臺灣博碩士論文加值系統

遠距醫療相關概念之應用已有50年的歷史；因為人們對醫療行為之既有觀念，相關醫療法規之限制以及過去之通訊技術以及軟硬體設備之環境，至今能未能成為普及應用。因此，本研究以視訊會議之概念為基礎，整合遠距生理訊號之監控，並以普及之電腦與周邊設備，實現一個遠距問診所需之軟體架構。系統實現之架構中，包含以Microsoft DirectShow為核心之即時影音之雙向傳輸程序，以提供遠距醫生與病人之間之互動通信，並以MIT生理訊號資料庫之ECG資料作為生理訊號監控之該念整合,以為遠端之ECG即時監控之運用。
本系統可在10/100Mbps之以太網路上穩定進行320*240 pixel，25 fps之未壓縮的雙向即時影像通訊，以及取樣率為44.1k Hz，解析度16bit 之WAVE格式即時聲音訊號之傳輸。影音擷取的機制乃以DirectShow為核心，其本身之特性(COM )之模組化能力，其對相關影音編碼機制有著靈活的擴充性。即時之心電圖監視，乃以MIT ECG Database之360Hz/12bit 的ECG樣本為模擬訊號來源，在雙向影音通訊的同時，同步對遠端之ECG波形監視。
本研究所實現之架構，可作為相關互動影音通信、常用生理訊號之遠距傳輸、監控之遠距健康照護、問診等遠距醫療應用之發展基礎。

The concept of Tele-medicine has emerged since (for example late 1950) and it has been evolving into a real-world application nowadays. Nevertheless, Tele-medicine is still facing a number of challenges on multiple fronts. In major society, patient-doctor direct consultation is still considered as the best health treatment method. Tele-medicine development is also hindered by a lack of regulation standards in medical area. Communication technology, as backbone for Tele-medicine was not as sophisticated as recent time. Those three factors are perceived to constraint the development and implementation of Tele-medicine system.
Tele-consultation system, as one of the supporting elements of Tele-medicine has been designed and implemented to demonstrate the basic, general purpose Tele-medicine system.
There are two functions integrated in the system. The first function is remote real-time ECG monitor. The second function is the bi-directional audio and video transmission. The implementation of the framework is based on the Microsoft DirectShow environment. The MIT ECG database is utilized to simulate ECG signal on the patient-side.
The system can transfer the bi-directional video through Ethernet 10/100 Mbps network with 320 x 240 pixel resolution without particular coding algorithm. The frame rate can be up to 25 fps. The audio is transmitted using 44.1 kHz sample rate with 16 bit resolution per sample. The remote side can monitor the ECG signal at 360 Hz rate and 11 bit resolution synchronously.
The system can provide the basic form of the bi-directional video transmission and general remote bio-signal monitor as foundation for Tele-healthcare and Tele-consultation applications.

