遠距醫療會診中，在影像內容與影像處理指令的類型及順序之間，存著一個關鍵的相依性。因此，當要將會診過程中產生的醫學資源作進一步的應用時，此關鍵的相依性會有些問題必須克服。以重播功能為例，必須在重播功能真正執行之前，將目標影像的內容還原至適當的狀態，以符合該關鍵的相依性。在本論文中，是利用一個三階索引架構的智慧型記錄機制(three-level indexing hierarchy, TIH)來搜尋適當的重播切入點，並確認哪些影像處理指令必須被執行，以還原影像內容至該重播切入點的原始狀態。本論文中亦利用TIH來完成許多智慧型重播功能，包含從任一時間點重播、重播某指定醫師所操作的會診片段、重播某特定醫學影像的處理片段，及蒙太奇重播。
由於會診是透過網路的媒介來進行，因此當有斷線重連或遲到的使用者加入會診時，系統如何維持所有會診參與者均保有相同影像內容，將是一重大的挑戰。本論文提出了由兩個模組所構成的一個新的還原機制，第一個模組即為TIH，其記錄了改變每張影像內容的所有指令，因此當還原機制運作時，可快速地確認並傳輸這些指令給使用者；第二個模組為「優先還原策略」，其利用TIH來達成前景影像優先還原的機制，可讓斷線重連或遲到的使用者在加入會診時，能更快速地與其他參與者同步。而為了將遠距會診的內容製作成電子醫學報告，本論文採用了DICOM SR作為建構醫學報告內容的標準，並藉由TIH來擷取會診中具決定性與代表性的醫學資源，以作為DICOM SR報告中的證據物件。
實驗結果亦顯示，在重播功能的應用裡，TIH在運算效能與儲存空間上，均優於現有以畫面存取為主的系統；而在會診還原的應用，相對於傳統的訊息記錄機制，TIH與「優先還原策略」的結合，能顯著地減少了還原延遲時間。

In teleconsultation sessions, a critical dependency exists between the image contents and the type and sequential order of the image processing commands applied by the various participants. Accordingly, when retrieving desired medical resources generated during the course of the session for further applications, some issues concerned with this dependency arise. Taking the playback application for example, when executing playback functions, it is necessary to restore the target image contents to the appropriate condition before commencing the playback routine. In this study, this is achieved by using a smart logging scheme designated as three-level indexing hierarchy (TIH) to search for the appropriate cut-in point in the session and to identify the commands which should be applied to restore the current image contents to their original condition at the cut-in point. Applying TIH, a range of smart playback functions are realized, including replaying the session from a specified point in time, replaying all the session segments controlled by a particular physician, replaying all the session segments relating to a specific medical image, and playing a montage of the entire session.
As the teleconsultation sessions are performed through network, for re-entrant / late users, a significant challenge exists in restoring the image contents of the teleconsultation session in such a way that all the participants maintain a consistent view of the medical images. In this study, this problem is resolved using a novel recovery mechanism comprising two major components, namely the TIH and a prioritized recovery policy. TIH maintains a record of all the commands which affect the appearance of each medical image such that when a restoration process is required, these image-affect commands can be rapidly identified and transmitted to the user. The prioritized recovery policy further reduces the time required for re-entrant / late users to catch up with the on-going session by utilizing the cross-linkage design within TIH to restore the foreground image (i.e. the image under current discussion) before the background images (i.e. the remaining images in the session). In addition, for documenting the performed teleconsultation sessions into electronic medical reports, DICOM structured reporting (SR) developed for the provision of standard templates and context groups in medicine domain is adopted in this study as the standard of constructing the contents of medical reports. Taking advantage of TIH, the conclusive and representative medical resources generated during the course of sessions could be retrieved as the components of DICOM SR-based reports.
The evaluation results confirm that in playback application, TIH outperforms existing scene-based retrieval systems in terms of both an improved computational efficiency and a lower storage requirement, and in session-recovery application, the TIH architecture and prioritized recovery policy yield a significant reduction in the recovery-latency delay compared to that of traditional message-logging restoration systems.

[1] Rosr Dieng-Kuntz, David Minier, Marek Ruzicka, Frederic Corby, Olivier Corby, and Laurent Alamarguy, "Building and using a medical ontology for knowledge management and cooperative work in a health care network", Computers in Biology and Medicine, Vol. 36, No. 7, July 2006, pp. 871-892.
