Tele-Cardiology Based on wireless and sensor networksss

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Mobile, Secure Tele-Cardiology Based on Wireless and Sensor Networks Kimia Houshidari HIT93 

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CONTENTS > 4.1 Introduction 4.2 Significance of Next-Generation Wireless Networks for Tele- Cardiology > 4.3 Results on Tele-Cardiology Based on Integrated Wireless Networks > 4.3.1 Routing in Simplified Heterogeneous Wireless Tele-Cardiology Networks > 4.3.2 Performance Analysis » 4.4 Cardiac Monitoring Based on Wireless Sensor Networks 

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> 4.5 MSN-Based Tele-Cardiology Design > 4.5.1 Low-Power, Small-Size ECG Micro-Sensors > 4.5.2 Secure ECG Transmission > 4.5.2.1 Single-Patient Case > 4.5.2.2 Multi-Patient Case > 4.6 Conclusions 

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> In this chapter, we first present a mobile tele-cardiology architecture that is based on the next-generation wireless networking platforms, which are able to switch among different wireless networks (including cellular networks, wireless LAN, WiMAX, ad hoc networks, and _ satellite networks) seamlessly and automatically when cardiac patients move to different locations (at home, large buildings, suburbs, or highways). > then, we discuss the importance of wireless sensor networks in cardiac monitoring. > Finally, we provide our tele-cardiology results on secure ECG signal transmission based on a Skipjack cryptography algorithm. 

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4.1 Introduction > Cardiovascular diseases are among the most widespread health problems and the single largest cause of morbidity and mortality in the United States and the Western world. > The entire nation has doubled its health care expenditure over the last two decades. Thus, low-cost and high-quality cardiac health care delivery is a critical challenge. > Tele-health monitoring can be defined as “mobile computing, medical sensor, and communications technologies for health care.” this represents the evolution of e-health systems from traditional desktop “telemedicine” platforms to wireless/mobile configurations. > Tele-health for cardiac monitoring would largely benefit our society : > (1) by enhancing accessibility to care for underserved populations (such as in rural/remote areas), > (2) by containing cost inflation as a result of providing appropriate care to cardiac patients in their homes/communities, and > (3) by improving quality as a result of providing coordinated and continuous care for cardiac patients and highly effective tools for, decision eosuort. 

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commercial telemetry systems . CardioNet . Philips . The GMP Wireless Medicine Corp . A third-generation universal mobile telecommunications system (UMTS) solution for the delivery of cardiac information from an ambulance to a hospital is presented in Gallego et al. A combined hardware and software platform known as CodeBlue. key ‏نب‎ Other sensor-based cardiac monitoring systems: 5. SMART 6. WiiSARD 7. AID-N 

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4.2 Significance of Next- Generation Wireless Networks for Tele- “Cardiology One of the biggest shortcon 5 01 most existing cardiac monitoring systems is that they are based on a single type of wireless network (most of them use cellular networks and some others use WLANs in buildings). >» However, a reliable cellular connection may not be available in many areas same as WLANs. > the cellular or WLAN networks alone cannot achieve “anywhere anytime” cardiac monitoring. Moreover, the health provider will need to install many telephone lines for receiving tele-health data when many patients use cellular networks in the future. On the other hand, these health providers already have high-speed Internet connections. 

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en ial” one ‏هت‎ Ina Plane ‘weCare-Next-generation (4G) Integrated Wireless Tele-health SS ‏ا‎ In the City or 3 Traveling FS. ‏لباز‎ ‘or Recreational Areas Remote Cardiac Monitoring Center Alarm to Rescue Squad Figure 4.1. Achieve “anywhere anytime” cardiac care throug] less networks. 

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Another serious issue is the lack of comprehensive wireless quality-of-service (QoS) support (including not only delay, bandwidth, and jitter but also packet loss rate, cellular call dropping rate, and other metrics) in a single wireless network. For example, certain types of queries and patient data can be assigned a higher priority to better resources than others in the presence of radio congestion. Other Health Boards can be more reliable and economic, if patient data and command data in Hospital / control / query can be achieved through technology, wireless communication D-FF depending on where the patient is transferred (instead of a single type), network availability, and quality of service required. Note that any type of wireless networks has different data FF current rate, the end of the delay, the radio coverage area, cost of deployment, and user mobility is allowed. 

