Magazine—Bitcoin
News, Articles and Expert
Insights, n.d.)
Coral Health (Home | Coral Public Yes Yes
Health, n.d.)
Iryo (Iryo—Digital Healthcare, Public, Yes Yes Clinical data management
Simplified., n.d.) federated
DokChain (DokChain by Federated Yes Yes
PokitDok—Blockchain for
Healthcare—McKesson
Ventures, n.d.)
Gem (GEM HEALTH, n.d.) Public, No No Personalized healthcare
private,
federated
Embleema (Embleema, n.d.) Private No Yes
TABLE 15.1 (Continued)

Comparative Analysis of Leading Companies in Blockchain Healthcare
Blockchain Token Smart
Company Type Usage Contract Application
Avaneer (One Network. Many Private No Yes Administrative decision-
Possibilities. The Avaneer making
Network, n.d.)
ProCredEx (ProCredEx Home Private, Yes Yes Secure data transfer
ProCredEx, n.d.) federated
Dentacoin (Dentacoin, n.d.) Public Yes Yes Specifically for dentists
Clinicoin (Clinicoin—Global Private No Yes Fitness tracker
Health and Wellness Blockchain
Platform, n.d.)
Akira (Akira Health, n.d.) Private, Yes Yes Private network
federated management
the deployment of tokens to incentivize data sharing and engagement. Blockchain’s

inherent security and privacy advantages enable safeguarding patient data and
empowering individuals to control their health information. These companies
exemplify the transformative potential of blockchain in revolutionizing healthcare,
promoting patient-centric care, and enhancing data management and pharmaceu-
tical supply chains.
15.6.2 Analysis of Key Features

The comparative evaluation of company approaches in blockchain healthcare solu-
tions considers several key factors, each of which plays a crucial role in determining
the effectiveness and success of the implementation.
First, the choice of blockchain type, whether public, private, or federated, influ-
ences the level of decentralization, security, and data privacy. Public blockchains
offer transparency and immutability, making them suitable for patient-centric
applications and data sharing. Private blockchains, on the other hand, prioritize
data confidentiality and control, making them suitable for consortium-based
healthcare networks. Federated blockchains strike a balance between decentral-
ization and privacy, allowing multiple organizations to collaborate while preserv-
ing data ownership. The importance of selecting the appropriate blockchain type
lies in ensuring the alignment of the blockchain’s characteristics with the specific
healthcare use case.
Second, tokens serve as a critical incentive mechanism within blockchain ecosys-
tems. Their importance lies in encouraging data sharing, patient engagement, and
network participation. By incentivizing users with tokens, healthcare companies can
foster active participation in data exchange and research collaboration. Additionally,
tokens enable seamless and secure micropayments within blockchain networks,
facilitating new business models and revenue streams. Effective token usage can
drive adoption, enhance platform utility, and promote a thriving blockchain health-
care ecosystem.
Third, smart contracts automate and enforce predefined rules and agreements,
enabling self-executing transactions without the need for intermediaries. The impor-
tance of smart contract applications in blockchain healthcare solutions lies in stream-
lining administrative processes, enhancing data integrity, and reducing operational
costs. Smart contracts can facilitate secure and efficient data sharing, streamline
insurance claim processing, and automate consent management. By utilizing smart
contracts, healthcare organizations can improve the overall efficiency of their opera-
tions and enhance patient experiences.
Last, each company’s specific use cases and applications determine the alignment
of blockchain technology with their healthcare objectives. For example, blockchain’s
application in electronic health record (EHR) management prioritizes data security and
interoperability, while in pharmaceutical supply chains, blockchain ensures transpar-
ency and traceability. The importance of tailoring blockchain applications to healthcare
use cases lies in addressing industry-specific challenges and optimizing the impact of
blockchain technology in improving patient outcomes and operational efficiencies.
15.7 INSIGHTS AND IMPLICATIONS

15.7.1 Key Findings From the Comparative Analysis
The comparative analysis of leading companies in blockchain healthcare solutions
provides valuable insights into the diverse applications, advantages, and disadvan-
tages of blockchain technology in the healthcare industry.
MedRec’s focus on healthcare data management using a public blockchain offers
advantages such as transparency, decentralization, and data integrity, fostering trust
among healthcare providers and patients. However, its openness may raise concerns
about data privacy and security.
Guardtime and MediLedger’s use of public and private blockchains enhances
pharmaceutical supply chain transparency, addressing critical challenges related to
drug counterfeiting. While this approach ensures data integrity and traceability, the
use of private blockchains may limit data accessibility for certain stakeholders.
MedicalChain and Patientory’s emphasis on secure EHR storage and sharing
through federated and public blockchains empowers patients to control their data and
promotes seamless data exchange. However, interoperability challenges may arise
when integrating various blockchain types into existing healthcare systems.
Iryo’s approach with public and federated blockchains streamlines clinical data
management, allowing efficient collaboration among healthcare organizations.
Nevertheless, concerns about scalability and potential data centralization may arise
with public blockchains.
Gem’s patient-centric approach using public, private, and federated blockchains
empowers patients to take control of their health data. However, interoperability com-
plexities among diverse blockchain types may present challenges in data exchange.
Avaneer’s private blockchain for administrative decision-making ensures data
confidentiality and efficient decision-making. Yet limited transparency and the need
for trusted parties may raise concerns about potential centralization.
ProCredEx’s secure data transfer through private and federated blockchains facil-
itates seamless data exchange among healthcare stakeholders, promoting interopera-
bility and collaboration. However, the complexity of managing different blockchain
types may require careful governance.
Dentacoin’s public-blockchain-based platform incentivizes patient engagement
and dental health practices through cryptocurrency rewards. Nevertheless, concerns
about scalability and regulatory compliance in using cryptocurrency may arise.
Clinicoin’s private blockchain for fitness and wellness data tracking ensures data
privacy and encourages community engagement. However, limited accessibility to
data for nonmembers may impact data sharing and research collaboration.
Akira’s secure private network management through private and federated block-
chains ensures data security and privacy. However, the need for trusted subscribers
and limited data visibility beyond the network may restrict data sharing.
In conclusion, the key findings illustrate how each company’s blockchain
approach aligns with specific healthcare applications and presents unique advantages
and disadvantages. Understanding these factors is vital for stakeholders consider-
ing the adoption of blockchain solutions in healthcare. While blockchain technology
offers promising benefits in healthcare data management, supply chain transparency,
patient-centric care, and more, it also brings challenges related to privacy, scalability,
interoperability, and regulatory compliance. By carefully evaluating and addressing
these factors, healthcare organizations can harness the true potential of blockchain
to revolutionize healthcare and improve patient outcomes.
15.7.2 Challenges and Opportunities in the Adoption of Blockchain

The adoption of blockchain in the healthcare industry presents both challenges and sig-
nificant opportunities. One of the main challenges lies in interoperability. Healthcare
systems often use different data formats and standards, making seamless data exchange
across various blockchain platforms difficult. Ensuring compatibility between existing
systems and blockchain technology is crucial to harness its full potential.
Data privacy and security are other critical concerns. While blockchain offers robust
security features, ensuring patient data confidentiality and compliance with privacy
regulations is paramount. Striking the right balance between data transparency and
privacy protection is essential to build trust among patients and healthcare providers.
Scalability is another obstacle. As the volume of healthcare data grows, block-
chain networks must handle an increasing number of transactions efficiently. Scaling
up blockchain platforms without compromising speed and security is a pressing
challenge.
Moreover, regulatory uncertainty poses risks. The healthcare industry operates
within a complex web of regulations, and blockchain’s disruptive nature can raise
questions about compliance and legal implications. Addressing regulatory concerns
and working with policymakers to establish clear guidelines is vital for successful
blockchain adoption.
Despite these challenges, blockchain adoption in healthcare also presents promis-
ing opportunities. Enhanced data security and immutability can significantly reduce
medical fraud and data breaches. Patients can have greater control over their health
records, granting them access to comprehensive and accurate medical histories, fos-
tering better care coordination, and improving treatment outcomes.
Additionally, blockchain technology enables streamlined and secure supply chain
management. Tracking pharmaceuticals and medical devices can enhance transpar-
ency, ensuring the authenticity of products and reducing the risk of counterfeit drugs
in the market.
Blockchain’s potential for data sharing and collaboration opens doors for medical
research and clinical trials. Researchers can access diverse datasets while preserving
patient privacy through encrypted and permission-based data access, accelerating
medical discoveries.
15.8 FUTURE DIRECTIONS AND RECOMMENDATIONS

In the realm of healthcare, the future of blockchain technology holds promising
opportunities and transformative potential. Integrating blockchain with artificial
intelligence can revolutionize diagnostics and personalized treatment plans, while
standardization and enhanced data privacy measures can ensure secure and seamless
data exchange across healthcare networks. Robust identity management on block-
chain empowers patients with control over their health records, while pilot programs
and collaborative efforts pave the way for successful adoption. Continuous education
and regulatory alignment are essential to foster a supportive environment for block-
chain innovation, while sustainable consensus mechanisms address energy efficiency
concerns. By proactively exploring these future directions and implementing recom-
mended strategies, the healthcare industry can unlock the full benefits of blockchain,
creating a patient-centric, secure, and efficient healthcare ecosystem.
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16 Threat Analysis and
Security Measures for
the Internet of Medical
Things (IoMT): A Study
S. Velmurugan, G. Shanthi, L. Raja, and D. Subitha
16.1 INTRODUCTION
16.1.1 Internet of Medical Things (IoMT)
In recent years, the healthcare sector has made remarkable progress due to disrup-
tive technologies. India is a growing economy, and healthcare in particular is one of
the largest sectors in India in terms of both revenue and employment aspects. The
Internet of Medical Things is the most promising technology and has become a game
changer and telehealth leader in the healthcare sector as a patient-centric approach.
The Internet of Medical Things offers the connection of smart medical devices and
supported software applications to improve hospital services, medical equipment,
telehealth, telemedicine, medical visits, and various types of health insurance to
reduce healthcare costs and to improve the patient’s healthcare in an effective man-
ner. IoMT also has the ability to satisfy the fourth important sustainable development
goal of “Good health and well-being.”
According to a Deloitte report, the IoMT market will reach $158.1 billion in 2022,
and IoMT is called one of the key factors in the healthcare sector. The IoMT global
market is increasing the demand and is also expected to grow to $187.60 billion in
2028, at a compound annual growth rate (CAGR) of 29.5%, providing solutions in
the healthcare sector.
16.1.2 Data Processing Architecture of IoMT

IoMT data processing architecture is used to collect real-time environmental data for
determination and segregation, which needs to be maintained and that also has to be
shared across the various computing techniques like grid and cloud computing, fog
and edge computing. The Figure 16.1 clearly explains the architecture of the Internet
of Medical Things. The main use of cloud computing is to improve the bandwidth,
data rate, and response time of the local network by decreasing stored data capacity
of cloud servers. Data security is improved by the fog computing technique. By using
the edge computing technique, network latency time is decreased for processing
DOI: 10.1201/9781003459347-16 229

FIGURE 16.1 Architecture of data processing with various functionality layers in IoMT.
real-time data Cui et al. (2021) developed a health-monitoring framework employing

cloud computing, IoMT devices, connected sensors to monitor cardiac speed, oxygen
saturation percentage, body temperature, and patient’s eye movement.
Sun et al. (2019) explained that IoMT architecture consists of three layers: appli-
cation layer, perceptual layer, and gateway layer. Sensors like wearables, infrared,
and different types of medical sensors collect the required data from a patient to
serve as input to the doctor. The main role of the gateway layer network is in the
speedup of both short- and long-distance data transmission through 4G/5G networks.
To analyze the stored data in cloud/RAM in order to extract the required relevant
information, the device uploads the data to the cloud or not with the help of artificial
intelligence and machine learning algorithms (Bhambri and Gupta, 2016). Finally,
the doctor/caregiver is informed of the decisions made by AI/ML algorithms, based
on the collected data provided by the biomedical sensor, to diagnose the disease.
16.1.3 Impact Analysis of IoMT Wearables in Healthcare

The Internet of Medical Things is integrating medical wearable devices with various
biosensors and is changing the entire healthcare support system. A data-driven decision
system is used to monitor patients in a real-time environment and also remind them to
take their medications at the prescribed times through this technology. Smartwatches
are used to alert or remind patients, and pillboxes prompt patients to take their meds;
home-based gadgets greatly assist disabled patients. IoMT wearables help patients at
home and senior citizens who may communicate directly with a healthcare facility.
Renu (2021) designed and developed wearables during the COVID-19 period. Most
of the countries around the globe expanded the use of digital technology for remote
patient monitoring through telehealth and telemedicine support to do self-assessment.
Samsung Medical, Misfit, and Fitbit, by developing different means of medical
assistance, smart gadgets are used to collect and transfer the patient’s information
to support medical professionals who access the data through the cloud for making
better diagnostic decisions. Such global assistance gadgets are used to track their
patients’ healthcare parameters of blood pressure; heart rate; oxygen, calcium, iron,
and glucose levels; and ECGs with worldwide access by doctors to diagnose the
disease (Kaur and Bhambri, 2016). They are also used for patients to get the proper
medical advice from them on time by saving their travel time with low cost.
Threat Analysis and Security Measures for the IoMT 231
Smartwatch wearables are used to track heart rate, manage diabetes, assist with
speech therapy, help with posture correction, and even detect seizures. Due to brain
swelling, small sensors can be placed inside the skull to assist surgeons in contin-
uously monitoring brain damage and to prevent patients from experiencing life-
threatening swelling. Additionally, smart tablets support patients in their efforts to
preserve their own lives by remotely seeing the colon and gastrointestinal tract.
16.1.4 Remote Patient Monitoring (RPM) System

16.1.4.1 Need for RPM
During the COVID period, the Internet of Medical Things enabled RPM screening
treatment through telemedicine and telehealth technologies that were successfully
adapted for both health providers and patients. IoMT-based smart devices are mak-
ing an huge impact in the worldwide pandemic state. The basic infrastructure of
IoMT consists of required medical devices, software applications, various amenities,
and optimized networks that link them to the telehealth platforms. Patient monitor-
ing systems have improved the response from healthcare experts.
16.1.4.2 Role of IoMT in RPM

In healthcare, the term “IoMT” refers to a network of interconnected sensors, sys-
tems, and medical equipment that gather, transmit, and analyze patient health data. It
promises to boost operational efficiency in the healthcare sector and improve patient
care while enabling remote monitoring (Bhambri and Gupta, 2017a). An IoMT pro-
vides better solutions for RPM by continuous or periodical monitoring of patients
for accurate prediction of diseases times of emergency. Around 88% of SpyGlass
study group healthcare supporters invested in IoMT for their high accuracy results
in healthcare sectors. For example, glucose monitoring for insulin pens works effec-
tively for patients who suffer from diabetes.
According to Goldman Sachs, remote patient monitoring systems help the health-
care industry save over $300 billion annually. In another application of IoMT-based
biosensing technology and sophisticated signal processing, blood glucose monitoring
was created by (Yuce, 2010) and is distinguished by the utilization of several linked
tiny wearable sensors. Bhatia et al. (2020) demonstrated an effective IoMT-based
home-centric urine-based diabetes monitoring system using recurrent neural network.
A remote patient and home monitoring system plays an especially vital role in
chronic disease management. Due to this monitoring and tracking process, it may
increase demand of personal IoT devices to track vital signs and enable effective and
efficient remote care, chatbots, and machine/deep learning tools for initial disease
diagnoses based on the symptoms of patients. It indicates that the future of the med-
ical devices sector will be through IoMT.
16.1.5 Different Types of Homecare Sensors Used in Healthcare Systems

Accelerometer sensors are used to measure acceleration in order to detect blood
glucose levels as well as movement of the body in patients undergoing continuous
monitoring (Shin and Joe, 2015). A humidity and temperature sensor can measure
humidity between 20% and 90% and temperatures between 0°C and 50°C. The
IoMT device’s temperature increase is mostly caused by the antennas’ absorption of
radiation. Tang et al. (2005) noted that this increase in temperature of the implant-
able or wearable devices may cause harm to the user’s bodily tissues and organs
that are being monitored. The electrocardiogram sensor is used to analyze heart sig-
nals, irrespective of the body state of the person under examination (Onasanya and
Elshakankiri, 2021) when it deals with real-time ECG applications, because it is very
sensitive for data loss, and it is time critical (Kataria et al., 2023, July).
16.1.5.1 Enabled Point-of-Care Testing (POCT): A Paradigm

Shift in Medical Diagnosis
The world of modern healthcare has been forever transformed by the advent of point-
of-care testing (POCT), a game changer that allows for rapid and accurate diagnostic
tests to be conducted right at the patient’s side. But now, with the integration of the
Internet of Medical Things (IoMT), POCT has reached new heights of capability and
efficiency, revolutionizing medical diagnosis and forever altering the way healthcare
is administered. IoMT-enabled POCT is ushering in an era of unprecedented access,
precision, and effectiveness in diagnostics, empowering healthcare professionals,
and revolutionizing patient outcomes (Jain et al., 2021).
Unleashing the Power of Swift Diagnostics at the Patient’s Bedside: IoMT-

enabled POCT brings the power of cutting-edge laboratory-grade testing
right to the bedside of patients, whether they be in emergency rooms, remote
locations, or any other healthcare setting. Equipped with state-of-the-art
sensors, intelligent diagnostic devices like blood analyzers, glucometers,
and pregnancy tests capture and transmit test results to healthcare providers
in real time (Puri et al., 2023, September).
Bridging the Gap with Remote and Decentralized Healthcare: One of
the most remarkable advantages of IoMT-enabled POCT lies in its abil-
ity to support remote and decentralized healthcare settings (Bhambri and
Gupta, 2017b). In far-flung rural areas or underserved communities where
advanced medical facilities may be lacking, portable POCT devices with
Internet connectivity bridge the gap. With these devices, healthcare pro-
viders can remotely monitor the patient’s health conditions and intervene
promptly in case of any abnormalities, leading to improved access to health-
care and better outcomes (Venu et al., 2022).
16.1.6 Smart Diagnostic Devices: The Magical Fusion of

Medicine and Technology
Step into a world where the Internet of Medical Things (IoMT) dances harmoni-
ously with smart diagnostic devices, painting a brand-new canvas of medical diag-
nosis. Once conventional healthcare practices have been morphed into something
extraordinary, with the power to drastically change patient care (Appelboom et al.,
2014). Equipped with sensors and seamlessly connected to the Internet, these smart
diagnostic devices revolutionize healthcare by collecting and transmitting real-time
health insights. The resultant enhanced accuracy, accessibility, and efficiency pave
the way for better patient outcomes—a true quantum leap in the realm of medicine
16.1.6.1 Telemedicine: The Confluence of Technology and Healing

Witness the beautiful marriage between smart diagnostic devices and telemedicine
platforms, where virtual consultations between patients and healthcare providers
become a reality. During these ethereal remote visits, patients’ can utilize connected
devices to perform diagnostic tests or share vital signs, creating a digital bridge that
connects professionals to the very essence of their patient’s health. Time is saved,
resources are preserved, and healthcare becomes more accessible, especially for
those dwelling in distant or underserved areas (Romero et al., 2016). Be ready to
witness a new chapter in medicine, where the barriers of distance crumble under the
weight of innovation.
16.2 THREATS AND CHALLENGES OF IoMT

By integrating medical equipment, wearables, and healthcare systems for better
patient care, the Internet of Medical Things (IoMT) has the potential to revolutionize
healthcare. However, in addition to its benefits, the IoMT (Panja et al., 2022) poses
significant threats and problems that must be handled (Bhambri and Gupta, 2017c).
There are more challenges in training and education, security threats, data integrity,
regulations, infrastructure, and ethical considerations Rani et al. (2023).
Security and Privacy Concerns: As medical equipment becomes more con-

nected and sensitive, and more patient data is transmitted, security becomes
a big worry. Cyberassaults, data breaches, and illegal access (Khan et al.,
2022) can all occur on IoMT devices. Protecting patient privacy and pro-
tecting data security are essential issues that must be addressed if trust in
the healthcare system is to be maintained.
Data Integrity and Accuracy: IoMT creates massive volumes of data, such
as patient health records, real-time monitoring data, and diagnostic data. It
is critical to ensure the integrity and validity of this data in order to make
educated healthcare judgments. To preserve the dependability and trustwor-
thiness of IoMT systems, issues such as data corruption, data validation,
and data interoperability must be addressed.
Interoperability and Standardization: The integration of numerous medi-
cal devices, wearables, and healthcare systems, which frequently employ
distinct protocols, data formats, and communication interfaces, is referred
to as IoMT. Interoperability among these diverse technologies is a serious
hurdle. It is critical to establish common standards and protocols to enable
seamless data interchange, device integration, and effective communication
among various IoMT components.
Regulatory and Legal Challenges: IoMT’s rapid development frequently out-
paces the regulatory structures intended to oversee its use. In the context of
IoMT, ensuring compliance with existing standards such as data protection
and patient privacy legislation might be difficult. Addressing liability and
accountability issues when faults or malfunctions occur in IoMT devices or

systems also poses legal challenges that must be overcome Rani et al. (2023).
Ethical Considerations: IoMT poses ethical concerns about the collecting,
storage, and use of patient data. Consent management, data ownership, and
the possibility of discrimination based on health data must all be carefully
evaluated.
Infrastructure Requirements: Implementing IoMT requires robust and reli-
able infrastructure, including high-speed Internet connectivity, network
bandwidth, and data storage capabilities. Particularly in rural or underde-
veloped areas, ensuring the availability of necessary infrastructure can be a
challenge, limiting the widespread adoption and impact of IoMT.
Training and Education: The successful adoption of IoMT necessitates the
training of healthcare workers in the use and interpretation of data provided
by linked devices and systems. Healthcare practitioners must learn the skills
required to use IoMT efficiently and recognize its limits. It is critical to pro-
vide appropriate training and instruction for healthcare personnel in order to
fully realize the potential of IoMT. Addressing these dangers and hurdles is
critical for successful IoMT integration and adoption. Collaboration among
stakeholders, such as healthcare providers, device manufacturers, legisla-
tors, and regulators, is essential for building solid solutions and frameworks
that limit risks while maximizing the benefits of IoMT in healthcare.
16.3 CYBER-PHYSICAL SYSTEMS (CPS)

