Testing Telemedical Applications under Extreme Conditions
by Giampiero Ravagnan
The vast possibilities offered by telemedical applications not only in scientific work but also in the organisation of the public health services has meant that, in recent years, the quality of medical assistance in Italy has considerably improved. For example, intelligent systems for remote diagnosis or to manage emergency hospitalisation are effective both in reducing costs and guaranteeing increasingly reliable services. The Institute of Experimental Medicine of the Italian National Research Council (IMS-CNR) is now verifying the performance of certain innovative telemedical technologies by testing them under extreme conditions.
The Italian National Research Council (CNR) has installed a research laboratory the Piramide Laboratory at the foot of Mount Everest, more than 5,000 m above sea level. IMS-CNR has decided to make use of this structure to carry out a series of experiments aimed at testing telemedical applications in mountain expeditions at high altitude. This study is being conducted within the framework of the EAST project (Extreme Altitude Survival Test), an important technological and sportive event which also represents a unique opportunity for research. Apart from IMS-CNR, several other prestigious European scientific institutions are working on this project: the Institute for Advanced Biomedical Technologies (CNR - Milan); the Institute for Diseases of the Respiratory Apparatus (Milan University); the San Camillo Hospital, Rome; the Max Planck Institute (Göttingen); the INSERM Laboratory for Pharmacology, Paris, etc., together with a number of important industries (TELECOM, CSELT, TELESPAZIO, SIRM, ELETTRONICA, BIOTRONIX, COSMED ...).
During the 1994/5 expedition, the vital cardio-respiratory parameters of the Italian alpinists were sent, in real time, first to the base camp and from there to Italy for analysis. The devices and procedures used for data storage and transmission and the remote control and acquisition functionalities were all experimented with complete success. The overall system performance was thus tested under extreme conditions. In particular data on cranial eco-doppler traces, recorded at the Piramide laboratory, were transmitted in real time to the receiving station located in the Department for Angiology at San Camillo Hospital, Rome, using a Colby device for the transmission of images via slow video, thus opening a continual visual communication channel with Italy.
The Piramide Laboratory is currently very popular as it provides an ideal platform for the testing of equipment and methodologies to be adopted at high altitude. For instance, an agreement has been stipulated with the Region of the Valley of Aosta regarding rescue operations at high altitude, and a technical working group has been formed to prepare an experimental system to deal with health emergencies in the Region.
Another example of a site where telemedical applications can be tested under extreme conditions is the Antarctic which, for its geographical and climatic features and the enormous ice cap covering it, represents the ideal environment for particular types of research. Within the context of the National Programme for Research in the Antarctic, the Telemedicine Project has made it possible to achieve positive results in the following fields:
- Studies on the hardware and software structures used for the acquisition, compression and transmission of data from the South Pole Base camp to Italy and from the remote camps to the base. These studies will concentrate on increasing the efficiency and the speed of the data transmission and guaranteeing the continuity of the transmission means, currently based on a single satellite.
- Studies on alterations and physiological responses to stress through the recording of physical and biological parameters (ECG traces, plethysmographs, body and external temperatures), acquired by a recording device and transmitted from the remote camps to the base and from there to Italy.
- Studies on the alterations in the rhythm and quality of sleep; the raw data are compressed and transmitted to Italy and Chile for analysis. This study is performed through a collaboration with the University of Chile, which is very interested in acquiring know-how on data transmission and compression.
The experiments performed so far have permitted the transmission of instrumental data, images and diagnostic traces, in real time, using fractal compressing software and a portable satellite telephone, to Italian hospital structures. The data is then analysed and an immediate reply is given to the diagnostic query posed by the remote operator.
As a result of these studies, the National Programme for Telemedicine of the Italian Ministry for Research and Technology is now working on the industrialisation of a series of research prototypes for the management, transmission and local and remote storage of bioimages and the development of computerized procedures to manage hospital data. Thus, systems which were designed for and tested under extreme environmental conditions are now being adopted to improve the quality of everyday life.
Giampiero Ravagnan - IMS-CNR
Tel: +39 6 8609 0258