5G Remote Surgery and Telehealth Solutions

One of the most controversial 5G use cases is the remote surgery. In this post I want to quickly look at the history and what is possible. Before I go to that, here is a short summary video that I am embedding upfront.



As far as I can recall, Ericsson was the first vendor that started talking about remote surgery. This is a tweet from back in 2017.

With #5G and the tactile internet, doctors can perform remote
surgery on a patient anywhere in the world. https://t.co/U81bayv3ws pic.twitter.com/pSXFg1NCJX

— Ericsson (@ericsson) August 28, 2017

Huawei didn't want to be far behind so they did one at MWC Shanghai in 2018. Their tweet with video is embedded below.

Meet the Remote Surgery Robot. At #MWCS18, Huawei stiches together a vivid picture of how #5G’s reliable connection can save lives: https://t.co/cobykl1KKP #WirelessXLabs pic.twitter.com/Pbme8BmcoT

— Huawei (@Huawei) June 28, 2018

In January 2019, South China Morning Post (SCMP) showed a video of a remote surgery on an animal. While the video and the article didn't provide many details, I am assuming this was done by Huawei as detailed here. The video of the surgery below.



This was followed by Mobile World Congress 2019 demo where a doctor used 5G to direct surgery live from a stage at MWC to Hospital Clinic Barcelona over 3 miles away. The team of doctors was removing a cancerous tumor from a patient's colon. This video from that is embedded below.



Vodafone New Zealand had a silly remote surgery of a dog video but looks like they have removed it.  Nothing can beat this Telecom Italia ad embedded below.



There are some realistic use cases. One of them being that with 5G the number of cables / wires in a hospital can be reduced saving on the disinfection.

NTT Docomo showcased 5G Mobile SCOT (Smart Cyber Operating Theater) which is an Innovative solution to enable advanced medical treatment in diverse environments. You can read more details here.

There are lots of other things going on. Here is a short list:

• April 2020: Because of Coronavirus COVID-19, NT Times has an article on Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’ - even though this does not involve 5G, it just shows that we are moving in that direction.
• February 2020: 5G-aided remote CT scans used to diagnose COVID-19 patients in China (link)
• February 2020: Verizon teamed with Emory Healthcare to test new 5G use cases for the medical industry at the latter’s Innovation Hub in Atlanta, in a bid to discover how the technology can be used to improve patient care. The collaboration will explore applications including connected ambulances; remote physical therapy; medical imaging; and use of AR and VR for training. (link)
• February 2020: Vodafone 5G Healthcare – Conference & Experience Day (link)
• November 2019: TIM enables first live remote-surgery consultation using 5G immersive reality (link)
• October 2019: Along with a hospital in Malaga, Telefónica has presented what it claims is the first expert assistance system for medical interventions that runs on 5G. (link and video)
• September 2019: Mobile Future Forward 2019 - World's First Remote VR Surgery Demo conducted on Sept 4th, 2019 in Seattle by Chetan Sharma, James Youngquist, Evie Powell, Nissim Hadar, David Colmenares, and Gabe Jones. (link)

Finally, a nice video on Benefits of 5G for Healthcare Technology by T-Mobile



Related Posts:

• The 3G4G Blog: NTT Docomo's Vision on 5G Evolution and 6G
• The 3G4G Blog: 5G eXtended Reality (5G-XR) in 5G System (5GS)
• The 3G4G Blog: Real-life 5G Use Cases for Verticals from China
• The 3G4G Blog: 5G Private and Non-Public Network (NPN)
• The 3G4G Blog: 5G and Industry 4.0
• The 3G4G Blog: Spectrum for 5G NR beyond 52.6 GHz

Quick summary of Mobile World Congress 2018 (#MWC18)

This year at MWC, I took the time out to go and see as many companies as I can. My main focus was looking at connectivity solutions, infrastructure, devices, gadgets and anything else cool. I have to say that I wasn't too impressed. I found some of the things later on Twitter or YouTube but as it happens, one cannot see everything.

I have to be honest, haven't seen a WOW demo yet at #MWC18. While there are lots of interesting stuff, it's all the same, old and tired stuff.