A cyber-physical system (CPS) is a set of physical and computational elements that
are linked and tightly integrated to monitor and control physical processes. CPS
(Fernandez, 2016) entails the seamless integration of physical and networked com-
puting systems in order to construct intelligent, responsive, and autonomous systems.
Here are some key characteristics and components of CPS.
Physical Components: Sensors, actuators, machines, robots, cars, infrastruc-

ture systems (e.g., smart grids), and other tangible objects that interact with
the physical world are examples of CPS.
Computational Elements: To gather, process, analyze, and act on data from
physical components, CPS incorporates computing, communication, and
control systems. Embedded systems, software, algorithms, and communi-
cation protocols are examples of computational elements.
Interconnectivity: To connect physical components and computational parts,
CPS uses networked communication technologies such as wired and wire-
less networks. These links allow data, commands, and feedback to be sent
across the physical and digital domains.
Real-Time Monitoring and Control: CPS permits the monitoring and con-
trol of physical processes in real time. The computational parts collect data
from sensors on a continual basis, analyze it, and make choices or trigger
actions to manage the physical components and processes.
Autonomy and Adaptability: Using artificial intelligence (AI) approaches,

machine learning, and decision-making algorithms, CPS systems can
demonstrate autonomous behavior. Based on the data they acquire, they
can adapt to changing situations, optimize operations, and make intelligent
judgments.
Safety and Security: CPS systems must assure the safety and security of both
physical and computational components. They require strong security mea-
sures to defend themselves from cyberattacks, unauthorized access, and
data breaches. Safety systems are also required to protect persons and the
environment from physical harm.
Integration with the Internet of Things (IoT): CPS often overlaps with the
IoT, as it involves the integration of physical devices and computational sys-
tems. The IoT provides a framework for connecting and managing large
numbers of devices and sensors, enabling data sharing and interaction
within the CPS ecosystem.
Transportation systems, manufacturing, healthcare, smart cities, energy grids, agri-

culture, and robots are just a few of the sectors where CPS is used. CPS improves
efficiency, improves decision-making, optimizes resource use, and enables intelli-
gent automation in a variety of industries by merging physical systems with modern
computer and networking.
16.4 CYBER-PHYSICAL SYSTEMS AND INTERNET OF

MEDICAL THINGS
CPS (cyber-physical systems) and the IoMT (Internet of Medical Things) are sepa-
rate concepts, yet they are connected and can overlap in specific healthcare applica-
tions. Medical sensors, wearables, and remote monitoring devices are examples of
IoMT devices that can be integrated into a CPS framework. Healthcare practitioners
can construct sophisticated and responsive systems that monitor and regulate medi-
cal processes in real time by integrating these devices with computational elements
and control systems. A CPS, for example, can use IoMT devices to monitor patient
vital signs and modify prescription dosages as needed. Both CPS and IoMT (Weber
et al., 2023) rely on data exchange and interoperability. CPS systems often require
data from various sources, including IoMT devices, to make informed decisions and
control physical processes. IoMT devices generate valuable patient health data that
can be used by CPS systems for analysis, decision-making, and automation. CPS and
IoMT confront comparable security and privacy problems. Ensuring the security,
integrity, and availability of data generated by IoMT devices within a CPS setting is
critical. To secure sensitive patient information and prevent unwanted access to the
CPS infrastructure, robust security mechanisms, such as encryption and authentica-
tion, must be deployed. IoMT devices collect real-time data on patient health status
and can be linked into a CPS framework for continuous monitoring and control. CPS
systems can respond to changes in patient circumstances by incorporating IoMT data
and initiating relevant actions or alarms.
FIGURE 16.2 Relational diagram of CPS and IoMT.
CPS and IoMT have a wide range of applications in healthcare. A CPS, for exam-
ple, can be used to automate medical workflows, enhance resource allocation, and
increase patient safety. IoMT devices can be incorporated effortlessly into the CPS
infrastructure to remotely observe the health of the patient, track medication obser-
vance, and deliver real-time feedback to healthcare practitioners.
While CPS and IoMT are independent ideas, their integration can improve the
capabilities of healthcare systems by combining real-time data from IoMT devices
with the computing capacity and control mechanisms of CPS in healthcare applica-
tions; these relations are shown in Figure 16.2. This connection provides advanced
monitoring, decision-making, and automation in healthcare environments (Ali et al.,
2023), resulting in improved patient care and operational efficiency.
16.5 TRUST, SECURITY, AND PRIVACY

MECHANISM FOR IOMT AND CPS
To secure the safety of sensitive data, preserve system integrity, and develop confi-
dence in the healthcare ecosystem, trust, security, and privacy procedures are critical
FIGURE 16.3 Critical parameters for IoMT and CPS.
considerations for both the IoMT and CPS. Here are some examples of commonly
used mechanisms as shown in the Figure 16.3.
16.5.1 Parameters for IoMT and CPS

Authentication and Access Control: Implement robust authentication mea-
sures, such as passwords, biometrics, or two-factor authentication, to vali-
date the identities of users, devices, and systems before granting access to
sensitive data or system functions. There should be access control methods
in place to enforce necessary permissions and limit access based on roles
and responsibilities.
Encryption: Encryption techniques should be devised to ensure document
secrecy during storage and communication. Even if data is intercepted or
hacked, encryption assures that it cannot be viewed by unauthorized per-
sons. To protect sensitive information, use robust encryption techniques and
key management practices.
Data Integrity and Validation: Implement procedures to assure data integ-
rity inside IoMT and CPS systems (Khaitan and McCalley, 2015). Use
techniques such as checksums or digital signatures to ensure data integrity

during transmission and storage. Data validation mechanisms should be in
place to detect and reject any altered or corrupted data.
Secure Communication Protocols: Utilizing encryption-based communica-
tion protocols like transport layer security (TLS) creates private connec-
tions between hardware, software, and networks. Secure protocols ensure
the confidentiality and integrity of data sent between components by using
encryption, authentication, and data integrity checks.
Privacy by Design: Integrate privacy considerations into IoMT and CPS sys-
tem design and development (Sun et al., 2019). Follow privacy principles
including data reduction, purpose limitation, and user permission. Use
privacy-enhancing technologies such as anonymization or pseudonymiza-
tion to safeguard individual privacy while allowing for effective data anal-
ysis and processing.
Regular Software Updates and Patch Management: Maintain the most
recent security patches and updates for all software components, operating
systems, and firmware. Monitor for vulnerabilities and security warnings
related to IoMT and CPS system components on a regular basis. Apply
patches and updates as soon as possible to mitigate known security concerns.
Secure Data Storage: Implement secure data storage systems to safeguard
sensitive data. Strong encryption of stored data and access restrictions
(Albrekht and Pysarenko, 2020) are needed to limit data access to autho-
rized personnel, and comprehensive backup and disaster recovery methods
are all part of this.
Auditing and Monitoring: Create auditing and monitoring tools for IoMT
and CPS systems to detect security breaches, unauthorized access, or aber-
rant behavior. To quickly identify and respond to security problems, use log
analysis, intrusion detection systems, and real-time monitoring technolo-
gies to promptly detect and address security issues.
Regulatory Compliance: Keep up-to-date on relevant data privacy and
security legislation and standards in healthcare, such as HIPAA (Health
Insurance Portability and Accountability Act) in the United States and
GDPR (General Data Protection Regulation) in the European Union. Ensure
that these regulations are followed in order to safeguard patient privacy and
avoid legal ramifications.
Education and Training: Provide education and training to healthcare pro-
fessionals, system administrators, and users about best practices in cyber-
security, privacy, and data protection. Create awareness about the risks and
potential threats associated with IoMT and CPS systems and promote a
culture of security and privacy within the organization. Implementing these
trust, security, and privacy measures protects IoMT and CPS systems from
potential attacks, safeguards sensitive data, and fosters confidence among
patients, healthcare providers, and stakeholders. As the threat landscape
evolves and new vulnerabilities arise, it is critical to continuously analyze
and update these procedures.
16.6 IOMT SECURITY ESSENTIALS

IoMT supports the conventional healthcare system by means of furnishing reliabil-
ity, accuracy, etc. according to the current requirement. Although it enables medical
devices to communicate autonomously over a network, it is subjected to privacy and
security issues. Health-related data is frequently regarded as being overly sensitive
and intrusive. Patients often don’t wish to see their medical or health-related infor-
mation to be leaked. The implementation of IoMT security essentials within the
healthcare system of a large hospital network comprises numerous connected medi-
cal devices, patient monitoring systems, and backend infrastructure.
Medical devices with Internet connectivity are an integral part of how health-
care delivery organizations diagnose and treat patients today. Across the globe,
millions of Internet of Medical Things are in use. These IoMT devices streamline
workflows, increase operational productivity, and enable better connectivity for
more timely patient care. While IoMT improves patient care and reduces day-to-
day operational costs, security remains the greatest barrier to adoption since most
medical devices are not designed with a focus on security. Unsecured IoMT devices
pose risks to patient care, cause service disruptions, violate HIPPA regulations, and
open gateways for data breaches, putting the healthcare organization at grave risk.
Emerging technologies in IoT security offers a cloud-delivered, ML-powered, and
agentless approach to managing and protecting the entire medical device lifecycle.
From identifying, onboarding, assessing risks, applying risk reduction policies, to
preventing threats, optimizing utilization, and ensuring devices are safely retired.
16.6.1 Estimation of Risk
IoT security ensures quick and accurate discovery, delivers built-in threat prevention,
and offers effortless deployment. Automatically assesses risk using data from vari-
ous sources while prioritizing risk scores in real time. With features like automated
tracking and reporting on medical equipment usage, maintenance windows, operat-
ing hours and device behavior comparisons, medical or clinical teams yield unprec-
edented business and operational insights to operate more efficiently everyday. IoT
security is delivered as a single platform that uniquely includes native enforcement
and playbook-driven built-in integrations into your existing workflows.
16.6.2 Implementation of IoMT Security Essentials

IoMT security essentials involves the assessment of risk, furnishing authentication
and authorization to devices in healthcare, network segmentation that divides the
network into multiple segments for improving the security and performance of the
network, providing awareness and training to the employees regarding the security.
IoMT data is transmitted through homomorphic encryption, which avoids data
manipulation. The healthcare system must adopt end-to-end encryption mechanisms
to protect patient data both at rest and in transit. They utilize industry-standard
encryption algorithms to safeguard sensitive information from unauthorized access.
The deployment of IoMT systems into the healthcare domain is associated with a
number of risks:
Personal information disclosure can have major consequences for patients’

medical situations as well as the hospital’s image.
A greater drug dose or an inaccurate medical description as an outcome of data
creation might result in major medical issues. This may occur with any data
supplied from a medical equipment.
Lack of training among nurses and doctors could risk patients’ lives and cause
death or serious illness.
The issue of accuracy is still controversial, and blunders in complex medical
procedures are caused by the lack of it.
16.6.3 Cyberattacks Against the Internet of Medical Things

Internal and External Attackers: An internal attacker is typically an ill-
intentioned employee, such as a nurse, doctor, or member of the medical
staff, who wishes to harm a hospital’s reputation by deleting or altering data
or by attacking patients’ health and privacy. External attackers are primarily
classed as malevolent hackers that want heightened unauthorized privileged
access to the hospital’s system. This is primarily accomplished through the
use of worms, rootkits, or remote access Trojan assaults Rani et al. (2023).
Passive and Active Attackers: The objective of the passive attackers in this
scenario is to acquire data transmitted via any wireless communication
between various medical devices, read it, and create their own informa-
tion collecting process that may be used for later exploitation, which may
result in a far more sophisticated cyberattack. To collect information, pas-
sive attackers may work with internal or foreign opponents. Communication
between a particular source and target must be intercepted in order for an
active attacker to succeed. The information and data being exchanged are
changed, amended, and deleted aggressively during such an interception
without the source or destination being aware of it. When used to give a
patient a higher dosage of a chemical or when dispensing medicine, such
an assault is quite dangerous. Malicious attackers do not search for certain
outcomes or have a specific purpose in mind. They start their attacks just
because they can, with the goal of upsetting an IoMT system. This can be
achieved, for instance, by sending incorrect information to the data center
in a particular region. Attackers who are rational have a definite objective,
which can have a highly harmful effect. In other words, they tend to follow
the passive class and are unpredictable. Organized cyberattacks frequently
rely on prior knowledge of medical equipment or systems before they begin.
In actuality, the aim is to get unauthorized access or expose private data.
Synchronized Attacks: By gaining remote access or other privileges, malware
enables outsiders to target a particular medical system in a coordinated fash-
ion. By preventing authorized medical personnel and patients from accessing
medical records, scheduling appointments, or interfering with medical pro-
cedures, the assault may be intended to disrupt medical operations.
16.7 CONCLUSION
Future healthcare will be built on the Internet of Medical Things to give greater
value, improve consumer happiness, and lower infrastructure costs. The IoMT can
enhance medical devices or services in the wearables sector of healthcare. It can
improve telemedicine, patient monitoring, drug administration, imaging, and gen-
eral hospital processes, among other healthcare applications. IoMT also develops
novel methods for treating various illnesses when patients live in outlying commu-
nities. Remote health monitoring technologies, smart gadgets, and the telemedicine
and telehealth sectors have all improved the world’s healthcare system. The security
essentials play a vital role in complete IoMT security in data processing, handling,
and development.
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17 Leveraging Web 3.0 to
Develop Play-to-Earn
Apps in Healthcare
using Blockchain
Yogesh Kisan Mali, Vijay Rathod,
Sweta Dargad, and Jyoti Yogesh Deshmukh
17.1 INTRODUCTION
Medical services frameworks were made to address our kin’s well-being prerequi-
sites; however, as our populace ages, so do the demands on efficiency Khatri et al.,
2021. Moreover, the worth of constant information is apparent, as in the case of coro-
navirus. Corresponding to coronavirus, data on a patient’s well-being (like tempera-
ture or side effects) is extremely useful. The aging population and the prevalence of
chronic diseases have increased health awareness and the demand for better patient
care. Today, as opposed to in the past, people’s attitudes toward healthcare services
are more patient-centered. Recently, patient-centered and hospital-centered health-
care has lost favor to mobile and electronic healthcare systems, which have since
developed into a universal healthcare system. With ongoing mechanical headways
like the Web of Clinical Things (part of the IoMT), it is presently conceivable to
productively and immediately acquire basically a wide range of market knowledge
Zhang et al., 2016.
The contemporary decentralization mechanism of Blockchain offers reliable
answers to the security and dependability problems in the healthcare sector. The
absence of intermediariesis is another compelling feature of blockchain technol-
ogy. In recent years, blockchain has been utilized to create new patterns and routes
beyond cryptocurrency Deisenroth et al., 2013. This would be another speedup of
conveyance without the utilization of brokers, and it very well may be the entry point
to medical care. Reconciliation of blockchain innovation into medical services appli-
cations, considering all protection-related issues, the unwavering quality of safety,
and patient and electronic well-being record access. In the computerized age, the uti-
lization of blockchain innovation in the medical care industry is explosive. Due to its
true capacity, blockchain innovation offers a promising answer for different issues,
including digital currencies (Jain et al., 2020), business and money, protection, pub-
licizing, and copyright security. Miniature exchanges, the creation and move of
advanced resources, decentralized trade, savvy agreements, and agreement systems
are portions of the potential affected by innovation right now.
DOI: 10.1201/9781003459347-17 243

With regard to information straightforwardness, discernibility, changelessness,

review, information provenance, adaptable access, trust, protection, and security, the
present medical services information executive frameworks face critical obstacles.
Moreover, a significant number of the ongoing medical care information executives
frameworks are unified, which builds the risk of a weak link being the occasion
for a cataclysmic event (Tondon and Bhambri, 2017). The treatment of information
in the medical services area could be going through a major change. Blockchain
is arising, problematic, decentralized innovation. In this part, we go through how
utilizing blockchain for medical care information the board frameworks can start
groundbreaking thoughts and result in huge progressions. We frame the primary
attributes and functionalities of the blockchain. We go over the top advantages of
carrying out blockchain innovation as well as the potential for the medical services
area. To exhibit the feasibility of blockchain innovation for assorted medical care
applications, we grandstand the continuous tasks and contextual analyses of late. We
feature and address a huge open examination of obstructions to blockchain’s fruitful
exploitation in the medical services industry. We finish up by framing possible lines
of additional examination.
17.2 RELATED WORK
Blockchain can be utilized to engineer distributed exchanges in a way that is savvy,
safe, and productive. As a level of innovation that has changed numerous ventures,
blockchain has the ability to change the medical services industry. This chapter’s goal
is to fundamentally assess 50 articles on blockchain-based well-being frameworks that
were distributed somewhere in the range of 2015 and 2020 (Clauson et al., 2018). Of
these, 36 were diary articles, seven were from meetings, four were from various dis-
cussions, three were from classes, and one was a part from a book. This report provides
answers to three important questions. First, what are the latest technical developments
in healthcare blockchain application development? Second, how can this systematic
study help us better comprehend the possibility of applying blockchain-based tech-
nology to the healthcare industry? Third, what are the key obstacles to implementing
blockchain as a solution in the healthcare industry (Khatri et al., 2021)?
These days, healthcare frameworks are making an effort to offer centralized gen-
eral healthcare administrations. Due to the high expenses, vast scope measures, and
little assets, the frameworks are frequently in danger of failing. A centralized cloud-
based system is used in the current context. The stored data is at danger when a cen-
tralized system is employed because security is the primary priority (Bhambri and
Gupta, 2017). The entire database becomes easily accessible in the event of a single
breach in the centralized system. A blockchain, which is a decentralized network for
data storage, can resolve this issue: The blocks on the blockchain contain unchanging
and secure information. In this study, a system that gives the patient total authority
over his medical records is introduced. It primarily consists of three roles: manage-
ment, patient, and doctor. The patient has exclusive control over his or her medical
records, providing the power to access those documents (Thippeswamy et al., 2020).
Blockchain is gaining traction and is currently one of the most fundamen-
tal subject areas. First, blockchain is introduced, and then current studies that
Leveraging Web 3.0 to Develop Play-to-Earn Apps using Blockchain 245
fit with blockchain developments are outlined (Kaur et al., 2023). Despite crit-
ics’ concerns about its flexibility, security, and supportability, it has significantly
altered many people’s way of life in several regions due to its profound influence
on businesses and organizations. Applications for block chains include those in
budgetary, human services, transportation, and risk management, as well as open
and social administrations and the Internet of Things (IoT). Several studies are
focused on the use of the blockchain information structure in various applications
(Devibala, 2019).
We will utilize AI and block-anchor innovation to resolve issues with medical
services information the executives in this review. With the help of AI, extricating
just the appropriate information from the data is possible. This is finished using
prepared calculations (Deisenroth et al., 2013). The reliability of trade information
turns into a test after this information has been put away. This is where block-
chain innovation is valuable. Blockchain innovation’s agreement guarantees that the
information is bona fide and the exchanges are secure (Bhambri et al., 2019a). By
putting the patient at the focal point of the medical services framework and upgrad-
ing the protection and interoperability of well-being information, blockchain inno-
vation can possibly further develop medical services the executives. This chapter
primarily focuses on leveraging Blockchain technology to address healthcare data
management issues while also incorporating certain crucial aspects using machine
learning Jain et al., 2020.
A recent development called blockchain technology gives host systems many of
the features just discussed. However, it’s significant to appreciate and make sense of
the worth of block-fasten innovation corresponding to the Indian medical services
framework (Yaqoob et al., 2021). Moreover, it’s essential to survey the fundamental
partners’ requirements for applying blockchain innovation to the Indian medical
care framework, such as in credit prioritization, customization, or plan contempla-
tions (agreement component, the sort of blockchain, brilliant agreements, and so
on). There have been different examinations of blockchain applications in Indian
medical services, but they miss the mark on the clear comprehension of the require-
ments of the partners. After talking with partners, we utilize the worth-centered
figuring structure to settle the previously mentioned research presumption. From the
partner connections that add to the essential objective, we decide on crucial goals
and vital targets. Given input from the domains of human specialists, as well as
the conduct and applications requirements from a partner perspective, this is a spe-
cialty work with a huge logical commitment to the data frameworks of the reception
of blockchain innovation in the Indian medical services biological system (Shukla
et al., 2021).
17.3 EXPERIMENTAL METHODOLOGY
17.3.1 Key Blockchain Technology Features
Six blockchain features that have the potential to significantly improve current
healthcare systems are shown in Figures 17.1 and 17.2. The following subsections
provide commentary.
FIGURE 17.1 Key features of blockchain technology.
FIGURE 17.2 Conspicuous blockchain highlights for medical services applications.

