International Journal of Information Management xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

International Journal of Information Management

journal homepage: www.elsevier.com/locate/ijinfomgt

Mobile edge computing based QoS optimization in medical healthcare

applications
⁎ ⁎
Ali Hassan Sodhroa,b, Zongwei Luoc, , Arun Kumar Sangaiahd, , Sung Wook Baike
a
Sukkur IBA University, Sukkur, Sindh, 65200, Pakistan
b
DISP LAB, University Lumiere Lyon 2, Lyon, France
c
Shenzhen Key Laboratory of Computational Intelligence, Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen,
518055, China
d
School of Computing Science and Engineering, Vellore Institute of Technology, Vellore, 632014, Tamil Nadu, India
e
Intelligent Media Laboratory, Digital Contents Research Institute, Sejong University, Seoul, Republic of Korea

A R T I C LE I N FO A B S T R A C T

Keywords: Emerging trends in mobile edge computing for developing the efficient healthcare application such as, remote
Mobile edge computing monitoring of the patients with central electronics clouds (e-Clouds) and their increasing voluminous multi-
Medical healthcare media have caught the attention of everyone in industry and academia. So, clear visualization, big sensing level,
QoS and better quality of service (QoS) is the foremost priority. This paper proposes the window-based Rate Control
Window-based rate control algorithm
Algorithm (w-RCA) to optimize the medical quality of service (m-QoS) in the mobile edge computing based
BSA
healthcare by considering the network parameters for instance, peak-to-mean ratio (PMR), standard deviation
(Std.dev), delay and jitter during 8 min medical video stream named “Navigation to the Uterine Horn, trans-
ection of the horn and re-anastomosis’ transmission over 5 G networks. The performance of the proposed w-RCA
is evaluated and compared with the conventional battery smoothing algorithm (BSA) and Baseline by using
MPEG-4 encoder for optimizing m-QoS at the source or the server side. The experimental results demonstrate
that the w-RCA outperforms the BSA and Baseline by optimizing QoS in remote healthcare application i.e., Tele-
surgery. Besides, it is observed and analyzed that w-RCA produces better and effective results at small buffer and
window sizes unlike BSA and Baseline by adopting large buffer size during QoS optimization.

1. Introduction attracted the several healthcare industries due to emerging revolution

Mobile edge computing is the paradigm shift for the every corner of
the medical world, in the mean-time remote Sensing (RS) is an en-
couraging ingredient which plays very vital role in several fields spe-
cifically, the efficient remote healthcare domain with big and bright
picture of the incident, healthcare surveillance, disaster monitoring,
etc. Close and effective coordination between physical and digital
worlds promise the high quality of service (QoS) for human life in order
to make medical world smart and sustainable landscape. Remotely-
sensed information, combined with location and application informa-
tion gathered locally or through wearable sensor nodes, depicts several
bright sides for building medical smart landscape with mobile edge
computing. High medical resolution data are remotely sensed and
monitored by many healthcare industries to entertain the claims and
needs of various users. QoS is one of the most important assets during
remote sensing and monitoring of healthcare data to fulfil the demands
of society as shown in Fig. 1. The medical media streaming has
in the state-of-the art technologies such as 5 G, internet of things (IoT)
Big Data, cloud computing, etc. The quality of service (QoS) in terms of
end-to-end delay guarantees to real-time applications is especially im-
portant for the new generation of Internet applications such as, video
on demand (VoD) and other consumer services (Karambakhsha et al.,
2018; Mukhopadhyay, Navyashree, & Meenakshi, 2015; Sodhro, Li, &
Shah, 2016; Clark, Gross, & Wu, 2013; Sodhro, Kumar Sangaiah et al.,
2018; Sodhro, Sekahri et al., 2018; Sodhro, Kumar Sangaiah, Pibhulal,
2018a; Sodhro, Kumar Sangaiah, Pirbhulal, 2018b; Zingoni et al.,
2017). Basic network performance indicators are throughput, delay,
jitter and packet loss ratio (PLR).
(Enayet & Fortino, 2018; Sodhro et al., 2012), present the novels
techniques for the dynamic resource management such as, quality of
service in the healthcare application with the key focus at power and
battery lifetime of the tiny wearable devices. Detecting the sensing of
the objects during video transmission with big and better visualization
is very challenging due to several features for instance, size, contrast,

⁎
Corresponding authors.
E-mail addresses: luozw@sustc.edu.cn (Z. Luo), sarunkumar@vit.ac.in, arunkumarsangaiah@gmail.com (A.K. Sangaiah).

https://doi.org/10.1016/j.ijinfomgt.2018.08.004
Received 3 March 2018; Received in revised form 6 August 2018; Accepted 9 August 2018
0268-4012/ © 2018 Elsevier Ltd. All rights reserved.

