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This paper presents a novel indexing architecture to support a range of smart playback functions in collaborative telemedicine systems. These functions include replaying the session from a specified point in time, replaying all the session segments controlled by a particular physician, replaying all the session segments relating to a specific medical image, and playing a montage of the entire session. Since the contents of telemedicine sessions vary over time depending on the particular commands invoked by the physician(s) during the session, when executing the smart playback functions, it is necessary to restore the target image contents to the appropriate condition before commencing the playback routine. In this study, this is achieved by using an indexing scheme designated as three-level indexing hierarchy (TIH) to search for the appropriate cut-in point in the session and to identify the commands which should be applied to restore the current image contents to their original condition at the cut-in point. In the proposed indexing scheme, the performance of the cut-in point determination process and the content restoration procedure is enhanced by maintaining a link between all the changes which take place in the image contents over the duration of the session and the commands which induce these changes. The evaluation results confirm that TIH outperforms existing scene-based retrieval systems in terms of both an improved computational efficiency and a lower storage requirement.