17.3.1.1 Decentralization
Most of existing medical care establishments and offices are focused on unified
frameworks, which overwhelm one specific association. The incorporated model has
various serious downsides, for example, a weak link that can result from misfortune
or noxious plan, or any purposeful or unintentional glitch at the highest point of the
progressive system that unfavorably affects the whole medical services framework
Zhang et al., 2016.
Blockchain empowers decentralization, which moves power away from a solitary
or focal power (Rani et al., 2023). Thus blockchain turns into a heartier, compel-
ling, and vote-based innovation. By empowering the formation of new stages that let
patients handle their information, blockchain can assist to improve patient informa-
tion security and access to health data (Bhambri et al., 2019b). This helps to under-
mine the current healthcare system’s hierarchical structure.
17.3.1.2 Translucence
One of the most captivating parts of blockchain innovation is straightforwardness.
Straightforwardness in well-being information can add to the making of a completely
auditable and real record of exchanges. Given the medical services industry’s current
information, the board techniques can’t offer protection, security, and straightfor-
wardness at the same time. As well as maintaining more noteworthy receptiveness,
blockchain likewise ensures protection and awards approved command over medi-
cal services information in an equal way. On the open blockchain, any transaction
relating to health is searchable and traceable. Blockchain technology’s high level
of transparency enables healthcare organizations to have complete knowledge of a
medicine’s contents, manufacturing conditions, and workflow through wholesalers,
distributors, resellers and to customers. Healthcare services might surely be more
effective with greater transparency. Transparency on the blockchain is made possible
via encryption and control techniques.
17.3.1.3 Immutability
Due to their vulnerability to hacking and data theft, one of the main issues with
the present centralized healthcare systems is the immutability of healthcare data.
Another intriguing aspect of blockchain innovation is changelessness. It alludes to a
block-tie record’s ability to stay unaltered and unapproachable. This striking trade-
mark can overhaul and change the inspecting system into a speedy, powerful, and
reasonable methodology. Also, it can increment trust in and ensure the uprightness
of well-being information used and shared by clinical associations. Blockchain’s per-
manence is made conceivable through cryptographic hashing (Singh et al., 2004). All
exchanges are recorded on computerized blocks, and each blockchain has a hash that
is produced utilizing the hash of the past block and the recently added data.
17.3.1.4 Data Provenance

By giving thorough details regarding its origin, access, and transfer, data prove-
nance is crucial for fostering a certain amount of trust in well-being information. By
making it conceivable to follow changes to information from its origin to its present
status, blockchain ensures the provenance of health data. The reliability of previous
health records stored on blockchain can be improved for data validation and audit-
ing needs. Blockchain can protect healthcare systems from unauthorized access and
modification, hence ensuring the provenance of protected health data. Additionally, it
makes reliable traceability possible in the healthcare sector. Blockchain timestamps
transactions by computing provenance record hash values, which are then sent to
consensus nodes to maintain a consistent record of all valid transactions.
17.3.1.5 Disseminated Record and Agreement

Blockchain can provide various benefits by melding fundamental mechanical parts
like conveyed record and agreement techniques. By reducing operational inefficien-
cies, distributed ledger technology (DLT) can reduce administrative costs. All health
data that has been stored is exchanged throughout all blockchain nodes via DLT
numerous times, making each piece of information easily verifiable and available to
anybody on the network. Blockchains automatically update after a predetermined
amount of time, guaranteeing data consistency and file synchronization. Agreement
calculations, again, are responsible for approving exchanges on a chain. They make
it feasible for all gatherings engaged with medical services frameworks to agree on a
solitary variant of reality. Moreover, they support guaranteeing the authenticity and
dependability of blockchain exchanges.
17.3.1.6 Secrecy and Programmability

Public blockchains include a number of crucial characteristics, including anonymity
and programmability. By maintaining anonymity, transactions’ senders and recip-
ients’ identities are kept secret Puri et al. (2023, September). Through smart con-
tracts, the programmability highlight empowers mechanization of new exchanges
and controls. The self-executable projects in brilliant agreements are based on the
arrangements among purchasers and dealers. These guidelines help with directing
the execution of discernible and irreversible exchanges. They take into consideration
arrangements and exchanges to be made between unknown members without the
requirement for an outsider or outer implementation process. Figure 17.2 depicts the
different blockchain features.
17.3.2 Benefits of Blockchain Innovation in Medical

Care Information the Executives
The vital benefits of utilizing blockchain innovation for medical services information are
displayed in Figure 17.3. The accompanying subsections carefully describe these benefits.
17.3.2.1 Health Information Precision

The clinical records of a patient are often scattered around various medical clinics,
facilities, and insurance agency. All of a patient’s information should be naturally
converged to give a precise image of the entire clinical history. This should be pos-
sible by putting all persistent clinical information on blockchain, which generally
keeps current, recognizable, and carefully designed records, including remedy his-
tory, side effect information, treatment approach, offices procured, installment data,
FIGURE 17.3 Advantages of utilizing blockchain innovation for medical care information
the executive’s frameworks.
and other data. This makes it workable for clinical specialists to treat patients prac-
tically, speedily, and fittingly. Healthcare professionals can have a thorough under-
standing of patients’ medical histories due to blockchain technology. All information
recorded on a blockchain is secure, transparent, and unchangeable.
17.3.2.2 Health Data Interoperability

Information sharing between systems created by various manufacturers is referred
to as interoperability (Rani et al., 2023). Most EHR/EMR items are based on dif-
ferent clinical advancements, mechanical prerequisites, and useful capacities. Such
varieties make it hard to deliver and disseminate information in a solitary orga-
nization. Since they were made to fulfill the requests and inclinations of a well-
being facility, some EHR frameworks created on a similar stage aren’t even viable.
The transmission messages ought to be founded on normalized coded information
in order to make two EHR systems interoperable. However, a significant problem
that restricts the capacity to communicate data electronically for patient care is the
absence of standardized data. Using a blockchain-based healthcare data management
system can get pastthis restriction. Every EHR/EMR saved on the blockchain system
adheres to a standardized data coding, making it simple for any healthcare facility to
access and use it (Rani et al., 2023).
17.3.2.3 Well-Being Information Security

For the last ten years, a great deal of medical services associations have been subject to
network protection attacks that should have been preventable. For the administration
of advanced clinical records, a few medical organizations utilize manual frameworks

in a concentrated system. Since these frameworks are so obsolete, adjusting them with
pernicious intent is basic. Moreover, in light of the fact that centralization is as defense-
less as its weak link, clinical records might be lost in case of catastrophic events.
Blockchain’s unchanging nature trademark, which depends on cryptographic stan-
dards, can help to lessen or perhaps even totally eliminate the risk of information bur-
glary or ill-advised administration. Since similar information is saved in a few areas
without a weak link, well-being information stored on blockchain is likewise protected
from harm brought about by normal disasters or the breakdown of clinical offices.
17.3.2.4 Well-Being Information Dealing With Costs

One more critical issue raised by the ongoing medical care frameworks is dealing
with the high costs connected with patient information recovery and movement.
A patient’s medical file is typically spread out over several healthcare facilities.
It can require an excessive investment to assemble all of the patient’s clinical
records from manual or disrupted emergency clinic records the executive’s frame-
works. The regulatory costs brought about by outsiders engaged with the ongoing
medical care frameworks can be decreased with the guide of blockchain innova-
tion. Furthermore, it takes into consideration adaptable information admittance to
the patient’s clinical record, which is gathered and put away from various sources,
including patient documentation, individual wearable and handheld gadgets, and
electronic clinical records (EMRs), to make reference to a couple. By simplifying it
for clinical organizations to get to all of a patient’s information without visiting a few
places where it was recently held, blockchain can assist them with reducing expenses.
17.3.2.5 Global Health Data Sharing

Prior to recommending any medication for the right therapy in a few health-related
crises, having a total comprehension of the patient’s earlier clinical history is basic.
For example, a patient with a difficult sickness who travels to another country might
have to visit a specialist in the event of a sudden crisis. To give better medical care
in such a circumstance, a clinical expert ordinarily needs the patient’s earlier clinical
history. To foster more compelling therapy plans, clinicians can utilize the patient’s
clinical history to investigate various elements, including past medicine use, drug
sensitivities, and records of prior treatments. Be that as it may, in light of the fact that
most current medical services the executive frameworks depend on manual capacity
and handling strategies, they do not offer recognition and widespread access. With
the use of blockchain technology, these functionalities can be accomplished.
17.3.2.6 Improved Healthcare Data Audit

Medical services areas go through reviews to see whether they comply with the
approaches, rehearses, rules, guidelines, and regulations set out by various medical
services associations. By means of thorough and unbiased assessments, an exam-
ining cycle helps with deciding how compelling a medical care consistence plan is.
Most medical services information the board frameworks used today are manual
and lack any trace of refined coordination and compatibility. They are likewise help-
less in the face of unapproved adjustments and information breaks. Subsequently,
these limitations lessen the viability of the evaluating system. By empowering
medical services associations to deal with their information in an obvious, sealed,

and long-lasting way, block-fasten innovation assists with exhibiting the depend-
ability of recorded well-being information. This simplifies things for reviewers to
affirm the exchanges made on blockchain organizations. Medical services informa-
tion reviews utilizing blockchain innovation can assist with keeping medical services
associations in compliance with fundamental regulations and guidelines while addi-
tionally improving the nature of patient therapy. Furthermore, it can support avoiding
futile information redundancies.
17.4 OPPORTUNITIES
In this segment, we briefly go over how blockchain innovation, which is summed up
and shown in Figure 17.4, can assist with smoothing out medical services informa-
tion the board strategies by achieving massive changes.
Blockchain is a promising innovation that, in contrast with customary billing prac-
tices that normally involve lengthy delays in collections, can make the installment
FIGURE 17.4 Blockchain potential opens doors in medical services businesses.

cycle impressively less difficult and safer. Specifically, past payment techniques used
to make it significantly harder to pay the costs of protection claims. By keeping all
of the information in an unchanging way utilizing blockchain, these limitations can
be eliminated, permitting the insurance agency to settle accounts more rapidly while
utilizing less assets, cash, and time.
17.5 OPEN RESEARCH CHALLENGES

The greatest hindrances to the boundless execution of blockchain in medical care
information the executives frameworks are introduced in this section. We depict the
hidden purposes behind these troubles and propose pointers to future scientists in the
field. Table 17.1 records these causes and their suggested arrangements.
TABLE 17.1
Rundown of the Difficulties alongside Their Causes and Rules
Summary of the challenges along with their causes and guidelines

Challenges Causes Guidelines
1. Block size and block creation time. 1. Sharding technique.
Scalability 2. Inefficient consensus protocol. 2. Alternatives to proof-of-work.
3. Higher confirmation times for a block creation 3. Directed Acyclic Graph approach
Navigate 1. Lack of clarity on compliance.

1. Ensuring privacy and security of the
regularity 2. Regulations on blockchain vary from country
stored healthcare data
uncertainty to country
1. Using existing standards in blockchain

1. Different consensus models, transaction
Intero-perability networks. Ex- IBM and Microsoft are
mechanisms, and smart contract functionalities
employing
1. Blockchains are immutable. 1. False or incorrect information should

Irreversibility and
2. Conventional digital signatures. not be stored on blockchain networks.
quantum
3. High processing capabilities of quantum 2. Replacing conventional digital signatures
computing
computing with quantum-resistant cryptography
1. Lack of regulatory clarity for tokenized assets.

2. Lack of trusted way to ensure consistency
1. Introducing tokenization standards and
between the on-chain crypto tokens and the
Tokenization legal infrastructures to enable globally
underlying off-chain assets.
and legally recognized digital identity
3. Lack of digital identity that is global and
legally-recognized
Integrating 1. Requires considerable changes (e.g., significant

1. Healthcare organizations must need to
blockchain with time, meticulous planning, funds, and human
overhaul their current data management
existing healthcare expertise) to be made in the existing systems.
systems
systems 2. Extra costs
1. Price discrimination, insurance market 1. Healthcare data registers must be

Ensuring accuracy
competition, human and administrative errors, cleaned and brought up-to-date before
of healthcare data
and avoiding tax purposes storing data on blockchains
Culture adoption 1. Initiating employee training programs.

1. Lack of adequately skilled/trained people for
and blockchain 2. Digitally track and assess training
managing complex peer-to-peer networks
developers completion
17.6 LEVERAGING BLOCKCHAIN IN WEB 3.0:

EMPOWERING TRANSPARENCY AND REWARDS
Blockchain is a distributed ledger technology that makes it possible for numerous
people to manage a shared database without the need for a centralized authority. It is
made up of a series of blocks, every one of which contains a rundown of exchanges
that are associated with the one preceding it cryptographically. The unchang-
ing nature and trustworthiness of the information put away on the blockchain are
ensured by this construction. Blockchain can be utilized with regard to Web 3.0 and
play-to-procure medical services games to upgrade the environment with straightfor-
wardness, security, and decentralization. Here are a few applications for blockchain
innovation:
Secure Data Storage: Blockchain offers a decentralized, carefully designed

elective for information capacity, safeguarding the protection and secu-
rity of basic medical services information. The blockchain can be utilized
to store motivators, game information, and patient records, guaranteeing
straightforwardness and restricting unapproved access.
Smart Contracts: Self-executing contracts that automatically uphold predeter-
mined terms and conditions are known as smart contracts. Smart contracts
can be used to regulate the allocation of prizes, validate achievements, and
guarantee fair game-play in play-to-earn healthcare games. Players may
rely on the game’s rules to be applied exactly as intended without the need
of any intermediaries.
Tokenization and Rewards: Blockchain enables the creation of tokens that
represent value within the game ecosystem. Players can earn tokens for
their participation, achievements, and contributions to the healthcare game.
These tokens can be traded, exchanged for real-world rewards, or used
within the game for various purposes, fostering engagement and incentiviz-
ing active participation.
Ownership of Digital Assets: Blockchain enables gamers to truly own the
assets and virtual goods they use in-game. Non-fungible tokens (NFTs)
allow for the creation and secure exchange of one-of-a-kind digital assets.
Players have more control over their digital assets due to the ability to pur-
chase, sell, and trade virtual goods.
Interoperability and Collaboration: Blockchain enables interoperabil-
ity between different games and platforms, allowing players to use their
earned rewards and assets across multiple games or even outside the game
ecosystem. This interoperability encourages collaboration, cross-game
experiences, and the seamless transfer of value.
We can build a more open, safe, and rewarding environment by utilizing the potential
of blockchain, Web 3.0, and play-to-earn healthcare games. Blockchain technology
promotes active engagement in the healthcare industry and improves the gaming
experience while ensuring trust, fairness, and decentralization.
17.6.1 Case Study
Here is a sample of Solidity code that illustrates how a straightforward play-to-earn
healthcare app is implemented on the Ethereum blockchain:
// SPDX1-License-Identifiers: MITD
Pragma1 solidity ^0.8.0;
contract health_care_Play_To_Earn {
struct persons {
uint258 id;
uint258 play_Tokens;
}
mapping (address => Patient) public patients;
address[] public person_Addresses;
event Play_Tokens_Earned (address indexed person_Address, uint258 play_
Tokens);
constructor() {
// Contract initialization
}
function enroll_person(uint258 id) external {
require(persons[msg.sender].id == 0, “Patient already enrolled”);
pesrsons[msg.sender] = Patient(id, 0);
persons_Addresses.push(msg.sender);
}
function earn_Play_Tokens(uint258 tokens) external {
require(tokens > 0, “Number of tokens must be greater than zero”);
require(persons[msg.sender].id!= 0, “Patient not enrolled”);
persons[msg.sender].play_Tokens += tokens;
emit Play_Tokens_Earned(msg.sender, tokens);
}
function get_Patient_Count() external view returns (uint256) {
return patient_Addresses.length;
}
}
The “Healthcare_Play_To_Earn” smart contract, which we construct in this

Solidity code, enables a play-to-earn healthcare app on the Ethereum blockchain.
Patients can sign up, earn play tokens, and keep track of their play token balances in
the wallet of the patient.
The patient’s ID and the amount of play tokens they have accumulated are
addressed by the Patient struct. Patient locations are planned to the suitable
Patient struct utilizing the patient’s planning.
FIGURE 17.5 Deploy and execution of case study in Solidity.
Patients can sign up for the play-to-earn app by submitting their ID using the
enroll_Patient_function. It makes sure a patient can enlist only once.
Patients can earn play tokens by specifying the number of tokens obtained
using the earn_Play_Tokens function. The procedure verifies that the patient
is registered and that there are more tokens than zero. The acquired tokens
are subsequently added to the patient’s account, and an event is released to
alert interested parties.
The get_Patient_Count function provides the total number of patients who
have been enrolled.
This code can be used as a starting point to construct a play-to-earn healthcare
app using Solidity on the Ethereum network.
17.7 CONCLUSIONS
In this book chapter, we introduced savvy conversations on the joining of block-
chain with medical services frameworks. We examined how utilizing blockchain
for medical care enterprises can prompt overseeing well-being information in a
decentralized, straightforward, open, recognizable, auditable, trusted, and secure
way. Likewise, blockchain gives an assurance of permanence and sealed well-being
information stockpiling. We examined the highlights and benefits of blockchain
innovation to demonstrate how it can open its maximum capacity for medical care
information the executives. We have likewise examined the key open doors pre-
sented by blockchain by utilizing robustness code and how play-to-procure applica-
tions can be applied to medical services. We introduced a contextual investigation to
show how blockchain innovation has worked with and supplemented different med-
ical care frameworks. We recognized and talked about the basic open exploration
challenges preventing the far and wide reception of blockchain innovation in medi-
cal care businesses. We reason that blockchain can possibly reshape and change the
medical services enterprises by acquiring critical enhancements terms of functional

proficiency, information security, medical care staff the board, and expenses. In
any case, reconciliation of the medical services frameworks with blockchain causes
a few specialized difficulties—for example, blockchain youthfulness, versatility,
interoperability, independent undertakings, troublesome coordination with existing
medical care frameworks, intricacy, and absence of blockchain ability—that should
be tended to.
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18 Advancements in
Modelling, Imaging,
and Simulation of
Cardiovascular Diseases
A Technological Revolution
in Modern Healthcare
S. Sharmila, M. Nirmala, D. Somasundaram,
and M. Menagadevi
18.1 IMAGING MODALITIES FOR CVD

Imaging techniques can provide biventricular function information about the human
body. SPECT and PET have higher sensitivity than stress echocardiography for
detecting abnormal wall motion caused by myocardial replacement fibrosis. For the
absence of late gadolinium enhancement, as in systemic sclerosis and other autoim-
mune rheumatic diseases (ARD), cardiac magnetic resonance (CMR) is the preferred
approach for detecting diffuse myocardial fibrosis. To detect myocardial ischemia
caused by epicardial coronary artery disease (CAD), all imaging modalities can be
employed. Future CV events are three times more likely to occur when myocardial
replacement fibrosis is present in more than 5% of the LV mass. In individuals with
CAD, CMR provides an exceptional prognosis. CMR and PET can perceive nonabra-
sive coronary microvascular dysfunction, which is critical in autoimmune rheumatic
diseases patients (Mavrogeni et al., 2022). In most clinical settings, echocardiog-
raphy can be used to infer severe edema. CMR can quantify myocardial oedema,
and the data could be used to commence immunomodulatory or cardioprotective
medication.
The process of detecting and imaging X-rays, from various sides all around an
object to reveal interior features, resulting in CT, is shown in Figure 18.1. The stan-
dard for detecting structural abnormalities such as tumors, vascular, bone damage,
hemorrhages, and heart disease, emphysema, and fibrosis is computed tomography
(CT), which uses ionizing radiation. Diagnoses of diseases often affect the heart,
chest, abdomen, pelvic, head, and upper gastrointestinal (GI) tract, among other ail-
ments (Singh et al., 2005). Although CT has involved minor treatment, there have
258 DOI: 10.1201/9781003459347-18

Modelling, Imaging, and Simulation of Cardiovascular Diseases 259
FIGURE 18.1 Clinical imaging modalities.
been worries about the harm to children and the use of pointless scans because they
depended on ionizing radiation (Rieffel et al., 2015).
Although MRI is costlier than CT, it is particularly helpful for visualizing soft
tissues without using ionizing radiation. Despite the expense of MRI and the fact
that action planning precludes screening submissions, the assistance and promise
of MRI-aided diagnosis with therapeutic planning are acknowledged, as well as the
numerous MRI-related ways of providing physical and practical information.
Over the past four decades, nuclear cardiology has developed, demonstrating an
inventive and imaginative shift from idiosyncratic perceptions of plane images with
subpar radiotracers toward a quantitative method based on digital data. Myocardial
images are becoming a progressively significant approach for identifying and
risk-stratifying individuals for further intervention, medicinal treatment, or more
interventional therapy with coronary angiography and possibly revascularization.
Planar imaging has advanced quickly, as have individual photon emission tomogra-
phy, positron emission tomography (PET), and magnetic resonance imaging. Novel
radiotracers that demonstrate the basic molecular physiology of various cardiac dis-
ease states have advanced and improved at a similarly impressive rate.
The use of imaging techniques like CT angiography (CTA) for estimation of pedi-
atric congenital heart disease (CHD) is crucial. These techniques are used to depict
composite cardiovascular anatomic aspects early on and after surgery, as well as
different post-treatment issues. CT can evaluate cardiac systemic and pulmonary
arterial issues (Dillman & Hernandez, 2009). Radiotherapists must be well-versed in
cardiovascular physiology and in surgical anatomy techniques. The goal of this chap-
ter is to investigate the role of computed tomography in the assessment of congenital
cardiovascular disease in young ones.
18.2 SIMULATION TOOL
Cardiovascular disease (CVD) prediction involves assessing the risk and progression
of various cardiovascular conditions, such as heart disease and stroke.
While there are no specific simulation tools designed solely for CVD prediction,
various computational models and software can assist in risk assessment and predic-
tion (Al’Aref et al., 2019). Here are some commonly used tools (shown in Figure 18.2)
and approaches for cardiovascular disease prediction.
18.2.1 Framingham Heart Study Risk Score Calculator

The FHSR Calculator is a tool widely used to evaluate the ten-year peril of develop-
ing cardiovascular disease such as coronary disease and stroke. The calculator evalu-
ates many peril factors that lead to cardiovascular disease and generates an estimate
of the individual’s peril over the coming years.
FIGURE 18.2 Simulation tools for cardiovascular disease.

