T4MOD - Telemedicine for reMote Operations in Distant areas

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T4MOD project aims at developing and validating a user-friendly Telemedicine system, through an interoperable IP overlay satellite network associated to an intelligent end-to-end communication service, capable to support different medical specialities. This solution, to be validated in a military environment, could be also extended for future exploitations in civilian field for organisations (for example national health systems) operating in underserved and/or geographically isolated areas, such as in case of natural disasters or humanitarian crises. The system can be instrumental to develop new medical protocols for a cooperative medical work of diagnosis and therapies. T4MOD involves as users the health Department of four Ministries of Defence: France, Germany, Italy and Spain.


  • Developing a system capable to fulfil different needs in terms of applications and services for the provision of tele-healthcare in the frame of military peace keeping missions, with the possibility of evolving towards civilian utilisation (for disaster relief and humanitarian missions);
  • Leveraging collaboration among public institutions within their national contexts and among the four representative member states;
  • Enabling the medical experts on the reference site to assist the remote site in case of a medical emergency or during a planned consult;
  • Provide, an easy to use solution able to be operated by medical and non-medical (but trained) personnel;
  • Procuring technical elements (satellite capacity, IT elements, critical breakthrough medical technology, etc.) to implement the designed system;
  • Ensuring inter-operability (with other systems used by the same Medical Service) and intra-operability (among different Medical Services of the four MoDs) via the overlay provided by the T4MOD system;
  • Providing an intelligent and cost effective solution requiring minimal training, installation, maintenance and running costs;
  • Developing and enabling an optimised shared approach for the satellite capacity to minimise the communications costs;
  • Providing a comprehensive framework for evaluating the applications and the project overall outcomes.
  • Deploying the system in operational environments, performing field trials to validate the capabilities and usefulness of the system

Users and their needs

The system is addressed to end users belonging to Military Health Services of France, Germany, Italy and Spain. The hospitals involved in the pilot will be in Europe and in some remote areas of operations. 

The main need refers to Medical Services deployed for peacekeeping and humanitarian missions in geographically isolated and underserved areas, with the most difficult environmental and operational conditions due to the lack of local medical specialists. The T4MOD project will use two space assets (i.e. satellite communications and use of a technology initially developed for manned spaceflights: robotised tele-echography).

Service/ system concept

The following telemedicine services will be the primary focus of the project:

  • Radiology
  • Microbiology
  • Cardiology
  • Dermatology
  • Trauma surgery
  • Neurosurgery
  • Intensive care
  • Emergency medicine (casualty care and management)

A high layer application will be developed with the purpose of managing the services within and inter- and ita-operable environment. This layer will simplify the system operations and integrate elements that could simplify the standard medical workflow while keeping the compliance with the working procedure of the end users. Finally it will help to extract, in the friendliest and automatic way, those parameters that could contribute to measuring the clinical performance gain. These important advantages will be enhanced by means of an efficient satellite architecture.

Space Added Value

T4MOD relies on two main assets coming from space technologies: one side satellite communications, and on the other side a robotized tele-echography solution initially developed to support crews on board the International Space Station.

Product Benefits

The implementation of telemedicine services on large scale is inherently affected by a number of barriers that the T4MOD project tries to overcome with the support of institutional entities such as MoDs, National Space Agencies and ESA.

This common effort should mitigate the hurdles of barriers, helping the project to develop an effective solution and to address all the necessary issues with adequate answers.

The T4MOD project is expected to deliver costs reduction due to the utilisation of medical information for better decision (e.g. avoiding non-necessary medical evacuations), cooperative use of shared technical resources, decrease of medication errors, improved labour productivity and additional health care.

Product Features

T4MOD aims at offering an innovative architectural solution in terms of a system and associated operational Telemedicine services; strong points are the provision of broadband communications over very wide coverage in mesh topology, the ability to manage dynamic on demand access using a simple and user friendly interface for the users and the ability to handle the booking of the different resources according to the four reference Medical Services’ needs. The T4MOD solution presents the following key characteristics:

  • A satellite capacity shared between the users and made available via a suitable scheduling or on priority basis.
  • A distributed deployment: hospitals have to create an ad-hoc structure in terms of logistics, inventory stocks, personnel , help desk and management of satellite infrastructure distributed on single sites;
  • An on-demand solution, based on assignment of satellite resources according to the needs, consequent to the non–continuous nature of the T4MOD service;
  • An integrated algorithm able to manage and assign also medical resources and specialists.
  • The T4MOD Network Control Centre (TCC), main core of system and located at the Fucino Space Centre (FSC, Central Italy).
  • Security: authentication and confidentiality thanks to the security framework implemented at the MoD sites.

In the following figure it is depicted the high level T4MOD architecture.

T4MOD Architecture


Key Issues

In this project, a number of critical elements are addressed. The most important of them are those concerning the characterisation of medical services in a military environment, those related to interoperability issues (analysing the technical aspect and implementing a common application layer) and finally those involving the security considerations (aiming at dealing with the aspects of IP acceleration, compression and security that guarantee the compliance of the architectural proposed solution with the security norms and regulations that are applicable for telemedicine service).

Current Status

After the successful close-out of the field trials activities, a sustainability analysis has been performed, including an assessment of the lessons learnt during the project. This analysis highlights in particular the potentials for a possible commercial deployment of the T4MOD service, which is based on a reliable and highly performing technological solution.

The perspectives for a “Dual Use” follow-on have also been investigated, showing high potential opportunities to use the T4MOD System use in civilian environments.

All these aspects, together with the finalised main Deliverables and Project Documents have been discussed during Final Meeting, held on 2015 October 14th, which declared the successful closure of the T4MOD Project activities.

The final presentation of T4MOD was given during the ARTES 20 ESA Presentations Day Workshop, held at ESA ESTEC Premises in Noordwjik (NL) on November 19th, 2015.

Status Date

Updated: 30 November 2015 - Created: 15 February 2014