Docinthemachine Expands Fertility Analysis and Reporting

Since its inception docinthemachine has focused on sharing a vision of how technology can transform medicine.  I am excited to expand my postings and analysis of all things related to fertility diagnosis and treatment.  As most of you are aware I am a board certified reproductive endocrinologist — which is an Ob Gyn with addition training and expertise in infertility.  i am currently the Medical and Scientific Director at Gold Coast IVF in Syosset, NY.  When I first started DITM I planned on setting up a second blog solely focused on infertility.  With the efforts required to post here and continue my clinical practice and research that idea sat on my “to do” list.  I have frequently posted on fertility topics here nonetheless.

After some sould-searching and planning and discussions with my good friends and fellow med bloggers Nick Genes and Gene from Medgadget  I have decided to jut add all that content here to docinthemachine.  While it does not have a sexy-fertility name its a part of me that has a fantastic group of readers…  Everyone I spoke with unanimously agreed to just expand the content here!

So stay tuned for more fertility related posts in the days to come. 

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New Technique Sees Inside Blood Vessels in a Microsecond

Technology Review is reporting on a new technology to look inside the tiniest spaces such as blood vessels in a microsecond. Up until now endoscopic surgery has been limited as engineers tried to shrink telescopes to ever smaller diameters shifting from glass lenses to fiberoptic scopes to newer technologies. You can read my brief history and overview of microendoscopy here.

The new scope is based on optical coherence tomography but now uses new mathematical image analysis. Read the full article if you are interested in the heavy technical foundations of the system.

Suffice it to say, the system is a sort of “ultrahigh resolution optical ultrasound” and the new modification allows it to process the signal so fast that it could be used inside blood vessels without needing to interrupt blood flow and flush out the blood. The players in this development are two compnaies – LightLab and CardioSpectra of Austin, TX. The latter company was recently purchased by Volcano, one of the leading manufacturers of IVUS products for $25M.

Example of an OCT image of a fingertip (standard old OCT system)

Basic Explanation of How the Foundation Technology of OCT Works from wiki

“OCT is a technique for obtaining sub-surface images of materials at a resolution equivalent to a low-power microscope. It is effectively ‘optical ultrasound’, imaging reflections from within tissue to provide cross-sectional images. It is attracting a great deal of interest in the medical community, because of its potential to provide images at a far higher resolution (better than 10 µm) than is possible with other imaging modalities such as MRI or ultrasound.”

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Welcome to Docinthemachine 2.0

Welcome to the new layout theme for docinthemachine.  Now that the site database and wordpress install have been debugged and upgraded we needed a snazzy new look to show off to the world.

Stay tuned for more posts on future medical technology.  As always, I will focus on future technologies and how they will transform medicine.  By looking outside of medicine into the digital technological revolution I will make predictions of how the technology behind these devices will impact medicine.  I will review new medical devices approved or in development and make cross specialty predictions.  I provide a general overview of medicine with a special focus on minimaly invasive surgery, laparoscopy, women’s health, and fertility.

Let me know how you like the new look!

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DITM is Back Blogging! Blog Database Error Fixed!

Good News!  The sql database errors and wordpress corruption have all been fixed!  Thanks to the brilliant work of Gene the site is up and alive again.  In the process we upgraded WP 2.5.  No thanks go to my ISP who moved and hid my entire blog sql database without ever telling us as they went thrrough a server upgrade- making it totally inaccessible to us. 

Well at the end of the day we are back online.  If the site stays up and running trough our testing today I will launch the new site redesign this week. 

Thanks for coming by and I look forward to seeing you all again.

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DITM Blog Upgrade Coming! New Logo is Here

 docinthemachine logo

Thanks to the loyal readers coming.  I really appreciate you!  I appologize for the wave of database page errors many of you have seen and the site starting to crash.  We have had somedatabase issues with wordpress and sql and have called in the big guns to get all databases in line.  They know what happens to bad databases that do not behave.   Let’s just say all databases have been taken out back and have been spoken to.

 Stay tuned for a major upgrade and site redesign.  For now enjoy our new logo– let me know what you think of it!  Thanks so much to Lana for designing it.

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Retraction From Pointe Conception Medical

As a practicing physician, consultant to industry and the investment community, and medical technology blogger, my independence is of utmost importance to me.