— Zahid Ghadialy (@zahidtg) February 26, 2018

I will be writing a blog on Small Cells, Infrastructure, etc. later on but here are some cool videos that I have found. As its a playlist, if I find any more, it will be added to the same playlist below.



The big vendors did not open up their stands for everyone (even I couldn't get in 😉) but the good news is that most of their demos is available online. Below are the name of the companies that had official MWC 2018 websites. Will add more when I find them.

Operators

• NTT Group
• Telefonica
• Orange
• Verizon
• Deutsche Telekom

Network Equipment Vendors

• Huawei 
• Nokia
• Ericsson
• ZTE
• Samsung

Handset Manufacturers

• LG
• Huawei (see above)
• Samsung

Chipset Manufacturers

• Qualcomm
• Intel
• MediaTek

Did I miss anyone? Feel free to suggest links in comments.


MWC Summary from other Analysts:

• Mobile World Congress 2018 Event Report - ThinkSmallCell
• Mobile World Congress 2018: trends, news, announcements - Radio Electronics
• Observations from MWC 2018 - Frank Rayal
• Mobile World Congress: State of the Industry 2018 - Xona Partners
• Mobile World Congress 2018 Report: Day 1, Day 2, Day 3, Day 4 - CCS Insight
• MWC 2018 Roundup - Counterpoint Research

Verizon's 5G Standard

Earlier this year I wrote a Linkedin post on how operators are setting a timetable for 5G (5G: Mine is bigger than yours) and recently Dean Bubley of Disruptive Analysis wrote a similar kind of post also on Linkedin with a bit more detail (5G: Industry Politics, Use-Cases & a Realistic Timeline)

Some of you may be unaware that the US operator Verizon has formed 'Verizon 5G Technology Forum' (V5GTF) with the intention of developing the first set of standards that can also influence the direction of 3GPP standardization and also provide an early mover advantage to itself and its partners.

The following from Light Reading news summarizes the situation well:

Verizon has posted its second round of work with its partners on a 5G specification. The first round was around the 5G radio specification; this time the work has been on the mechanics of connecting to the network. The operator has been working on the specification with Cisco Systems Inc., Ericsson AB, Intel Corp., LG Electronics Inc., Nokia Corp., Qualcomm Inc. and Samsung Corp. via the 5G Technology Forum (V5GTF) it formed late in 2015.

Sanyogita Shamsunder, director of strategy at Verizon, says that the specification is "75% to 80% there" at least for a "fixed wireless use case." Verizon is aiming for a "friendly, pre-commercial launch" of a fixed wireless pilot in 2017, Koeppe notes.

Before we go further, lets see this excellent video by R&S wherein Andreas Roessler explains what Verizon is up to:



Verizon and SKT are both trying to be the 5G leaders and trying to roll out a pre-standard 5G whenever they can. In fact Qualcomm recently released a 28 GHz modem that will be used in separate pre-standard 5G cellular trials by Verizon and Korea Telecom

Introducing #Snapdragon X50, our first #5G modem. https://t.co/MBmAS86WaH pic.twitter.com/ewOdm4OVzE

— Qualcomm (@Qualcomm) October 18, 2016

Quoting from the EE times article:

The Snapdragon X50 delivers 5 Gbits/second downlinks and multiple gigabit uplinks for mobile and fixed-wireless networks. It uses a separate LTE connection as an anchor for control signals while the 28 GHz link delivers the higher data rates over distances of tens to hundreds of meters.

The X50 uses eight 100 MHz channels, a 2x2 MIMO antenna array, adaptive beamforming techniques and 64 QAM to achieve a 90 dB link budget. It works in conjunction with Qualcomm’s SDR05x mmWave transceiver and PMX50 power management chip. So far, Qualcomm is not revealing more details of modem that will sample next year and be in production before June 2018.

Verizon and Korea Telecom will use the chips in separate trials starting late next year, anticipating commercial services in 2018. The new chips mark a departure from prototypes not intended as products that Qualcomm Research announced in June.

Korea Telecom plans a mobile 5G offering at the February 2018 Winter Olympics. Verizon plans to launch in 2018 a less ambitious fixed-wireless service in the U.S. based on a specification it released in July. KT and Verizon are among a quartet of carriers that formed a group in February to share results of early 5G trials.