[2] Wenhua Huang, Yuhua Ai, Zhenyu Chen, Qinghua Wu, Hanbin Ouyang, Peifeng Jiao, Zhexing Liu, and Chihua Fang, "Computer Supported Cooperative Work (CSCW) for Telemedicine", Computer Supported Cooperative Work in Design, 2007. CSCWD 2007. 11th International Conference on, April 2007, pp. 1063-1065.
[3] Shengjun Xue, Xukui Liu, and Tan Ran, "Study on the CSCW-Based Web Teaching System", Computational Intelligence and Software Engineering, 2009. CiSE 2009. International Conference on, Dec. 2009, pp. 1-4.
[4] James Marsh, Mashhuda Glencross, Steve Pettifer, and Roger Hubbold, "A network architecture supporting consistent rich behavior in collaborative interactive applications", Visualization and Computer Graphics, IEEE Transactions on, Vol. 12, No. 3, May-June 2006, pp. 405-416.
[5] Tanvir Ahmed and Anand R. Tripathi, "Security Policies in Distributed CSCW and Workflow Systems", Systems, Man and Cybernetics, Part A: Systems and Humans, IEEE Transactions on, Vol. PP, No. 99, May 2010, pp. 1-12.
[6] Shen Ze, Kang Ruihua, and Shao Xiongkai, "CSCW-based virtual team cooperation platform analysis and design", Informatics in Control, Automation and Robotics (CAR), 2010 2nd International Asia Conference on, Vol. 3, March 2010, pp. 323-326.
[7] Edward D Lemaire, Yvon Boudrias, and Gayle Greene, "Low-bandwidth, Internet-based videoconferencing for physical rehabilitation consultations", J. Telemed. Telecare, Vol. 7, No. 2, 2001, pp. 82-89.
[8] Carlos Costa, José L. Oliveira, Augusto Silva, Vasco Gama Ribeiro, and José Ribeiro, "Design, development, exploitation and assessment of a Cardiology Web PACS", Computer Methods and Programs in Biomedicine, Vol. 93, No. 3, March 2009, pp. 273-282.
[9] Sanghun Park, Wontae Kim, and Insung Ihm, "Mobile collaborative medical display system", Computer Methods and Programs in Biomedicine, Vol. 89, No. 3, March 2008, pp. 248-260.
[10] Kuntalp M. and Akar O., "A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries", Computer Methods and Programs in Biomedicine, Vol. 75, No. 2, Aug. 2004, pp. 117-126.
[11] Jose Carlos Dafonte Vazquez, Alfonso Castro Martinez, Angel Gomez, and Bernardino Arcay Varela, "Intelligent agents technology applied to tasks scheduling and communications management in a critical care telemonitoring system", Computers in Biology and Medicine, Vol. 37, No. 6, June 2007, pp. 760-773.
[12] Michal Kosiedowski, Cezary Mazurek, Maciej Stroinski, and Jan Weglarz, "Medical Digital Library Services as an Improvement of the Teleconsultation System in the Regional Health Network", eHealth, Telemedicine, and Social Medicine, 2009. eTELEMED '09. International Conference on, Feb. 2009, pp. 154-159.
[13] A. Holopainen, F. Galbiati, and K. Voutilaninen, "Use of Smart Phone Technologies to Offer Easy-to-Use and Cost-Effective Telemedicine Services", International Conference on the Digital Society, Jan. 2007, pp. 4-4.
[14] Chien-Cheng Lee, Pau-Choo Chung, Yunghsiang Sam Han, Dyi-Rong Duh, and Chi-Wei Lin, "A Practice of a Collaborative Multipoint Medical Teleconsultation System on Broadband Network", Journal of High Speed Networks, Vol. 13, No. 3, 2004, pp. 207-222.
[15] Jin Li, Zhigao Chen, and Wei Li, "A Multimedia Telemedicine System", Biomedical Engineering and Computer Science (ICBECS), 2010 International Conference on, April 2010, pp. 1-3.