Please cite this article as: Sodhro, A.H., International Journal of Information Management, https://doi.org/10.1016/j.ijinfomgt.2018.08.004
A.H. Sodhro et al.
Fig. 1. 5G Architecture for Mobile Edge Computing based Medical Healthcare Applications.
velocity and trajectory, etc. Besides, the dynamic nature of the wireless
channel deteriorates or reduce the QoS. Many previous researchers
achieved good performance merely in some specific fields but the
medical QoS optimization during video transmission for healthcare
over mobile edge computing networks and smart cities is not en-
tertained in-depth. Rate control algorithms remarkably improves the
visual video playback quality by properly adapting the variations in the
wireless channel, because the dynamic nature of the wireless link af-
fects the QoS as well as the perception level of the users. (Kaba, 2018),
develops the internet based approach to classify the users on their
socio-economical level. In addition they present the limitations and
possible solutions to further improve that technique in near future for
sustainable and better options.Ultra-high resolution-enabled medical
videos can be downloaded within seconds with the state-of-the art 5 G
technology, besides it handles big data with lesser delay and provides
more bandwidth. Telemedicine is the physical networks which with
different interconnected technologies e.g., Wi-Fi, Bluetooth and Cel-
lular on a single platform and requires high data, high speed and better
QoS with reliable connectivity. All these hard requirements are fulfilled
by dynamic and superfast capabilities during remote sensing and ef-
fective, economical treatment. (Chen et al., 2015; Zhao, Cai, & Zhao,
2016), develop the video frame rate control based scheme for max-
imizing the quality of experience of the user, but the QoS optimization
during medical video transmission is not the center of their attention.
The technological development and dynamic revolution in wireless
Telemedicine applications have broadened the innovative ideas and
services; their unique and fundamental ideology is to smooth the
variable bit rate (VBR) medical video by reducing high peak data rate
and rate variability over flexible and high capacity network to optimize
the m-QoS. 5 G networks has been developed with relatively high
bandwidth requirements to provide m-QoS guarantees with dynamic
cost management in real time applications such as, smart grids
2
International Journal of Information Management xxx (xxxx) xxx–xxx
(Ferdous, Alamri, Fortino, & Zhou, 2017). The basic aim of these state-
of-the art networks is to provide continuous, quick and cost-effective
health services to patients and doctors at remote location. One of the
most interesting services offered by 5 G networks is the end user in-
teractive multimedia transmission of video. In addition to typical cor-
porate applications 5 G is widely used in medical applications where
latency and high resolution imaging are very important. It ensures
uninterrupted and lossless delivery of data regardless of high inconstant
bandwidth of wireless channel and comparatively high data bit rates.
The long lasting interconnection between Real-time Transport Protocol
(RTP) and User Datagram Protocol (UDP) offers the sustainable media
services in the heterogeneous networks (Aloi et al., 2016; Fortino,
Gravina et al., 2017; Fortino, Russ et al., 2017) because of their com-
patibility and economical service provisioning capability. In addition
one of the other emerging media transmission protocols such as, Real
Time Control Protocol (RTCP) is playing an important role in m-QoS
monitoring and optimization by transforming the control packets be-
tween the transmitter and the receiver. RTCP’s function is to deliver
data distribution quality information to the streaming server. Traffic
parameters’ feedback of the real time video streaming like jitter, free
residual client buffer space, playout delay and sequence number of
received packets is also provided by RTCP. The control packets of RTCP
periodicity of the RTCP is normally from one second (9000 frame times)
to five seconds. The value of control packets are determined at the start
of session (Fortino, Giordano, Guerrieri, Spezzano, & Vinci, 2016;
Fortino, Gravina et al., 2017; Fortino, Russ et al., 2017). The feedback
provided by the streaming server i.e. frames information at the client
side for buffering or playout during medical video transmission can
help to optimize the quality of service at server end. As per the size of
buffer and compressed data type characterized by the user, bit rate of
data transmission is maintained by the streaming server. Users of
wireless network receives data thorough wireless link, which is the
A.H. Sodhro et al.
bottleneck of whole transmission system due to high peak data rate and
rate variability of wireless VBR channel. To overcome these short-
comings, a window-based rate control algorithm for m-QoS optimiza-
tion in Telemedicine system over 5 G network is proposed. The two
well-known characteristics of MPEG compressed videos i.e. high bit rate
and high variability rate in short and long sessions. This variability (in
compressed stream bit rate) is mainly because of the use of different
coding techniques but transmission of inconstant bit rate stream needs
to transport burst traffic in an effective manner over the Telemedicine
networks. In interactive medical video applications the sender knows
that small size of video frames imposes strict delay bounds to clients.
Because of this constraint, interactive video quality can be improved by
employing such methods which can cope-up with the changing sizes of
video frame, bandwidth and available buffer size. This can be achieved
by averaging the transmitting frame sizes and approximating the new
frame sizes on the basis of current frame sizes at server side. For
building mobile edge computing based healthcare platform with big
sensing and portraying bright picture of the incident is the key target of
this paper. For clear and better visualization at the edge of the networks
QoS optimization is very vital, because high rate variability, large
peaks, delay and jitter values during medical video transmission gives
un-satisfactory level to the patients and doctors. So, in order to remedy
these challenges two algorithms such as, w-RCA, BSA, and Baseline are
compared while optimizing the QoS in terms of network metrics i.e.,
PMR, Std.dev, delay and jitter.
Contribution of this paper is threefold.
• First, to propose window-based rate control algorithm for the
medical video application such as, Tele-surgery over 5 G networks to
remotely access the incident and portray it with big and clear pic-
ture.
• Second, a mobile edge computing-based 5 G framework for QoS
optimization in medical media healthcare is proposed.
• Third, to establish tradeoff between client buffer size, window size
and network metrics; such as, standard deviation, peak-to-mean
ratio, delay, and jitter to optimize QoS level for interactive medical
application.
The rest of the paper is organized as follows. Section 2 proposes the
window-based rate control algorithm. Section 3, develops the mobile
edge computing based medical video transmission framework. Section
4 demonstrates the experimental results with detailed discussion. Sec-
tion 5 concludes the paper.
2. Related work
Mobile edge computing is rapidly changing the entire scenario of
the digital medical world, especially in the medical healthcare domain.
There are various techniques and tools for building smart medical cities
with effective and clear visualization, and better QoS during video
transmission at remote location i.e., Telemedicine. Several researchers
already have investigated the role of emerging technologies in various
fields with the significant contribution for example, (Sodhro et al.,
2012) design optimal smoothing algorithm for QoS optimization in
Telemedicine system, although medical video stream with rate control
algorithm is not considered. (Zingoni et al., 2017), present the effective
technique to detect the path of the moving objects in the real-time video
transmission, but do not consider the medical domain and QoS opti-
mization challenges. (Abdalla & Venkatesan, 2015), propose a perva-
sive healthcare platform with real-time window based local call ad-
mission control algorithm to achieve QoS in IP networks (Cui et al.,
2016; Liao, Qi, & Wang, 2016; Wua, Kao, & Sambamurthy, 2016), de-
velop the various different methods of self-adaptive, human motion
tracking and e-health management with great trends and practices
(Wua et al., 2016), propose the theoretical model with main three en-
tities related to healthcare in association with IT supporting system.
3
International Journal of Information Management xxx (xxxx) xxx–xxx
Besides, they found the impact of that developed system on the hospital
management platform (García, Tomás, Parra, & Lloret, 2018), design
the promising mechanism for recognizing the cerebral stroke detection
by adopting the cloud to store and interpret the data to facilitate the
common citizens. Moreover, signs and symptoms of the cerebral related
diseases are examined with some practical trends and data analysis
tools (García et al., 2018; Liu et al., 2016a, 2016b, 2016c; Van Ma et al.,
2017; Xu, Zhao, & Ji, 2011), discuss the efficient and secure healthcare
monitoring tricks for example, window-enabled data rate smoothing,
fuzzy-based decision making, artificial intelligence for dynamic mobile
care, and m-health based on cloud-computing mechanism. Besides, they
presented the rate control algorithm to smooth picture quality and