Pointe Conception Medical issued the following statement today:

“Pointe Conception Medical (PCM) regrets the use of the quote from Dr. Steven Palter in our presentation materials.  Dr. Steven Palter did not provide PCM permission to use his name or any type of endorsement from him in any of our promotional materials.  Steven Palter is not affiliated in any way with Pointe Conception Medical.”.

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Second Life for Medicine

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More and more social networking sites, web 2.0 sites, and other initially recreational new internet systems are migrating to work and educational related functionality.  The potential for medical uses, online research, education, and patient networking is seemingly endless.

This wiki lists general grid and teen grid educational sites on second life as does this very comprehensive one.

On May 25, 2007, 1300 educators from around the world gathered at the Second Life Best Practices in Education: Teaching, Learning, and Research 2007 International Conference in the virtual world of Second Life. The event was the first 24 hour, international conference ever to take place entirely within a virtual world.  Details are here.

My award winning friend-blogger Bertalan Mesko has the most comprehensive blog on web 2.0 medical resources has put together this great list of everything about seond life and medical education.

Check this out.  I’ll be writing much more about vitual communities in the future and medical uses.

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Friday Fun Post- Human Statue Video

‘Duct tape is like the Force. It has a light side, a dark side, and it holds the universe together’ – Carl Zwanzig

My sci-fi writer wifeinthemachine being the creative type posted 2 funny videos – one is a mind-freak experiment where a couple of hundred people in NYC Grand Station simultaneously freeze and freak people out

the second is a song from India featured in the end credits of Inside Man that will get stuck in your brain- everyone loved the song but no one knew who or what it was.  Here it is- she calls it her writer muse-crack

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Docinthemachine is Back!

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Hello again all my friends, supporters, and loyal readers! After far too long of an absence I am back. So much time has passed and so much has happened that I wanted to fill you all in and welcome you back to my regular schedule of postings on all new in medical technology.

So you may ask- what the heck happened to you? We thought you were dead? Here is my free form list of all that has happened to tie me up and take me (temporarily) off-line. Here is a list of just some of things that took my attention in the last few months.

1) First and foremost my wife gave birth to our son the babyinthemachine. Despite being old pros at this a newborn really takes a hit to your free time! Happily she did awesome in pregnancy and labor and all went perfectly. It is always a bit of an event when an Ob Gyn’s wife gives birth we have really seen it all before, but that gets mixed up with the knowledge of every little thing that could go wrong at every step and trying to stay at the correct end of the bed (the head) ! The little guy came home and has been a delight. This led to the quick realization that these kids no way fit in our car we had to buy some new transportation. Thanks to Edmunds – remember never pay over invoice I won’t say what we got but I am sure you can guess…

Here’s the little guy in utero

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2) All of my research of the use of High Definition video for Surgery got picked up by the medical and lay press and I was doing a fair bit of lecturing and speaking. This was a real pleasure for me having worked on the development of these tools since 1999.

3) National Geographic featured footage from my high def surgery on their special Inside the living body. This led to a series of interviews and lectures including the peculiar thing that is morning drive FM radio shock jocks. No need to go any further. I’ll post some excerpts coming soon.

4) 20/20 did a piece on my research on visualization in surgery including high def and future vision autofluorescent laparoscopy. What a delight that was to do. Bob Brown and crew were great to work with and they then invited me back onto ABC News for a show about innovators. I’ll be posting video clips from this too.

5) DITM – this blog- hit its one year anniversary and I celebrated all that the experience has brought to me and allowed me to share.

6) My wifeinthemachine Michele Lang sold and published a major future tech-sci fi-romance Netherwood which included dozens of examples of current and future med tech from the pages of this blog in the Shomi Line from Dorchester Publishing. All this is woven into a story of a technological future world where computers become sentient and the local sheriff must destroy the man set out to destroy the network but learns he is her virtual reality lover who holds the secret to the survival of mankind. The book can be ordered at Amazon now and has gotten amazing reviews. She be posting some updates and interviews here to come!

7) I was honored to be chosen to be a High Definition Visionary Site by Sony Medical. As one of the few MD’d chosen for this distinction I have access to their wealth of electronic knowledge and product engineering. For full disclosure I do not receive any financial payments for this relationship. They are helping me with a demo research project for HD surgery education on the internet and on improving visualization and archiving of surgery. I’ll be posting more from this to come.

