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Radio News, -
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, data, fax, ) D 16Kbit/s,
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16


:
Internet
fax .

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2 .

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group 4,
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.
(modulation).
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splitters () ,
.

17

 : ADSL

ADSL :

(LAN)

, ATM (Asynchronous Transfer
Mode). ATM cells, TCP/IP
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(real time video),
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18


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.

.
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19

( ) ,
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1. , , ,

2. .
3.
(Browsers) .
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.
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, (disk
arrays)

20

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(, )

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. 1950
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23

4.

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.

.


.
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4.1.

, , ,
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.

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kilobytes megabytes
.


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24

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,
ASCII Unicode
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spreadsheet
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PC .
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PC s WAV format
. format
.

25


pixel (
) .

(scanner) ,
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pixel pixels
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pixels. pixel
bits grey-scale
8 bits (255 ) grey-scale 24 bits (16,77 )
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.

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26


.
.

,
. format :

NTSC (National Television Standards Committee)

525
frame rate 25 .
PAL (Phase Alternating Line)
, 625
frame rate 25 .

. format CIF (Common
Intermediate Format) NTSC
PAL 288 30
.

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.
, data, ,
.

.
software
,
Hardware,
video, , .
, /
(codec)
.

.
1,5-3:1
20 100:1.
, .

27

Huffman
Huffman
.

. .

.
Huffman prefix ,
.
.

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.

: Huffman

28



Huffman.
.


.
.

.
graphical digitized .
.
graphical ,
digitized .
digitized
.
JPEG (Joint Photographic Expert Group)

.

baseline mode lossy sequential mode.

: 1)image 2) block
preparation 3) Forward DCT 4) Quantization 5) Entropy encoding 6)
Framebuilding.

Jpeg blocks.
blocks
(RGB).
block DCT. quantization

.

frames .
.

Video
video
.
videoconferencing, video .

video ,
.

29

H video
.
(frames)
. video
. video
standards.

video

.
frames. video

. moving JPEG MJPEG.
10:1
20:1.
3 sec
180 frames.

.
frame
frames
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.

frames frames.
frames
.
.
motion estimation. frames

frame
frame.


.

. motion compensation.

MPEG
Motion Pictures Experts Group
() video
. video
,
,

30

 .
MPEG :

MPEG 1:
352x288 pixels. VHS
.
1.5
Mbps, .

MPEG 2:
studio . format 4
:
-Low: 352x288 pixels.
MPEG 1 VHS.
CD 4 Mbps.
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CD.
15Mbps 20 Mbps.
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(HDTV)
60 80 Mbps.
-High: 1920x1152 pixels.
(wide screen High
Definition TV). 80 100 Mbps.

MPEG 4:
(4.8 64 Kbps).

. ;

,

.
,
,
.

.
,

.
.

31


,

.
video .
frames () I frames (Intracoded frames)
, Predictive frames P
(predictive) B (bidirectional) frames.

4.3.
(Twisted pair)

.
.

.
( )
.
, .,
.
: STP (Shielded Twisted Pair),
UTP (Unshielded Twisted Pair) FTP (Foiled Twisted Pair).
,
Mbps .
5-6 Km
2-3 Km.
.

: .

32


MHz.
. ,
,
(bandwidth).
.

. 5
.

( ),
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bit (10109bit/s 10Gbit/s 10Gb/s 10Gbps, Giga
bit per second),
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33


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(connectors)
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.

34

 ,
.

35

5.

5.1.


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)

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37

.
.


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.
, Voxel Man
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38

. , (, , )

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25m.

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2. .
3. .
4. .

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:
1. .
2. .
3. .
4. .

41



.
:

FILE SIZE

2048 204812 bits

32 Mb

51251210 bits
1024102410 bits
4096512012 bits

160 Mb

51251212 bits

15 Mb

(CT)

(MRI)

25625612 bits50
images
2562568 bits
6404808 bits
1281288 bits

6,3 Mb
1,5 Mb
0,4 Mb

:
. .. laser scanner.
.
.
. frame grabber.
DICOM.
:
1) .
2) (point to point).
DICOM

42

 point to point .
client server.
3) (conformance levels) ,
.