buffer occupancy, but their work did not consider the medical video
stream and QoS optimization over LTE networks. (Van Ma et al., 2017),
develop the fuzzy logic based adaptive video transmission algorithm to
adjust the high peak rate fluctuations with respective to the networks
conditions. However, they do not emphasis the QoS estimation during
medical video transmission (Chen, Zhou, & Fortino, 2016; El &
Ghalwash, 2016; Szpyrka & Biernacka, 2016), design the human emo-
tions enabled systems, energy efficient video streaming and rate control
based approaches for the sensor and healthcare platforms. Besides, they
propose energy aware and adaptive cross layer scheme for multimedia
content transmission over WSNs. Their scheme only emphasized on
energy-efficient transmission, nevertheless, rate control and offline
smoothing algorithms during multimedia transmission is not high-
lighted in their study. (Majedi, Naeem, & Anpalagan, 2016), examine
the emerging role of communication technologies in the healthcare
with key focus at the efficient resource management.
(Pace, Frustaci, Aloi, Gianluca, & Fortino, 2017; Pirbhulal, Zhang,
and Wu, (2016)), develop the novel security frameworks and algo-
rithms for the protecting the healthcare environment. In addition their
research presented adaptive streaming technique for 3GPP packet
switched streaming service, however, they did not consider rate control
and offline algorithms for medical video transmission in remote health
monitoring applications. (Alwakeel & AlGhanmi, 2011; Banerjee &
Sharif, 2016; Gupta, Kar, Baabdullah, & Al-Khowaiter, 2018; Ou &
Somayazulu, 2015; Pirbhulal et al., 2016; Sodhro & Fortino, 2017),
propose the various human biological signal transmission, video, image
and other vital sign signals with main focus on the energy, security and
quality of service optimization in the medical healthcare. Moreover,
they proposed energy-efficient transmission power control algorithm
for patient's vital sign signals transmission over wireless body area
networks, however, they do not focus at medical video stream with QoS
optimization over 5 G networks. Moreover, they developed media
transmission algorithm between patients and physicians at remote lo-
cation over WBSNs for healthcare applications i.e. Tele-Education. In
addition their work focuses at the energy-efficient and friendly video
streaming, but medical video stream with network metrics is not dis-
cussed. Also their research addressed one of the hot methods for re-
moving the repeated video sequences, and hence the power drain.
Whereas, their work did not discuss medical video stream transmission
with RCA over 5G. Also they develop the augmented reality based
framework to enhance the teaching and learning performance in the
medical institutes. Besides, neural network enabled gesture and posture
recognition techniques are proposed to clearly understand and examine
the structure of the human behaviour (Gupta et al., 2018), rigorously
reviewd the previous and on-going trends and practices for Big data and
cognitive computing and their strong association. Besides, several da-
tasets from world popular databases for example, ISI web of sceicnes,
scopus and DBLP are taken into account for further realization (Ying,
Jia, & Du, 2018), present the case-study based information is revealed
about the airlines from Hainan district and then e-commerce enabled
security mechanism is proposed known as blockchain for providing
high security, by protecting the information. Wang and Zhao (2014)
developed joint resource allocation and multimedia stream authenti-
cation technique to preserve the video quality while offering security
A.H. Sodhro et al.
and energy efficiency, but they have not focused at m-QoS optimization
for video transmission over 5G networks. (Li et al., 2016) proposed
optimal smoothing algorithm to minimize the energy over the video
link, but their research did not focus on rate control mechanism for
online medical applications (Koga et al., 2018), propose the novel deep
learning based vehicle detection technique, but do not focus at the
video transmission in medical applications.
(Xiao Chen, et al.) design adaptive video frame rate control algo-
rithm for adjusting the deviations in the scene during the movement of
the object, while their research do not focus at the medical video and
QoS measurement. Authors in (Chen et al., 2016; El & Ghalwash, 2016;
Majedi et al., 2016; Pace et al., 2017; Szpyrka & Biernacka, 2016),
present the Green and secure methods for the IoT, BSN and WSN for the
efficient and authenticated health facilities to the aging society, but
they do not focus at the QoS-optimization in remote medical domain.
(Zhao, Ni, & Zhou, 2017), adopt the real-time data sets from the almost
35 subjects and performed the statistical analysis for proposing the
detailed guidelines in mobile healthcare from the age factor perspec-
tive. (Du, Cui, & Su, 2018), present an efficient and customer conflict
management technique known as, online and offline channel conflict
management and monitoring in the e-commerce world. (Nagai,
Okamawari, & Fujii, 2016), discuss the several techniques with novel
architectures for the IoT-enabled, AHP-based heart rate failure, and
battery friendly techniques for the healthcare in this emerging world,
but they do not focus at the QoS estimation techniques for the remote
healthcare environment. Also they addressed the various domains such
as, hear-rate variability, routing protocols, electroencephalogram, se-
cure and green video transmission algorithms in medical healthcare,
but their research is not the key point to understand the QoS estimation
in the medical landscape. (Koga et al., 2018) propose the method for
recognizing the computational complex functionality with two novel
methods for instance, temporal and adaptive multi-task oriented for
classifying the distinct features. (Liu et al., 2016a, 2016b, 2016c), de-
velop the state-of-the art human motion detection technique named
fusion formation for combining the low and high dimensioning state
space vectors. In addition their research present the effective dynamic
variation technique for identifying the actions of the human. Liu et al.
(2016a, 2016b, 2016c), develop the career optimization method with
the support of the network data. Besides they focus on the quality water
estimation by adopting the several learning methods. Liu et al. (2016a,
2016b, 2016c) design the innovative approach based for predicting the
water quantity or level in the urban areas. Besides, a framework is
proposed by applying the famous Chinese policy for running the res-
taurant to predict the future items in the restaurant environment.
Previous researchers worked in different domains for instance, QoS
analysis in heterogeneous networks, algorithm development for re-
source allocation, bandwidth maximization, etc, but they do not con-
sider medical QoS optimization in smart medical cities in remote
healthcare applications over 5 G networks. Besides, they have not fo-
cused at the impact of client buffer size on m-QoS metrics such as,
standard deviation, peak-to-mean ratio, delay, and jitter.
3. Proposed window-based rate control algorithm for mobile edge
computing healthcare applications
Because of voluminous medical health data collection from the
mobile edge clouds such as, for Tele-medical news casts video trans-
mission, server is not able to smooth the complete stream. The w-RCA is
periodically applied while video is transmitted in new smoothing
window each time. For w-RCA development, a method is applied in
which video source creates one data frame per unit time. Frames of
smoothening window given by W inserts a playback delay of W time
units at client side and the server should be able to secure a buffer space
of W frames for Telemedical feeds. Finally, large values of W provides a
smooth video transmission but at the cost of large server buffer and
greater client playback delay. In w-RCA, the pre-fetching is bounded
4
International Journal of Information Management xxx (xxxx) xxx–xxx
due to video data availability in W frames window and the pre-fetch
Buffer of client. Proposed w-RCA is an offline server side algorithm
where frame rate is controlled by overlapping of N video frames, size of
W window. Transmission schedule cannot be changed after allocating
the N and W most of time, to remedy that problem size of the window
W is increased upto the 600 frames or 20 s frame time for sustaining the
reasonable delay between the transmitting and the receiving parties.
The W − RCA playing the fair rules of the game by intelligently con-
trolling the frame rate and hence, the smoothed video transmission at
the transmitter side. It is very vital to select the W according to the size
of the raw (i.e., unsmoothed video) stream in order to reduce the high
rate variability and the deviation in the different data packets. By un-
derstanding this game carefully, the raw video sequence is transformed
into the smoothed form by assigning the length to the each video frame
as given in the Eq. (1)
LN (1) = f 1f 2f 3
LN (2) = f 4f 5f 6
LN (3) = f 7f 8f 9
..................
..................
LN (480) = f 1438f 1439f 1440 (1)
Whereas, fi is the ith media frame.
N
D (t ) = ∑ Lf (i)
i=1 (2)
Whereas, D (k ) , k ≥ 0 , reveals the average size of the media frames (N )
and fk , k ≥ 0 , shows the kth media frame. The w-RCA smooths the high
peak rate video streams by adopting both the feedback information
over the initial and client buffer size. As the initial buffer fill level in-
formation is randomly provided by the (RTCP) in Δts seconds to the
media server at starting client buffer of 64KB. For each sliding window