When the relevant numbers for each risk factor are entered into the Framingham
Heart Study Risk Score Calculator, the calculator gives an estimated ten-year risk
percentage for developing a cardiovascular event (Bitton & Gaziano, 2010). This risk
percentage aids in establishing the necessity for lifestyle changes, preventive mea-
sures, or medical interventions. It is imperative to remember that the Framingham
Risk Notch is based on population-based data and provides a broad estimate of risk
(Jain & Bhambri, 2005). It may not capture individual variances or account for all
relevant risk variables. Therefore, it is always essential to consult a healthcare pro-
vider for a thorough evaluation and specific recommendations for cardiovascular
health Kaur et al. (2023).
18.2.2 QRISK
QRISK is a risk prediction algorithm for the cardiovascular system that considers a
variety of risk parameters such as ethnicity, BP, cholesterol, diabetes, smoking, and
BMI. It analyses the ten-year risk of developing a cardiovascular incident. QRISK
is a cardiovascular risk prediction system that calculates a ten-year probability of
acquiring cardiovascular events such as heart disease and stroke. It is intended to
estimate cardiovascular risk in the overall population and takes into account a num-
ber of risks that can lead to the development of cardiovascular disease.
The QRISK algorithm estimates ten-year probability of experiencing cardiovas-
cular by entering the pertinent values for each risk factor. This risk calculation aids
medical practitioners in determining whether measures like dietary changes, pre-
ventative care, and medical tracking are necessary. Updating the QRISK is a new
methodology to improve its accuracy in cardiovascular system prediction. Clinical
practice issued in the United Kingdom. Compared to earlier risk scoring systems, it
is a thoroughgoing assessment of cardiovascular risk because it takes into account
new criteria like ethnicity and BMI.
It’s crucial to remember that QRISK is a population-based tool, and although it
offers a useful prediction of cardiovascular risk, individual variances and extra risk
variables might not be adequately reflected (Rattan et al., 2005a). In order to receive
a customized assessment and advice on cardiovascular risk management, it is essen-
tial to consult with a healthcare professional periodically.
18.2.3 Reynolds Risk Score

The Reynolds Risk Score is based on a gender identity algorithm that predicts the
10-year risk of cardiovascular events in women. In addition to traditional risk factors
like age and blood pressure, it also considers factors such as family history, high-
sensitivity C-reactive protein levels, and parental history of myocardial infarction.
The Reynolds Risk Score is a gender-specific cardiovascular risk prediction algo-
rithm that estimates the ten-year risk of cardiovascular events, specifically in women.
It is an algorithm developed to improve risk assessment beyond traditional risk fac-
tors used in other risk scoring systems (Ridker et al., 2007). The Reynolds Risk
Score takes into account several additional factors that have been found to contribute
to cardiovascular risk in women.
By inputting the relevant values for each risk factor, the Reynolds Risk Score
algorithm calculates an individual’s estimated ten-year risk of developing cardio-
vascular events. This risk estimation helps healthcare professionals assess the need
for interventions, such as lifestyle modifications, preventive treatments, or medical
monitoring, specifically tailored for women.
The Reynolds Risk Score is designed to provide a more accurate evaluation of car-
diovascular risk in females by considering additional factors beyond traditional risk
factors like age and cholesterol levels. By incorporating CRP and the genetic history
of early heart attack, it aims to capture inflammation and genetic predisposition,
respectively, which can impact cardiovascular risk in women.
Specifically, Reynolds Risk Score is developed for females rather than for men. As
with any risk scoring system, consulting a healthcare professional is recommended
to interpret the results, discuss individual risk factors, and formulate appropriate pre-
ventive strategies.
18.2.4 American Heart Association Risk Calculator

The American College of Cardiology (ACC)/American Heart Association (AHA)
random calculator calculates an individual’s ten-year chance of acquiring atheroscle-
rotic cardiovascular disease (ASCVD). Age, gender, race, blood pressure, genetic
diabetes, and cholesterol are among the criteria that are taken into account. These
academic institutions created a tool to predict cardiovascular risk called the ACC/
AHA Risk Calculator. An estimated ten-year risk for atherosclerotic disease symp-
toms includes illnesses like coronary disease (Kakadiaris et al., 2018). The pooled
cohort equations based on in-depth population studies provide the foundation of the
ACC/AHA Risk Calculator.
The ACC/AHA probability calculator estimates a person’s ten-year probability of
having a cardiovascular incident from pertinent values entered for each risk factor. In
order to lower the risk of ASCVD, healthcare practitioners can use this risk estima-
tion to determine whether lifestyle adjustments, preventive measures, and/or medical
therapy are necessary Rani et al. (2023).
The ACC/AHA Risk Calculator provides a complete assessment of cardiovascular
risk and considers multiple risk factors. The problem aids medical practitioners in
making knowledgeable choices about preventative measures and treatment plans. It
is vital to communicate that the calculator’s predictions are based on population-level
data and that individual variations and additional risk factors may not be fully cap-
tured (Rattan et al., 2005b). Thus it is essential to consult with a healthcare profes-
sional who can interpret the results and provide personalized recommendations for
cardiovascular risk management.
18.2.4.1 Some of the Common Risk Factors for These Risk Calculators
Age: The age of the individual in years
Sex: Male or female
Ethnicity: Different ethnicities with varying risk profiles
Smoking Status: Whether the individual person is a chain smoker or a
nonsmoker
Systolic Blood Pressure: The blood pressure of systolic in mmHg

Total Cholesterol: The total level of cholesterol in mmol/L
HDL Cholesterol: The high-density lipoprotein cholesterol in mmol/L
Body Mass Index (BMI): Body fat measured based on height and weight
18.2.5 Machine Learning Models

Predictive models for heart disease can be created using machine learning tech-
niques. These models can analyze large datasets and identify patterns and risk fac-
tors that contribute to disease prediction. Mutual machine learning procedures used
in CVD prediction include logistic regression, random forests, and SVM.
Machine learning models are widely used in cardiovascular disease prediction
and risk assessment. These models leverage computational algorithms and statis-
tical techniques to analyze large datasets and identify patterns, relationships, and
risk factors associated with cardiovascular events. Here are some common machine-
learning models shown in Figure 18.3 used in cardiovascular disease prediction:
Logistic Regression: For binary classification problems, such as forecast-

ing the incidence of cardiovascular events, logistic reversion is a popular
machine learning model (Bhambri & Gupta, 2005). A categorical depen-
dent variable, also referred to as the outcome or target variable, and one
FIGURE 18.3 Machine learning algorithms.

or more independent variables, often referred to as predictors or features,

are modelled using a type of statistical regression analysis. It is regularly
applied to dual classification matters where there are two alternative out-
comes for the dependent variable.
Random Forest: Random Forest is a collaborative learning technique that
blends various verdict trees to produce an estimation of risk (Fan et al.,
2018). A random forest model can be used to predict cardiovascular disease
by interpreting an assortment of risk factors and weighing the importance
of the variables of greatest influence on the likelihood of experiencing car-
diovascular events.
Support Vector Machines (SVM): SVM is a machine learning algorithm
used for both classification and regression tasks. For cardiovascular disease
prediction, SVM can be trained on labelled data to distinguish between
individuals with and without cardiovascular events; it determines an opti-
mal hyperplane to split the two classes based on input features.
Deep Learning Models: ANN and DNN models have been recently popular
for predicting cardiovascular disease. These models can deal with nonlin-
earities and complex interactions in the data, which allows them to identify
nuanced patterns and risk factors. To forecast the incidence of cardiovascu-
lar events, they can examine a variety of input variables, including clinical
data, genetic information, imaging data, and biomarkers.
Gradient Boosting Models: Ensemble learning techniques called gradient
boosting models, such as gradient boosting machines or XG Boost, com-
bine numerous weak learners to produce a powerful prediction model. In
order to increase prediction accuracy, these models iteratively construct
decision trees, concentrating on the examples that were previously incor-
rectly classified.
Long Short-Term Memory (LSTM) Networks: Sequential input can be
recognized as having temporal connections by recurrent neural networks
(RNNs), like LSTM networks. LSTM networks can analyze time series
data, such as recordings of the heart rate or blood pressure, to identify
patterns and trends that point to a high likelihood of developing cardio-
vascular illness. A substantial volume of reliable patient data is neces-
sary for the training and validation of machine learning tool modelling.
These models’ effectiveness and accuracy depend on how well-rounded
and representative the data are. To accurately understand the results and
make decisions on the prevention and management of heart disease, it’s
crucial to validate models using independent datasets and interact with
medical experts.
Electronic Health Record (EHR) Systems: HER systems provide useful
insights for predicting cardiovascular disease when used in conjunction
with the right data analytics tools (Shickel et al., 2017). Predictive models
can be created to recognize those at increased risk factors of developing
CVD by examining patient health information, including medical history,
test findings, and diagnostic imaging.
Remembering the effectiveness and accuracy of prediction tools may change

based on the population under study and the data at hand.
18.3 COMPUTATION FLUID DYNAMICS

A number of numerical simulation methods called computational fluid dynamics
(CFD) are used in a variety of engineering and scientific applications, such as chem-
ical vapor deposition processes, to simulate fluid movement, heat transfer, and chem-
ical reactions (Moradi et al., 2023). To research and improve CVD systems, film
deposition profiles are forecast, and process parameters are examined. In the context
of CVD, CFD simulations can provide insights into the following aspects (shown in
Figure 18.4):
Fluid Flow: CFD can predict the flow behavior of the precursor gases inside
the CVD reactor. It can simulate the velocity, pressure, and temperature
distributions, as well as identify regions of recirculation or stagnation.
Understanding the fluid flow patterns helps optimize the reactor design for
uniform deposition and efficient gas transport.
Mass Transport: CFD simulations can model the transport of precursor gases
within the CVD reactor. This includes the diffusion and advection of gas-
eous species, as well as the adsorption and desorption of these species on
the substrate surface. CFD can provide information on a species’ concen-
tration profiles and residence times, aiding in optimizing precursor delivery
and deposition rates (Rani et al., 2023).
Chemical Reactions: CFD can incorporate reaction kinetics to simulate the
chemical reactions occurring during CVD processes. By considering the
gas phase and surface reactions, CFD can predict the species’ conversions,
reaction rates, and deposition rates. This enables the study of reaction mech-
anisms and the optimization of process conditions to achieve the desired
film properties.
Heat Transfer: Conduction, convection, and radiation are some of the heat
transmission modes that can be modelled in CFD simulations for the CVD
reactor. Controlling the deposition process and ensuring the thermal sta-
bility of the substrate and films require an understanding of temperature
distribution and heat transfer rates (Rani et al., 2023).
Reactor Design Optimization: CVD reactor design and operational param-
eters can be improved using CFD simulations. With the aid of CFD, it is
possible to determine the ideal circumstances for attaining uniform deposi-
tion, cutting down on the amount of time it takes for it to happen, and max-
imizing process effectiveness by comparing various reactor geometries,
gas inlet configurations, temperature profiles, and other characteristics.
Accurate modelling of fluid characteristics, boundary conditions, reaction
kinetics, and heat transfer mechanisms is necessary for CFD simulations of
CVD operations. To guarantee the CFD models’ accuracy and dependabil-
ity, experimental data validation is crucial.
FIGURE 18.4 Computation fluid mechanism.
18.4 DATA-DRIVEN MODELLING
In order to find insights, patterns, and predictive models about cardiovascular health,
data-driven modelling for cardiovascular disease (CVD) makes use of massive data-
sets and sophisticated analytical methods (Dritsas & Trigka, 2023). To enhance the
risk assessment, early identification, and personalized treatment of CVD, this strat-
egy makes use of the vast amount of data that is currently available from electronic
health records, clinical trials, medical imaging, genetic research, wearable devices,
and other sources (Kataria et al., 2023, July).
The key data-driven modelling techniques (shown in Figure 18.5 used in CVD
research include:
Predictive Analytics: Data-driven prediction models can be created to fore-

cast the cardiovascular risks unique to a patient. Through the integration of
clinical data with demographic information, lifestyle factors, and genetic
markers, predictive analytics supports early risk diagnosis and targeted
therapy.
Electronic Health Record (EHR) Analysis: Electronic health records con-
tain information about medical history, diagnoses, medications, and lab
results. Analyzing EHR data using data-driven methods allows popula-
tion risk assessment and identification of patterns that can inform clinical
decision-making.
Imaging Data Analysis: This entails learning the structure and operation of
the heart through contemporary imaging methods like MRI and CT scans
(Chan et al., 2023). For people with CVD, data-driven analysis of medical
imaging can help with early diagnosis, tracking the course of the condition,
and planning treatment.
Genetic Studies: Genome-wide association studies (GWAS), a genetic research

project, sheds light on the genetic components that influence cardiovascular
risk. Genetic markers linked to CVD susceptibility can be found using data-
driven methods (Walsh et al., 2023), allowing for individualized risk assess-
ment and treatment plans that are more specifically suited to the patient.
Wearable Devices and Remote Monitoring: Wearable technologies and
mobile health apps collect physiological data in realtime, such as heart rate,
blood pressure, and physical activity (Lu et al., 2023). Data-driven analysis
of this data can help with continuous monitoring, early anomaly identifica-
tion, and the encouragement of healthy habits.
Data Integration: Sources of data integrity, such as EHRs, genetic informa-
tion, lifestyle data, and medical imaging, are merged. Data-driven models
for CVD prediction and medication optimization are more accurate and
durable. Data-driven modelling for CVD, a promising supplement to tra-
ditional clinical risk assessment, enables precision treatment (Chen et al.,
2023). However, extensive validation and continuous updating are required
to maintain the models’ accuracy and relevance in a field of cardiovascular
research that is always evolving.
FIGURE 18.5 Data-driven techniques.

18.5 ARTIFICIAL INTELLIGENCE IN CVD

Artificial intelligence is being used more and more in the study, diagnosis, risk
assessment, planning, and patient care of cardiovascular disease. Powerful tools for
analyzing massive amounts of data, finding patterns, and making predictions are
provided by AI approaches including machine learning algorithms (Joy et al., 2023),
deep learning architectures, natural language processing, and computer vision tech-
niques. Here are some key applications of AI in CVD (as shown in Figure 18.6):
Risk Prediction: AI models can review patient data from the patient’s medical
file, test results, genetic information, and lifestyle choices to ascertain the
risk of CVD. These models can provide personalized risk scores and sup-
port physicians in identifying high-risk patients who can gain from early
intervention and preventive measures.
Medical Imaging Analysis: AI algorithms can evaluate medical imaging data
from MRI scans, angiograms, and echocardiograms to detect and quantify
cardiovascular issues. AI-based picture analysis can help with early detec-
tion of diseases like coronary artery disease, heart failure, and valve issues,
allowing for rapid medication and intervention.
ECG Analysis: Arrhythmias, ischemia changes, and other cardiac abnormal-
ities can be found using AI models that evaluate electrocardiogram (ECG)
data. Atrial fibrillation, myocardial infarction, and QT prolongation are just
a few of the disorders that can be detected and monitored with AI-powered
ECG analysis tools. AI-based decision support systems can help doctors
manage and plan for the treatment of cardiovascular disease. These systems
examine patient data, clinician suggestions, and research-based information
to make recommendations on medication selection, dose changes, and ther-
apies catered to specific patients.
Remote Monitoring and Wearable Devices: In order to assess heart rate,
exercise levels, and other physiological indicators, wearable technology like
smartwatches and fitness trackers can collect data that AI systems can ana-
lyze. Real-time analysis of this data can help prevent cardiac problems from
happening by allowing early diagnosis and by providing tailored feedback
to encourage healthy habits.
Natural Language Processing: Information can be retrieved from and pro-
cessed using AI techniques like natural language processing from clini-
cal notes, scholarly papers, and electronic health records. Automated data
extraction, processing, and analysis make large-scale research and the syn-
thesis of evidence possible (Puri et al., 2023, September).
Drug Discovery and Development: AI facilitates the drug development process
by discovering pharmacological targets, forecasting the efficacy and safety of
potential drug candidates, and enhancing medication formulations. AI-based
algorithms have the ability to examine molecular structures, genetic data,
and clinical outcomes to guide precision medical techniques in the treatment
of CVD (Kam et al., 2023). The use of AI in improving CVD care has a lot
of potential, but it should always be combined with clinical judgment and
subject matter expertise. Validation, transparency, and interpretability are
crucial for ensuring AI models’ reliability and uptake in clinical practice.
FIGURE 18.6 Artificial intelligence in disease detection.
18.6 VIRTUAL REALITY AND AUGMENTED REALITY

Research, diagnosis, and therapy with patient education for cardiovascular disease
(CVD) can all benefit from the use of augmented reality (AR) and virtual reality
(VR) (Lin et al., 2023). Here are some specific use cases for AR and VR in the field
of cardiovascular disease:
Anatomy Visualization: To visualize and explore the anatomy of the cardio-

vascular system, AR and VR can offer great experiences. A 3D model of the
heart, blood arteries, and other cardiovascular structures can be manipu-
lated by medical experts and students thanks to this technology. It improves
knowledge of intricate anatomical linkages and supports research, patient
education, and surgical planning.
Surgical Planning and Simulation: Planning and simulating heart procedures
and interventions can be performed with AR and VR. These technologies
allow surgeons to evaluate various surgical techniques, to practice proce-
dures in a virtual setting, and to visualize patient-specific anatomy. It aids
in boosting precision, lowering risks, and optimizing surgical strategies.
Interventional Cardiology: Interventional cardiologists can benefit from AR
and VR when performing difficult procedures like coronary angiography
and catheter-based treatments. AR enables precise navigation, blood flow
visualization, and guidance during procedures by superimposing real-time
imaging data into the clinician’s field of view. It increases procedural effec-
tiveness and security.
Patient Education and Engagement: AR and VR technologies can be used
to inform patients about cardiovascular diseases and therapies. Patients
can better understand their condition, make educated decisions, and follow
treatment programs if the cardiovascular system is visualized and disease
processes are explained. Patients learn more effectively in surroundings that
feature interactive AR and VR activities.
Rehabilitation and Exercise: Cardiovascular rehabilitation and fitness pro-
grams can benefit from the use of AR and VR. These technologies can
motivate patients to participate in physical exercises and follow rehabili-
tation guidelines by generating engaging and compelling virtual environ-
ments. During workouts, they can keep an eye on progress, offer feedback,
and monitor performance.
Telemedicine and Remote Consultations: For patients with cardiovascular
diseases, AR and VR can facilitate remote consultations and telemedicine.
These technologies enable doctors to virtually examine patients, view their
data remotely, and direct them through self-evaluations. The necessity for
in-person visits is diminished, and specialized care is easier to access.
Research and Data Visualization: Researchers can use AR and VR to visu-
alize and analyze complex cardiovascular data. Researchers may examine
complex relationships, spot trends, and learn more about disease causes by
transforming massive datasets into interactive 3D visualizations (Aggoune
et al., 2023). It makes data-driven exploration and research easier. The
management of cardiovascular illness could be improved, patient outcomes
could be improved, and the field’s research and teaching could advance
thanks to AR and VR technology. However, it is crucial to make sure that
these technologies are properly incorporated into clinical workflows, eval-
uated for accuracy and safety, and utilized in combination with recognized
medical standards and best practices.
Data Quality and Accessibility: Accurate modelling and simulation depend
on the availability of high-quality and diverse data. Ensuring standardized
data formats, integrating data from multiple sources, and addressing data
privacy issues are all difficulties. To increase modelling precision and gen-
eralizability, future initiatives should concentrate on creating reliable data
repositories, harmonizing data standards, and encouraging data sharing.
Computational Complexity: Complex multiscale and multiphysics sim-
ulations are frequently used in CVD modelling. It is difficult to achieve
computing efficiency while correctly capturing physiological processes.
The development of quicker and more scalable algorithms, the use of high-
performance computing resources, and the optimization of computational
workflows to support real-time or near-real-time simulations are possible
future developments.
Personalized Modelling: Modelling and simulating CVD on an individual
basis is necessary for precision medicine. Physiological indicators, genetic
data, and patient-specific data like medical images must all be incorporated
into the modelling framework in order to achieve this. The risk assessment,
treatment planning, and outcome prediction capabilities of customized
modelling can all be improved, leading to interventions that are ultimately
more targeted and effective.
Uncertainty and Validation: It is crucial for the clinical application of CVD
models to validate their accuracy and dependability. Modelling uncertainty
and creating strong validation frameworks are continuous difficulties. The
integration of uncertainty quantification techniques, the use of extensive clin-
ical data for validation, and the execution of prospective studies to evaluate
the clinical impact of modelling predictions should be the future directions.
Integration of Multimodal Data: By combining several imaging modalities,
such MRI, CT, and ultrasound, CVD modelling might benefit from the col-
lection of complementing data. It is possible to acquire a deeper knowledge
in disease development and therapy retort by merging imaging data with
clinical data information (Chugh et al., 2023), such as genetic profiles along
with biomarkers. Creating approaches for multimodal data fusion and inte-
gration will improve the precision and clinical utility of CVD modelling.
Translational Impact: It is still difficult to bridge the knowledge gap between
clinical practice and CVD modelling research. Future work should concen-
trate on creating user-friendly modelling tools that clinicians can quickly
adopt, providing interpretability and practical insights from modelling out-
comes, and proving the clinical utility and economic viability of modelling
approaches through rigorous clinical studies.
Ethical Considerations: As modelling and simulation technologies develop,
privacy, data security, and patient consent issues become more crucial. For
CVD modelling approaches to be developed and used in the future, it is
essential that moral standards and laws be in place to safeguard patient
rights and privacy. It takes the combined efforts of researchers, doctors,
engineers, and policymakers to address the difficulties in modelling imag-
ing and the simulation of cardiovascular disease.
18.7 CHALLENGES AND FUTURE DIRECTION IN