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Table 4.1 The Features of Different Wireless Networks That Could Be Used for Cardiac Monitoring Data Allowable Radio End-to-End | Transmission | Patient | Deployment Coverage _| Delay Rates Mobility _| Cost Cellular | Approx. 35 | Mediunvhigh | 144 kbps~1 | High High/very networks | km Mbps high WiMAX Approx. 20 | Low Approx. 10 | Very high | Mediunvhigh km Mbps WLAN 50m~300 | Verylow |11~54Mbps | Medium | Medium m Satellite ۵ Very high |<144kbps [High Very high Adhoc | Typically > | Lowfmedium |300kbps~2 |Medium | Low networks | 1km Mbps 

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We can fully utilize the features of different wireless networks to design an “anywhere, anytime, real-time” cardiac tele-health system. For example: When a cardiac patient stays at home, some home Internet access technologies (such as DSL, cable modem, etc.) can be used to send the patient’s data to the health provider. When a patient is driving/shopping in the city, the cellular network or WiMAX may be a better choice because it has long-distance, high-speed radio communication. When the patient is at work or stays in a nursing home or hospital, typically WLAN (high-speed, covers building range) is available for local wireless Internet transmission. Cellular networks can also be used for cardiac data transmission when out of the WiMAX radio range, say, in suburban areas. Satellite networks could be the only choice when traveling in a plane or a desolate place. Ad hoc networks could be used to organize a temporary small area hop- to-hop network when many patients are close to each other and otHe: networks are not available. 

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4.3 Results on Tele-Cardiology Based on Integrated Wireless Networks 

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4.3.1 Routing in Simplified Heterogeneous Wireless Tele-Cardiology Networks > We have investigated the routing scheme in a mini “weCare” scenario, which integrates the cellular networks and ad hoc عم طاطم ممه wate (Backbone |__ Mobile Control Center Base Station Figure 4.2. The integration of cellular networks and ad hoc networks. 

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Figure 4.2 > A cardiac patient’s monitoring device utilizes other patients’ monitoring devices to relay ECG data in a hop-by-hop topology until it finally reaches a cellular base station (BS). h e BS can then transmit the ECG data to the health provider. Because the ad hoc network can forward data to its neighboring devices at a short distance at up to 1 Mbps, the data rate is much higher than the long- distance direct device-to-BS data forwarding (the cellular network data rates < 300 kbps).To find a shortest multi-hop path from a patient’s device to the BS quickly, we have designed a dynamic routing scheme that adopts the controlled flooding approach for route discovery. First, the source cardiac monitoring device broadcasts a route discovery packet. h e intermediate devices that receive this packet will rebroadcast it until it reaches the cellular BS. he BS sends a route reply packet to the source device and thus a route is formed, which is recorded in the routing table at the source device. To satisfy individual patient’s delay and data rate requirements or maintain the system efficiency, our routing protocol can allocate different paths for adaptive adjustment. For example, if a patient requires short delay and low data rate, our routing protoco] Oe, eRe ee ce en Ge ae Se ‏مد ات‎ 

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> For example, if a patient requires short delay and low data rate, our routing protocol can choose the cellular way (i.e., direct PDA-to-BS communication). On the other hand, if a patient requires transmission of high data rates, our routing protocol can choose the hop-to-hop relay for the source PDA. 

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4.4 Cardiac Monitoring Based on Wireless Sensor Networks > A cardiac patient with “multiple” health conditions needs a special telemedicine platform that is able to collect “multiple” health parameters from the patient’s body automatically and then send a timely alert to a remote health care office if those parameters are beyond normal ranges. those health parameters include heart rate (HR), blood oxygenation level (SpO2), blood pressure (BP), and so on. 

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Table 4.2 Multiple Health Care Parameters That Could Cause Alerts Detection Parameter That Coes beyond Normal Range 5002 < 90% (default values, adjustable) HR'> 40 bpm (default values, adjustable) HR > 150 bpm (default values, adjustable) |AHR per 5 minutes | > 19% Max HR variability from past 4 readings > 10% Systolic or diastolic change > +11.% Alert Type for Patients with Multiple Health Conditions Low $p02 Bradycardia Tachycardia HR change HR stability BP change 

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> Recently, a promising wireless telemedicine technology called a medical sensor network (MSN) has been proposed to monitor changes in patients’ vital signs closely and provide feedback to help maintain an optimal health status. < As shown in Figure 4.5, an MSN sensor typically includes a sensing chip to sense health care parameters, a microcontroller to perform local data processing (such as data compression) and networking operations (such as communicating with a neighbor sensor), and a radio transceiver to send/receive health care sensed data wirelessly. h e entire MSN sensor is powered by batteries with a lifetime of several months. Because the vower storaae is limited, it srations. ECG Signal Radio Transceiver ۲ igure 4.5 MSN sensor hardware components. 

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> The MSN sensors can improve the health care quality greatly because the automatic, wireless health care data transmission can avoid patients’ frequent doctor visits and labor-intensive manual health care parameter collections. Such sensors are also important to capture medical emergency events. For instance, many serious heart problems affecting older people are transient and infrequent and can go unnoticed even by the patients. A sudden slowing of the heart rate that leads to a fainting spell may last less than a minute and occur only once or twice a week. ۳ That is often enough to make driving a car dangerous but not frequent enough for a doctor to spot during a checkup or even by using a portable 24-hour ECG recorder called a Holter monitor. Another problem, the uncoordinated quivering of the small upper chambers of the heart, a leading cause of stroke in people over 70, can be both infrequent and without obvious symptoms. > Therefore patient-triggered ECG recorders could easily miss it However, our MSN ECG sensor can automatically collect ECG data and trigger an alert to the doctor if the ECG data mining software detects an anomaly. 