目錄
第1章、緒論………………………………………………………………………………1
1-1 前言……………………………………………………………………………………1
1-2 研究背景與文獻回顧………………………………………………………………….2
1-2-1遠距醫療在台灣實施現況……………………………………………..….….………3
1-2-2遠距問診系統相關文獻……………………………………………………….……5
1-3 研究動機與目的……………………………………………………………..…..….9
1-4 論文架構……………………………………………………………………………11
第2章、研究工具與理論模式………………………………………………..…………12
2-1 DirectShow簡介……………………………………………………………………12
2-1-1DirectShow SDK組織架構…………………………………………………………13
2-1-2應用程式基本單元 - Filters 與 Filter Graphs….……...………………………….14
2-2 DirectShow應用程式基礎類別……………………………………………………15
2-2-1類別庫組織架構………………………….…………………………..……………..16
2-2-2物件導向程式之設計模式………………………………………………….………17
2-3 生理訊號來源………………………………………………………………..………19
第3章、系統架構與設計方法……………………………………………………..…….20
3-1 系統架構…………………………………………………………………………….20
3-2 系統建置環境與軟體架構………………………………………………………….21
3-2-1 程式開發與系統建置環境…………………………………………………………...22
3-2-2 軟體架構……………………………………………………………………………..22
3-3 設計方法……………………………………………………………………………..25
3-3-1 網路連線架構……………………………………………………………………….25
3-3-2 網路通信互動流程……………………………………………………………………27
3-3-3 相關程序設計及程式運作流程……………………………………………………...30
3-3-3-1DirectShow之影音擷取、顯示與網路傳輸…………………………………….…32
3-3-3-2ECG讀檔、繪圖與網路傳輸………………………………………………………38
第4章、研究結果與討論……………………………………………………………...…..43
4-1 系統運作結果…………………………………………………………………………43
4-2 程式界面操作說明…………………………………………………………………....45
4-3 討論…………………………………………………………………………………….47
第5章、 結論與未來展望………………………………………………………..………49
參考文獻……………………………………………………………………………………50
附錄一、應用程式相關類別關係圖………………………………………………………….51
附錄二、ECG資料規格………………………………………………………………………52
圖目錄
圖 1 1台大醫院與金山鄉衛生所之連線架構………………………………………….……..3
圖 1 2 遠距問診概念系統……………………………………………………………………..6
圖 1 3 "MANY-ONE-MANY"架構示意圖……………………………………………………..6
圖 1 4 "AMBULANCE ON THE WEB" 遠端傳回畫面………………………………………7
圖 1 5居家照護多媒體系統……………………………………………………………………8
圖 1 6居家照護系統架構……………………………………………………………………….8
圖 1 7 遠距行動緊急救護資訊平台建置……………………………………………………...10
圖 2 1 DIRECTSHOW 系統架構………………………………………………………………14
圖 2 2 FILTER GRAPH MANAGER……………………………………………………………14
圖 2 3 DOXYGEN所產生之類別合作關係圖…………………………………………………17
圖 2 4 OBSERVER PATTERN類別模型……………………………………………………….18
圖 2 5 OBSERVER PATTERN實例-試算表程式………………………………………………18
圖 3 1系統架構圖………………………………………………………………………………..20
圖 3 2 軟體架構之階層組織圖………………………………………………………………….23
圖 3 3 模組化程式類別之運作機制……………………………………………………………24
圖 3 4通信協定與連線架構……………………………………………………………….……26
圖 3 5資料傳輸網路連線架構……………………………………………………………..……27
圖 3 6 CHATTING-PROCEDURE互動流程圖…………………………….……………………29
圖 3 7 ECG TRANSMISSION-PROCEDURE 互動流程圖…………………..…………………29
圖 3 8 CCHATTINGFRAMEDC之OBSERVER NOTIFICATION MECHANISM……………30
圖 3 9 繼承CMSGSTATION之相關類別…………………………………………………..…..32
圖 3 10 繼承CMSGRECEIVER之相關類別………………………………………………..….32
圖 3 11 CHATTING-PROCEDURE程序操作示意圖…………..…………………………….…33
圖 3 12 DIRECTSHOW影音資料擷取步驟…………………………………….………….……34
圖 3 13 調整影音參數用途之FILTER GRAPH……………………….……….…………..……35
圖 3 14 裝置列舉之通用流程示意圖……………………………………………………………35
圖 3 15 雙向影音傳輸之FILTER GRAPH ……………………………………………………37
圖 3 16 ECG MONITOR-PROCEDURE程序操作示意圖 ………………………………………39
圖 3 17標準ECG圖紙格式………………………………………………………………………40
圖 3 18 ECG背景圖格設計 ………………………………………………….……………….……41
圖 3 19 ECG波形顯示畫面………………………………………………….……………….…….41
圖 3 20 ECG繪圖、傳輸機制……………………………………………………………….……..42
圖 4 1病人端程式介面…………………………………………………………………….…….…43
圖 4 2醫生端程式介面…………………………………………………………………….……….44
圖 4 3病人端實際操作情形…………………………………………………………………………44
圖 4 4 調校功能選單項目…………………………………………………………………………45
圖 4 5 影音設備調校視窗畫面……………………………………………………………………46
圖 4 6 影像、聲音設備屬性設置畫面…………………………………………………………46
圖 4 7 P-SERVER IP位址設定介…………………………………………………………………47
圖 4 8 起動ECG TRANSMISSION-PROCEDURE………………………………………………47

表目錄
表 2 1 引用基礎類別列表…………………………………………………………..…16

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