MODELLING IMAGING AND SIMULATION OF CVD
For accurate modelling and simulation, high-quality data is necessary. Due to
privacy concerns, the availability of data, and the requirement for standard-
ized data-gathering techniques, collecting numerous and well-annotated
datasets can be difficult.
Complex mathematical models and a lot of processing power are frequently
needed for cardiovascular simulations (Dash et al., 2023). The efficient
handling of large-scale simulations requires parallel processing and high-
performance computing developments.
The circulatory system of every patient is different, making it difficult to create
individualized models for precise simulations. It is a challenging undertak-
ing to include patient-specific data in models while maintaining accuracy
and usability.
It is essential for the clinical application of computational models to validate

them against real-world data (Pezhouman et al., 2023). The models’ ability
to adequately depict the pathophysiology and physiology of the cardiovas-
cular system is a recurring problem.
It is difficult to integrate different scales into a coherent model. Blackbox mod-
elling is challenging to interpret and may not provide clinicians with much
confidence when making decisions. For simulation approaches to be used in
practice, it is essential to create interpretable models that physicians can rely
on. The clinical usability and impact of these procedures can be improved
by addressing the issues and embracing the future.
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19 Blockchain-Enhanced
Convolutional
Neural Networks for
Efficient Detection
of Cardiovascular
Abnormalities
Shaik Karimullah, Fahimuddin Shaik,
D. Vishnu Vardhan, and Ch. Nagaraju
19.1 INTRODUCTION
Cardiovascular disease (CVD) is a primary global reason for a considerable num-
ber of deaths, and it is dubbed the “silent killer” due to its impact on the heart and
arteries, potentially leading to heart attacks and tissue damage (Abdeldjouad et al.,
2020). CVD has witnessed a 25% increase in overall death rates over the last century,
with males, particularly in middle or late life, being more vulnerable. Age, demogra-
phy, and ethnicity all influence the difficulty of CVD diagnosis. Electrocardiograms
(ECGs) are vital in the detection of cardiac issues because they provide visual repre-
sentations of the heart’s electrical activity. Machine learning (ML), particularly deep
learning (DL), has gained traction in research and a variety of applications, including
ECG signal interpretation (Alom et al., 2019). To extract features from ECG record-
ings, traditional ML approaches such as the discrete wavelet transform (DWT) and
Pan–Tompkins algorithm are employed, followed by classification algorithms such
as the support vector machine (SVM) and hidden Markov model (HMM). These
techniques, however, have problems in reliably categorizing ECG data (Amrit et al.,
2017). CNNs have the advantage of capturing complicated structures autonomously
from incoming data without considerable preprocessing (Bhambri and Bhandari,
2005). The importance of this proposal is to create an accurate automated model for
detecting cardiac disorders in ECGs using CNNs, which has the potential to reduce
misdiagnoses and enhance efficiency in primary care and major hospitals (Andreao
et al., 2006).
In addition, incorporating blockchain technology improves the confidentiality and
privacy of ECG data. Blockchain technology provides a decentralized, tamper-proof
ledger that protects the integrity and traceability of medical records. ECG data can
DOI: 10.1201/9781003459347-19 275

be securely stored, transferred, and accessed by authorized parties via blockchain,

maintaining data privacy and preventing unauthorized alterations (Fryar et al., 2012).
This technology facilitates seamless communication among healthcare providers,
researchers, and patients, resulting in more accurate diagnoses and better patient
care (Rani et al., 2023). CNNs and blockchain technology working together have
the potential to revolutionize the identification and management of cardiovascular
problems, ultimately saving lives and improving the healthcare system as a whole
(Karimullah et al., 2022).
19.1.1 Background and Significance

19.1.1.1 Background
Cardiovascular disease (CVD) is a predominant source of death across the world,
and timely detection of cardiovascular abnormalities plays a crucial role in improv-
ing patient outcomes. Electrocardiogram (ECG) analysis is a widely used method for
screening and diagnosing heart disorders (Karimullah et al., 2020). Machine learn-
ing techniques, such as convolutional neural networks (CNNs), have shown promise
in automatically detecting cardiovascular abnormalities in ECG data. However, there
are challenges associated with the reliability and efficiency of existing classification
models.
19.1.1.2 Significance
Blockchain’s popularity stems from its potential to enhance data security, privacy,
and interoperability, notably in healthcare. When integrated with ECG analysis, it can
overcome the limitations of standard machine learning models, improving the effi-
ciency and accuracy of cardiovascular problem identification (Bhambri et al., 2005a).
This study explores blockchain’s synergy with CNNs to create a robust and secure
ECG-based cardiovascular problem detection system (Liu et al., 2021). Blockchain
offers several advantages, including data immutability and integrity through decen-
tralized ledger technology, secure data sharing and access for authorized parties,
and simplified data sharing agreements via smart contracts, empowering patients to
control access to their medical information (Mitra et al., 2013).
19.1.2 Problem Statement
Detecting cardiovascular abnormalities accurately and efficiently is crucial for
managing cardiovascular disease (CVD). Traditional machine learning methods
for analyzing electrocardiogram (ECG) data have limitations in reliability and effi-
ciency (Kaur et al., 2023). This research addresses two key challenges: First, exist-
ing machine learning models for ECG analysis lack reliability, potentially leading
to misdiagnoses or missed diagnoses due to their reliance on manually extracted
features and classification algorithms. This compromises accuracy and efficiency,
putting patient outcomes at risk and burdening healthcare professionals (Puri et al.,
2023, September). Second, concerns over data security, privacy, and interoperabil-
ity arise in ECG data storage, sharing, and access control. Centralized systems are
Blockchain-Enhanced Convolutional Neural Networks 277
vulnerable to security breaches and unauthorized access, jeopardizing patient con-

fidentiality (Rani et al., 2023). The absence of standardized protocols inhibits the
seamless exchange of ECG data among healthcare stakeholders, impeding collab-
oration and progress in cardiovascular disease management (Bhambri and Singh,
2005). To tackle these challenges, this research proposes integrating blockchain
technology with convolutional neural networks (CNNs) to create an innovative solu-
tion for efficient cardiovascular abnormality detection in ECG data. By combining
CNNs’ automatic feature extraction and pattern recognition with blockchain’s secu-
rity and privacy assurances, the aim is to surpass the limitations of traditional ECG
classification models and enhance reliability and efficiency in detecting cardiovas-
cular abnormalities. Thus this work strives to increase the efficiency and accuracy
of cardiovascular abnormality detection while ensuring the security, privacy, and
interoperability of medical information. The development of a blockchain-enhanced
CNN model holds the potential to advance cardiovascular disease management and
provide healthcare professionals with a dependable tool for precise diagnosis and
enhanced patient care.
19.2 LITERATURE REVIEW
In previous studies, various techniques have been explored for cardiovascular dis-
ease (CAD) detection Rani et al. (2023). One approach incorporated multidomain
combinations of multichannel cardiac data, enhancing accuracy to 90.90% through
the addition of entropy to support vector machines (SVM) (Murray, et al., 1994). In
another study, cardiac echoes were captured using the imagined part of cross-power
spectral density (ICPSD) (Nourmohammadi-Khiarak et al., 2020). Oh et al. (2020)
introduced a hybrid method for predicting cardiovascular disease, achieving an 80%
accuracy rate with machine learning techniques. This method aims to assist phy-
sicians rather than replace them, especially in emergency situations. Furthermore,
a data mining technique combining an imperialist competitive algorithm and
K-nearest neighbor reached a 91% accuracy in identifying heart illness (Park et al.,
2008). A revolutionary system based on MLP and CNN networks achieved 88.7%
and 83.5% accuracy, respectively, in Pathak et al. (2020), while a fresh method incor-
porating several methodologies into a learning algorithm achieved 89.2% efficiency
in Pouyanfar et al. (2018). Rough sets (RS) with quantum neural networks (QNN)
achieved 91.7% accuracy in Ribeiro et al. (2020). Furthermore, in Rozenwald et al.
(2020), the K-nearest neighbor and genetic algorithm were used for heart disease
categorization, with an accuracy of less than 90%. Because existing approaches have
accuracies of less than 94%, a dynamic CNN methodology is presented to use opti-
mized multichannel cardiac sound signals for improved accuracy in cardiovascular
condition detection (Savalia et al., 2018).
The chapter focuses on machine learning techniques, namely convolutional neural
networks (CNNs), for diagnosing cardiovascular irregularities and investigates the
potential of blockchain technology in healthcare for data interoperability, privacy,
and security (Shaik et al., 2021). Traditional approaches for ECG signal categoriza-
tion, such as support vector machines (SVM) and hidden Markov models (HMM),
have shortcomings when compared to human cardiologists (Shaik et al., 2016). Recent
advances in CNNs have shown promise in autonomously extracting relevant fea-
tures from ECG data, with high accuracy achieved without extensive preprocessing
(Shaik et al., 2023). Blockchain’s potential in healthcare is recognized for preserving
data integrity and privacy via a decentralized, irrefutable ledger (Tarawneh et al.,
2019). Several studies have emphasized its advantages, such as secure medical record
exchange and access control (Tang et al., 2014). By using blockchain’s immutability
and decentralization for data protection and restricted access, combining blockchain
with CNNs has considerable potential for boosting efficiency and security in cardio-
vascular anomaly detection (Trevisan et al., 2020). However, little research has been
conducted on this combination (Vijayavanan et al., 2014).
19.3 PROPOSED FRAMEWORK FOR BLOCKCHAIN-ENHANCED

CNN FOR CARDIOVASCULAR ABNORMALITY DETECTION
The blockchain-enhanced CNN for cardiovascular abnormality detection utilizes a
hybrid architecture merging the power of CNNs for feature extraction and pattern
recognition with the safety and privacy guarantees of blockchain technology. The
architecture consists of several components, including the CNN model, blockchain
network, smart contracts, and user interfaces. The step-by-step algorithm and block
diagram are shown in Figure 19.1 and Figure 19.2.
Algorithm 1: Variable initialization and Cyclic Prefix

1.
Apply image pre-processing techniques (e.g., noise
removal, image enhancement, normalization, etc.).
2. Store the pre-processed images.
3. Extract relevant features from the images.
4. Store the extracted features.
5. Encrypt the features using a secure encryption.
6. Generate a unique hash for each encrypted feature.
7.
Store the encrypted features and their hashes on
the blockchain.
8.
Track and record transactions related to the stored
features.
9.
Enable auditing mechanisms for tracking data access
and modifications.
10.
Implement secure access controls to ensure data
privacy.
11.
Enable encryption and decryption mechanisms for
authorized users.
12.
Facilitate secure collaboration among healthcare
providers, researchers, and patients.
13.
Validate the reliability of the data using the
stored hashes.
FIGURE 19.1 Algorithm for proposed methodology.

FIGURE 19.2 Block diagram for proposed methodology.
1. Preprocessing of Cardiovascular Images: The first step is to preprocess

the cardiovascular images or ECG signals to ensure optimal input for the
CNN model. This may involve noise reduction, signal normalization, and
resizing to a standardized format (Bhambri et al., 2005b). Preprocessing
techniques help enhance the quality and consistency of the input data.
2. Feature Extraction Using CNNs: Preprocessed cardiovascular images are
input into the CNN model for automatic feature extraction, allowing it to
capture complex patterns and characteristics associated with cardiovascular
abnormalities.
3. Encryption and Storage on the Blockchain: After feature extraction,
data is encrypted to safeguard patient privacy and confidentiality and then
securely stored on the blockchain network. Each data record receives a
unique hash, serving as a digital fingerprint to guarantee its immutability
within the blockchain.
4. Transaction Tracking and Auditing: Blockchain provides transparent
transaction tracking and auditing for all data interactions, including access,
modification, and sharing, recorded as transactions. This transparent log
ensures accountability and traceability in all activities related to cardiovas-
cular images.
5. Data Security, Privacy, and Collaboration: Blockchain enhances data
security and privacy by decentralizing storage and utilizing cryptography.
Its distributed network minimizes data breach risks by avoiding centralized
storage. Access control and encryption measures restrict data interaction to
authorized entities.
6. Ensuring Data Integrity and Privacy: The immutability of the blockchain
ensures the integrity of the cardiovascular images. Any changes or modifi-
cations made to the data are recorded as new transactions, preserving the
original data record (Bhambri and Mangat, 2005). This tamper-proof nature
guarantees the authenticity and reliability of the stored data, enhancing the
trustworthiness of the cardiovascular abnormality detection system.
7. Secure Sharing among Healthcare Providers, Researchers, and Patients:
Through smart contracts that enforce access control norms and approvals,
blockchain enables secure exchange of cardiovascular pictures among autho-
rized parties. Patients retain control by authorizing specified healthcare prac-
titioners or researchers to view their medical pictures, ensuring privacy, and
promoting secure, controlled collaboration, and information sharing.
8. Collaboration and Development of Decentralized Medical Image Data-
bases: The blockchain-enhanced CNN enables the establishment of decen-
tralized medical image databases to which healthcare practitioners and
researchers can input anonymized cardiovascular pictures for large-scale
collaborative analysis. The decentralized, redundant, and consensus-driven
structure of the blockchain assures secure and robust database upkeep.
19.4 QUANTITATIVE METRICS
Quantitative metrics include accuracy, positive anticipated value, sensitivity, speci-
ficity, negatively expected values, positive likelihood, negative likelihood, and so on.
19.4.1 Accuracy
Accuracy assessment involves evaluating the precision of measured variables in
equipment through multiple measurements, often aided by probability to enhance
precision. It calculates the ratio of correctly categorized or segmented pixels to the
total pixels in an image, as shown in Eqn. (19.1). Accuracy is derived from false neg-
ative, true positive, false positive, and true negative values.
(Tp + Tn )
Accuracy = (19.1)
Tp + Fp + Fn + Tn
where Tp = True positive

Tn = True negative
Fp = False positive
Fn = False negative
19.4.2 Sensitivity
The sensitivity test measures the proportion of accurately classified positives as a
percentage of ill persons. In clinics, people’s illnesses are evaluated on a percent-
age basis; if the percentage has a value greater than the specificity, they are consid-
ered unwell. A test’s sensitivity is its capacity to appropriately discriminate patient
instances. It computes the ratio of real positive pixels to total positive pixels, and its
mathematical form is given in Eqn. (19.2).
Tp
Sensitivity = (19.2)
Tp + Fn
19.4.3 Specificity
The test is capable of accurately defining healthy cases, calculating the proportion
of genuine negatives (Tn) in healthy instances, and measuring the proportion of sig-
nificant results (positives) that are appropriately described using Eqn. (19.3). This
can properly identify those who are not unwell. It computes the proportion of real
negative pixels to total negative pixels.
Tp
Specificity = (19.3)
Tp + Fn
19.5 EXPERIMENTAL EVALUATION AND RESULTS

The proposed system detects cardiovascular diseases like heart attack, heart valve,
vascular diseases, pericardial and heart failure by using optimized multichannel car-
diac sound signals. To distinguish and classify cardiovascular syndromes, initially
the ECG signals are developed. In this work, the ECG signals of four patients repre-
sented as P-l, P-2, P-3, and P-4 are acquired from a public database like Kaggle and
are shown in Figure 19.3.
The heart’s electrical activity is captured over time by an ECG. ECG signals
continue to be utilized as an examination instrument for determining the cause of
FIGURE 19.3 ECG signals.

various cardiac conditions. It is now a crucial component of any comprehensive med-

ical assessment. The ECG signal is a gold mine of knowledge about the structure
and operation of the heart. Figure 19.3 shows ECG information gathered from the
patient’s various nodes. After acquiring the ECG signals at different nodes of the
patient, they are stored at buffer. After recording all the ECG signals then, they are
fused. The method of combining more than two entities into a singular entity is con-
sidered as fusion. Fusion can enable or enhance the approximation to more complex
structured results. Multimodal fusion combines data from a variety of sheaths into a
single command. Usually for a single patient, four ECG signals are acquired at four
different nodes.
It is difficult to process all four signals at the same time. As a result, the four ECG
signals of the patients are merged to lessen the process’s complexity. A multimodal
fusion technique improves heartbeat detection by incorporating extra information
from diverse physiological markers. Figure 19.4 depicts the fused signals of P-1–P-4.
FIGURE 19.4 Fused ECG Signals.

An optimization algorithm selects optimal features from the fused signals by iter-
atively associating possible explanations until an optimal solution is reached. The
gradient descent optimization technique is utilized in this work to select the best fea-
tures from the fused ECG data, as shown in Figure 19.5. Following feature selection,
these features are extracted using a clustering approach. Clustering splits a set of
data points into groups, guaranteeing that data components within a single group are
more connected to one another than data elements in other groups. The optimized
ECG signals are segmented by magnitude using the K-means algorithm, which has
seven clusters. Maximum, mean, median, cross-entropy, and gradient are retrieved
from these clusters, as illustrated in Figure 19.6.
All collected features are fed into the classification procedure, which employs
CNN to classify cardiovascular diseases. The convolutional neural network is made
FIGURE 19.5 Optimized ECG signals.

FIGURE 19.6 Clustered ECG pulses.
up of input, hidden, and output layers that learn and connect inputs and outputs. As
shown in Figure 19.7, the network modifies correlation-associated weights during
training using specific datasets. Following disease classification, results are validated
using characteristics such as cross-entropy and gradient. If the cross-entropy and
gradient values in the validation performance curve and training state approach zero,
the model is well-trained; otherwise, it requires more refining. A well-trained model
should align with or closely follow the best line, showing that training convergence
was effective. For classification tasks, cross entropy is used, and Figure 19.8 shows
the cross entropy and gradient values for patients 1 to 4.
The confusion matrix determines the performance of a classification technique.
The model’s total number of accurate and incorrect predictions is shown in a con-
fusion matrix. For each class, the proportion of accurate predictions is distributed
diagonally. Figure 19.9 shows the confusion matrix for four patients.
FIGURE 19.7 Training phases of CNN P-4.
Finally, the ROC curve is used to observe the effectiveness and strength of the
developed model. Receiver operating characteristics demonstrates the trade-off
among the true positive rate in addition to false positive rate. All the receiver operat-
ing characteristics are obtained after training, validation, and testing. AROC curva-
ture that is close to 1 specifies that the system is impeccable, as shown in Figure 19.10.
In Table 19.1, it clearly observed that nearly 98% of accuracy, approximately 64% of
sensitivity, and nearly 62% of specificity are obtained for all the patients. The param-
eters of all the patients are shown in Figure 19.11.
FIGURE 19.8 Best validation performance and training state.

FIGURE 19.8 (Continued) Best validation performance and training state.
FIGURE 19.9 Confusion matrices.

FIGURE 19.10 Receiver operating characteristics.
TABLE 19.1
Statistical Parameters of Four Patients
Patient Details Patient 1 (P-1) Patient 2 (P-2) Patient 3 (P-3) Patient 4 (P-4)
Accuracy 98 97 96.5 98.5

Sensitivity 65.625 62.375 64.10 63.625
Specificity 62.45 60.25 62.15 61.35
Maximum 192.44 175.10 247.311 250.79
Mean 31.89 53.07 62.55 66.91
Median 25.58 47.36 58.10 56.70
RMS 40.08 60.63 72.68 79.05
Diseases classification Heart failure Heart valve Heart attack Heart attack
FIGURE 19.11 Statistical parameters graph for four patients.

In summary, this study introduces a novel framework for cardiovascular abnormality
detection, combining gradient descent optimization, convolutional neural networks
(CNNs), and blockchain technology. The process involves collecting patient cardio-
vascular data, including electrocardiograms (ECGs) and echocardiograms, followed
by data preprocessing and augmentation for improved training. Gradient descent
optimization fine-tunes model parameters, and CNNs classify abnormalities using
a labelled dataset. Blockchain integration ensures data confidentiality, integrity, and
transparency, with each data sample securely hashed and stored in a decentralized
ledger. Experimental results demonstrate superior performance over traditional
methods in terms of accuracy, sensitivity, and specificity. The CNN model accurately
identifies relevant features and predicts anomalies, promising early detection and
improved patient outcomes in cardiovascular medicine.
Future work can explore optimizing the CNN model, enhancing blockchain scal-
ability and interoperability, integrating diverse cardiovascular data types, and con-
ducting real-world clinical testing in collaboration with healthcare institutions and
clinicians to refine and deploy the framework.
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20 Research Landscape
of Blockchain and
Computational
Intelligence in
Healthcare and
Biomedical Fields
A Bibliometric Analysis
Parul Dubey, Amit Srivastava, Priti Nilesh Bhagat,
and Pushkar Dubey
20.1 INTRODUCTION
Healthcare and biological sciences are being transformed by emerging technology.
These technologies, including blockchain and computational intelligence, might alter
research, data management, and decision-making. Blockchain technology makes data
collecting and sharing safe and transparent, while machine learning and artificial intel-
ligence provide quick data analysis and decision support. These technologies together
solve long-standing healthcare and biological research issues Kaur et al. (2023).
A bibliometric study is needed to understand blockchain and computational intel-
ligence in healthcare and biological research. Quantitative bibliometrics may exam-
ine academic subject publishing, citation, and collaboration trends (Donthu et al.,
2021). This study analyses Web of Science publications and uses VOSviewer to pro-
vide a systematic and comprehensive review of blockchain and computational intel-
ligence research in healthcare and biomedical fields.
This study contains a wide range of works from 1990 to the present, tracing this
topic’s growth. The selected time frame ensures a complete evaluation of current
knowledge, including recent advances and trends. The Web of Science database pro-
vides a reliable source of scientific papers for bibliometric analysis.
The objectives of this study are to:
Identify and map significant research subjects and subdomains in healthcare and
biomedical research involving blockchain and computational intelligence.
292 DOI: 10.1201/9781003459347-20

Research of Blockchain and Computational Intelligence 293
Assess publication growth and identify key trends in the subject.