For its part, the 3GPP standards group is also stepping up the pace of the 5G standards efforts it officially started earlier this year. It endorsed last month a proposal to consider moving the date for finishing Phase I, an initial version of 5G anchored to LTE, from June 2018 to as early as December 2017, according to a recent Qualcomm blog.

Coming back to Verizon's 5G standard, is it good enough and compatible with 3GPP standards? The answer right now seems to be NO.

The following is from Rethink Wireless:

The issue is that Verizon’s specs include a subcarrier spacing value of 75 kHz, whereas the 3GPP has laid out guidelines that subcarrier spacing must increase by 30 kHz at a time, according to research from Signals Research Group. This means that different networks can work in synergy if required without interfering with each other.

Verizon’s 5G specs do stick to 3GPP requirements in that it includes MIMO and millimeter wave (mmWave). MmWave is a technology that both AT&T and Verizon are leading the way in – which could succeed in establishing spectrum which is licensed fairly traditionally as the core of the US’s high frequency build outs.

A Verizon-fronted group recently rejected a proposal from AT&T to push the 3GPP into finalizing an initial 5G standard for late 2017, thus returning to the original proposed time of June 2018. Verizon was supported by Samsung, ZTE, Deutsche Telecom, France Telecom, TIM and others, which were concerned the split would defocus SA and New Radio efforts and even delay those standards being finalized.

Verizon has been openly criticized in the industry, mostly by AT&T (unsurprisingly), as its hastiness may lead to fragmentation – yet it still looks likely to beat AT&T to be the first operator to deploy 5G, if only for fixed access.

Verizon probably wants the industry to believe that it was prepared for eventualities such as this – prior to the study from Signal Research Group, the operator said its pre-standard implementation will be close enough to the standard that it could easily achieve full compatibility with simple alterations. However, Signals Research Group’s president Michael Thelander has been working with the 3GPP since the 5G standard was birthed, and he begs to differ.

Thelander told FierceWireless, “I believe what Verizon is doing is not hardware-upgradeable to the real specification. It’s great to be trialing, even if you define your own spec, just to kind of get out there and play around with things. That’s great and wonderful and hats off to them. But when you oversell it and call it 5G and talk about commercial services, it’s not 5G. It’s really its own spec that has nothing to do with Release 16, which is still three years away. Just because you have something that operates in millimeter wave spectrum and uses Massive MIMO and OFDM, that doesn’t make it a 5G solution.”

Back in the 3G days, NTT Docomo was the leader in standards and it didn't have enough patience to wait for 3GPP standards to complete. As a result it released its first 3G network called FOMA (Freedom of Mobile Access) based on pre-standard version of specs. This resulted in handset manufacturers having to tweak their software to cope with this version and it suffered from economy of scale. Early version of 3G phones were also not able to roam on the Docomo network. In a way, Verizon is going down the same path.

While there can be some good learning as a result of this pre-5G standard, it may be a good idea not to get too tied into it. A standard that is not compliant will not achieve the required economy of scale, either with handsets or with dongles and other hotspot devices.


Related posts:

• AT&T's 5G Trials
• 5G New Radio (NR), Architecture options and migration from LTE
• Some more thoughts on 5G
• 3GPP Release-14 & Release-15 update

S8HR: Standardization of New VoLTE Roaming Architecture

VoLTE is a very popular topic on this blog. A basic VoLTE document from Anritsu has over 40K views and my summary from last years LTE Voice summit has over 30K views. I assume this is not just due to the complexity of this feature.

When I attended the LTE Voice summit last year, of the many solutions being proposed for roaming, 'Roaming Architecture for Voice over LTE with Local Breakout (RAVEL)' was being touted as the preferred solution, even though many vendors had reservations.

Since then, GSMA has endorsed a new VoLTE roaming architecture, S8HR, as a candidate for VoLTE roaming. Unlike previous architectures, S8HR does not require the deployment of an IMS platform in VPLMN. This is advantageous because it shortens time-to-market and provides services universally without having to depend on the capability of VPLMN.



