Pricing Diagnostic Value Under a Clinical Deadline: A Triage- Aware Truthful Auction for Semantic Medical-Image Transmission in Healthcare IoT

Telemedicine in emergency and remote care relays medical images from ambulances and rural clinics to a hospital edge-computing server over a congested wireless uplink. Existing work prices such transmissions per bit or per quality-of-experience; neither metric captures the clinical value of a medical transmission. Diagnostic utility vanishes below a modality-specific acceptability floor rather than degrading gracefully, the deadline is determined by triage acuity rather than by the network, and a missed finding is far costlier than a false alarm. A per-bit clearing price therefore disadvantages the node that has expended local compute to produce a compact, diagnostically sufficient stream. We propose SemAuc , a triage-aware truthful mechanism for medical-image admission over a rate-splitting uplink, in which the shared semantic knowledge base rides the common stream, and case-specific residuals ride private streams. SemAuc filters tiers below the diagnostic floor and beyond the clinical deadline, reserves a regulated-price lane for life-threatening cases, and allocates remaining capacity through a single-parameter contestable auction whose bid-independent pre-selection step satisfies the conditions of Myerson’s lemma. The contestable lane is dominant-strategy truthful, individually rational, near-linear in the number of nodes, and achieves a constant-factor density-greedy welfare guarantee; the clinical lanes follow from triage policy without disturbing these properties. Diagnostic value is grounded by an offline kernel fitted on BraTS and CheXpert. On a Rayleigh-faded uplink at two hundred contending nodes, SemAuc preserves the high-acuity diagnostic service-level objective where bit-centric benchmarks fail, and tracks the offline optimum.