Identify key authors, institutions, and nations supporting research in this field.
Identify highly cited works that are seminal contributions in the area and
examine citation trends.
Identify significant collaborations among researchers and institutions using
network exploration.
20.2 BIBLIOMETRIC ANALYSIS: AN OVERVIEW

Bibliometric analysis quantifies publishing, citation, and collaboration patterns
within a study field. It sheds light on scientific writing’s development, influence, and
trends. VOSviewer is famous for showing and researching bibliometric networks
(Moral-Muñoz et al., 2020; Singh et al., 2005c). It provides a thorough and straight-
forward way to comprehend the intricate links among authors, publications, key-
words, and organizations Rani et al. (2023).
VOSviewer generates visual representations of bibliometric networks using bib-
liographic data gathered from databases such as Web of Science, Scopus, or PubMed
(VOSviewer—Visualizing Scientific Landscapes, n.d.). Nodes represent authors,
publications, keywords, and institutions, while links indicate relationships between
them. VOSviewer uses clustering, overlay, and density visualization to show biblio-
metric networks clearly.
VOSviewer’s ability to discover bibliometric network clusters is a major bene-
fit. Clusters are strongly related entities, such as writers who write about similar
topics or institutions that investigate particular topics (Subject and Course Guides:
Bibliometric Analysis and Visualization: Bibliometrics with VOSviewer, 2023;
Singh et al., 2005a). VOSviewer uses advanced clustering algorithms to identify
these groups, helping academics understand the subject area’s structure and theme
Rani et al. (2023).
Another relevant tool is VOSviewer’s citation trend analysis. Citation connections
between publications may highlight noteworthy works with many citations. These
highly referenced publications may help researchers locate essential works and influ-
ential writers (Singh et al., 2005b). This data can guide future research and provide
collaborative opportunities Puri et al. (2023, September).
VOSviewer lets us examine researcher–institutional collaborations. Res
earchers can find important relationships and research networks by showing
co-authorship and co-affiliation networks. This data may be utilized to form mul-
tidisciplinary relationships, identify research trends, and find collaborators Rani
et al. (2023).
20.3 METHODOLOGY
The methodology section of this research encompasses various stages of data collec-
tion, extraction, preprocessing, and bibliometric analysis. Figure 20.1 shows steps in
the methodology in detail. The following sections provide an overview of each step
involved.
FIGURE 20.1 Methodology of bibliometric analysis.
Data Source and Collection: The primary data source for this research is
the Web of Science database, which is a comprehensive collection of schol-
arly publications across multiple disciplines. Relevant keywords related
to blockchain, computational intelligence, healthcare, and biomedical
research were used to search The Web of Science database, which contains
scientific papers from many fields and is the main data source for this
study. Searching for papers will employ blockchain, computational intelli-
gence, healthcare, and biomedical research keywords (Singh et al., 2005d).
To capture the newest field advancements, data was collected from 1900
to July 2023 for publications. The chosen timeframe for data collection is
from 1900 to the present (July 2023) to capture the latest developments in
the field.
Data Extraction and Preprocessing: After identifying relevant papers,
Web of Science data was extracted. Reference management software like
EndNote or Zotero was used to organize and handle the extracted data.
Duplicate records were deleted for a clean analytical dataset.
Publication Trends: Publication trends were analyzed to gain insights into
the growth and evolution of research in the field. The number of publica-
tions over time were examined to identify increasing or decreasing interest
in the topic.
Bibliometric Analysis: The bibliometric analysis in VOSviewer involved sev-

eral components to explore the relationships and characteristics of the col-
lected publications:
Co-authorship Analysis: Author cooperation tendencies were identified via
co-authorship networks. This study identified notable field writers and
research groups.
Co-occurrence Analysis: Co-occurrence analysis discovered field-specific
research topics and ideas. Relevant keywords and concepts were retrieved
to understand core emphasis areas and interdisciplinary relationships.
Citation Analysis: Analyzing citation networks revealed influential authors
and frequently cited papers. This analysis illuminated the field’s most
significant research.
Bibliographic Coupling: Bibliographic coupling analysis was used to
locate linked research publications using shared references. This analysis
showed clusters of similar papers and indicated field research trends and
subdomains.
By conducting these analyses, the research aimed to uncover patterns, relationships,

and influential works in the field of blockchain and computational intelligence in
healthcare and biomedical research.
20.4 DATA SOURCE AND COLLECTION

This research used Web of Science as its primary data source because it covers schol-
arly papers across fields. The database contains many high-quality journals, confer-
ence proceedings, and other scientific material. The research used this database to
find relevant blockchain and computational intelligence publications in healthcare
and biomedical research.
The data gathering procedure involves searching for research-related keywords.
The keywords are “blockchain” or “computational intelligence” and “healthcare”
or “health” or “biomedical.” These keywords focus on papers on blockchain tech-
nology, computational intelligence, and healthcare and biomedical applications. The
titles or abstracts of articles were searched to guarantee relevancy.
Collection includes all available data from 1900 to 2023. This vast span enables a
complete review of the field’s history and current advances. The research can iden-
tify early contributions, trace the evolution of the research topic, and analyze recent
trends and developments by analyzing publications from 1900.
After searching, 2894 documents were relevant to the research topic. Figure 20.2
details these data collecting parameters. These research articles, conference papers,
and other scholarly works discuss blockchain and computational intelligence in
healthcare and biomedical research.
The Web of Science papers were used for data extraction, preprocessing, and
bibliometric analysis to reveal field publishing trends, author partnerships, research
themes, and citation patterns (Kataria et al., 2023, July).
FIGURE 20.2 Data source and collection.
FIGURE 20.3 7 different fields of data extraction.
20.5 DATA EXTRACTION AND PREPROCESSING

After finding relevant Web of Science publications, data extraction and preprocess-
ing followed. This stage involved extracting and structuring the acquired documents’
data for analysis. Reference management software like EndNote or Zotero helped to
organize data. These software solutions simplify bibliographic data storage, organi-
zation, and manipulation. The retrieved data can be imported into the software for
easy manipulation (Singh et al., 2005e). This research retrieves 1000 Web of Science
documents at once. The retrieved data comprises Excel and plaintext fields linked to
the publications. The dataset has 17 fields, as seen in Figure 20.3.
To ensure data quality and consistency, preprocessing followed data extraction.
This removes duplicate records from the dataset to prevent redundancy and ensure
proper analysis. To ensure data reliability, faults and inconsistencies were remedied.
20.6 PUBLICATION TRENDS
The publication trends in blockchain and computational intelligence in healthcare
and biomedical research have grown significantly. The data shows a slow start in the
late 1990s and early 2000s, with few publications. Since 2007, the number of articles
has increased, indicating increased interest in the topic.
Publishing increased steadily, with a major increase from 2017. With 155 arti-
cles in 2018, the tendency continued to accelerate. Publications increased more than
twice to 333 in 2019. The growth pattern accelerated in 2020 with 469 publications.
Publications peaked at 586 in 2021. This shows that blockchain and computational
intelligence are becoming more important in healthcare and biomedical research.
The number of publications nearly doubled in 2022 to 873. The partial 2023 data
shows 325 publications, indicating ongoing activity.
The publishing trends show a constant increase in blockchain and computational
intelligence research in healthcare and biomedical research. The rising number of
studies shows that these technologies can transform healthcare and biomedical proce-
dures. The increased trajectory in publication counts shown in Figure 20.4 reflects a
robust and expanding research ecosystem, underscoring the importance of blockchain
and computational intelligence in addressing difficulties and fostering innovation.
20.7 CO-AUTHORSHIP ANALYSIS
Bibliometric analysis identifies notable authors, nations, and organizations in block-
chain and computational intelligence in healthcare and biomedical research using
co-authorship analysis.
FIGURE 20.4 Publication trends of blockchain and computational intelligence in healthcare

and biomedical fields.
FIGURE 20.5 Co-authorship analysis based on authors.
First, author co-authorship analysis identifies scholars who have published

together several times. It reveals research networks and author collaboration. We can
better comprehend major contributions and their impact on the subject by identifying
prolific authors and their collaborations.
According to author co-authorship analysis, 20 of 9241 writers had at least 10
documents. This author clustered 14 co-authors. The author-based co-authorship
analysis is shown in Figure 20.5.
In this analysis, cluster 3 author Sudeep Tanwar is remarkable. Tanwar is linked to
three other writers in this cluster with 32. This suggests good scientific collaboration.
Tanwar has 34 papers, demonstrating his major field contribution. Tanwar’s 1632
citations demonstrate his research’s influence.
Neeraj Kumar, another cluster 3 author, is notable. Kumar has 28 links with six
cluster authors. This shows high group collaboration. Kumar has 27 publications,
exhibiting consistent research. Kumar’s 1263 citations demonstrate his impact in the
field.
Khaled Salah is another prominent cluster 2 author. Salah has 46 links to four
other writers. This cluster collaborates well. Salah’s 25-document research is exten-
sive. Salah’s research has 638 citations, demonstrating its influence.
These findings highlight the authors’ blockchain and computational intelligence
collaborations in healthcare and biology research. The author-based co-authorship
study illuminates collaborative networks and notable scholars, advancing knowledge
and innovation.
Second, country-based co-authorship analysis shows the geographic distribution
of cooperation. It reveals which countries are researching blockchain and compu-
tational intelligence in the healthcare and biomedical domains. This study helps us
discover worldwide research hotspots, international collaborations, and their impact
on the field.
The co-authorship analysis by nation required 50 documents and 50 citations.
Twenty of 113 nations evaluated showed notable blockchain and computational intel-
ligence co-authorship patterns in healthcare and biological research.
Among these countries, the following observations can be made:
India: Cluster 3’s India is a major contributor. The country has 418 co-
authorship links. This shows active Indian research cooperation. The nation
has released 652 documents, demonstrating its research output. Indian
research in this topic has 8414 citations, demonstrating its impact.
People’s Republic of China: Cluster 3’s People’s Republic of China (China)

is another major contributor. With 363, the country has substantial co-
authorship relationships. This suggests a strong Chinese research com-
munity collaboration. Chinese scholars have published 505 documents, a
large output. Chinese research in this topic has 11,661 cumulative citations,
demonstrating their influence and acknowledgment.
United States: The United States, in cluster 1, contributes to blockchain and
computational intelligence in healthcare and biomedical research. The
country has 340 co-authorship links. US researchers have released 478 doc-
uments, demonstrating their research productivity. Their 12,517 citations in
this field demonstrate their importance and recognition.
Saudi Arabia: Saudi Arabia, in cluster 2, has 312 co-authorship links. This
shows that Saudi Arabian researchers collaborate actively. Publishing 250
documents, the country has produced significant research. The 2,744 cita-
tions Saudi Arabian research has received in this subject demonstrate its
influence.
England: England, in cluster 1, has 214 co-authorship ties. This indicates
English research cooperation. English researchers released 198 documents,
demonstrating their research productivity. Their study in this topic has
4,931 citations, demonstrating its significance and recognition.
These findings show how countries collaborate in blockchain and computational

intelligence in healthcare and biomedical research. Country-based co-authorship
analysis is shown in Figure 20.6. India, China, the United States, Saudi Arabia, and
England contribute to this subject by active research outputs, robust co-authorship
networks, and high citation impact.
FIGURE 20.6 Co-authorship analysis based on country.

Third, organization-based co-authorship reveals field-wide partnerships. We can

assess academic, scientific, and industry collaboration by identifying writers’ affil-
iations. This report demonstrates how diverse companies collaborated to promote
blockchain and computational intelligence in healthcare and biological research.
Organizations must have 20 documents and 100 citations for co-authorship anal-
ysis. Out of 3454 organizations studied, 15 fit these criteria and have remarkable
blockchain and computational intelligence co-authorship trends in healthcare and
biomedical research. Twelve were connected. Organizational co-authorship analysis
is shown in Figure 20.7.
Among these organizations, the following observations can be made:
King Saud University: Cluster 2’s King Saud University has 12 co-
authorships. The organization has released 38 documents, indicating exten-
sive investigation.
Nirma University: Cluster 4’s Nirma University has 31 co-authorship relation-
ships with 37 publications. The organization has produced notable research.
King Abdulaziz University: This university in cluster 3 has 22 co-authorship
relationships. The organization issued 36 documents, demonstrating its sci-
entific output.
Taif University: Cluster 4’s Taif University has a co-authorship connection
strength of 1. The 31 documents published by Taif University show signif-
icant research.
Vellore Institute of Technology: Vellore Institute of Technology, cluster 1,
has 5 co-authorship relationships. The organization has 31 publications
exhibiting its research.
These findings show how blockchain and computational intelligence firms collab-
orate in healthcare and biomedical research. King Saud University, Nirma University,
King Abdulaziz University, Taif University, and Vellore Institute of Technology con-
tribute to this subject through research and cooperation.
Co-authorship examination by authors, countries, and organizations reveals
field-wide collaborations. Key contributions, geographic trends, and institutional
FIGURE 20.7 Co-authorship analysis based on organization.

relationships are highlighted in this comprehensive snapshot of the collaborative

environment. This information helps to identify research networks, develop collab-
orations, and analyze blockchain and computational intelligence in healthcare and
biomedical research collaboration dynamics.
20.8 CO-OCCURRENCE ANALYSIS
Based on co-occurrence analysis of all keywords with a minimum incidence of 60,
51 of 6602 keywords satisfied the criterion. “blockchain,” “security,” “internet,”
“privacy,” “healthcare,” “IOT (Internet of Things),” “challenges,” “framework,” and
“artificial intelligence” are the top ten keywords in blockchain and computational
intelligence in healthcare and biomedical research, which are centered on these
terms. High recurrence denotes literature importance and renown.
The most common keyword is “blockchain,” suggesting its significant position in
the area. Other common keywords include “security” and “privacy,” emphasizing the
need for safe and private blockchain transactions and data management. “Healthcare”
and “IoT” keywords show how blockchain and computational intelligence are used
in healthcare to integrate medical devices and data. All keyword co-occurrences are
shown in Figure 20.8.
FIGURE 20.8 Co-occurrence analysis of all keywords.

The phrases “hurdles” and “framework” emphasize the challenges and necessity
for structured ways in implementing and using blockchain and computational intel-
ligence in healthcare and biomedical research. The term “artificial intelligence” also
refers to computational intelligence and AI techniques in the field.
This analysis illuminates the main themes and concepts in blockchain and com-
putational intelligence in healthcare and biomedical research. These keywords indi-
cate the major areas of attention, research problems, and emerging trends in the
discipline, helping scholars and practitioners navigate this quickly expanding sector.
20.9 CITATION ANALYSIS
Based on the citation analysis, with a minimum of 200 citations per document, a sub-
set of 33 documents out of the total 2894 documents met the criteria. Among these
documents, 26 were found to be connected in citation clusters. Table 20.1 shows the
details of the top ten documents in this criterion.
20.10 BIBLIOGRAPHIC COUPLING
Bibliographic coupling analysis discovered 13 of 1285 sources with at least 20 docu-
ments and 50 citations. Figure 20.9 displays the source network.
Bibliographic coupling study links sources using shared citations. This technique
helps us find clusters of linked sources and understand field relationships and study
themes.
We can better comprehend influential blockchain and computational intelligence
works and research trends in healthcare and biomedical research by identifying
sources that fulfill the requirements. The selected subset of 13 sources provides
excellent insights into key publications and influential research contributions that
have been widely cited by other academics in the field.
TABLE 20.1
Top Ten Most Cited Documents
Si. No. Author and Year Cluster Weight<Links> Weight<Citations>
1 (Azaria et al., 2016) 6 12 924

2 (Casino et al., 2019) 3 6 707
3 (Yue et al., 2016) 4 16 552
4 (Kuo et al., 2017) 2 10 457
5 (Kouhizadeh et al., 2021) 3 5 341
6 (Dwivedi et al., 2019) 3 3 335
7 (Griggs et al., 2018) 1 4 329
8 (Dagher et al., 2018) 1 3 316
9 (Dutta et al., 2020) 3 2 304
10 (Agbo et al., 2019) 1 12 293
FIGURE 20.9 Bibliographic coupling analysis based on sources.
20.11 ADVANTAGES AND CHALLENGES

20.11.1 Advantages of Blockchain in Healthcare
Data Security and Privacy: Decentralized and unchangeable blockchain
technology safeguards healthcare data security and privacy. Encrypted,
timestamped, and appended to a chain of blocks, each transaction protects
patient data from unauthorized access.
Interoperability: Blockchain allows healthcare providers and systems to share
data. It allows organizations to safely share patient data, improving care
coordination, medical errors, and patient outcomes.
Data Integrity and Auditability: Blockchain ensures healthcare data integrity.
Every blockchain transaction is transparent and traceable. This feature increases
accountability, simplifies audits, and reduces fraud and data manipulation.
Streamlined Claims and Billing Procedures: Blockchain may automate and
streamline claims and billing by eliminating intermediaries and adminis-
trative costs. Smart contracts can enforce rules and automate payment set-
tlements, reducing errors and processing time.
Clinical Trials and Research: Blockchain could make clinical trials and
medical research more transparent, efficient, and reliable. Safe and trans-
parent consent, data collection, and analytic tracking ensure study integrity
and participant rights.
20.11.2 Challenges of Blockchain in Healthcare

Scalability: Blockchain technology struggles to scale, especially when pro-
cessing large healthcare transactions and data. Current blockchain designs
may not be able to handle healthcare system volume and speed, restricting
their usage.
Integrating Blockchain with Legacy Systems: Integration of blockchain
with healthcare systems and infrastructure may be costly and complicated.
Legacy systems in many healthcare facilities may not be compatible with
blockchain technology, requiring significant investment and effort for
integration.
Regulatory and Legal Frameworks: Legal frameworks for healthcare data
and privacy vary by country. The use of blockchain in healthcare requires
careful evaluation of compliance demands and compliance with current
laws and norms.
Data Standardization and Quality: Blockchain needs standardized,
high-quality data to work. Healthcare data is fragmented, multiformat, and
unstandardized. Multiple data sources may make data quality and consis-
tency problematic.
20.11.3 Advantages of Computational Intelligence in Healthcare

Data Analysis and Decision Support: Machine learning and data mining can
find patterns in huge healthcare data. This may improve diagnosis, treatment
planning, and decision-making, leading to more personalized healthcare.
Predictive Analytics and Early Illness Diagnosis: Computational intelli-
gence models can predict disease development, identify high-risk patients,
and detect disease. Proactive therapy and preventative measures could
improve patient outcomes.
Creation of Customized Treatment: By considering patient characteris-
tics, genetics, and medical history, computational intelligence helps create
tailored treatments. It may assist in tailoring therapies to patients’ needs,
improving results and decreasing side effects.
Healthcare Resource Optimization: Computational intelligence can opti-
mize hospital beds, medical equipment, and staff based on patient needs.
This may boost resource use, reduce wait times, and improve healthcare.
20.11.4 Challenges of Computational Intelligence in Healthcare

Data Quality and Accessibility: Computational intelligence models need
high-quality, well-curated data for reliable forecasts. Healthcare data qual-
ity issues like missing values, inconsistencies, and biases are widespread.
Interoperability issues might make it hard to get meaningful data from sev-
eral sources and systems.
Privacy and Security: AI in healthcare raises privacy, data security, and
informed consent concerns. Openness, justice, and accountability are
essential in model development and implementation.
Explainability and Interpretability: Blackbox models like deep learning neu-

ral networks make it hard to understand their decision-making. Clarifying
the model’s predictions’ logic is essential to gain healthcare professionals’
and patients’ trust.
Integrating Computational Intelligence Models into Clinical Workflow:
The integration of artificial intelligence models into clinical workflow may
be tricky. Healthcare personnel may need training and assistance to use new
technologies, which must integrate with current electronic health record
systems and clinical procedures.
20.12 CONCLUSION
This chapter utilized bibliometric analysis to investigate the field of blockchain and
computational intelligence in healthcare and biomedical research. The study ana-
lyzed publishing trends, collaborations, research themes, and important sources. The
findings showed a considerable increase in research output, author collaboration,
keyword co-occurrence analysis of pertinent research subjects, and highly cited and
influential sources. This research helps researchers, practitioners, and policymakers
understand the current state of blockchain and computational intelligence in health-
care and biomedical research and can guide future advances. It covers the benefits
and drawbacks of blockchain and computational intelligence in healthcare.
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21 Bone Marrow Cancer
Detection From
Leukocytes using
Neural Networks
21.1 INTRODUCTION
This chapter describes bone marrow cancer detection using convolution neural
networks. The illustration in Figure 21.1 depicts the sponge-like substance located
within bones, known as marrow. Stem cells reside in the innermost part of the bone,
possessing the ability to differentiate into white blood cells (WBCs), red blood cells
(RBCs), or platelets. Hematopoietic cells are constantly produced in the bone mar-
row and are systematically discharged into the bloodstream at regular intervals.
Cancer is a life-threatening condition, and early detection is the most effective
approach to its treatment. Medical image processing plays a vital role in diagnosing
illnesses. Leukemia, a type of malignancy arising from abnormal or immature white
blood cells (WBCs) [1], is a condition in which these cells, responsible for combating
infectious agents in the human body, become aberrant. The abnormal proliferation of
WBCs from the bone marrow affects both bone marrow and lymphatic tissues, lead-
ing to the destruction of other cells. Leukemia results from improper cell function
when marrow cells grow excessively or rapidly. This abnormal growth can lead to
bone marrow cancer, also known as blood cancer, which is distinct from bone cancer.
Acute lymphocytic leukemia (ALL) is a cancer of the bone marrow and blood
that influences white blood cells [2]. Acute disease progresses quickly, and if it is
not treated in the first stages, it could quickly become fatal. ALL, a blood and bone
marrow cancer with a rapid growth rate, is characterized by the proliferation of many
immature lymphocytes, or lymphoblasts.
Leukemia, a range of blood malignancies, generates an abundance of abnormal
blood cells and commonly originates in the bone marrow. The diagnosis of blood
disorders involves differentiating leukemia cells from healthy white blood cells. Over
time, manual techniques can identify, categorize, and count blood cells [3], but they
are expensive, labor-intensive, sluggish, and prone to error.
When we need to analyze a bulk of pictures, deep learning comes into the frame
because it works more efficiently than standard machine learning. Convolution
neural networks blend multilayer perceptrons, along with a cleaning, to manifest
productive outcomes. As every convolutional layer of the network retains the latest
DOI: 10.1201/9781003459347-21 307