Telecom Italia has a nice quick summary, reproduced below:

S8HR simplicity, however, is not only its strength but also its weakness, as it is the source of some serious technical issues that will have to be solved. The analysis of these issues is on the Rel13 3GPP agenda for the next months, but may overflow to Rel14. Let’s see what these issues are, more in detail:

Regulatory requirements - S8HR roaming architecture needs to meet all the current regulatory requirements applicable to voice roaming, specifically:

• Support of emergency calls - The issues in this context are several. For example, authenticated emergency calls rely on the existence if an IMS NNI between VPLMN and HPLMN (which S8HR does not provide); conversely, the unauthenticated emergency calls, although technically feasible in S8HR, are allowed only in some Countries subject to the local regulation of VPLMN. Also, for a non-UE-detectable IMS Emergency call, the P-CSCF in the HPLMN needs to be capable of deciding the subsequent action (e.g. translate the dialed number and progress the call or reject it with the indication to set up an emergency call instead), taking the VPLMN ID into account. A configuration of local emergency numbers per Mobile Country Code on P-CSCF may thus be needed.
• ­Support of Lawful Interception (LI) & data retention for inbound roamers in VPLMN -  S8HR offers no solution to the case where interception is required in the VPLMN for inbound roamers. 3GPP is required to define a solution that fulfill such vital regulatory requirement, as done today in circuit switched networks. Of course VPLMN and HPLMN can agree in their bilateral roaming agreement to disable confidentiality protection to support inbound roamer LI but is this practice really viable from a regulatory point of view?

Voice call continuity – The issue is that when the inbound roamers lose the LTE coverage to enter into  a 2G/3G CS area, the Single Radio Voice Call Continuity (SRVCC) should be performed involving the HPLMN in a totally different way than current specification (i.e. without any IMS NNI being deployed).
Coexistence of LBO and S8HR roaming architectures will have to be studied since an operator may need to support both LBO and S8HR VoLTE roaming architecture options for roaming with different operators, on the basis of bilateral agreement and depending on the capability.
Other issues relate to the capability of the home based S-CSCF and TAS (Telephony Application Server) to be made aware about the VPLMN identity for charging purposes and to enable the TAS to subsequently perform communication barring supplementary services. Also, where the roaming user calls a geo-local number (e.g. short code, or premium numbers), the IMS entities in HPLMN must do number resolution to correctly route the call.
From preliminary discussions held at Working Group level in SA2 (architecture) and SA3 (security) in April, it was felt useful to create a new 3GPP Technical Report to perform comprehensive technical analysis on the subject. Thus it is expected that the discussions will continue in the next months until the end of 2015 and will overheat Release 13 agenda due to their commercial and “political” nature. Stay tuned to monitor the progress of the subject or contact the authors for further information!

NTT Docomo also did some trials back in February and got some brilliant results:

In the trials, DOCOMO and KT achieved the world's first high-definition voice and video call with full end-to-end quality of service. Also, DOCOMO and Verizon achieved the world's first transoceanic high-definition VoLTE roaming calls. DOCOMO has existing commercial 3G and 4G roaming relations with Verizon Wireless and KT.

The calls were made on an IP eXchange (IPX) and network equipment to replicate commercial networks. With only two months of preparation, which also proved the technology's feasibility of speedy commercialization, the quality of VoLTE roaming calls using S8HR architecture over both short and long distances was proven to be better than that of existing 3G voice roaming services.

In fact, NTT Docomo has already said based on the survery from GSMA's Network 2020 programme that 80% of the network operators want this to be supported by the standards and 46% of the operators already have a plan to support this.

The architecture has the following technical characteristics:
(1) Bearers for IMS services are established on the S8 reference point, just as LTE data roaming.
(2) All IMS nodes are located at Home Public Land Mobile Network (HPLMN), and all signaling and media traffic for the VoLTE roaming service go through HPLMN.
(3) IMS transactions are performed directly between the terminal and P-CSCF at HPLMN. Accordingly, Visited Public Land Mobile Network (VPLMN) and interconnect networks (IPX/GRX) are not service-aware at the IMS level. The services can only be differentiated by APN or QoS levels.

These three technical features make it possible to provide all IMS services by HPLMN only and to minimize functional addition to VPLMN. As a result, S8HR shortens the time-to-market for VoLTE roaming services.

