Development of a Collaborative Environment applied to
Pediatric Oncology
André L. M. da Rosa Ilana de A. Souza
Laboratório de Sistemas Integráveis (LSI)
Engenharia de Sistemas Eletrônicos da Escola Politécnica da USP
Avenida Prof. Luciano Gualberto, travessa 3 nº 380 - CEP - 05508-900 - São Paulo/SP, Brasil.
55 (11) 3091-9739
{amiranda,iasouza,ayhira,mkzuffo}@lsi.usp.br
ABSTRACT
This project aims to brighten up those problems in the
brazilian area of Pediatric Oncology, making possible the
simultaneous collaboration of medical information between
professionals of childhood cancer remotely located. It's the
implementation of a collaborative environment in which the users
can benefit itself with resources as Chat, Video-conference, Bi-
dimensional Collaborative Blackboard and Collaborative
Volumetric Visualization of medical images, also being able to
get second medical opinion for diagnosis at distance for one or
more cases of childhood cancer.
Categories and Subject Descriptors
H.5. INFORMATION INTERFACES AND PRESENTATION -
H.5.3. Group and Organization Interfaces - Collaborative
computing and Computer-supported cooperative work.
General Terms
Algorithms and Human Factors.
Keywords
Computer Supported Collaborative Work, Second Medical
Opinion, Pediatric Oncology.
1. INTRODUCTION
The main goal of this project is the specification and
implementation of a communication and controlling protocol that
provides the Computer Supported Collaborative Work (CSCW)
systems services, using Telemedicine to apply it to Childhood
Cancer. It allows that health professionals, located remotely, may
visualize and argue (collaborating through the Internet) about
digital medical images, such as Computerized X-rays and CT
scans. This way, it provides efficient and precise diagnosis,
besides allowing the exchange of information and the acquirement
of new knowledge. It consists of chat, videoconference,
collaborative bi-dimensional blackboard and collaborative
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volumetric visualization, allowing better interaction and
contribution between the users.
The system presented here makes use of the diverse data from a
medical image database in DICOM (Digital Imaging
Communication in Medicine) or JPEG formats. Thus, the medical
specialist that participates of the collaborative meetings will be
able to talk in the text mode and/or videoconference mode and to
visualize and/or manipulate medical examinations images of its
respective patients, stored in the database, through the
Collaborative Environment (CE) presented in each meet.
This work is related to the telemedicine in childhood cancer
project developed by the Laboratory of Integrated Systems of the
Polytechnical School of São Paulo University (LSI-EPUSP),
called "Oncopediatria", that is the conception of a communication
system and long-distance processing to support medical practice
aiming the establishment of a tele-health pilot net in Pediatric
Oncology.
2. METODOLOGY, ARCHITECTURE
AND IMPLEMENTATION
The communication protocol was implemented in Java language.
It was developed of such form that the creation of many meetings
is possible, in the same moment, between different participants
located in different geographic regions. For the collaborative tool,
two auto-complementary software were developed: a Server, that
is responsible for the control of all the existing meetings, and a
Client, that is executed in the remote machines of each using
specialist participant of a meeting.
To allow the collaboration between users, the Java RMI
technology (Remote Method Invocation) was used. A centered
topology was used, becoming more easily manageable. Figure 1
shows the system architecture, where we can observe the user
access to the application server through the Internet and the link
of the server with the database.
The implemented collaborative protocol allows different meetings
to occur at the same time. It can be obtained using Sessions
(considered logical abstractions that differentiate all the meetings
that are happening at the same time) completely independent ones
of the others, that will be able to have different users and
collaborative data.
The update solicitations created by the users are sent first to the
server, that processes them and then sends updates notifications
messages to all users of the respective session.

Figure 1: System Architecture
This way, to minimize the message traffic in the system and also
to prevent the necessity of constant verification of new updates
(received by the server from another session user) because it’s
dealing with a RMI connection, the client also keeps a Socket
connection with the server to be able to receive session updates
notifications.