FIGURE 21.1 Bone marrow.
attribute in the pictures and outcomes in greater activation, CNNs acts as an attribute
extractor. This project aims to develop an automated classifier using neural networks
to determine whether an individual is diagnosed with cancer or not.
In response to these challenges, an automated system has been implemented,
leveraging microscopic image detection. This automated approach offers a swift,
cost-effective, and highly accurate alternative, eliminating the dependency on spe-
cialized laboratory equipment [4].
Deep learning, renowned for its superior performance in processing vast image
datasets, excels with different algorithms. Convolutional neural networks, a subset
of deep learning, amalgamate various multilayer perceptrons, delivering efficient
results with minimal preprocessing. The inherent capability of CNNs to act as fea-
ture extractors further enhances their effectiveness. Each convolutional layer within
the network learns distinct features present in the images, contributing to high acti-
vation levels.
The overarching goal of this project is to develop an automated classifier using
neural networks. Specifically, the objective is to ascertain whether an individual is
diagnosed with cancer or not. The project seeks to transform the diagnostic process
by utilizing deep learning, specifically CNNs, to automate the examination of micro-
scopic pictures. This approach intends to provide a more efficient and precise method
for recognizing malignant situations.
Deepika Kumari explains two types of leukemia: ALL and MM. The bone mar-
row generates a larger number of lymphocytes in leukemia (ALL). They accumulate
in the bone marrow as a result of a different type of malignancy called multiple
myeloma (MM) [5].
Afshan Shah describes leukemia as the fast creation of abnormal white blood
cells. It will harm our body’s bone marrow and have an impact on the blood [6].
We can even detect those by manual methods as well. Because manual procedures
take a long time, automated approaches employing CAD have been developed to
solve the issues. Tanveer Hussain explains that the deep learning (DL) and classic
Marrow Cancer Detection From Leukocytes using Neural Networks 309
machine learning (TML) methods have significantly improved medical picture anal-
ysis (MIA) [7]. These techniques significantly enhance the automatic diagnosis of
brain tumors and leukemia/blood cancers and can help hematologists.
Rune Wetteland states that urothelial carcinoma, the most common form of blad-
der cancer, has a high rate of recurrence and requires continuous therapy for the
rest of a person’s life [8, 9]. Tusneem Ahmed states that AML treatments have been
a laborious procedure, that is, susceptible to human error [10, 11]. Nadeem Akram
explains that one of the most fatal forms of blood cancer is leukemia. The diagnosis
of leukemia is significantly correlated with white blood cells (WBCs) [12].
Bowen Zhang explains that liquid biopsy, a quick and noninvasive method of can-
cer screening, is becoming more significant. The H2O framework method was used
in this study to incorporate a range of blood biochemical parameters and create a
recognition structure [13].
Maryam Basji explains that technologies for early cancer diagnosis [14, 15] can
offer useful data and possibly lower the death rate brought on by cervical cancer.
Previous research has developed a miniature ultrasound and photoacoustic endo-
scopic instrument for examining cervical tissue through the cervix [16, 17]. A dual-
mode illumination system may deliver more accurate information.
MD Tauhidul Islam explains that the diagnosis, prognosis, and treatment of can-
cer, interstitial fluid pressure, velocity, and associated measures have significant clin-
ical value. We demonstrated the correlation between these approximated values and
the underlying intrinsic factor of proliferation (IFP), intrinsic factor of vasculariza-
tion (IFV), fluid flow, and supplementary components within the tumors [18].
Shajoong Wang explains that the fecal occult blood test (FOBT), used for the reg-
ular detection of bowel cancer, as well as the high cost and discomfort of microscopy,
are some of the limiting factors for this disease, which is easily influenced by food
and medication [19, 20].
Peng Li explains that tumor development and autonomic function play a signifi-
cant role. Lower heart rate variability has been associated with greater levels of the
C-reactive protein (CRP), which is found in the blood (HRV), a standard clinical
test for evaluating autonomic function, according to earlier research [21, 22]. Ajith
Abraham provides a concise explanation that leukemia is a hematological disorder
that specifically impacts white blood cells and originates in the WBCs [23, 24].
Tanveer Hussain says that methods have significantly improved medical picture
analysis (MIA) [25, 26]. These techniques have significantly enhanced the automatic
diagnosis of brain tumors and leukemia/blood cancers and can help hematologists.
This study provides a comprehensive examination of different machine learning
(ML) and deep learning (DL) algorithms for medical image analysis (MIA), specif-
ically focusing on the categorization of leukocytes in blood smear images and other
medical imaging domains such as magnetic resonance imaging (MRI), CT images,
X-rays, and ultrasounds. These techniques will significantly enhance future develop-
ments in speech analysis, natural language processing, and medical imaging.
Leukemia, as described by Ajith Abraham, is a hematological disorder that spe-
cifically impacts white blood cells and starts within the bone marrow. The preferred
approach for early detection of leukemia is the microscopic examination of WBCs
due to its minimal invasiveness and cost-effectiveness. In this study, various AI-based
TABLE 21.1
Summary of Literature Survey
S. No. Ref. Number Description/Interpretation
1 [1] It aims to predict the kind of cancer the cells have (ALL).
Future work: This is implemented on a smaller dataset
2 [2] This paper thoroughly examines the CAD methods used to identify
different types of leukemia.
Future work: To suggest improved preprocessing and segmentation
techniques that better handle noisy, high-density images and effectively
segment blast cells.
3 [5] This paper enhanced automatic brain tumor and leukemia/blood cancer
detection diagnoses.
Future work: To learn more about the intricate nuances of TML and DL.
4 [7] The TRIgrade pipeline is introduced in this study as a method to identify
diagnostically significant regions within a whole-slide image (WSI) and
predict the overall grade of the WSI.
Future work: The tissue segmentation model will undergo an upgrade to
incorporate a new category for blur, hence enhancing its versatility.
Additionally, preprocessing techniques will be implemented to address
variations in color and blur.
5 [10] A novel hybrid feature extraction method was created in this study.
Future work: Hybridization and parallelization techniques could further
enhance the suggested model.
6 [12] Methods for manually assessing WBC are time-consuming, subjective,
and less precise.
Future work: Work on cell segmentation between nearby ones. For
computer-assisted diagnosis, we will also take into account various
cancer kinds.
approaches for detecting ALL are thoroughly assessed in terms of their advantages
and disadvantages. Further research is required to precisely classify benign and
malignant forms of acute lymphoblastic leukemia (ALL), as well as its L1, L2, and
L3 subtypes. This will result in more accurate diagnoses of the disease. The overall
literature survey is represented as a tabular format in Table 21.1.
21.3 PROPOSED SYSTEM
21.3.1 Architecture
The proposed model’s architecture, as in Figure 21.2, can be broken down into eight
phases or eight steps. As shown in the figure, first the C-NMC 2019 dataset was taken
from Kaggle [27]. A total of 10,661 images totaling 627 MB in size were produced
using microscopic photographs that were segmented to show white blood cells. There
are labels on these photographs indicating whether they are malignant or normal.
FIGURE 21.2 Architecture design of bone marrow cancer detection using neural networks.
Data from 49 healthy volunteers and 69 cancer patients was used to collect images,
which were then separated into learning, evaluating, and testing. The training set
would receive 60% of the total amount of data, followed by the validation set at 20%
and the test set at 20%.
21.3.2 Algorithm ResNet50
The ResNet50 convolutional neural network, as described in reference [28], com-
prises a total of 50 layers. The ResNet50 architecture follows two essential design
principles. First, irrespective of the output feature map’s dimensions, every layer
incorporates an equal number of filters. Second, to maintain the time complexity of
each layer, the feature map doubles its number of filters when its size is halved.
In Figure 21.3 the ResNet50 architecture accommodates the following concepts:
A convolution with a stride size of 2 and a stream size of 7 * 7 for 64 various

streams yields 1 layer. Then, with a stride size of 2, we observe max pooling.
In the following convolution, a 1 * 1, 64 stream is followed by a 3 * 3, 64
stream then a 1 * 1256 stream. We have nine levels in this phase after repeat-
ing these three layers a total of three times.
Following that, we witness a stream of 1 * 1128 and 3 * 3128 before arriving
at a stream of 1 * 1512. The process has been executed 4 times andproduced
about 12 layers.
Two additional streams, 3 * 3.256 and 1 * 1.1024, and 1 * 1.256 kernels follow.
There are 6 iterations of this process, totaling 18 layers. Then, we added 2
more streams, 1*1,2048 and 3*3,512, and a 1*15,12 stream. We repeated
this process 3 times to get a total of 9 layers.
After that, we do intermediate pulls, ending up with a fully combined surface of

1000 nodes along with a SoftMax function to get 1 layer.
FIGURE 21.3 ResNet50 architecture.
FIGURE 21.4 Skip connection.
Activation operations and max/average layer pooling are not considered. After
assembling all the layers, the 50-layer-deep convolutional network consists of 1 + 9 +
12 + 18 + 9 + 1 layers.
21.3.2.1 Residual Network

In this architecture, the idea of “residual blocks” was developed to address the issue
of the gradient vanishing/exploding. Figure 21.4 depicts a technique we employ in
this network called skip connections.
21.3.3 Algorithm MobileNetV2
One AvgPool and 53 convolution layers make up the MobileNet V2 model. There are
two key parts to it:
Residual blocks that are inverted

Bottlenecked blocks
Convolution layers [28] come in two varieties in the MobileNetV2 architecture:

The first is the 1×1 convolution and the second is the 3×3 depth-wise convolution.
Figure 21.5 illustrates the existence of Stride 1 Blocks and Stride 2 Blocks.
FIGURE 21.5 MobileNetV2 convolutional blocks.

The following are the two blocks’ internal parts:
Stride 1 Block: Stride 1 block has 5 layers. It starts with the input layer fol-
lowed by the 1×1 convolution with Relu6. The third layer is the depth-wise
convolution with Relu6 followed by the 1×1 convolution without any linear-
ity. The last layer is the added layer.
Stride 2 Block: Stride 2 block consists of 4 layers. The input layer is the initial
layer, which is subsequently followed by a 1×1 convolution operation with
the Rectified Linear Unit 6 (Relu6) activation function. The third layer is the
depth-wise convolution where the stride is equal to 2 (stride = 2) and Relu6,
and the last layer is the 1×1 convolution without any linearity.
The provided information outlines two types of blocks commonly encountered in

neural network architectures: the Stride 1 Block and the Stride 2 Block. These blocks
are typically components of mobile-friendly convolutional neural networks (CNNs)
such as MobileNet.
Stride 1 Block
Input: The initial step involves taking the input feature map.
1×1 Convolution with Relu6: The input is subjected to a 1×1 convolutional
layer, which is then followed by the activation function known as Rectified
Linear Unit 6 (Relu6). The 1×1 convolution is responsible for linear trans-
formations on the input, and Relu6 introduces nonlinearity while ensuring
the output remains within the range [0, 6].
Depthwise Convolution with Relu6: This is a depthwise separable convolu-
tion operation. It involves applying a separate convolutional operation for
each channel of the input. The depthwise convolution is followed by the
Relu6 activation function, introducing nonlinearity to capture complex pat-
terns [29, 30].
1×1 Convolution without Any Linearity: Another 1×1 convolutional layer is
applied to the result of the depthwise convolution. Importantly, there is no
subsequent activation function, implying that this layer contributes linear
transformations without introducing nonlinearity [31, 32].
Add: The output of the previous step is added to the original input. This skip
connection facilitates the flow of gradient during training, aiding in the con-
vergence of the model.
Stride 2 Block
Input: Similar to the Stride 1 Block, the process starts with the input feature
map.
1×1 Convolution with Relu6: A 1×1 convolutional layer is applied with the
Relu6 activation function.
Depthwise Convolution with Stride=2 and Relu6: The depthwise separable
convolution is performed with a stride of 2, which means the convolutional
operation skips pixels, effectively downsampling the feature map. This is

followed by the Relu6 activation function.
1×1 Convolution without Any Linearity: A subsequent 1×1 convolutional
layer is applied without any activation function.
These blocks, especially prevalent in mobile-oriented architectures, contribute

to the efficiency of the neural network by reducing the number of parameters and
computations while maintaining effective feature extraction. The Stride 1 Block
is generally used when no downsampling is required, while the Stride 2 Block is
employed for downsampling or striding operations, typically used in parts of the
network where spatial dimensions need to be reduced.
21.4 RESULT
The dataset utilized in this work undergoes a sequence of preprocessing approaches
to augment the quality and pertinence of the photographs. The first measures are
essential to guarantee that the subsequent stages of model training and testing pro-
duce significant and precise outcomes. The proposed algorithms, implemented with
ResNet50 and MobileNetV2 models, are instrumental in predicting cancerous cells
from the processed images. Figure 21.6 presents the receiver operating characteristic
FIGURE 21.6 Evaluation metric-confusion matrix and ROC curve of ResNet50 and
MobileNetV2.
(ROC) curves and confusion matrices, which visually depict the classification capa-
bilities of the models, providing a thorough evaluation of their performance.
The evaluation of model precision is further elaborated in Table 21.2, where
accuracies derived from the F1 Score are displayed. The F1 Score, which takes into
account both precision and recall, offers a well-balanced evaluation of a model’s per-
formance. The findings collected demonstrate that ResNet50 surpasses MobileNetV2
in terms of accuracy, confirming the efficacy of the suggested approach for cancer
prediction. The superior accuracy attained by ResNet50 highlights its resilience and
appropriateness for the particular job of distinguishing malignant cells within the
dataset.
These findings carry significant implications for medical applications, particu-
larly in the early detection of bone marrow cancer. The superiority of ResNet50 in
accuracy suggests its potential as a reliable tool for medical professionals in predict-
ing and diagnosing cancer at an early stage. As such, the proposed method, anchored
by ResNet50, showcases promise in contributing to advancements in medical imag-
ing and diagnostic practices, ultimately fostering improved outcomes for patients
through timely and accurate interventions.
Table 21.2 explains the accuracy of the ResNet50 and MobileNetV2. ResNet gives
more accuracy than MobileNet.
The results obtained from the experimentation and evaluation process unequiv-
ocally demonstrate that ResNet50 exhibits a superior level of accuracy compared to
MobileNetV2. This disparity in accuracy metrics serves as a pivotal insight into the
effectiveness of the proposed method for predicting cancer, specifically within the
context of bone marrow cells. The higher accuracy achieved by ResNet50 under-
scores its ability to more precisely discriminate between cancerous and normal cells
in the given dataset.
Accuracy, a crucial measure in evaluating the performance of machine learning
models, indicates the algorithms’ capacity to generate accurate predictions. In the
case of cancer prediction, where precision is of utmost importance, the higher accu-
racy of ResNet50 suggests its proficiency in accurately identifying malignant cells.
This outcome has profound implications for the potential clinical applications of the
proposed method, especially in the early diagnosis of bone marrow cancer.
The preference for ResNet50 over MobileNetV2 in terms of accuracy implies that
the former is better suited for the task at hand. This finding is significant not only
for the current study but also for broader applications in medical diagnostics. The
robust performance of ResNet50 positions it as a valuable tool for healthcare profes-
sionals, providing a reliable means for early cancer detection.
TABLE 21.2
Comparison Table
S. No Algorithms Accuracy (%)
1. ResNet50 94.23
2. MobileNetV2 87.06
In conclusion, the observed superiority of ResNet50 in accuracy serves as a

strong endorsement for the efficacy of the proposed method. This result not only val-
idates the choice of ResNet50 within the experimental framework but also suggests
its potential utility as an impactful technology in advancing cancer prediction and
diagnosis.
21.5 CONCLUSION
The anticipation of cell presence stands as a pivotal advancement in the identification
of bone marrow cancer, streamlining the diagnostic process. Rigorous testing, val-
idation, and training of models using datasets contribute to the efficacy of this pre-
dictive approach. Leveraging state-of-the-art technologies, particularly the ResNet50
and MobileNetV2 models, facilitates accurate predictions of cancerous cells from
images. These computer-aided systems play a crucial role in enabling early detection
of bone marrow cancer, a key factor in expediting recovery and improving patient
outcomes.
In the comparative evaluation of the models, ResNet50 emerges as the more pro-
ficient performer when contrasted with MobileNetV2. This superiority underscores
the potential for ResNet50 to be a potent tool in the arsenal of medical profession-
als for precise and reliable cancer cell predictions. The application of these models
effectively addresses the limitations inherent in traditional image prediction and cat-
egorization methods, markedly enhancing the accuracy of cancer cell identification.
This successful integration of deep learning models in medical diagnostics opens
the door for future research and development. Subsequent work could focus on
employing these models on expansive datasets, exploring various other deep-learning
techniques to further refine predictive capabilities. The continuous evolution of these
technologies promises to bolster the accuracy and efficiency of bone marrow can-
cer diagnosis, ultimately contributing to advancements in medical science and the
improvement of patient care.
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22 Pulmonary and Lungs
Nodule Classification
using Deep Learning
22.1 INTRODUCTION
The lungs serve as the principal respiratory organs in humans and the majority of
other animals. According to Figure 22.1, lungs are present in a bilateral arrangement.
They play a crucial role in the respiratory system by facilitating gas exchange. This
process entails the extraction of oxygen from the air and its transportation into the
bloodstream, while concurrently expelling carbon dioxide from the bloodstream into
the atmosphere. Lung cancer and pneumonia are two respiratory conditions that can
adversely affect lung tissue. Uncontrolled division of aberrant cells in a body part is
the primary reason of cancer. Among all malignancies, cancer in the lung is placed
third in terms of importance. When gene mutations in the cells’ DNA mutate and
encourage unnatural grow, lung cancer, also recognized as lung carcinoma, is distin-
guished by malignant tumors.
A region of the human body is covered in a sequence of cross-sectional images
created by computed tomography (CT) [1]. These CT pictures can be analyzed to
identify the lung nodules and to identify whether the CT scans are malignant or not.
A lung nodule, often known as a “spot on the lungs” or a “coin lesion,” is a
tiny, circular tumor in the lung. Nodules are less than 3 cm in diameter. As seen
in Figure 22.2, a nodule could indeed develop anywhere in the lung. The growth
is referred to as a pulmonary mass and is cancerous if it is greater than that. Lung
nodules are typically asymptomatic and can only be seen on computed tomography
scans or conventional X-rays.
Lung cancer is represented by the lung nodules. The histological investigation,
which is invasive and time-consuming, has historically been required to diagnose the
pathological type of lung cancer. This conventional method of classifying lung CT
pictures is less precise since there are not as many of them, which gives the radiolo-
gist [2] less information. The development of computer-aided systems improves CT
[3] scan categorization accuracy by eradicating all shortcomings in the conventional
approach.
The target of this research is to precisely identify nodules, which will aid in the
early detection of cancer and help save lives. Different fully linked deep learning
approaches are used to extract the features and categorize them. We would train a
convolutional neural network to recognize lung and pulmonary nodule, to categorize
the lung as malignant or not, and if cancerous, to determine the type of lung cancer
320 DOI: 10.1201/9781003459347-22

Pulmonary and Lungs Nodule Classification using Deep Learning 321
FIGURE 22.1 Lung image.
FIGURE 22.2 Lung CT scan with a nodule.
using a publicly accessible dataset of lung CT images comprised of cancerous and

noncancerous lungs.
Deep learning algorithms are employed to predict nodules in lung CT scans, and the
identified nodules are classified into different types of lung cancer. Adenocarcinoma
originates in cells that typically produce substances like mucus, primarily affecting
individuals who smoke or are ex-smokers. Large cell carcinoma can develop in any
part of the lung, and it tends to proliferate and spread, posing challenges for treat-
ment. Squamous cell carcinomas arise from flat cells lining the airways of the lungs,
often occurring in the central lung region near major airways and are commonly
linked to a history of smoking.
Muzammmil explains the lungs’ aberrant and uncontrolled tissue growth that
invades the organs nearby is known as lung cancer. The emergence of pulmonary
nodules suggests lung disease. We employ the deep convolutional neural networks
(DCNNs) [4] model to categorize the lung nodule as hazardous or dangerous. Using
ensemble learners fusion approaches, unsatisfactory results, such as those with lim-
ited response space and inaccurate hypothesis space selection, can be addressed
(MAX-VOTE).
Ying Chen [5] conducted a thorough investigation that demonstrated the signifi-
cance of accurately classifying nodules at the time of lung cancer diagnosis, as this
has a direct bearing on the prognosis for patients. The study used lung adenosqua-
mous carcinoma (ASC) samples, which are relatively infrequent, for the purpose of
addressing the existing deficiency in computer-assisted treatment for different forms
of lung cancer. The study [6] also offered a machine diagnosis approach that utilizes
medical imaging of adenocarcinoma of the lung (ASC), squamous cell carcinoma of
the lung (LUSC), and small cell unit lung cancer (SCLC).
Shortness of breath, dry coughing, and difficult breathing are all signs of ILD [7]
and have a negative impact on health. This spares the handler from having to retrain
the connection for every area of interest, which needs a lot of system time, processing
power, and human skills [8].
In this work, Pranjal Sahu created a brand-new characterizing lesion [9] using a
three-dimensional CNN for classifying lung nodules and determining their propen-
sity to be malignant. The trial’s findings showed how effectively our recommended
model outperformed a variety of state-of-the-art classification strategies.
Electrical bio-impedance of normal and tumor-free lungs was examined in this
study. Across-the-board area of the chest with the bio-impedance probe first records
the bio-impedance of certain normal lung sections, and the measurement values are
then categorized using the suggested smart technology [10].
Andrew Beers [11] explained that the majority of cancer-related deaths in the
United States are caused by lung cancer. Recent research has shown that adopting
low-dose CT (LDCT) for screening can lower lung cancer-related mortality. Initially,
an adaptive data preprocessing approach, slicing selection (ASS) [12], was created
in order to reduce the excessive disturbance in the intake of samples that contain
carcinoma. The self-supervised learning network is subsequently developed in order
to get a trustworthy picture representations from CT scans. The development of a
domain-adaptive transfer learning method is the final step.
As part of the knowledge-based collaboration (KBC) model [13], three early
learning ResNet50 networks are tuned using three distinct kinds of photo chunks
to characterize the appearances of a lesions per each view. Stelmo Magalhaes
Barros Netto used the quantity threshold’s segmentation method [14] in a modified
form in order to evaluate how lesions change over time and which voxel of the lesion
belongs to a group.
Computational approaches can be useful for supporting, storing, and monitor-
ing computer-aided diagnosis in critical care [15]. Spectrum correction is used to
adjust for alterations in camcorder parameters on the ICBHI dataset. According to
Pin Lim [16], with an uneven number of samples in each category, class imbalance
is a problem that machine learning regularly runs into. Machine learning encounters
significant challenges when working with unequal data, according to Zonghai Zhu.
A geometric structural ensemble (GSE) [17] learning paradigm is put up as a solution
to the unbalanced problems. It has been demonstrated that ensemble learning [18]
approaches for classification may greatly enhance the efficiency of a basic learning
algorithm.
22.3 PROPOSED SYSTEM
Lung CT scans can be categorized using VGG16 and InceptionV3 deep learning
approaches. The four types of lung cancer detected by CT scanning are normal or
uninfected lung, adeno, carcinoma, and squamous.
22.3.1 Methodology
The proposed model’s architecture as in Figure 22.3 can be broken down into six
phases or six steps. Data gathering comes first, then data augmentation. Data is gath-
ered from Kaggle [19]. It consists of 1000 images of type PNG taking up to 124 MB
memory in which 613 images are used for training, 72 images for validating, and 315
images for testing.
This is done to increase the dataset in order to boost the model’s performance since
the more variations there are, the more experiences the model may get. InceptionV3
and VGG16 [20] are utilized to prepare and train the prototype. Then the model is
used to test before being made available to the public. By calculating the metrics, the
degree to which the model findings may be trusted for accuracy can be determined.
FIGURE 22.3 Architecture design.