of W frames, w-RCA generates a transmission plan that minimizes both
the high peak data rate and rate variability by taking care of D (t ) and
B (t ) curves as shown in Eqs. (2) and (3). When free buffer information
from RTCP varies in time, then B (t ) curve is modified as in eq. (3)
B (t ) = min{D (t − 1) + Buffer , D (N )} (3)
Assume that the free buffer information holds for the entire peri-
odicity interval, until it is refreshed by grand new coming from client.
The new buffer information as generated by the client is immediately
available at server side, so that smoothing can continuously be per-
formed without interruptions. In w-RCA frame size is L (t ) , whereby,
t = 1, 2, 3, .........., N , buffer variation profile in a generic interval and
maximum frame rate F max is calculated without overflowing.
Similarly, F min and Fopt are the minimum and optimal frame rates
calculated without buffer starvation at client side. As S (t ) represents the
rate controlled (i.e., smoothed) bit stream in the discrete time slot. The
smoothed medical video transmission plan is given by a monotonically
increasing and piecewise linear path that lies between D (t ) and B (t )
curves in Eqs. (2) and (3). There are a growing number of VBR inter-
active medical video applications in 5 G networks that require potential
methods to reduce high peak data rate and rate variability during vo-
luminous data transmission.
VF
∑t = 1 [D (t ) + Buffer ] − W
F max =
tB (4)
B (t ) − q _buffer
tB =
t (5)
Whereby, tB is the starting time with the clear information about the
filled level of buffer while transmitting video at F max , similarly, the
minimum video frame rate is represented by F min by adopting the
initial buffer level i.e., q _buffer .
A.H. Sodhro et al.
N
∑t = 1 D (t ) − q _buffer + W
F min =
tD
D (t ) − q _buffer
tD =
t (7)
F min +F max
Fopt =
2 (8)
By considering the W frames as [f , (f + W − 1)] whereby, f is the video
frame, and w-RCA calculates F max , F min , Fopt , tB and tD as shown in
Eqs. (4)–(8), in each discrete timet . If there is t ′ < f + W − 1, such that
(t ′)
F min > F max , surely a buffer underflow occurs in t ′, scheduled bit
rate will thus be F max in [α, t ′ − 1], then setting α = t ′ − 1.Similarly, if
(t ′)
F min > F max buffer overflow occurs. The scheduled frame rate will
be F min in [α, t ′ − 1] and α = t ′ − 1. This process generates the var-
iation free i.e., smoothed transmission schedule accordingly as
[f , (f + W − 1)], which shows less rate variable based video stream. The
proposed w-RCA intends to reduce the high peak spikes and Stad.dev in
the raw video stream by considering the large window size, which ef-
fectively optimizes the m-QoS. The shifting margin of α is made in the
window W as W − α to further obtain the smoothed and feasible video
transmission schedule as [f + α, (f + W − 1 + α )]. The entire informa-
tion of the buffer filled level Buffer (f − α ) , the average video schedule
S (f − α ) is preserved to smooth the whole video streams S (t ) by ap-
plying the smoothed window. When, the new α unsmoothed frames are
added into the smoothing window, then data underflow will be mini-
mized by considering the W − α which is the final window length.
Proposed w-RCA modifies the transmission schedule accordingly during
transmission of the video sequence in Δts sec, by following the previous
buffer fill level. Furthermore, at the beginning of the video stream, w-
RCA calculates the stream schedule on the basis of W (video frames)
window length of α frames. When the first buffer information areal (Δts )
arrives to server at frame time Δts , it calculates new upper bound B (t )
as in Eq. (7)
The transmission and rate controlling schedule of proposed w-RCA
is calculated through Eq. (8) starting from Δts , always sliding the W
frames window by α frames, until 2Δts and so on. Proposed w-RCA
computes video transmission rate on the basis of available frames and
calculates pre-fetching more aggressively through effective heuristics
by anticipating next frame lengths. In MPEG encoding, W denotes an
integer multiple of frames quantity G in a group of pictures (GOP) to
assure similar proportion of window in every I, P, and B frame, as
shown in the Fig. 3(a) and (b) (Table 1).
Window or sliding window executes smoothing on overlapping
window of size W . To integrate the received video frames, the w-RCA
calculates the transmission schedule on each α time units for future W
frames, where α (slide length) is less than equal toW . At time t w-RCA
smooths and sustains a segment of video at position p to p + W is
shown in Figs. 2 and 4. During t + α , α extra frames are sent, smoothing
is made by algorithm from frame position p + α + 1 to p + α + W + 1.
The present window smoothing at t + α contains a starting (W − α )
slots (grey colored region) which is included in some previous
smoothing windows, and fresh frame positions given by α (non-colored
area). The dark region represents smooth transmission schedule be-
cause of smoothing completed at t . The benefit of sliding window for
smoothing in w-RCA is based on the frequency of video source re-
computations of transmission schedule to include new frames at arri-
vals. To calculate the sensitivity of the w-RCA to the computational
frequency, sliding window performance is compared at various α values
over different window sizes W such as; SLWIN (1), SLWIN (W /2),
SLWIN (W /3) and SLWIN (W /4) with different client buffer sizes.
However small slide length reduces the burstiness of the medical video
streams. To check the performance of the w-RCA, we will use different
window sizes W , start up latency of 0.5 s and slide length (α ) of
α = W /2 . For greater window size, the server could use a greater
International Journal of Information Management xxx (xxxx) xxx–xxx
amount of data and is better able to take advantage of lookahead to
workahead more aggressively. For bigger windows, the client buffer has
(6)
the limitation of workahead amount; the server holds sufficient data but
is bounded by the comparatively smaller client buffer. For such buffer
sizes larger smoothing windows permits the w-RCA to attain reduction
in peak rate and rate variability close to the BSA. Nevertheless, rate
controlling of VBR medical video stream is still effective to reduce high
peak data rate and rate variability. Further optimization of smoothed
transmission plan is obtained by applying w-RCA on time windows of
W frames and increasing client buffer size. The overlapping degree
among consecutive smoothing windows will thus be N − W frames.
Proposed w-RCA is thus applied and composed by N − W smoothed
frames calculated in the previous window, plus W new unsmoothed
frames. It is observed that performance of w-RCA is improved for higher
overlapping degrees (N − W ) .
3.1. Mobile edge based medical healthcare video transmission framework
In this section we propose the novel 5G-enabled mobile edge and
QoS-aware framework for the healthcare applications, there are three
main layers at the both server and client side with various protocols
such as, Session Description Protocol (SDP), Real Time Streaming
Protocol (RTSP), Transmission Control Protocol (TCP), Real-time
Transport Protocol (RTP), Real-time Transport Control Protocol
(RTCP), User Datagram Protocol (UDP), Internet Protocol (IP), etc and
L2, L1. There is a strong connection between server and client while
exchanging video frames through the wireless channel. We classify the
proposed framework into three main levels for instance, level 1, level 2,
and level 3 as the streaming server, network performance indicators,
and the streaming client accordingly. Level 2 or middle level is very
important to analyze the performance of the medical healthcare ap-
plications during video transmission at remote location, as resented in
the Fig. 5.
4. Experimental set-up for mobile edge computing healthcare
applications
This section presents the detailed explanation of test-bed. We si-
mulate in MATLAB a 8-minute pre-recorded medical media stream ti-
tled, ‘Navigation to the Uterine Horn, transection of the horn and re-
anastomosis’ with MPEG-4 encoder (640 × 480). Medical quality of
service (m-QoS) is optimized in mobile edge computing during
healthcare video transmission at remote location. Better visualization
with big sensing is analyzed during remote sensing for portraying the
clear picture of the incident throughout the experiment with single-hop
communication scenario. Here, we assume media stream with high
variability such as, dissection during Tele-surgery of emergency pa-
tients, which causes more delay with high peak variable frame rates. In
addition, regardless of the encoder selection, m-QoS depends on the
complexity and content of the media sequence and its effect on overall
smart medical city. A comparison of QoS optimization is presented for
proposed w-RCA, and conventional BSA, Baseline as given in Table 2.
Experimental results in Table 2, reveals the performance analysis of w-
RCA, BSA and Baseline depending upon various buffer size and start-up
delay, t0 of 2 frame. It was observed that increase in idle time decreases
media sequence’s rate variability. Monte Carlo simulation is conducted
for attending 99% confidence level in the outcome, detailed parameters
are presented in Table 2.
4.1. Video sequence and parameters for mobile edge computing medical
applications
In this sub-section the 8-min video stream named, ‘Navigation to the
Uterine Horn, transection of the horn and re-anastomosis’ with MPEG
encoder 640 × 480 is adopted. Basically, video comprises Left, Right
and Stereo parts with total capacity of 7.5 GB (2.5 GB for each section).
5
 A.H. Sodhro et al.

