Real-Time Tele-Auscultation Consultation Services over the Internet: Effects of the Internet Quality of Service

A real-time tele-auscultation over the Internet is effective medical services that increase the accessibility of healthcare services to remote areas. However, the quality of auscultation’s sounds transmitted over the Internet is the most critical issue, especially in real-time service. Packet loss and packet delay variations are the main factors. There is little knowl edge of these factors affecting auscultation’s sounds transmitted over the Internet. In this work, we investigate the effects of packet loss and packet delay variations, in particular, heart and lung sounds with auscultation’s sound over the Internet in real-time services. We have found that both sounds are more sensitive to packet delay variations than packet loss. Lung sounds are more sensitive than heart sounds due to their timing interpretation. Some different levels of packet loss can be tolerated, e.g., 10% for heart sounds and 2% for lung sounds. Packet delay variation boundary of 50 msec is recommended. In addition, we have developed the real-time tele-auscultation prototype that tries to minimize the packet delay variation. We have found that real-time waveform of auscultation’s visualization can help physician’s confident level for sound interpreting. Some techniques for quality of service improvement are suggested, e.g., noise reduction and user interface (UI).