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*NOTE > Note that an MSN sensor is different from traditional wearable medical devices that are also marketed as “portable”—but this does not always indicate that they are small and have wireless communications capability. Most such appliances are much heavier and larger than an MSN sensor that can be conveniently attached to a patient’s body. 

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We have designed a practical MSN that has the following characteristics: >» Our MSN is able to collect multiple health care parameters continuously from a patient with multiple health conditions. >» Each sensor node can sense, sample, and process one or more physiological signals. For example, an ECG sensor can be used for monitoring heart activity, an electromyogram (EMG) sensor for monitoring muscle activities, an electroencephalogram (EEG) sensor for monitoring brain electrical activity, a blood pressure sensor for monitoring blood pressure, and a breathing sensor for monitoring respiration. >» Our MSN uses a wireless body area network (WBAN) in each patient’s body to perform multisensor data integration. A medical super-sensor (MSS), shown in Figure 4.6, is a WBAN, integration center that can use a radio frequency to communicate with all body sensors. It can also use anoth 

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spo2 & Hee BP Sensor es = Medical EMG Super Sensor Sensor Motion Sensor Figure 4.6 Multiple sensors. 

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> Our MSN can be applied in large U.S. nursing homes through a self-managed, relay-based wireless communication architecture. We built an MSN hardware/software system that is suitable to large nursing homes with a radius of 300 to 1000 feet. Because each patient’s MSS has limited wireless communication range (typically less than 100 feet) due to the low-power transceiver and tiny antenna in each sensor, this project will design a patient-to-patient (i.e., hop-to-hop) wireless transmission relay scheme. h at relay scheme can automatically search neighbor patients’ MSS and use them to relay the medical sensed data to a remote medical monitorina center. shown in Fiaure 4.7. If the dist nicate wit aa, oe > Wireless Data Relay Figure 4.7 Medical sensor networks for nursing homes. 

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> Our MSN design also considers patients’ mobility behaviors. If the patient moves around in a nursing home, our dynamic MSN routing protocol can automatically search a new patient-to-patient path to send the remote patient’s data to the monitoring center. > In summary, our nursing home MSN has automatic wireless network management (such as neighbor discovery, mobility, adaptivity, etc.) and multisensor data transmission functions. 

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4.5 MSN-Based Tele-Cardiology Design 8-Fh ROW Ro wae Smalk Size BCG Micro-Sensors, inc. and the CodeBlue research group at Harvard, the authors have led the researchers in the Wireless Networking Lab in the Computer Engineering Department at RIT to develop a prototype of ECG sensor networks. Our ECG micro-sensor shown at the top of Figure 4.8 has three leads that attach to the patient’s upper and lower SiOSL: Ona Aad bamias ‏ع رع ا ا ال‎ Cad thé other ty ‏سس‎ مومسم ها | ‎sensor: RE‏ Board (made by ux 205) Figure 4.8 (Top) Three-lead ECG sensor. (Bottom) Wireless communication board. 

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Our sensor network protocols can keep track of the location of each patient based on the MoteTrack algorithm. Transmission of each ECG data packet occurs regularly and no more frequently than once every 50 msec. Because other patients’ ECG sensors may be in the vicinity during the operation of ECG sensor network, it would not be appropriate to send ECG data with a higher frequency than once per 50 msec, which will risk corrupting the information being sent to and from other patients’ RF devices. > > 

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4.5.2 Secure ECG Transmission 4.5.2.1 Single-Patient Case > To protect the two important aspects of cardiac patient “privacy” in tele-cardiology systems, i.e., (1) confidentiality (only the source/destination can understand the medical data through crypto-keys), and (2) integrity (no data falsifying during transmission), we need to apply strong end-to-end security mechanisms to the cardiac data packets that are transmitted between any two network entities, such as between a patient’s sensor and a physician’s PC. 

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4.5.2.2 Multi-Patient Case < To get closer to the real tele-cardiology MANET scenario, we have extended the above single-patient transmission security to a multi- patient case. Although it is currently a fixed, small MSN (with only a few sensors), it would serve as the basis of our future research work ona large-scale MSN. 

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4.6 Conclusions > Mobile telemedicine is an active research and development field. This chapter summarized the tele-cardiology systems based on advanced wireless networks. v this includes two aspects: 3 (1) using integrated wireless networks (such as wireless LAN, cellular networks, WiMAX, and so on) to transmit ECG and other cardiac data to any place; and ¥ (2) using low-power sensor networks to collect ECG data remotely. >» We have also reported our research results on secure ECG transmission in sensor networks. 

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References: > This presentation has 42 references.