Figure 2 shows the attach procedure for S8HR VoLTE roaming. From Steps 1 to 3, there is no significant difference from the LTE data roaming attach procedure. In Step 4, HSS sends an update location answer message to MME. In order for the MME to select the PGW in HPLMN (Step 5), the MME must set the information element VPLMN Dynamic Address “Allowed,” which is included in the subscribed data, to “Not Allowed.” In Step 6, the bearer for SIP signaling is created between SGW and PGW with QCI=5. MME sends an attach accept message to the terminal with an IMS Voice over PS Session Support Indication information element, which indicates that VoLTE is supported. The information element is set on the basis of the MME’s internal configuration specifying whether there is a VoLTE roaming agreement to use S8HR. If no agreement exists between two PLMNs, the information element will not be set.

The complete article from the NTT Docomo technical journal is embedded

LTE-Broadcast making a push while Terrestrial broadcast still popular as ever

"TV isn't dying, it's having babies." This quote made my day. I have argued a few times in the past that terrestrial broadcasting will continue working and will be probably the most popular approach for a long time to come. The way things work with it may change. Multi-screen is one possible approach but you may have more interactions like 'red button functionality', etc.

Anyway, in Europe 800MHz spectrum has been cleared for use by Mobile Broadband technologies (LTE mainly). 700MHz is planned to be cleared as well by 2020, as per the suggestion in Lamy report. The other UHF band from 470MHz to 694MHz would be left as it is until 2030, with a review planned in 2025.

This has forced even big players like BBC to start looking at other mechanisms to deliver TV. While BBC3 was moved to online only, BBC is also exploring how to use LTE-Multicast to deliver content. It has been working to have its very popular iPlayer work with eMBMS.

Embedded below is a presentation from Cambridge Wireless CWTEC 2015 conference.

eMBMS is gaining popularity with its presence in lot more chipsets and even more trials. GSA report has shown that there are quite a few trials going on worldwide but the question remains about the business models. Most operators would not like to become content providers and compete with the incumbents in their markets. Having someone like BBC in the UK is helpful but not sure how many such options are available worldwide. Embedded below is the GSA presentation

GSA: LTE Broadcast (eMBMS) Update - March 2015 from Zahid Ghadialy

Great LTE Broadcast demo by @Ericsson using devices from Samsung & LG powered by Qualcomm. Consumers will love this. pic.twitter.com/1uroaV3mk9

— Ben Wood (@benwood) March 5, 2015

There were some nice pictures from MWC as can be seen above. Ericsson has a video as well (below) on how the app works.

M2M LTE Broadcast module fm D-Link / Verizon. Huge potential here for billboards, taxis or any screen U can think of! pic.twitter.com/WL2f5mZ5bB

— Ben Wood (@benwood) March 5, 2015

D-Link is also working on M2M modules that could be used in billboards to dynamically update the ads at very regular intervals. There is a video here that explains this further.

Finally here is a Video from Visteon/Verizon that explains how LTE-Multicast can be used to deliver software updates in the connected car:



Finally, here are couple of presentations that may interest you too:

• Delivery of Broadcast Content over LTE Networks
• Transitioning from Broadcast TV to Broadband TV

Mobile Telecoms Technology & Market Disruptions

Sometimes its good to take a step back and look at the new applications and services that are already happening or may be happening sometime soon. Some of these have a possibility to disrupt the existing industries and markets, giving rise to not only new players but a completely new order.

Embedded below is a presentation from Dean Bubley of Disruptive Analysis. While there are a few things that I look at differently, there are many interesting points that the industry should already be looking at.

A good example of disruption would be the SIM card evolution that Apple introduced in iPadAir2 and iPadMini3. While they had great expectations, it didnt work out exactly as they had hoped due to the operators not letting Apple use the feature they wanted. In fact John Legere, T-Mobile US CEO, took to twitter to explain the problem. See here.

Another example is the new MVNO model by Google (Fi) in the USA. The problem in USA compared to Europe is that the operators have monopoly in many areas (fixed and mobile) and they can also get away with charging far higher amounts.

In addition, the problem that the operators have is that they focus on areas where they don't have issues; crying wolf if required. An example is taking advantage of 'data tsunami' and using it to hoard spectrum, as be seen from the tweet below:

Verizon Wireless admits to hoarding spectrum, ends any argument about a spectrum crunch http://t.co/0aqpGxlEvm
— Kevin Ahoy (@FlightsimGeek) February 23, 2015

Anyway, here is the presentation. Let me know what you think.

