Installations, IT/AV

Beyond The OR

High definition, 3D and 4K are well known consumer entertainment terms, but professional versions of these technologies are also now increasingly in use by medical organizations worldwide. Cameras, recorders, displays and printers are assisting physicians and their teams, and making the training and education of medical students and professionals more dynamic, relevant and immersive.

Going Beyond The OR
Technology in medical environments is also going beyond the OR, as traditional audio/video and IP technologies become more accessible and affordable to all types of businesses, including healthcare. A May 2013 report from the US Department of Health and Human Services noted that doctors’ and hospitals’ use of health IT more than doubled from the prior year, a trend that many industry analysts forecast as growing steadily. Healthcare is also one of the fastest-growing markets for AV systems in North America, according to a recent study produced by InfoComm.

Business projectors, large-screen displays and videoconferencing systems are in hospital conference rooms and lecture halls, making meetings and presentations more efficient and collaborative. Digital signage systems welcome visitors in lobbies and give patients and staff information updates, visual directories and emergency notifications.

Robotic and pan-tilt-zoom (PTZ) cameras are in training and simulation areas, helping teams view and share procedures, and conduct multi-location conferences. IP “live” technologies and easy-to-use content production tools make training and education available any time, anywhere. HD monitors and remote cameras allow healthcare providers to remotely confer with other specialists in the same facility, in facilities across the country or even around the world.

PTZ cameras and videoconferencing systems can centralize patient monitoring from the nurses’ station, for example, and networked security cameras and surveillance technologies can monitor an entire complex from parking areas, to hallways to common areas. The InfoComm study notes that, like any professional office environment, medical organizations need AV systems, from digital signage to videoconferencing systems. And all healthcare facilities, new and old, can benefit from the new applications that AV systems enable.

AV technology can provide a link between emergency response teams in the field and hospital staff or specialists in other locations, and it can enable easier doctor-patient consultations and communications. For example, videoconferencing, combined with remote sign language services, has been used to help hearing-impaired visitors to hospital emergency rooms communicate their symptoms with medical personnel.

‘Virtual’ Meetings
The rise of AV in telemedicine has also made “virtual” physician-patient meetings more natural and realistic through the use of HD-quality displays. Ultra-high-resolution commercial projection and display systems are creating enhanced realism for visual and simulation training experiences, with the process recorded using AV cameras so it can be played back for later training sessions.

The use of professional AV equipment also extends to products traditionally used in broadcast production, which can deliver technological benefits and extra flexibility. For example, hospitals are using technologies with serial digital interface (SDI) and high-definition serial digital interface (HD-SDI) capabilities for transmission of uncompressed, unencrypted digital video signals, both internally and across multiple campuses.

4K technology (four times the resolution of high definition) is not just limited to monitors for viewing and playback. The Duke School of Medicine’s Anatomy Lab recently completed tests capturing 4K footage using 4K cameras. Medical teams were able to see a “quad-split” view of four full-HD signals on one display, helping them view different angles simultaneously of the same procedure.

All of these high-resolution, high-bandwidth signals have to be managed, shared, accessed—often by multiple parties simultaneously—and archived for long-term storage.

Level 3 Audio Visual (l3av.com), a medical engineering and AV integration group based in Mesa AZ, has worked with several medical organizations. A recent project involved a leading healthcare training center that uses AV technology in many areas throughout its campuses: robotic cameras, production switchers, networked business projectors in meeting rooms and lecture halls. The center is also using content management and production technology to streamline its video production and archive processes, to capture, edit and distribute classroom and lab footage, and to take advantage of web interfaces to allow faculty and students to access and work with content easily.

Perfect Fit
“The healthcare education market is a perfect fit for traditionally non-medical technologies,” said Brad Peterson, CEO at Level 3 Audio Visual. “Universities, especially those with multiple campuses, have very unique video production and management capabilities, in terms of capturing, storing and often sharing among locations. Technologies like these are designed to meet these needs now, and well into the future as an organization’s video library grows.”

Level 3 also worked with a leading hospital and medical center to revamp its medical training with a unique three-dimensional stream from the OR. They use 4K projectors to play back 3D footage to train neurosurgery medical residents and students. As a result, staff and residents can observe and learn about surgical procedures with more clarity and precision.

