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The actual problems with live demo surgeries

Specific way of teaching and exchanging of the experiences in the Medicine

Jiri Navratil1, Sven Ubik1,Pavel Peciva2

1 CESNET a.l.e. Zikova 4, Prague, 16000 Czech Republic2Krajska Zdravotní a.s., MNUL, Socialni pece 3316, Usti nad Labem, 40011 Czech Republ

The 6th Asia Telemedicine Symposium

December 14th, 2012

Fukuoka, Japan

•• Connects all universities and research organization in the Connects all universities and research organization in the country and provide them IT servicescountry and provide them IT services

•• Supports big user communities as Physicists, Medicine, Supports big user communities as Physicists, Medicine, Biomedicine, Informatics, etc. which are partners in large Biomedicine, Informatics, etc. which are partners in large International projects.International projects.

•• Collaborates with Multi Media and Virtual Reality companies Collaborates with Multi Media and Virtual Reality companies and Movie industry on advanced fast video transmissions. and Movie industry on advanced fast video transmissions. applicationsapplications

CESNET is research organization sponsored by Ministry of Education CR

and academic community

Hodonín

Havl.Brod Nové Město na M.To otherhospitals

Via EXCHANGE POINTPísek

University hospitals (11)Military hospitals (2)Research hospitals (16)via NIX to other hospitals in the regions

CESNET creates an ideal environment for medical collaboration

MNUL

Network connects all Medical Faculties and all large hospitals

•• Building Building „„last mileslast miles““ to the hospital facilityto the hospital facility

•• Providing technical service with needed devices on Providing technical service with needed devices on the sites (camera, codecs, networking)the sites (camera, codecs, networking)

•• Helping with special projection (3D)Helping with special projection (3D)

•• Establish E2E links on requests (from operation room Establish E2E links on requests (from operation room to conference halls, in frame of the country and also to conference halls, in frame of the country and also internationally)internationally)

Forms of supports to medical communities

GN2

MTI

GLIF – Global Lambda Integrated facility

http://www.glif.is/participants/

Teaching and Exchanging experiences via examples is getting more and more popular

Two basic independent ways:- Sharing data (video,PDF,etc.) via Internet (MedFaculties + CESNET)

MedFaculties – provide the content CESNET provides the infrastructure and control softwareStable application dedicated to students

-Live Surgery transmissions (CESNET + Clinics)

Live Surgeries are requested on medical congresses, annual conferences, etc.usually organized in attractive environments as Spa resorts, famous building in historical towns, concert halls, etc. with no or very weak connectivity !

Main problem: Nearly each event needs special preparation and extra cost. There are several tools which can be used

1) H323 videoconference units(0,5 - 6 Mbps with compression)

2) DVTS (35 Mbps)

3) MVTP-4K (1,5 – 10 Gbps)

(codec – high compressionLow quality of coloures and grey scale, high latency)

Software, no compression, no internal latencyQuality defined by the camera

FullHD quality, no compression, No internal latency, up to 8 channels, 3D

LiveSurgery

DVTS - Plus (CERNET application)

Multipoint VC, princip Client-Server, Internet connection

35 Mbps

since 2010

Server MCU

Makito codec MPEG-4 AVC / H.264

video from 352x288 až 1080p (Full-HD)Sending up to 8 destinations with two levels of quality and resolutionMaximum bandwidth for stream is 15 Mbps

~ 10 K US

Surgery room 1 Surgery room 2Camera 1 Camera 2

Videov4

v1

Management machine with all video signals on 4 windows s v1,v2,v3,v4(for teacher decisions)

Screen 1 Projector 2Seminar room

Voice 2 (fro m robot)

Voice1(microphone.)

ENC1ENC2

ENC3

ENC4IP

IP

IP

IP

Videov2

Videov1

Videov3

IPIP IP

IP

v2

v4

v3

VLC receiver: v1 | v2 |v3| v4 According to the teacher

VLC receiver: v1 | v2 |v3| v4 According to the teacher

mcast

for Questions

HospitalN e t w o r k

Interesting events in 2012

- Usually in the places where is no good network-There are other limitations as big halls-The attendees expect some form of show

Always big challenge for organizers

CENS 2012 neurosurgery lessons

2012

CENS 2012 neurosurgery lessons

Robot daVinciHD resolution

HD 3D camera

3D Video unit

F10 AS3D

H323Video conference

Robot da Vinci

MVTP-4k

2 HD videosignalsLeft a Right eye

MVTP-4k

3D video - General scenario using MVTP-4K

NETWORK10Gbps

Stereo projector F10AS3D

Video fromOperation room

ZD101 DLP

http://www.ces.net/project/qosip/hw/mvtp-4k.pdfModular Video Transport Platform - codec

2 HD videosignalsLeft a Right eye

http://www.ces.net/project/qosip/hw/mvtp-4K-v2.pdf

IN: 8x HD-SDI OUT: 8x HD-SDI

Network –10 Gigabit Ethernet

MVTP-4K (Modular Video Transfer Platform)

• 2x 4K or 8x 2K/HD• unlimited distance overregular Internet

• full-duplex• embedded audio• adds less than 1 msto networking delay

• output synchronizationwithout clock source

3D screen videoconference

CESNET – SANET Collaboration: daVinchi operation in MNUL to Banska Bystrica

Telebridge Ústi nad Labem (CR) – Banská Bystrica (SK)

3D screenvideoconference

Cheap passive glassesProblem: expensive projectorsAdvantage: quantity, large halls

3D projectors

Stereo projector F10AS3D

DepthQ PMunit for conversion from

Active to Passive 3D glasses

MVTP-4k

Cheap 3D screens (LG,SAMSUNG,Panasonic)Cheap passive glassesLimitations: for individuals or small lab set

ZOF 2012 Zlin’s Eyes Festival

Projection to 3 screens: A,B,C

3D screen

AB C

This is 3D Cinema projector

3D video in monoscopic view(without 3D glasses, all is doubled, blurred)

left eyeview right eye

view

Streamed into Internet

XIX congress of GPSSLS at Bratislava (SK)4 parallel surgeries

Stereo projector F10AS3D

DepthQ PMunit for conversion from

Active to Passive 3D glasses

MVTP-4k

2012

3D screen from robot daVinci

Live surgery Moderator

3D screen

Internet stream

Interesting events in 2012

Initial phase: Simple projector + expensive active glasses

Next step

a) Strong projectors + cheap passive glasses - expensiveb) Projector + PM to cheap passive glasses - contrast problems

New trends with new and cheap technology

3D TV displays (Panasonic, Samsung, LG) + glasses (active or passive) – cheap, very good resolution,Ideal for small labs and professional education

Where to go for congresses and symposia ?

Back to 2D ?

After 2 years of experiments2D/3D dilemma

Thank you for attention