8) I was involved in the keynote general session at the 38th Annual International Congress of Gynecologic Endoscopy (The AAGL). A true honor, this was the third time I led a session on new technology in medicine and the second year in a row. This year I focused the session on NOTES – or natural orifice surgery. This amazing new technology still in development is where physicians pass special flexible never before seen endoscopes through natural body openings (mouth, anus, vagina, etc) to reach any part of the body without any incisions at all. Needless the say the audience was in awe of the video of an appendectomy removed without external incisions and pulled out the patient’s mouth! More from this session will be posted with updates and excerpts on this technology.

9) As part of this session I presented new research of mine on the transformation of medical technological research and mathematical modeling that shows we are on the cusp of unparalleled explosive growth in med tech innovation. Of course more to come on this!

10) I was elected vice-president of the ACGE (Council for Gynecologic Endoscopy) – established to elevate standards in operative endoscopic procedures performed by gynecologists. We will be continuing our efforts on surgeon and facility standards and review including the validation of simulator based evaluations. More to come!

11) I was chosen by the AAGL as well on a special ongoing press conference panel on the future of gynecologic endoscopy. I have to say it was a real honor and validation of years of work when The President of the society Dr Charles Miller introduced me as the visionary of the society. Videos and transcripts will be posted.

12) Related to this I began an advisory role for a company developing a gyn NOTES procedure which will likely begin clinical trials for infertility very soon.

13) We had the Annual meeting of the American Society for Reproductive Medicine (ASRM) – the largest infertility meeting where I serve on the program committee and chair the video program. I’ll be posting updates of new research including a dinner I had with the world’s expert on human pheromones.

14) The Society of Reproductive Surgeons (SRS) of the ASRM invited me to chair their postgraduate course on fertility surgery at next year’s meeting. Of course the topic I chose is “New Technology in Fertility and Reproductive Surgery”. I’ll run the course as a lecture and hands on lab and we will include robotic surgery, alternatives to hysterectomy, surgical simulators, Natural Orifice Surgery, Autofluorescence, Office Surgery, High Definition, High Intensity Ultrasound surgey and many others. I’ll post updates as we go along.

15) I continued my usual lecturing, research, publications, and the development of a new innovative DITM podcast series.

16) Had some minor surgery- I am really an expert on edoscopes and the entire GI track as well now.

17) My clinical practice Gold Coast IVF had our busiest and most fertile year ever! Countless pregnancies in my usual mix of complex cases left me grateful and delighted to be a part of this specialty. Using all the tools in my armamentarium (drugs, surgery, IVF, egg and sperm donation, etc) allowed me to help create more families than ever. I treated local patients and those who traveled from around the country and from Nations as distant as Russia, China, and Nigeria.

OK – it has been a busy few months here but I am ready for 2008 to do even more! Welcome back to docinthemachine!

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Docinthemachine Research Featured on 20/20! MedTechno Insights From the Day

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I previously wrote about the upcoming National Geographic Special Inside the Living Body and my work featured in the special. I was delighted when the producers of 20/20 called to request an interview with me on my research featured on the show and my vision of the future technological transformation of medicine.   Bob Brown was interested in coming to interview me.  They have already posted a description of the upcoming interview and a summary of the show. 

They call it an “Unprecedented Journey Inside the Living Body- ‘We’re Seeing Things That We Had Never Seen Before,‘ Says Scientist (that’s me).

On their website they write:

Recent technological advances have allowed for such dramatic and amazing views of the inside of our bodies that watching the footage can feel like you’re in a science fiction film or on an imaginary expedition…In such a science fiction journey, the 1966 film “Fantastic Voyage,” a group of scientists and their submarine were miniaturized so they could be injected into a body in order to eliminate an otherwise unreachable brain clot.

“I use clips from that movie when I lecture about these new technologies,” said Dr. Steven Palter, the medical and scientific director of Gold Coast IVF in Syosset, N.Y. “Now, physicians can actually see the workings of the body and understand it in a way that they never could before.”

Palter, who has a medical technology blog called docinthemachine.com, is a pioneer of methods capable of producing spectacular high-definition surgical images.  Palter obtained his footage by advancing well-established procedures that allow doctors to insert cameras through small incisions and view the target areas of their surgeries. He successfully hooked up high-definition cameras and, he said, was awestruck by the results.

“With high definition, we’re seeing things that we had never seen before … with depth perception, clarity and detail … because now it’s enormously clear and magnified. We have views that you don’t get with your naked eye.”