:

bandwidth

.
Huffman coding run length.
JPEG
wavelet transform
(30:1) (mammography). O wavelet
transform

.

:


laser .
:
1. (Fidelity)
(luminance) dynamic range, (distortion),
,
tests
.
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.

5.8.
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-

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1970 FAX
.

12
() .

43

 .
, ,
.

:

.
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Personal Computer (PC)

(digital ECG) PC

(
)

:

, , ,
( 256 Kbps).
Videoconferencing.


.

5.9.

' . 1968


. ,
. 1986


44

 ' (,
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:
1) Multimedia :


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:
. 8 bit dynamic range
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(gamma correction). .
3) :

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,
.

gamma correction
.

45

4) :
6,3 9%.
.


.
low power (
zoom) high power ( , zoom ).
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high power
.

high
power .
high power .
low power
high power .
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46

 . ,
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( 30% )

.

:
.


.
1. .

video. video
.


.
.
video
.
(Jpeg mpeg video).

.
:

.
(.. e-mail).
6
min.

:

.. .

.
.

2. .

47



.

,
. PC
videoconferencing .
.

broadcast quality.
monitor
.
.
.
:

.
.


.

.

:

.

10 25 min.

.

.


.

.
, video camera
,
.

.

48

5.11.
,
,
.


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.


.
CCD
.

.
Laser
(Scanning Laser Ophthalmoscope)
.
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.

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.

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cameras
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50

6.

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 , .
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.

.
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System)
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52


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, .

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.

: .

&
/.
.
modem
( )
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PCMCIA (Personal Computer Memory Card International Association),
(laptop).
Bluetooth,

53

 ,
.

: Bluetooth.

/.
,
,
.
modem ,
, ,
,
,
.
,
, .

: .

'

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54

 '

, (,
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,
Proton Labs,
Ari-Act.
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, o (,
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, .
, (
).
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, ' .

: , ARI-ACT,
.

55

(CR, CT, MRI, , CAT, ) .
(
DICOM) (
/film digitizers) ,
.

/ DICOM,
.
(real time),
( 386Kbps), (store & forward).


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.

: .

video
(, , ) :
.

56

 ,
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CCD (.
) .

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( IP, ISDN
, ).
.

: -

,
. UC Davis

,
, robot.
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robot
, .
, TV , robot
.
,
, .

57

 . Johns Hopkins,

,
.

: Robot.

. , '
.
, ATM,
,
, , ,
.
.

: .

58


,

.
,

.
,
-, ,
PC-based (
). PC-based
(custom made solution) ,
.
, .
,
, ,

.

,
(
- software development kit), CE
FDA, ,
.
,
.
,
( )
.

.

59

7.HOME CARE -HEALTH

T home care

, ,
.
1% 30%
, 2020
80% .
'
/ .

,
,
.
home care
. .
10.000 ,
.
, ,
,
.
,

.
home care

. ,
, (
), ' ,
.
, ,
.

(30-50%).
.
home care,

.

.

60

 e- health

. ,
, ,
.
'
,
(e-health).

, .
'
(Home telehealth home telecare).

:
() ,

. '
.

video ,
(ISDN, ADSL ..)
, ,
, , ,
, , , ,
, .

61


'
, , .
.
(wearable) (sensors),
.
24
.

:

.
,

, '
.

,


.
,

,
' e-health

.
, ,
.
:

62

(home hospitalization)
(follow up - tele-monitoring)
(tele-rehabilitation)

(, )

(Hospice)

,
,
, .
, ,
-
.

' e-health

' e- health ,
.
, ,
, .
,
.
,
.
:

.

' (self management), -

63

 .
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.

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64

 , ,
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65

8.

10
60 . , 320 247
60 2000. 81 %
80 .
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66

,

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( -)
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(SIDS),
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.


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.)

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.

67


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,
.
(local intelligence unit)

(remote control center).
Eindhoven .

,
.
.
PROSAFE
.
.

68

 '
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NurseBot 1998 ,

.

69

 Flo Pearl ,
, ,
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Carebot .

. ,
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, Matsushita , .
, ,
.

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.
128
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, .