[16] Go Kentaro, Kashiwagi Kenji, Naohiko Tanabe, Ken'ichi Horiuchi, and Nobuya Koike, "Iterative design of Teleoperative Slit Lamp Microscopes for Telemedicine", Pervasive Computing Technologies for Healthcare (PervasiveHealth), 2010 4th International Conference on-NO PERMISSIONS, March 2010, pp. 1-4.
[17] V.Thulasi Bai, "Real time portable telemedicine system for cardiac patient", BioMedical Information Engineering, 2009. FBIE 2009. International Conference on Future, Dec. 2009, pp. 57-60.
[18] Chien-Shun Lo, Ching-Wen Yang, Pau-Choo Chung, Yen-Chien Ouyang, San-Kan Lee, and Ping-Song Liao, "A Mammography Tele-Consultation Pilot System in Taiwan", Journal of High Speed Networks, Vol. 9, 2000, pp. 31-46.
[19] Klymash M.M., Romanchuk V.L., and Krasko O.V., "Telemedicine system model using Internet-technology", Modern Problems of Radio Engineering, Telecommunications and Computer Science (TCSET), 2010 International Conference on, Feb. 2010, pp. 259-259.
[20] Ching-Wen Yang, Pau-Choo Chung, Chein-I Chang, San-Kan Lee, and Ling-Yang Kung, "A Hierarchical Model for PACS", Computerized Medical Imaging and Graphics, Vol. 21, No. 1, Jan. 1997, pp. 29-37.
[21] Marco Masseroli, Alberto Visconti, Simone Giovanni Bano, and Francesco Pinciroli, "He@IthCo-op: a web-based system to support distributed healthcare co-operative work", Computers in Biology and Medicine, Vol. 36, No. 2, Feb. 2006, pp. 109-127.
[22] Suman Kundu, J. Mukherjee, A. K. Majumdar, B. Majumdar, and Sirsendu Sekhar Ray, "Algorithms and heuristics for efficient medical information display in PDA", Computers in Biology and Medicine, Vol. 37, No. 9, Sept. 2007, pp. 1272-1282.
[23] S. Sudhamony, K. Nandakumar, P.J. Binu, and S. Issac Niwas, "Telemedicine and tele-health services for cancer-care delivery in India", Communications, IET, Vol. 2, No. 2, Feb. 2008, pp. 231-236.
[24] Ching-Wen Yang, Pau-Choo Chung, San-Kan Lee, Chein-I Chang, Chia-Hsien Wen, and Ling-Yang Kung, "An Image Capture and Communication System for Emergency Computed Tomography", Computer Methods and Program Biomedicine, Vol. 52, No. 2, Feb. 1997, pp. 139-145.
[25] Alessandro Gobbi, Ilaria Milesi, Leonardo Govoni, Antonio Pedotti, and Raffaele L. Dellaca, "A New Telemedicine System for the Home Monitoring of Lung Function in Patients with Obstructive Respiratory Diseases", eHealth, Telemedicine, and Social Medicine, 2009. eTELEMED '09. International Conference on, Feb. 2009, pp. 117-122.
[26] Pinkesh J. Shah, Ralph Martinez, and Bernard P. Zeigler, "Design, Analysis, and Implementation of a Telemedicine Remote Consultation and Diagnosis Session Playback Using Discrete Event System Specification", IEEE Trans. on Information Technology in Biomedicine, Vol. 1, No. 3, Sept. 1997, pp. 179-188.
[27] Baldine B. Paul and M. Reha Civanlar, "VTJukebox: implementation issues for RTP-based recording and on-demand multicast of multimedia conferences", Multimedia Signal Processing, 1998 IEEE Second Workshop, Dec. 1998, pp. 259-264.
[28] J.C. Guerri, C.E. Palau, A. Pajares, A. Belda, J.J. Cermeno, and M. Esteve, "A Multimedia Telemedicine System to Assess Musculoskeletal Disorders", Proceedings of the 2003 International Conference on Multimedia and Expo, Vol. 1, July 2003, pp. 1-701-4.
[29] Mohamed Kholief, Kurt Maly, and Stewart Shen, "Event-Based Retrieval from a Digital Library Containing Medical Streams", Proceedings of the 2003 Joint Conference on Digital Libraries, May 2003, pp. 231-233.