The Control Messages implemented by the protocol can be
divided in some types: Session message (allows to the creation or
exclusion of sessions in the server); Log message (allows the
entrance or exit of a user to an existing session); Update message
(allows to update the CE properties); Notification message
(informs all the users from one session about CE updates); Text
message (allows the communication in text mode between the
session participants); and Videoconference message (allows the
communication in videoconference mode with audio and video
between the session users).
In the client application, the following collaboration modules had
been developed: Chat, Videoconference, Bi-dimensional
Collaborative Blackboard (2D-CE – 2D Collaborative
Environment) and Collaborative Volumetric Visualization (3D-
CE – 3D Collaborative Environment).
The 2D-CE is a bi-dimensional area that allows the users its
visualization and modification in a collaborative way and any
modification (as notations inclusion) can be instantly visualized
by all users. The 2D-CE contains the many operation options,
represented by a toolbar that can be done over the user layer in
the collaborative image, such as brush, rubber, geometric models,
arrows, ruler, lines, text, movements, zooming, effects
(Brightness, Contrast, Clearness, Blur, Inverse image and Filter)
and calculations as point distances, angles and areas.
We also developed the 3D-CE that is a module for data
volumetric rendering by software. We used 3D graphical
accelerating boards that support the OpenGL library (Open
Graphics Library). For the implementation of this module, we
used a library for game implementation with professional quality
in Java, called LWJGL (Lightweight Java Game Library). We aim
to provide the volumetric visualization of some images, for
example, acquired from Computed Tomography using DICOM or
JPG formats, beyond others. To test the system, we used the
segmented images of Visible Human head [1] in JPG format.
The Chat or text mode collaboration allows, beyond the
conversation between the users, the visualization of text messages
of the server (useful for some updates verification of user entrance
or exit).
The videoconference module allows the audio communication,
with microphones, and the visualization of the session users
through video, with webcams. The videoconference module was
implemented with JMF technology (Java Media Framework) that
is an extension of the Java technology with which it uses RTP
protocol (Real Time Transportation Protocol) for the audio and
video real time transmission flow. The management of the video-
conference also is made by the server software that controls all
the collaborative sessions, and each user play both video-
conference client and server (through a peer-to-peer connection),
that means that it will transmit images and sounds as much as
receive them.
Figure 2 shows a screen of the implemented client application,
where it is possible to visualize the system with three participant
users.
Figure 2: Client Collaborative Application.
3. RESULTS
Nowadays, the system has being tested and evaluated by
SOBOPE (Brazilian Society of Pediatric Oncology) doctors. The
system is currently in phase of integration with the
“Oncopediatria Portal”, also in development in our University.
The execution of the CE will occur transparently to the user who
will be able to click in a link on the Portal’s collaborative
environment and the CE will be automatically working. For the
CE calls, Java WebStart (JWS) technology is being used.
According to Srinivas [2], some of its advantages are if the remote
application is modified, an automatic version update of the local
cache is done in the next invocation of the application and it
allows that the applications may be executed independent from
the web browser (allowing a communication freedom).
4. DISCUSSIONS AND CONCLUSIONS
One of the problems found in the implementation of this system
was the videoconference transference flow for sub-nets passing
through NAT (Network Address Translation). A suitable solution
was the use of NAT doors redirection for a internal net machine,
where the chosen door could be specified in the CE to be used by
the system.
5. REFERENCES
[1] Souza, I.A., Sanches-Jr, C., Binatto, M.B., Lopes, T.T., Zuffo, M.K.
(2004). Direct Volume Rendering of the Visible Human Dataset on
a Distributed Multiprojection Immersive Environment, Anais do VII
Symposium on Virtual Reality (SVR’04), São Paulo, SP, Outubro,
183-194.
[2] Srinivas, R. N., “Java Web Start Rescue – Find out how Java Web
Start aids client-side deployment”, Java World. Available at
http://www.javaworld.com/javaworld/jw-07-2001/jw-0706-
webstart.html. 5th July 2005.