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,

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 . '

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.

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.

,
(videoconferencing)
(virtual visit).

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.

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Perception Questionnaire),
.

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75

10. :

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.

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: 2, . 3 .
4 , .
5,
6.

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(Wireless LAN = WLAN).
.
GSM 9.6
kbps.

: .

76


GSM, High Speed Circuit Switched Data (HSCSD).
(time slots)
.
14.4 kbps ( 50%),
43.3 kbps.
2G
2.5G {iDEN, 64 kbps; GPRS, 171 kbps; EDGE, Enhanced Data rate for GSM
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wideband code-division multiple access; CDMA2000, TD-, CDMA).
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,
.
, 2.4 kbps,
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.
To WLAN ,
(Local
Area Network = LAN). ,
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, , ,
, .


(real time) . ,

.

.

1.


(DICOM - Digital Imaging and Communications in Medicine).
1983 (American College of
Radiology = ACR)
(National Equipment Manufacturers Association NEMA. DICOM,
.
, DICOM JPEG,
(lossless) JPEG-LS\

77

JPEG2000. DICOM
MPEG.
(bandwidth)
. . , ,
, 40 50 MB.
, ,
.
,

(lossless) ,
.
, 2 3.7.
(lossy) .
.

. ,

.
. ,
(region of interest = ROI)
, .
, 20%
15.1 JPEG-LS,
2.58.
,

.
,
.
lossless ,
( I, 2, 4096 ). ,
jPEG-LSa& lossless 2.58,
3.83 -lossless { I ). ,
20% ,
15.l 22.0.

2.
, DICOM
. MPEG-2
, MPEG-2
-
(frame synchronization'). -
ATM (Asynchronous Transfer Mode = ),
MPEG-2 ATM ,
(offline).

78


(realtime)
, ,
.
.

.


. '
38-128 kbps Dolby AC-2, MPEG-I Layer 2 (32-256
kbps) Dolby AC-3 (96- 768 kbps) . , -, .261( 64
kbps - 1.92 Mbps) .263 (15-64 kbps) .
,
-.
,
MPG4. MPEG-4
(time stamp) (frame).


.
, (bit rates)
,
.
,
. ,

. ,
,

(frames).
. , -
- -
, .

.
(interactive),
.

INSPEC MEDLINE
-: , (telemedicine & mobile)
GSM, (telemedicine & GSM) GPRS (telemedicine & GPRS).
(
)

79

 1979 2001 132.

.
: GS, ,
(WLA).
, , , -, -, -,
' (
, '
). , 2,
:
() -, I ,
-, () ,
() () . 2
.
(18) GS 1999 2001.
(8),
- (4) - (3).
(12).
' (8)
(2) - (2).

. .
-
.
WL
-.

80

 1: GSM

81

 2: , .

,
,
-, -,
.

: Ambulance Emergency-112

1. :
-112
,
, "Ambulance",

.

82



. ,
, .. ,
, ..., .
(GSM) ,
,
.
,

,
.

Ambulance HCI00I Emergency-112 HC4027.
Ambulance

,
GSM.
,
. : (1)
, (2)
,
.
-, '


.
Emergency-112,
Ambulance,
.
- ( ECG,
BP, HR, SpO, ),
,
. - , .

, , GSM,
POTS ISDN. Emergency-112


(- ),
,
(user interface) .
. ,
.

( ).

83

 .

(
).
(,
, )
' . Emergency-112
(, )
1998.

2.-
-

,
(whole-body spiral-computed-tomography scanner)
.
, ,
() -
, .
,
.
12
,
. ,
(C),
, , . server Sun Sparc 1000, RAID 7
209GB 21 ,
1728 X 2304, 1280 x 1600.
155 Mbps
() SD.
DICOM 3.0
.
10 16.5 .
19,117 29 .
75 ,
. ,
,
' .

(US$ 8,000,000),
, .
10
,
multi port format
.

84

3. : (MOMEDA)

,
. ,
,

( ).
,
/
, .

Momeda HC4015,
/DGXIII .
, (I)
(2) .

: Momeda

(Personalized Medical System-PMIS.
(customized)
, ,
(life-style)
.