[30] Yeongho Kim, Jeong-Ho Choi, Jongki Lee, Myeng Ki Kim, Nam Kuk Kim, Jin Sup Yeom, and Yong Oock Kim, "Collaborative surgical simulation over the Internet", IEEE Internet Computing, Vol. 5, No. 3, May-June 2001, pp. 65-73.
[31] Shu-Di Bao, Lian-Feng Shen, and Yuan-Ting Zhang, "A novel key distribution of body area networks for telemedicine", International Workshop on Biomedical Circuits and Systems, Dec. 2004, pp. 1- 17-20a.
[32] A. Holopainen, F. Galbiati, and K. Voutilaninen, "Use of Smart Phone Technologies to Offer Easy-to-Use and Cost-Effective Telemedicine Services", International Conference on the Digital Society, Jan. 2007, pp. 4-4.
[33] Slobodan Kovacevic, Mario Kovac, and Josip Knezovic, "System for Secure Data Exchange in Telemedicine", International Conference on Telecommunications, June 2007, pp. 267-274.
[34] C. Chronali, S. Kostomanolakis, P. Lelis, P.J. Lees, F. Chiarugi, M. Tsiknakis, and S.C. Orphanoudakis, "Integrated teleconsultation services in cardiology", Computers in Cardiology, Sept. 2000, pp. 175-178.
[35] G. Zahlmann, S. Kluthe, M. Obermaier, M. Mertz, and G. Mann, "Establishment and use of a teleconsultation network in ophthalmology", Annual International Conference on the IEEE Engineering in Medicine and Biology Society, Oct. 1997, pp. 924-927.
[36] Qiang Huang, Kobayashi, and Bede Liu, "Energy/security scalable mobile cryptosystem", International Symposium on Personal, Indoor and Mobile Radio Communications, Sept. 2003, pp. 2755-2759.
[37] Saber Zrelli and Yoichi Shinoda, "Specifying Kerberos over EAP: Towards an integrated network access and Kerberos single sign-on process", International Conference on Advanced Information Networking and Applications, May 2007, pp. 490-497.
[38] Saber Zrelli, Tune Medeni, Yoichi Shinoda, and Tolga Medeni, "Improving Kerberos Security System for Cross-Realm Collaborative Interactions: An Innovative Example of Knowledge Technology for Evolving & Verifiable E-Society", International Conference on Research, Innovation and Vision for the Future Information Networking and Applications, March 2007, pp. 211-219.
[39] Shoichi SAKANE, Nobuo OKABE, Ken-ichi KAMADA, and Hiroshi Esaki, "Applying Kerberos to the communication environment for information appliances", Symposium on Applications and the Internet Workshops, Jan. 2003, pp. 214-217.
[40] Nadir Gaylani and Y.M. Erten, "Handling NAT Traversal and Mobility for Multimedia Traffic", IEEE Consumer Communications and Networking Conference, Jan. 2006, pp. 112-116.
[41] Lubomir Cvrk, Jiri Misurec, and Vit Vrba, "Application-independent Decentralized and Secure Communication with NAT traversal", International Conference on Networking, International Conference on Systems and International Conference on Mobile Communications and Learning Technologies, April 2006, pp. 58-58.
[42] Tzu-Chi Huang, Ce-Kuen Shieh, Wen-Huang Lai, and Yu-Ben Miao, "Smart Tunnel Union for NAT Traversal", IEEE International Symposium on Network Computing and Applications, July 2005, pp. 227-231.
[43] O.T. Satyanarayanan and J. Shiva Shankar, "Management of NAT-based Private Networks", IFIP/IEEE International Symposium on Integrated Network Management, May 2005, pp. 573-586.
[44] Sadanori Aoyagi, Makoto Takizawa, Masato Saito, and Hiroto Aida, "ELA: A Fully Distributed VPN System over Peer-to-Peer Network", Symposium on Applications and the Internet, Feb. 2005, pp. 89-92.
[45] Vinay Pai and Pratik Rana, "A transparent framework for enabling incoming TCP connections to hosts behind a NAT gateway", International Conference on Computer Communications and Networks, Oct. 2003, pp. 572-575.
[46] Xiantai Gou and Weidong Jib, "Multi-agent System for Multimedia Communications Traversing NAT/Firewall in Next Generation Networks", Second Annual Conference on Communication Networks and Services Research, May 2004, pp. 99-104.