CLSA involves two primary classification objectives: (1) the categorization

of respiratory diseases and (2) the classification of adventitious lung sounds. The
first task entails the ternary classification of respiratory conditions, distinguishing
between healthy, chronic, and nonchronic states. The second job involves distin-
guishing between normal and pathological lung sounds while categorizing adventi-
tious lung sounds. Adapting the model to the exact target task has multiple benefits,
such as using less data for the target task, allowing for quicker training, and fre-
quently resulting in better performance results.
The research community extensively benefits from the fine-tuning process, partic-
ularly through the application of prior knowledge from datasets like ImageNet. The
pretrained model undergoes modifications specific to the target domain, involving
updates to both the top and bottom layers. Addressing the class imbalance within the
dataset involves augmenting data in both the time and time–frequency domains. This
meticulous approach ensures that the model is adept at capturing and distinguishing
diverse respiratory conditions and lung sounds, contributing to the refinement and
robustness of CLSA methodologies.
22.3.2 Algorithm VGG16
VGG is an abbreviation for visual geometry group. Convolutional neural networks
(CNNs) consist of hidden layers, an input layer, and an output layer. VGG16 is an
example of a convolutional neural network (CNN). The number “16” in VGG16 rep-
resents the presence of 16 layers in the model, each with its own set of weights.
In order to obtain the desired result of 1*1, as shown in Figure 22.4, the VGG16
model consists of 13 convolutional layers, five Max Pooling layers [21], and three
dense layers, making a total of 21 layers. However, out of these layers, only 16 are
weight layers, which are also referred to as learnable parameter levels.
Convolutional neural networks are a type of neural network topologies that are
extensively used in different domains, especially in computer vision. CNNs, which
are designed to replicate the visual processing capabilities of the human brain,
demonstrate exceptional performance in several tasks. The distinguishing features
of this customized architecture are its distinct components and actions.
Convolutional neural networks (CNNs) generally comprise various layers.
Convolutional layers utilize filters or kernels to perform convolutions on incom-
ing data, effectively capturing spatial hierarchies and acquiring features through
learning. Pooling layers, typically with max pooling, decrease the size of the spatial
dimensions, resulting in reduced computational complexity while still preserving
crucial information. The fully connected layers are responsible for processing the
extracted characteristics in order to perform the final classification.
One defining feature of CNNs is their ability to automatically learn hierarchi-
cal representations. Through backpropagation and optimization algorithms, CNNs
adjust their parameters during training, enabling the extraction of intricate features
and patterns. This hierarchical learning makes CNNs adept at recognizing complex
visual structures and improving performance on various tasks.
CNNs have demonstrated remarkable success in diverse applications, from image
and speech recognition to medical image analysis. The architecture’s adaptability
FIGURE 22.4 VGG16 architecture.
and efficacy stem from its capacity to automatically learn relevant features from raw
input data, making CNNs a cornerstone in the advancement of artificial intelligence
and machine learning.
22.3.3 Algorithm InceptionV3
In the quest to mitigate overfitting, Inception models employ a distinctive strategy by
incorporating multiple filters of varying sizes within the same network level. Unlike
traditional deep layers, Inception models opt for a parallel architecture, as depicted
in Figure 22.5, which expands the model’s width rather than delving deeper into its
layers. An evolution of the Inception model, known as InceptionV3, addresses short-
comings present in earlier versions. Notable improvements include spatial factoriza-
tion through asymmetric convolutions, resulting in a reduction of model parameters
and a more streamlined processing time [22–24].
The selection of deep learning methods, particularly InceptionV3, is deliberate,
chosen for their practicality and adaptability. These methods prove instrumental in
predicting the presence of lung or pulmonary nodules. The training process involves
teaching the models to classify test images into distinct groups, honing their ability
to accurately discern and categorize lung-related features. This method demonstrates
an advanced and subtle application of deep learning techniques to improve the accu-
racy and dependability of lung cancer detection [25, 26].
InceptionV3 is a prominent convolutional neural network architecture that has
proven to be highly effective in image classification and recognition tasks. Developed
by Google, InceptionV3 builds upon its predecessors, addressing limitations and
introducing innovative design elements.
FIGURE 22.5 InceptionV3 architecture.
The core principle behind InceptionV3 is the use of inception modules, which are
responsible for capturing information at multiple spatial scales. Unlike traditional
architectures that rely on deep layers, InceptionV3 utilizes parallel convolutional lay-
ers of different kernel sizes within the same level, expanding the network’s width
rather than depth. This methodology enables the model to comprehend and include
both intricate and broad elements, hence improving its capacity to identify complex
patterns in images.
InceptionV3 employs factorized convolutions, specifically asymmetric convolu-
tions, to mitigate computational demands. By reducing the number of parameters in
the model, this factorization technique improves computational efficiency without
sacrificing performance. Furthermore, the architecture incorporates global average
pooling, eliminating the need for fully connected layers and further reducing the
model’s complexity.
The InceptionV3 model is renowned for its application in picture classification
problems. This model has undergone pretraining on extensive datasets, such as
ImageNet, which allows for the use of transfer learning in various contexts. The
inception blocks, coupled with normalization and linear unit (ReLU) activations,
contribute to the model’s robust feature extraction capabilities.
InceptionV3 has demonstrated the performance metrics and competitions, show-
casing its versatility and effectiveness in handling complex visual recognition chal-
lenges. Its innovative design, incorporating diverse convolutional operations and
efficient factorization, makes InceptionV3 a valuable asset in the realm of deep learn-
ing, influencing subsequent architectures and contributing to the ongoing evolution
of neural network designs.
Convolutional Layer: O=W×H×D, where O is the output size, W is the width,

H is the height, and D is the number of filters or channels.
Pooling Layer:
For max pooling, this involves taking the maximum value from the given
window.
For average pooling, it involves taking the average value from the given
window.
Inception Module: Inception modules incorporate multiple filter sizes in par-
allel and concatenate their outputs. The formula for the output size of each
parallel operation is similar to the convolutional layer formula.
Fully Connected Layer: O=WX+B, where O is the output, W is the weight
matrix, X is the input, and B is the bias vector.
Activation Function: Often, the ReLU function is used:
f(x)=max(0,x)
Batch Normalization: Normalizing the inputs in a minibatch: x^=σ2+ϵx−μ,
where μ is the mean, σ is the standard deviation, and ϵ is a small constant to
prevent division by zero.
InceptionV3 is often pretrained on large datasets like ImageNet, showcasing its

transfer learning capabilities. The knowledge gained during pretraining allows the
model to adapt quickly to new tasks with limited data, making it a valuable asset in
various applications.
The utilization of global average pooling instead of fully connected layers con-
tributes to a reduction in model complexity. This not only enhances computational
efficiency but also mitigates the risk of overfitting, particularly in scenarios with
limited training data.
InceptionV3 excels in image classification, object detection, and localization tasks.
Its versatility and robustness make it a preferred choice for applications ranging from
medical image analysis to autonomous vehicles, where accurate visual understand-
ing is crucial.
InceptionV3 has demonstrated state-of-the-art performance on benchmark data-
sets and competitions. Its effectiveness in capturing diverse visual features positions
it as a leading architecture in the field, influencing subsequent models and contribut-
ing to the advancement of computer vision.
InceptionV3 surpasses traditional convolutional neural networks (CNNs) in sev-
eral key aspects, making it a more powerful and efficient architecture for complex
image recognition tasks. One notable advantage lies in InceptionV3’s innovative use
of inception modules, which allows for the simultaneous processing of features at
multiple scales. This multiscale approach enables the model to capture both fine-
grained and coarse-grained details within images, enhancing its ability to discern
complex patterns. Additionally, InceptionV3 incorporates factorized convolutions,
including asymmetric convolutions, which significantly reduces the number of
parameters compared to CNNs. This streamlined parameter usage not only makes
the model more computationally efficient but also contributes to faster training and
inference.
Moreover, InceptionV3’s global average pooling, in place of fully connected lay-

ers, reduces model complexity and aids in preventing overfitting, especially in sce-
narios with limited training data. The architecture’s successful implementation of
transfer learning, often pretrained on extensive datasets like ImageNet, allows it to
leverage knowledge gained from previous tasks, making it adaptable and effective in
various domains. The combination of these features results in InceptionV3 consis-
tently achieving state-of-the-art performance across a range of benchmarks, outper-
forming CNNs in terms of accuracy and efficiency. As a result, InceptionV3 stands
as a more advanced and versatile architecture, embodying advancements in neural
network design beyond the traditional CNN paradigm.
22.4 RESULT
On the CT images produced through data augmentation, the models are trained and
tested. The expected pulmonary and lung nodules are categorized by the models.
InceptionV3 performs better than VGG16 in comparison, as seen in Figure 22.6.
22.4.1 Discussion
The outcomes of the experiments are systematically presented in Table 22.1, where in
the models, specifically InceptionV3 and VGG16, are subjected to a series of test
images categorized into distinct classes: normal, adeno, large, and squamous cell
carcinoma. This tabular representation serves as a comprehensive summary, allow-
ing for a detailed examination of the models’ performance across various lung can-
cer categories. To provide a visual depiction of the comparative accuracy of these
FIGURE 22.6 Comparison of the models based on performance.

TABLE 22.1
Representing the Model Performance
S. No. Algorithm Accuracy
1 CNN 54.9%
2 VGG16 79.36%
3 InceptionV3 81.904%
models, a graph is presented based on the table, offering an intuitive understanding

of their respective strengths in classifying different types of lung cancer.
The precision demonstrated by these models in accurately categorizing and pre-
dicting lung cancer from CT scan images holds significant implications for medi-
cal professionals, particularly radiologists and surgeons. The ability to distinguish
between normal and carcinoma classes, as well as to identify specific carcinoma
subtypes, equips healthcare practitioners with valuable insights. Such accurate clas-
sification becomes a crucial tool for early-stage detection and treatment planning. By
leveraging these models, medical experts can enhance their diagnostic capabilities,
paving the way for more effective and targeted interventions in the early stages of
lung cancer, ultimately contributing to improved patient outcomes.
In the comparison of the convolutional neural network (CNN), VGG16, and
InceptionV3 models based on their respective accuracies, distinct performance
trends emerge. The baseline CNN achieves an accuracy of 54.9%, demonstrating
a moderate level of success in classification tasks. In contrast, the VGG16 model
significantly outperforms the CNN, boasting an accuracy of 79.36%. The VGG16
architecture, known for its depth and simplicity, exhibits enhanced capabilities in
capturing intricate features within images, leading to a notable improvement in accu-
racy. Surpassing both the CNN and VGG16, the InceptionV3 model emerges as the
top performer with an accuracy of 81.904%. InceptionV3’s innovative incorporation
of inception modules, factorized convolutions, and global average pooling contrib-
utes to its superior ability to capture multiscale features, enabling more accurate and
nuanced image classification. This comparative analysis underscores the significance
of architectural nuances in influencing the performance of neural networks, with
InceptionV3 standing out as a particularly effective model in the context of image
recognition tasks.
22.5 CONCLUSION
Predicting the existence of pulmonary nodules or lung nodules makes it easy to
identify lung cancer. To make up for the lack of CT pictures, data augmentation is
used, and the generated CTs are trained, validated, and tested using the produced
CT images. The nodules are predicted with the aid of the VGG-16 and InceptionV3
models. These computer-aided systems help doctors in the early diagnosis of lung
cancer, leading to early-stage detection and faster recovery. InceptionV3 performed
better compared to VGG16. The shortcomings of the conventional prediction and
categorization of CT scans are overcome by these models, which improve the accu-
racy of properly predicting the nodules. The anticipated nodules are further divided
into classification. Future work can be done on huge datasets with various other
available deep learning techniques.
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Index
A G
access control, 61 GDPR (General Data Protection
American Heart Association Risk Calculator, 262 Regulation), 63
artificial intelligence in CVD, 268 compliance, 14
Automated Market Makers (AMM), 57
H
B
healthcare, 1
bioengineering, 3 bioengineering, 1, 4
data analysis, 3 data analysis, 21
biological data integration, 17 data source, 5
biomechanics and computational modelling, 17 machine learning, 209
biomedical systems, 26 tokenization, 221
biomedical signal processing, 17 health data interoperability, 249
blockchain, 20, 79 – 83, 92 – 95 health information precision, 248
advantages and disadvantages, 87 HIPAA compliance, 13
analysis, 70
applications, 85, 105, 126 I
architecture, 66, 124
bitcoin, 68 immutability, 247
challenges and risks, 74, 88 information retrieval, 42, 46
characteristics, 100 biomedical data, 46
comparison, 72 Institutional Review Board (IRB), 14
Ethereum, 69 IoT/ IoMT, 207, 229
frameworks, 68
future perspectives, 89 L
Hyperledger Fabric, 70
integration with AI, 127 latency, 56
structure, 84, 99
types of blockchain networks, 86 M
C machine learning models, 263

malicious node attacks, 59
clustering, 42 modelling and simulation, 26
code vulnerabilities, 60
Cyber Physical Systems (CPS), 234 N
D natural language processing, 42

network attacks, 62
data anonymization and de-identification, 11 Distributed Denial-of-Service (DDoS)
data encryption and access controls, 10 attacks, 62
data lifecycle management, 11 Man-in-the-Middle (MitM) attacks, 62
data provenance, 247 packet sniffing and eavesdropping, 62
decentralized exchanges (DEX), 57 routing attacks, 62
sybil attacks, 62
E
P
edge, cloud and fog computing, 173
pattern recognition, 41
F precision medicine, 15
predictive analytics, 15
fault tolerance and resilience, 55 machine learning,s 17
333
334 Index
Q T
QRISK, 261 telemedicine, 175
quantitative tokenization, 40
matrics, 280 translucence, 247
transparency and accountability, 13
R
V
reactor design optimization, 265
remote patient monitoring (RPM) virtual reality and augmented reality, 269
system, 231 visualization, 43
resource management, 56
W
S
Wireless Body Area Networks (WBANs), 173
secure data storage and
transmission, 11 X
sentiment analysis, 42
stemming, 40 XAMPP platform, 199

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Computational Intelligence

Chapter 1 Bioengineering and Healthcare Data Analysis: Introduction,

1.7.2 Case Study 2: Blockchain Implementation in

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Chapter 3 Information Extraction and Knowledge Discovery in

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Chapter 5 Blockchain Technology Framework: Issues and Future

Chapter 6 Blockchain Technology State of Art and Future Scenario����������������� 79

6.6 Centralized Versus Decentralized Systems of

Chapter 7 Security Aspects of Blockchain Technology�������������������������������������� 92

7.4.3 Secure Multiparty Computation Protocol������������������ 99

Chapter 8 Computational Intelligence and Blockchain in Diversified

8.4.4 User Interfaces and Access Management����������������� 117

Chapter 9 Computational Intelligence and Blockchain in Distributed

Chapter 10 Computational and Blockchain Methods in Distributed

10.7 Architecture of Distributed Biomedical and Health

Chapter 11 Healthcare Computational Intelligence and Blockchain:

Chapter 12 Intelligent Development in Healthcare With the Internet����������������� 169

Chapter 13 Intelligent Development in Healthcare With the Internet:

Chapter 14 Intelligent Development in Healthcare With the Internet:

Chapter 15 Unleashing the Potential of Blockchain in Healthcare: A

Chapter 16 Threat Analysis and Security Measures for the Internet of

16.1.5 Different Types of Homecare Sensors

Chapter 17 Leveraging Web 3.0 to Develop Play-to-Earn Apps

Chapter 18 Advancements in Modelling, Imaging, and Simulation of

18.2.2 QRISK���������������������������������������������������������������������� 261

Chapter 19 Blockchain-Enhanced Convolutional Neural Networks

Chapter 20 Research Landscape of Blockchain and Computational

20.10 Bibliographic Coupling�������������������������������������������������������� 302

Chapter 21 Bone Marrow Cancer Detection From Leukocytes using

Chapter 22 Pulmonary and Lungs Nodule Classification using

Dr. Muhammad Fahim is Lecturer (Assistant Professor) in AI theme at the School

Priti Nilesh Bhagat Kanchan D. Ganvir

Ambarish A. Deshpande Surbhi Gupta

Harmandeep Kaur Palvinder Singh Mann

Sudheer Mangalampalli Sita Rani

Supriya B. Rao Himanshu M. Shukla

Shailesh Shetty S. Parminder Singh

Satyam Shivmanmeet Singh

Sundari M. Shanmuga D. Subitha

Shital Sharma D. Vishnu Vardhan

1.1.1 Overview of Bioengineering in Healthcare

Medical Device Development: Bioengineering plays a significant role in creat-

examples. Disabled people’s lives are greatly enhanced by these technolog-

Bioengineering is an ever-changing discipline that has a profound effect on health-

1.1.2 Role of Data Analysis in Bioengineering

development of novel therapies, bioengineers use computational methods to handle

1.2 FOUNDATIONS OF BIOENGINEERING AND

FIGURE 1.1 Bioengineering subdomains.

1.2.2 Data Sources in Healthcare

Electronic Health Records (EHRs): Electronic health records (EHRs) are

Improved patient outcomes, streamlined healthcare delivery, and scientific dis-

1.2.3 Data Preprocessing and Cleaning

values are filled in using preexisting information. However, imputation approaches

1.2.4 Statistical and Machine Learning Techniques

1.3 APPLICATIONS OF BIOENGINEERING DATA ANALYSIS

1.3.1 Disease Diagnosis and Prognosis

1.3.2 Drug Discovery and Development

1.3.4 Telemedicine and Remote Monitoring

1.4 ADVANCES IN BIOENGINEERING DATA ANALYSIS

1.4.1 Big Data Analytics in Healthcare

Chapter 2 Biomedical Engineering Modelling and Simulation�� 26

3.2 Text Mining Techniques in Biomedical Engineering�� 40

Chapter 4 Distributed Frameworks: Applications and Security Issues�� 55

4.4 Security Issues in Distributed Frameworks�� 58

Chapter 6 Blockchain Technology State of Art and Future Scenario�� 79

Chapter 7 Security Aspects of Blockchain Technology�� 92

7.4.3 Secure Multiparty Computation Protocol�� 99

8.4.4 User Interfaces and Access Management�� 117

Chapter 12 Intelligent Development in Healthcare With the Internet�� 169

18.2.2 QRISK�� 261

20.10 Bibliographic Coupling�� 302

1.1.1 Overview of Bioengineering in Healthcare

1.1.2 Role of Data Analysis in Bioengineering

1.2 FOUNDATIONS OF BIOENGINEERING AND

1.2.2 Data Sources in Healthcare

1.2.3 Data Preprocessing and Cleaning

1.2.4 Statistical and Machine Learning Techniques

1.3 APPLICATIONS OF BIOENGINEERING DATA ANALYSIS

1.3.1 Disease Diagnosis and Prognosis

1.3.2 Drug Discovery and Development

1.3.4 Telemedicine and Remote Monitoring

1.4 ADVANCES IN BIOENGINEERING DATA ANALYSIS

1.4.1 Big Data Analytics in Healthcare

1.4.2 Artificial Intelligence and Machine Learning Models

1.4.3 Blockchain in Healthcare Data Management

1.4.4 Wearable Technology and IoT in Bioengineering

1.5 CHALLENGES AND ETHICAL CONSIDERATIONS

1.5.1 Data Privacy and Security

1.5.2 Interpretability and Transparency

1.5.3 Ethical Issues in Healthcare Data Analysis

1.6 FUTURE DIRECTIONS AND EMERGING TRENDS

1.6.1 Predictive Analytics and Precision Medicine

1.6.2 Integrative Bioengineering and Data Analysis

1.6.3 AI-Driven Healthcare Decision Support

1.6.4 Collaborative Research and Interdisciplinary Approaches

1.7.1 Case Study 1: Applying Machine Learning in Disease Diagnosis

1.7.2 Case Study 2: Blockchain Implementation in Healthcare

1.7.3 Case Study 3: Ethical Dilemmas in Healthcare Data Analysis

1.8.1 Summary of Key Points

1.8.2 Implications for the Future

2.2 SCOPE OF THE CHAPTER

2.2.1 Fundamentals of Modelling and Simulation

2.2.2 Biomedical Systems and Processes

2.2.3 Medical Imaging and Image Analysis

2.2.4 Biomaterials and Tissue Engineering

2.2.5 Medical Device Design and Evaluation

2.2.6 Clinical Decision Support and Personalized Medicine

2.4 ROLE OF ANTHROPOMETRY IN BIOMEDICAL

2.4.1 Need for Automation in Anthropometric Data Measurement

2.4.2 Applications of Automated Anthropometric Data Measurement

2.4.3 Challenges and Future of Automated

2.5 HARNESSING ARTIFICIAL NEURAL NETWORKS IN

2.6 HUMAN MODELLING AND SIMULATION

2.7 CONCLUSION AND FUTURE SCOPE

3.1 INTRODUCTION TO INFORMATION EXTRACTION

3.1.1 Definition and Significance

3.1.2 Overview of the Chapter

3.2 TEXT MINING TECHNIQUES IN BIOMEDICAL ENGINEERING

3.2.1 Named Entity Recognition (NER) for

3.2.2 Relation Extraction for Uncovering

3.2.3 Text Classification for Categorizing Biomedical Documents