,
, GSM.
Nokia Communicator
.
(server)
, (MR).
(, ,
).

85

4.: '
, ,
,
. '
(.. ) , ,
.
, ,
.

,
, , (
).
, '
.
, ,
' ,
,
.
-

GSM/WAP (WAP=Wireless Access Protocol). .
mobile agents .. Anglets workbench IBM,
Concordia Mitsubishi, Voyager,
. 'mobile agents'
.

. ,
.
(adaptive intelligent interface)
,
GSM
-.

: .

86


, video ,
.
,
.

.
,
' .

, on-line
.
,
,
.
, . ,
video
. bandwidth (
)
. bandwidth
,
. , video
MPEG ,
video
bandwidth.
Maryland
,
. :
,
.

. video,
.

: .

87

, , .

tablet
.
2-8
.

: .

video . video
,
.
( ) .
, bandwidth
.
(. ,
CO2, ) bandwidth,
video,
.
, modems
.
(Microsoft SQL).
(Microsoft Internet Information Server)
.

88


,
.

, video, ,
().
,
bandwidth ,

. (Wearable computers)

. ,
,
(. ). ,
,
,
.
.
3 (3G),

, . '
,
,
.

.

'
. , ,
.

CT (Information Communication & Technology)
,
,

.
: ,
89

 ( )
(VoIP: IP)
.
,

(ICT)
.
, , , , ,
.
, (switches,
routers, gateway) .

,

.

,
(ICT), :

: ICT.

,
, :
,
.

.
Internet ,

.

90

,
.

,
.
.

,
,
.

, ,
,
,
.
- Hardware
-
-
-

-
-

- .
-
,
.
- .

,
(Helpdesk)

: :

,
C . ,
.
,
.

.
1 .
, 2
.

,

. -
pervasive computing (

, ), -
(intelligent-agents),
, ,
-
.

91

11.

, .
,
,
(standards)

.



.

Food and Drug Administration(FDA),

,
() :
,
,
.

(, , , .).

.
(patient- centric)
.
,
. ,

92

, ,
.

(anywhere) (anytime).
,
. ,
.
:
:
(,
, .)
. ,
( )

.
:

. ,

.

,
(
).
: ,

(electronic patient record) .

(
),
.

(, minimum, data sets, ) .
. ,

( ) (
). , ,
.
,

.

,

93

 (
) .

,

.

1. CENT/TC 251
CE (European Committee for Standardization)
.
CENELEC (
) SI(
), .
,
(Technical Committee TC)TC 251 C,

.

2. ACR
CR (American College of Radiology)
( )
, 30.000 .
ACR

.
www.acr.org.

3. HL7-Health Level Seven

HEALTH level Seven
SI (American National Standards Institute), 1987
2.000 ,
.
L7 ,

(L7 protocol)
.

4. IEEE
(Institute of Electronics Engineers) -
360.000
175 .
94


.
, 900
700 (standards .ieee.org).


802.11, ,
1073 .

5. American Telemedicine Association

(American Telemedicine AssociationATA) - 1993
.
, , ,

.
,
.
'
(telehomecare) - (telepathlogy), - , , .

.

( ) (low
bandwidth) , ,
ISDN .
( ) . ( )
(lossy compression)
.


( ) .
-
(lossless).
(standardized)
(proprietary). ,
ISO (International
Standards Organization) ITU (International Telecommunication Union).

JPEG (Joint Photographic Experts Group)
80 (' joint) ISO

95

 ITU. JPEG
()
( )
( near-lossless algorithms). near-lossless
(teleconsulation),

. , JPEG2000
(WAVELETS).
JPEG2000 JPEG,
.
(region- ofinterest, ROI) ,
(lossless compression)
.

,

.

. 95/46
. 2472/1997

(
) .
97/66 . 2774/99
,

. , ,
,
.
,
,

. ,
,
.

CASE STUDY - '

'
,
( )
' .
VITAL -,
96

' .

.
3/12 , , ,
, , .
, ( )
C/. VIL-


.
monitor,

interface VIL.

DICOM Supplement 30
(
). (VITAL DICOM
Sup.30)

. VITAL

'
, , , , .

