Installing a Hospital Video Network — Implementation of a Custom Design in the Cardiac Cath Lab and OR
With today’s often urgent need to both communicate and gain access to information, more and more healthcare providers and agencies want to be able to distribute data and information in sophisticated ways. While the business and social repercussions of the digital convergence revolution (the merging of different forms of media) are still being understood, the end result is the arrival of transparent, seamless access to services and information, regardless of location.1 No matter our discipline, medical professionals want to be able to work together to discuss shared challenges and learn from what others have accomplished. This need has always existed; what’s new is the manner through which information is transmitted. For interventional cardiologists and various practitioners, one large-scale example is the Transcatheter Cardiovascular Therapeutics (TCT) conference, where streaming video use has increased exponentially each year and can be seen by thousands of attendees at a time.
In the past, the ability to film and document cases of interest has been technically difficult. Generally, a film crew would have to be scheduled, various pieces of equipment needed to be sent into the hospital and a crew would have to be in the room to facilitate the filming. Today, the ability to film a case at any time with remote-controlled cameras can not be underestimated, and sending up live cases via streaming video can be one way to set your organization apart from the rest. On a smaller scale, setting up a version of the old-school operating room (OR) observation stage can also be accomplished with a remote video system for in-house viewing. If your facility is involved in research and/or training, or has an expert in the field that can share his or her experiences with others, you may want to explore the option of installing a built-in audio video (or “duplex”) system.
This article will demonstrate how a hospital can set up a system to record cases, without having to go through all the hassles of engaging a film crew each time, through the setup of a cost-effective, “built-in” duplex video system.2
Picking a System
As you might imagine, a film crew can be quite a hindrance to the personnel in a cardiovascular suite or OR environment. The installation of a remote-controlled video system is to specifically eliminate a film crew and the disturbance caused by bringing in many pieces of video equipment. You may quickly find that different capabilities are necessary for each room. Certain rooms need close-up, interactive cameras, while others do not. Usually there is also a need to have more cameras in peripheral labs than in other rooms to obtain additional simultaneous camera angles.
One of the options for a video system is a turnkey system built for the OR environment, meaning all details are covered by the company. However, these systems have a limitation where many of the electronics are dedicated to each room. As with many turnkey solutions, the positive aspect is that the company is responsible for everything. If a decision is made not to use a proven turnkey solution, it is then important to make sure the system chosen will do what is promised. Working with a local, reputable supplier is important. Have several companies provide your facility with demonstrations. If the decision is made to purchase a custom (rather than turnkey) design, the Sony AWS-G500 Live Content Producer and the listed equipment (Table 1, Figures 1-2) is a good example of what might fit your lab’s needs. Such a system can be purchased at less than half the cost of a system from the larger turnkey OR supplier, making the risk worth the benefit. In addition, at the local level, many companies can go the extra mile with planning and design due to lower overhead costs. With this methodology, it involves your concept and choice of equipment, but the supplier can do all of the detailed designs.
The Design
Often a system design focuses on cardiovascular procedure rooms performing both percutaneous and open OR-style cases, as well as electrophysiology procedures, along with the capability to expand. Cameras, such as BRC-300 cameras listed in Table 1, should have wide-angle capability for viewing of the activity in the room, and small footprint cameras (like the DXC-390 in Table 1), which allow the physician to speak with the audience. Lavalier wireless microphones with belt packs can be used for the operating physician.
The broadcast room design should have wall-mounted audio and video connections ,with the ability to easily move the broadcast switcher if needed. Due to its small size and portability, the switcher can be moved to another location if necessary.
A smaller facility will need to take greater consideration in deciding the placement of a broadcast location and areas to transmit information to, due to the size of the associated equipment and the cabling needs. With limited facility space, you will need to choose a system able to take in several different signals and output those signals in various formats. Several video signals can be in VGA, and/or composite forms. The ceiling structure at your facility may also necessitate using shielded cable for video quality. All control lines and video signals come back to a common room for distribution. Video output is then distributed to an internal conference room or to an outside weatherproof box for connection to a satellite-capable truck.
Capabilities
A facility may have several needs for video and audio transmitting. Perhaps research is being done; often there is a need to utilize in-house remote viewing in an associated conference rooms. There can also be occasional satellite feeds to other facilities. Departments asking for video teaching technology can include the cardiac cath lab, but the OR also may want to participate due to having new surgical procedures to demonstrate.
One website showcasing videotaped surgical procedures, OR-Live, notes on its home page, “OR-Live, Inc. is an Internet Broadcasting company which creates live and on-demand video-based communications solutions for clients in the healthcare industry. OR-Live, Inc. has an incomparable level of expertise in the healthcare field which has been showcased in its work for hospitals, allied health professionals, equipment manufacturers and pharmaceutical companies.”2
The success of a video solution designed to assist a facility in transmission of medical video for education and training was discussed in a February 28, 2008 press release by the Heart Hospital of Austin:3
“Sophisticated high-definition robotic cameras installed in the rooms make live broadcasting possible for education and conferencing to physicians across the U.S. … To highlight some of the new technologies, two procedures were broadcast today via the new video equipment permanently installed in the rooms. Dr. Roger Gammon, cardiologist with Austin Heart, performed a live vascular procedure and Dr. Stephen Settle, vascular surgeon with Cardiothoracic and Vascular Surgeons, walked participants through a taped endovascular (minimally invasive) aneurysm repair for an abdominal aortic aneurysm (AAA). …
“The video system offers the capability to perform an operation or procedure and distribute it live (in real time) to classrooms, hospitals, or facilities anywhere in the world via integrated satellite uplink system.”
In a HealthImaging.com article entitled “Reinventing the Cardiac Cath Lab,” John Cheatham, MD, director of cardiac catheterization and interventional therapy at The Heart Center at Columbus Children’s Hospital in Columbus, Ohio, notes: “We can call up ultrasound studies or echocardiograms, view physiologic data and even use two permanently mounted video cameras in the suite to provide live images to all of the team. We frequently participate in live case demonstrations of new hybrid procedures via satellite to educational conferences inside and outside of the U.S. using the sophisticated equipment in the suites.”4
Conclusion
The audio-visual mandate is to bring researchers, practitioners and students into the hospital procedure and operating rooms without risk and without allowing the equipment and staff to get in the way of the experience. Hospitals have been using audio-visual equipment for years in order to transmit medical images for teaching purposes. Notably, these systems have included setting up duplex audio-visual transmissions for conference sessions, as well as the creation of DVDs by audio-visual teams for teaching tools. With digital video equipment becoming more affordable, a quality, cost-effective audio-visual solution can be designed by local vendors using off-the-shelf equipment, allowing a healthcare organization to set themselves apart from their competitors.
Phil Regas can be contacted at Phil.Regas@hotmail.com
References
1. Schwartz E. Wireless leads network convergence revolution. InfoWorld February 3, 2003. Available at: http://www.infoworld. com/article/03/02/03/05neNetwork_1.html. Accessed May 16, 2008.
2. OR-Live, Inc., Available at: http://www.or-live.com/about/ Accessed May 20, 2008.
3. Pfluger S, Korenchen J. Heart Hospital of Austin’s Expansion Increases Patient Capacity by 30 Percent. February, 28 2008. Available at: http://www.reuters.com/article/pressRelease/idUS157602+28-Feb-2008+PRN20080228. Accessed May 16, 2008.
4. Fratt L., HealthImaging.com March 1, 2007. Reinventing the Cardiac Cath Lab. Inside Cardiac Imaging. Available at: http:// www.healthimaging.com/content/view/6017/158 Accessed May 20, 2008.