Table 1
Summary of Existing Works.
Ref. No Applications Proposed Techniques Component being Optimized Results

(Clark et al., 2013; Karambakhsha et al., 2018; Mukhopadhyay et al., 2015; Sodhro Mobile edge computing, IoT, BSN, Battery management Charge and energy Battery Aware
et al., 2016a; Sodhro, Kumar Sangaiah et al., 2018) healthcare
(Enayet & Fortino, 2018; Sodhro et al., 2018a; Zingoni et al., 2017) Mobile edge computing, Medical hospitals, Battery and energy-efficient TPC duty-cycle, data rate Less energy and battery
BAN, BSN driven and MAC based charge drain.
(Aloi et al., 2016; Chen et al., 2015; Ferdous et al., 2017; Fortino, Russo, Savaglio, Healthcare, 5G, milli-meter wave, smart TPC, and data rate based Security key, resource allocation Low power consumption
Shen, & Zhou, 2017; Kaba, 2018; Sodhro & Li, 2013b; Zhao et al., 2016;) mobile, security
(Abdalla & Venkatesan, 2015; Fortino, Gravina, Russo, & Savaglio, 2017, 2016) Healthcare, Security, IoT and ECG Algorithms, Architecture Authentication key, Duty cycle Minimize cost and energy
consumption
(Cui & Liu et al., 2016; Liao et al., 2016; Wua et al., 2016) IoMT, Telemedicine Battery-friendly, rate control Battery charge and modulation IoT longer media
level transmission
(García et al., 2018; Li et al., 2016; Van Ma et al., 2017; Xu et al., 2011) Wireless capsule, IoMT Predictive techniques Battery charge, data rates Improve mobility, battery
lifetime