(common data architecture),
(Platform
Independent and Vendor systems) W3C consortium (World
Wide WEB Consortium) xml. H XML

.

97

12.

1.
,
, .
,
. ,
,

.
, ,
,
.
, '

. ,


.

,
(ISDN, GS,
, , )
, .
,

. ,
( )

, ,
,
. ,
:

(confidentiality) ,
.

98

 , . ,
,
. (privacy),
, .

. ,
,
, .

, ,
.

(integrity) , , , .
, .. , , ,
. ,
.

(availability) ,
. ,
24 24-, , '
.
Denial
of Service (DoS attacks) (),

.

(Authentication service)
.
( user name),

.
,
.
:

(user authentication)
99

(data origin authentication)

(User authentication)
:

( )
(.. )
(..
(Personal Identification Number)
)

.
/ (challenge-response)
.
(challenge),
,
(response) .

,
,
.
challenge ,
,
response.
response ,
challenge. challenge
,
.

(Data origin
uthentication)
.

,
.

(non-repudiation)
(communication),
.

,
, , .
.

100

,
, ( ,
) ,
, .

,

.
' (firewalls),
,
(intrusion detection systems),
(backup), .
,
(identification) (authentication)
,
.


,
(, ,
) .

: .

usernames passwords,
,
. ,
(biometrics),
, , . '

101

, ..
.
( template
)
,
.

,

.
(digital certificates),
.

(Certification Authorities), .
,
(Health Professional Cards)
.

.
,

. ,
, .
( )
.

,
. ,
, monitoring, web , SSL, IPSec,
PGP, .
GSM.
, GPRS (3G),

.
(digital signatures).

,
. ,
,

. ,
e -mail

( ) .

102

: e-mail.

:


:
1. .
2. .
3.
.

.
,
(smart cards). ,
,
.

, (user profile).

.

.
.

103




.
.

. ,
.
.

:

(transaction log).
, /.

.
, .
(World Medical Association)
/ ,
. ,
International Conference of Medical Professionals
.

.

104



.
. , , .
, ,
( ) .

.

/

,
, .

,
. :
1. .
2. ,
.
3. .
4. .
5. .
6. .
7. .

105

2.

PKI (Public Key Infrastructure)

Internet.

. PKI
:

(Cs), ,
,
(domain).

(RAs),
(CAs)
.

(Certificate management
systems/CMS)
.
(CMS).

.500 (directories),


.

.
(trust relationship) .


(domains) .

(Trusted Third Parties).
,
(verified)
.
(PKI)
,
, .

- (digital timestamping services).
.


.

106

 Internet ,

. Internet,
(e-mail address),
.
.

(open standards)
.

, ,
.

1.

(cryptosystem).
. ,
(encryption),
(plaintext) format, ,
(ciphertext).
, (decryption)
, .

. ,
.
(random bitvector). ,

, ,

. .
,
.
.

(confidentiality) .
, "" , ,
,
. .
( / public-key cryptography).

,
.

107

(confidentiality) ,
:
.
.
.
,

: .

DES [FIPS 462] (Data Encryption Standard), 1977 NBS

(National Bureau of Standards) FIPS 46.
O DES , 64
(64 bits). DES 56 (56-bit),
.
US$200,000.

. DES
hardware.
hackers ,
hardware,
.
.
triple-DES.
triple-DES 112 (112 bits),
. triple-DES DES
.

(publickey cryptography), .

108


.
.

. , (private key)
, (public key)
,
.
, .
,
.

: .

.
,

(session keys),

.

:

()

.


.
(
),
N(N 1)/2 , .

,
.
109

, .

.

.

:

.

.
.
(public key
certificates)
(directory).

(hash function)
,
(hash value).
,
.
,
.
(message digest).
,
(message digest
algorithms).
,
.
(oneway functions).
,

. ,

.

.

.

. :

MD5 (Message Digest Algorithm 5) RSA

Laboratories. O MD5 128 (128

110

bits).
MD5.
SHA-1 (secure hash Algorithm),
NIST (National Institute of Standards and Technology)
NSA (National Security Agency). O SHA-1
160-bit. MD5,
,
,
.