LTE, M2M Device Addressing and IMSI

I was made aware of the following statement on the Verizon wireless brochure:

LTE’s inherent support for IPV6 addressing and IMSI-based telephone number identifiers makes mass deployments over LTE more easily achievable. The deployment of large numbers of mobile devices (think tens of thousands) becomes much more feasible because of LTE’s use of 15-digit IMSI telephone number identifiers for large-scale deployments, such as M2M or embedded wireless applications. 3G network technologies were limited by their use of 10-digit telephone number identifiers, which made large-scale deployments more difficult. With LTE, mass deployment of wireless services and applications, such as VoIP, smart metering, vending, and telematics, is now practical.

Now we know about the much touted 50 Billion connections by 2025 of which the majority would be M2M devices. So how are we going to handle the issue of addressing these many devices.

In the earlier presentation here, there was a mention of the direction for the solution as below:

The IMSI structure is as shown above. So depending on how it is used this can help alleviate the number shortage problem. 3GPP TR 23.888 gives the following information:

5.13      Key Issue - MTC Identifiers

5.13.1    Use Case Description

The amount of MTC Devices is expected to become 2 orders of magnitude higher than the amount of devices for human to human communication scenarios. This has to be taken into account for IMSI, IMEI and MSISDN. Regulatory bodies indicate shortages of IMSIs and MSISDNs.

The MTC Feature PS Only in TS 22.368 [2] includes a requirement that PS Only subscriptions shall be possible without an MSISDN. In principle an MSISDN is not used in any of the PS based signalling procedures. However, it will have to be assured that all PS procedures indeed work and subscriptions can be uniquely identified without providing an MSISDN. Furthermore, TS 22.368 [2] specifies that remote MTC Device configuration shall be supported for PS only subscriptions without an MSDISDN assigned. Current remote MTC Device configuration solutions (i.e. Device Management and Over-the-Air configuration) are based on SMS, which assumes the use of MSISDNs. So a solution to support remote MTC Device configuration that does not require the use of MSISDNs is needed.

The identifiers can be categorised into:

-     Internal Identifiers: used within the 3GPP system to identify a UE using a subscription (or the subscription itself e.g. when the UE is not registered).

-     External Identifiers: used from outside the 3GPP system (e.g. at the MTCsp interface), to refer to a UE using a subscription (or the subscription itself e.g. when the UE is not registered).

5.13.2    Required Functionality

-     It shall be possible to uniquely identify the ME.

NOTE 1:   This requirement relates to the ME which is generally identified by the IMEI.

-     It shall be possible to uniquely identify the UE using a subscription or the subscription itself.

NOTE 2:   The two requirements above also apply to human-to-human communications. However, for Machine-Type Communication identifiers will have to be able to cater for a number of identifiers up to two orders of magnitude higher than for human-to-human communications.

-     It shall be possible to use the following identifiers:

1.       IMSI, for internal usage within the 3GPP operator domain, and either

2.       E.164 MSISDN, for usage outside the 3GPP operator domain, or

3.       Unique identifier (e.g. FQDN), other than E.164 MSISDN, for usage outside the 3GPP operator domain.

NOTE 3: Use of IMSI outside the 3GPP operator domain is an operator option (i.e. not subject to standardization)

-     If no (unique or common) MSISDN is assigned to a PS only subscription, the Internal Identifier (IMSI) shall be used as charging identifier.

-     It shall be possible to associate one or more External Identifiers to the same Internal Identifier (e.g. several MSISDNs associated with the same IMSI).

-     Globally unique External Identifiers shall be supported for identifying UEs used for MTC that must be globally reachable (i.e. irrespective of which mobile operator owns the subscription)

-     Operator specific External Identifiers (e.g. based on a private numbering plan) may be supported for identifying UEs used for MTC that have to be reachable only from the operator domain to which they are subscribed.

-     The Internal Identifier shall be globally unique.

-     Remote MTC Device configuration shall still be supported for subscriptions without an MSISDN.

NOTE 4:   Current remote MTC Device configuration solutions (i.e. Device Management and Over-the-Air configuration) are based on SMS, which assumes the use of MSISDNs.

Any more information on this subject, more than welcome.