6
(Chen et al., 2016; El & Ghalwash, 2016; Majedi et al., 2016; Szpyrka & Biernacka, IoT, DLM, wireless ad-hoc networks Window-based algorithms, Transmission rates Battery-friendly, and energy-
2016) Battery models efficient
(Pace et al., 2017; Sandeep, Zhang, Wu, & Zhang, 2016; Sodhro & Fortino, 2017) Mobile edge computing, Medical media, Energy optimization algorithms Novel Frameworks Smart medical healthcare
5G system
(Pirbhulal et al., 2017; Sodhro & Li, 2013a; Pirbhulal et al., 2016) IoT, PLM, Edge computing, Industries Ontology-based methods and Battery lifecycle Smart PLM, Smart CPS
architectures
(Ou & Somayazulu, 2015; Sodhro et al., 2012; Sodhro et al., 2018b) QoS, Edge computing WSN, Security, Dynamic game-based and energy TPC and data rate To extend the lifecycle of
management medical devices
(Alwakeel & AlGhanmi, 2011; Banerjee & Sharif, 2016; Sodhro et al., 2016b; Sodhro, Healthcare, Energy Harvesting, PLM and Battery-friendly and Energy Battery charge Lifetime of smart IoMT and
Sekahri et al., 2018) WPT Harvesting BSN devices
(Gupta et al., 2018; Sodhro & Li, 2014; Sodhro et al., 2018a, 2018b; Sodhro, Kumar Mobile edge computing, EEG, Security in Routing-based power control To optimize QoS in PLM To monitor IoT based
Sangaiah et al., 2018; Sodhro, Sekahri et al., 2018; Singh, Ott, & Curcio, 2014; BAN techniques healthcare
Wang & Zhao, 2014)
(Chen et al., 2013; Du et al., 2018; Koga et al., 2018; Nagai et al., 2016; Ying et al., Artificial Intelligence, security ECG, QoS Fuzzy-logic, HRV and energy- To optimize, transmission power To obtain energy-efficient
2018; Zhao et al., 2017) and Energy management Frameworks efficient techniques and battery charge IoT based
(Liu et al., 2016a, 2016b; 2016c; Liu, 2016) Complex pattern recognition, optimal Novel pattern recognition To optimize the path selection Optimal and predictive
career path, approach, career methods
International Journal of Information Management xxx (xxxx) xxx–xxx
A.H. Sodhro et al. International Journal of Information Management xxx (xxxx) xxx–xxx