[47] Kiyoshi Tanaka, Tsutomu Sasaki, Yoshinobu Tonomura, Tadashi Nakanishi, and Noboru Babaguchi, "PlayWatch: Chart-Style Video Playback Interface", Proc. ICME 2005, 2005, pp. 731-734.
[48] Zheng Zhou, Brent J. Liu, and Anh H. Le, “CAD–PACS integration tool kit based on DICOM secondary capture, structured report and IHE workflow profiles”, Computerized Medical Imaging and Graphics, Vol. 31, No. 4-5, June 2007, pp.346-352.
[49] William Gropp and Ewing Lusk, "Fault Tolerance in Message Passing Interface Programs", International Journal of High Performance Computing Applications, Vol. 18, No. 3, Aug. 2004, pp. 363-372.
[50] David B. Johnson and Willy Zwaenepoel, "Sender-based message logging", 17th international symposium on fault tolerant computing, July 1987, pp. 14-18.
[51] E. N. Elnozahy, Lorenzo Alvisi, Yi-Min Wang, and David B. Johnson, "A survey of rollback-recovery protocols in message-passing systems", ACM Computing Surveys, Vol. 34, No. 3, Sept. 2002, pp. 375-408.
[52] DICOM 2008 Supplement 23. Available from: ftp://medical.nema.org/medical/dicom/final/sup23_ft.pdf
[53] David A. Clunie. DICOM Structured Reporting. Bangor PA: PixelMed; 2006
[54] David A. Clunie, "DICOM Structured Reporting and Cancer Clinical Trials Results", Cancer Informatics, Vol. 4, May 2007, pp.33-56.
[55] Bui AAT, Morioka C, Dionisio J DN, Johnson DB, Sinha U, Ardekani S, Taira RK, Aberle DR, El-Saden S, and Kangarloo H, "OpenSourcePACS: An Extensible Infrastructure for Medical Image Management", IEEE Transactions on Information Technology in Biomedicine, Vol. 11, No. 1, Jan. 2007, pp. 94-109.
[56] C Homorodean, D Olinic, S Nedevschi, and N Olinic, "Templates Implementation for Structured DICOM Diagnosis Reporting in Echocardiography", Computers in Cardiology, Vol. 32, 2005, pp. 379-382.
[57] Todd Jensen and Bob Baumgartner, "A flexible, multimodality structured reporting system based on medical and networking standards", International Congress Series, Vol. 1256, June 2003, pp. 893-899.
[58] Cheng-Hsiung Wang, Chien-Cheng Lee, Hewijin Christine Jiau, Pau-Choo Chung, Tsung-Lung Yang, Kuo-Feng Ssu, and Yu-Shian Kuo, "Improving the Tele-consultation Services – Capabilities of Retro", Proceedings of the 3rd European Medical & Biological Engineering Conference, Nov. 2005.
[59] DICOM 2008 Part 10. Available from: ftp://medical.nema.org/medical/dicom/2008/08_10pu.pdf
[60] SNOMED CT. IHTSDO, Copenhagen 2007. Available from: http://www.ihtsdo.org/
[61] LOINC 2.26. Available from: http://loinc.org/
[62] DICOM 2008 Part 3. Available from: ftp://medical.nema.org/medical/dicom/2008/08_03pu.pdf
[63] Zhang J., Stahl J.N., Huang H.K., Zhou X., Lou S.L., and Song K.S., "Real-Time Teleconsultation with High-Resolution and Large-Volume Medical Images for Collaborative Healthcare", Information Technology in Biomedicine, IEEE Transactions on, Vol. 4, No. 2, June 2000, pp. 178-185.
[64] Xiaolin Lu, "A Cooperative Telemedicine Environment for Stomatological Medical Diagnosis", Mechatronics and Automation, Proceedings of the 2006 IEEE International Conference on, June 2006, pp. 1647-1652.
[65] Yu-Chia Hsu, Po-Yen Lin, Steen J. Hsu, and Chia-Tai Chan, "Design and Implementation of Teleconsultation System for Instant Treatment", Bioinformatics and Biomedical Engineering, 2008. ICBBE 2008. The 2nd International Conference on, May 2008, pp. 1355-1358.