The project involved mixing different signals: HD-SDI broadcast, a mix of audio and video signals to analog and digital PC signals, and other sources to create the entire system, as well as work that had to be done from a construction perspective to accommodate a 3D-capable projection stream. “3D in healthcare is an amazing application, where depth of field provides the doctors an additional layer of information to utilize in their procedures,” Peterson said.

The Northwestern University Feinberg School of Medicine in Chicago uses a range of AV production technology – from portable live production systems and business projectors to medical recorders, robotic cameras and videoconferencing systems.

More Than 4000 Hours
In the past five years, the school has done more than 4000 event hours of capture, broadcast and presentation. The school does more than 100 hours a year of highly specialized training, approximately 50 hours each month of broadcasts to and from the various campuses associated with Northwestern Medicine, and more than 20 hours a week with team members using the AV tools to educate physicians, train PAs, medical students, residents and fellows.

“The biggest change for us in the last five years has been the migration from standard-def images to high-def images, and now we’re seeing the move to 4K images,” said Frank Schleicher, Integrated Media Services Director, IS Director for Surgery, Northwestern University, Feinberg School of Medicine. “Each time we’ve made a jump, our ability to take images out of procedure rooms and bring them to physicians and third parties for training has grown dramatically.”

The school is using its AV technology to capture content from the OR, procedure rooms, and GI and electrophysiology labs. The school uses recorders and its portable live production system to record and stream broadcasts to multiple campuses, often four to five times a week.

“Recently, we’ve been able to capture everything that the physician sees in an EP lab and broadcast it using our AV technology to another location on campus to many more people than normally would ever be able to see an EP lab type of procedure,” Schleicher said. “This makes a huge difference for our productivity, our ability to train, our ability to teach. As opposed to five or six years ago, with the tools that we have today, we’re able to capture, broadcast and archive signals from many more locations easily and consistently. We train significantly more numbers of physicians, technicians, PAs and nurses than we ever did before.”

Using Different Formats
One example of the benefits of using medical products based on traditional AV or broadcast technology is that Northwestern Medicine can input different formats, such as an HD-SDI high-def format and then output that signal in a standard-def, composite format. That is helpful when using a mix of monitors, with only some having composite capabilities. “We’re really maximizing everything that we could possibly do here, and we’re able to provide many more diverse services to our clients,” he said.

Moffitt Cancer Center located in Tampa FL is the third busiest by volume cancer center in the US and also an advocate of AV technology. Moffitt was one of the first institutions in the country to furnish its tumor boards, radiology locations and conference rooms with laser light source projection technology to review and share high-quality, high-contrast radiology images. The Center needed projection technology that would produce radiology images with the high contrast and color definition required for case review and discussion, to deliver an economical solution for numerous meeting spaces, to reduce maintenance and labor costs needed to keep more than 100 meeting spaces running without interruption, and to be more time efficient for the medical staff.

Moffitt has 30 lamp-based projectors of various models throughout their facility, but uses the laser models in high-use and offsite locations. The laser projectors deliver the vivid color and high-contrast images the radiology team required, and are also equipped with DICOM GSDF Simulation Gamma mode. The projector rollout has resulted in less downtime for Moffitt’s doctors and a reduction in overall maintenance and labor time, while eliminating lamp replacement costs.

No-Delay On/Off
The laser projector turns on and off instantly with no delay, while a lamp-based projector takes a few minutes to cool down and come back up. “A few minutes means that doctors are not talking about patients, which means they’re wasting their time, which impacts the next level of care,” said John Maass, AV Manager for Moffitt. He added that saving doctors a few minutes over the course of a day adds up to many hours over the course of a year. “That’s a huge amount of time lost that should be dedicated to the patient focus,” he explained.

Moffitt’s medical staff uses the laser projectors primarily for review in tumor board settings after the patient diagnosis has been made, as well as in educational settings for training fellows and residents. “A group setting is where they need to be able to see that contrast,” said Maass. “So, having a projector with DICOM GSDF Simulated Gamma mode, where they can see [what you’re talking about], makes all the difference.”

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