(public keys)
(authenticate user).

.

.

.
(certificate) [ISO 9594-8]
,
.
.

.
(Certification Authority)
.

:

"" .
""

:
1)
,
.
(message digest).

111

2)
.
3)
.
4)
.
5)
.
6)
.

,

.

,

.

.
.
PKCS-1 [PKCS#1],
RSA Laboratories .

,
. e-health
...
.

112



. ,
,
,
.
, ,
.

,
. ,
,
.
, ,
. ,

.
(.. ) , , .
. ,
(Risk Assessment)
(, , )
(, ).

. ,
, ()
,
. , ,
. ' ,
,

. , ,
, , .

113

13.

.

.
.

, , , ,
.
,
(VSAT - Very Small Aperture Terminal),
. ,

.

1960
.
.
.

.

.
,
, . ,
,
.

.
1945, Arthur Clarke
. 1950

114

 ,
,
.
, 1956
Echo ,
.

.
.

, ,
. Score 1958,
Courier 1960, Teslar 1962, Syncom1963. T 1964
. INTLESAT 1965.
1972
, INTERSPUTNIK. 1975

..- . 1977 ITU
, 1979

INMARSAT
(International Maritime Satellite erfanization ).
1981,
, 1982

. 1984 ,
, . 1987

INMARSAT, 1989-1990
.

.

. ,
,

.


.


.

115


:
1. O ,
, , ..
,
, :
ntelsat ( ) nmarsat
( ).
,
.
2. ,
, .
,
,
( ).

(Glbal sitining System) ,

24.
3. ,

.

,
.

, .
1994
"
".
4.
.
5. .
6. .
7. .
8. .

116

 : .

. =23h 56min 4.1
sec. To 37786 Km.
3075 m/sec. ,
o .


.

. ,
,
,
.

i. T
, ,
, .
, ,
.

.

117

.

, , ,
, , (
), .

, . :

,
,
.

, ,
.
.

, ,

.
:

.
.

.

.
, ,

.

. .


,
.

.
.

118

 .

.

.

.
Doppler .
,

.


.

.
42
, 10 .

.

,
.
.

: .

119



.
.

,
.
,
,

.
,
,
(),
.

.

.

, ,
.
,
.

.

,
. ,

. ,

.

,
.


.
:

120

,
.

( ).

:

121

(
)

.

,
,
.
,
. ,

.
.

, (.. ). ,
.
MSS (Mobile Satellite
System) :
(LEOs), 1000 km, (MEOs),
10000 km ,
(HEOs), . GEOs
INMARSAT-M, MSAT, ACTS, MOBILESAT
NSTAR. LEOs Iridium (66 770

122

km ), Teledesic (840 700 km). Odyssey

MEOs 12 10600 km
ELMSAT HEOs .


.

.

123

14.

(, , ),
.
.


,
, ,
.

:
, 42 .
, ,
. .

124

 , .. ,
.
, .

:
,
. ,
.
. ,
.
(Histogram).
, ,
. , ,
.

125

:
, 87 , ..
2. ...
. , ,
.

:
... , ,
, AVF, V1-V5. , o
.

:
( 9 Boffors),
, . ,

, . 4
, , ...
6.
( )
, .

126

:
50 , , ..,
, .
:
. , .
.

:
,
, .
.

:
,
, .
. . ,
.
, 2 .
, ,
. , ,
. 2
.

127

15.

- :
:

,
.
,
, .
, , .
,
.

:
:

.

( ).
(patient record).
.
.
.

.

.
:

.
.

.
,
.

, .

128



,
,
.
:

,

.

,

.

(cross-check)
.

, , .

- .

,

,
. ,
,
.

129


,
,

. ,
, .
,

.

(, ),

,
.
,
.

. ,
.


, , .
, , , , ,
,

.

130

[1] , : , . , . ,
. .
[2] , : , . , .
[3] :
[4]
.
[5] :
.
[6] , : , . , .
[7] .
.
,
[8] .
,
[9] Guide to health Informatics , Enrico Coiera , Hodder Arnold
[10] Site : Mosbys Medical Encyclopedia

131