Investigating the quality of video consultations performed using fourth generation (4G) mobile telecommunications

The use of fourth-generation (4G) mobile telecommunications to provide real-time video consultations were investigated in this study with the aims of determining if 4G is a suitable telecommunications technology; and secondly, to identify if variation in perceived audio and video quality were due to underlying network performance. Three patient end-points that used 4G Internet connections were evaluated. Consulting clinicians recorded their perception of audio and video quality using the International Telecommunications Union scales during clinics with these patient end-points. These scores were used to calculate a mean opinion score (MOS). The network performance metrics were obtained for each session and the relationships between these metrics and the session's quality scores were tested. Clinicians scored the quality of 50 hours of video consultations, involving 36 clinic sessions. The MOS for audio was 4.1 ± 0.62 and the MOS for video was 4.4 ± 0.22. Image impairment and effort to listen were also rated favourably. There was no correlation between audio or video quality and the network metrics of packet loss or jitter. These findings suggest that 4G networks are an appropriate telecommunication technology to deliver real-time video consultations. Variations in quality scores observed during this study were not explained by the packet loss and jitter in the underlying network. Before establishing a telemedicine service, the performance of the 4G network should be assessed at the location of the proposed service. This is due to known variability in performance of 4G networks.