Fig. 2. Window-based transmission mechanism in rate control Algorithm.

Each part contains two parameters such as, frame length and rate
variability which are the fundamental ingredients of any video se-
quence (Cui et al., 2016; Xu et al., 2011). Furthermore, the properties
and parameters calculation of aforementioned video stream are shown
in the Table 2.

4.2. Results and discussion

Experiment is performed by taking into account the client buffer

size, window (W ) and server, client buffer sizes, video stream
Transection of the horn and re-anastomosis with MPEG-4 encoder. We
compare w-RCA, BSA and Baseline for m-QoS optimization in terms of
different m-QoS metrics such as; peak-to-mean ratio, standard devia-
tion, delay, and jitter over 5 G network. We establish tradeoff between
window size, buffer size, peak-to-mean ratio, standard deviation, delay,
and jitter. It is analyzed that if window size (W ) and client buffer size
increase then peak-to-mean ratio and standard deviation decrease
which shows the smooth transmission of the real time VBR medical
video.
On the contrary delay and jitter values increase with the increase of
the client buffer size but their range is below the range of threshold
values of delay and jitter for Tele-surgery. For example; threshold value
of delay and jitter are 250 ms and 20 ms respectively, and our proposed
algorithm provide 132 ms of delay value and 0.40 ms of jitter value. In
addition, from experimental results it is clear that if any one parameter
from client buffer size and window size varies not in proportion to each
other than the performance of proposed w-RCA will be affected. After
experimental analysis it is found that our proposed algorithm performs
better than the offline optimal smoothing algorithm with window size
Fig. 4. Transmission schedule of window-based rate control algorithm.
of 600 frames or playback delay of 20 s. and client buffer size of 16MB
to optimize m-QoS in Telemedicine system.
The experiemtal results are demonstrated in Table 2 and Figs. 5–8.
Proposed w-RCA reduces high peak data rate and rate variability dra-
matically with window size ss (W ) of 600 frames and different client
buffer size than the BSA and Baseline for smart medical cities to opti-
mize m-QoS in terms of peak-to-mean ratio (PMR), standard deviation
(Std.dev), delay, jitter, average delay and average jitter in relation with
different client buffer size. If buffer size increases then PMR and
Std.Dev are decreasing while delay is increasing for both algorithms.
But the performance of the w-RCA is better than the BSA and Baseline
because by using large window size and increasing client buffer size the
w-RCA shows dramatic reduction in the PMR and std.dev then the BSA,

Fig. 3. Difference between packet and video frame transmission, (a) data packet, and (b) video frame.

7
A.H. Sodhro et al. International Journal of Information Management xxx (xxxx) xxx–xxx

Fig. 5. Proposed Framework for Mobile Edge Computing based Medical Healthcare Applications.

Table 2 5. Conclusion and future research

Experimental parameters for medical media transmission.
Parameter Value Parameter Value
In this paper, we develop window-based Rate Control Algorithm (w-
RCA) for the variable bit rate (VBR) medical video for remote health-
Total Video Frames 1440 Video frame total 8 mints care i.e., Tele-surgery over 5 G based mobile edge computing healthcare
(F) time (T) networks through work ahead transmission by delaying that video W
Video frame rate (r 3 per sec Video frame length 100 Bytes
time units. Besides, Baseline, BSA and proposed w-RCA are compred in
(t)) ( Lf )
Video frame arrival 5msec Inter-arrival time 1msec
terms of network metrics i.e., PMR, Std.dev, delay and jitter for m-QoS
time (t) ( Δ) optimization. Furthermore, a feedback information about real time
Buffer Size (Buffer) 64KB,512KB,2MB,4MB Initial buffer size 0 buffer fill level from client to server with real-time transmission control
Supply voltage 2.5 V Initial current (I) 200mA protocol (RTCP) is used to reduce the high peak data rate and Std.dev
which are the key components in m-QoS optimization. Medical server
or transmitter gets information about future frames and recomputes
and Baseline. The delay of w-RCA are is less than the suitable for the
transmission schedule as new frames arrive with the help of feedback
medical application such as, Tele-surgery and Tele-consultation be-
information from RTCP. A tradeoff between window size and Buffer size
cause the threshold values of delay and jitter for real time video medical
with m-QoS metrics is established mathematically and experimentally.
applications are 250 ms and 20 ms respectively, and our proposed w-
Experimental results show that proposed w-RCA outperforms the
RCA provides delay and jitter values 132 ms and 0.40 ms respectively.
Baseline and BSA by optimizing the m-QoS at remote location. Besides,
Figs. 6–8, reveals the peak-to-mean ratio (PMR), standard deviation
large window size, Buffer size and knowledge of future frames through
(Std.dev) and delay of different algorithms. In Fig. 6, PMR of Baseline,
RTCP server provides good transmission schedule for smart medical
w-RCA and BSA is compred at different buffer-size, and it is observed
cities at remote location such as,Tele-surgery. In addition, w-RCA bal-
that PMR of w-RCA reduces at larger extent with the increase of buf-
ances the use of processing, memory and network resources (i.e., peak-
fersize than the Baseline and BSA. Fig. 7(b), presents rate variability of
to-mean ratio, standard deviation, delay, and jitter). In near future, we
Baseline, w-RCA and BSA at different buffersizes for unsmoothed
will implement w-RCA on hardware for medical video transmission
(i.e.,raw video) and processed video, it is examined that rate variability
over joint body sensor networks (BSNs), bluetooth low energy (BLE)
of w-RCA decreases with the increase of the buffersize as compared to
and Internet of Things (IoT).
the BSA and Baseline. Fig. 8(a), the relationship between buffersize and
Following are the limitations of the proposed DAA.
delay at different buffersize for w-RCA, Baseline and BSA. It is ex-
amined that Baseline and BSA shows larger delay while w-RCA has less
delay. Fig. 8(b), presents the Std.dev of Baseline, w-RCA and BSA, it is • Due to static and less efficient nature of the conventional methods
QoS is not optimized properly in the medical healthcare application.
examined that w-RCA has less std.dev than the Baseline and BSA, and
Besides, the resource-constrained nature of the wearable sensor
becomes smaller with the increase of the buffersizeFinally, after ana-
devices it is very vital to carefully manage and monitor the QoS in
lysis and comparison of all algorithms we can say that w-RCA outper-
tiny sensor-based wearable devices.
forms the Baseline and BSA by optimizing m-QoS during video trans-
mission in smart medical cities at remote location. • Rate-control algorithms is applicable merely for the multimedia
application and big data platforms
• w-RCA shows relatively more delay

8
A.H. Sodhro et al. International Journal of Information Management xxx (xxxx) xxx–xxx

Fig. 6. Comparative Analysis (a),(b) Unsmoothed video stream; (c),(d) Buffer size = 64KB and Window size = 600; e),(f) Buffer size = 2MB and Window size = 600,
for Baseline, BSA and w-RCA, respectively.

Fig. 7. Peak-to-mean ratio of the w-RCA, BSA and Baseline.

9
A.H. Sodhro et al.
Fig. 8. (a) Relation between delay and buffer size, (b) trade-off between time and standard for Baseline, BSA and w-RCA, respectively.
In near future, we will implement w-RCA on hardware for medical
video transmission joint body sensor networks (BSNs) and Internet of
Things (IoT).
Disclosures
There is no conflict of interest between all authors.
Acknowledgement
This work is funded by HEC Pakistan under the START-UP
RESEARCH GRANT PROGRAM (SRGP)#21-1465/SRGP/R&D/HEC/
2016, and Sukkur IBA University, Sukkur, Sindh, Pakistan, and DISP
LAB University Lumiere Lyon 2, under Erasmus Mundus’s SMARTLINK
Program2017. This work is partially supported by Natural Science
Foundation of China6171101169, Guangdong Education Bureau
Fund2017KTSCX166, the Science and Technology Innovation
Committee Foundation of ShenzhenJCYJ20170817112037041, Science
and Technology Innovation Committee Foundation of Shenzhen (Grant
No. ZDSYS201703031748284), SUSTech Startup FundY01236215/
Y01236115.
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