They also write about my autofluorescent laparoscopy research: “New Way of Seeing Ourselves”

The technology used for the National Geographic Channel is also clearly on its way to helping revolutionize medical care. Palter contributed to the development of what’s called an auto-fluorescent laparoscope, which exposes diseased tissue inside the body that a surgeon couldn’t otherwise see.

“Instead of using visible light, it makes the disease fluoresce,” Palter said. “If you look with your naked eye, you see nothing. When you switch on the light and the filters, all of a sudden the disease is glowing green, and you can see disease that’s beyond the resolution of your naked eye.”

setup.jpgThe setup

Details and Insights from the Interview: It really was an amazing morning.  I have done countless interviews and seminars with the media over the years and this really stood out for me.  Perhaps most enjoyable was the genuine interest and fascination with the topic of their correspondent Bob Brown (who was also a first rate nice guy).  They showed up at 8AM and took 1.5 hours to dismantle my office and set up the lighting.  We started extra early with the fertility patients that day so they could be finished and out the door before the TV crew came in to protect their confidentiality and to not make them feel uncormfortable (always a key issue in my fertility practice Gold Coast IVF).

joep.jpgDirecting the shoot

The cameras and the Crew:  Being the techno videophile guy that I am I jumped at the chance to talk with independent film crew brought to shoot me.  They had 3 cameramen/directors and there were 2 producers from 20/20, Bob Brown the correspondent, and a media relations rep from National Geographic (in case questions came up about their part).  They set-up a 2 camera shoot in my office with blazingly hot spot lights to ensure I would be nice and sweaty on camera.  They shot in standard BetacamSP.  Of course I could not resist to ask them why they did not shoot in HD.  They answered that the news shows inthe studios shoot in HD but that in the US all field work is done in SD.  This is because there are countless freelancers and crews out there all using different equipment and all waiting for some semblance of an HD standard to evolve before they invest hundreds of thousands of dollars in new HD cameras and editing and risk it being the “wrong format”.  Wow- how similar to the confusion in the medical and consumer video sectors! I continued my fact-finding quest and asked about who was using what systems and the relative advantages of each- panasonic sony JVC image sensors, color fidelity, native chip resolution tape vs disk vs solid state recording editing etc etc all trying to gleam insights I could take back to medicine and the OR. 

bobandi.jpgShowing Bob Brown (and cameraman) a Laparoscope  

The interview and turning the tables:  Bob interviewed me for 2.5 hours until they ran out of film. I was excited to share my excitement and passion for the subject of the future of medicine and surgery and how my work fits into this vision.  Bob was interested in the medical technology behind the show.  He asked a very wide range of questions from how I thought to merge HD video and surgerr back in 1999 to what I think is more beautiful – the earth from space or the vista of the internal human organs, to how will we pay for these new technology developments.  He was interested in everything I was working on and what I thought would have the most impact.  We discussed robotic assited surgery, natural orifice surgery (NOTES), augmented reality and head mounted displays, surgical simulators for training and the potential for real-dataset preoperative practice, virtual colonoscopy and 3D/4D ultrasound etc etc.

I had a chance to turn the tables a bit and ask him why they chose this topic and how they felt it would appeal to the lay public.  He told me that TV shows like 20/20 they basically track viewers interest levels minute by minute as they shows air.  He added that the medical pieces they ran have huge audience ratings and the more real the higher the appeal.  We discussed how the netorks know that on shows like CSI it is often the medical technology that draws the audience in.  He has a special talent in reporting human interest segments and has an amazing ability to distill down the high tech medicine we discussed and share with non-medical viewers how it will affect their lives. 

Sharing the footage:  After the interview he wanted to watch some of my HD surgical footage that I shot for National Geographic with the true HD 1080 16:9 system which I fortunately had available on HD XDCAM with a Sony ultrahigh resolution 24″ LCD HD monitor. Both the 20/20 people and the video crew were amazed by the resolution of the images and one of them remarked “If I need surgery I want them to use that   Being video people the film crew and director’s understanding of the power of HD in the OR was immediate when they saw just a few seconds of the images.  I continue to have the same degree of awe and fascination each time I operate with these systems.

Bob Brown was especially interested in my research on the development of autofluorescent laparoscopy and my concept of “FutureVision“- where surgical technology surpasses inate human senses and we watched those videos as well.

They finished off with few minutes of B-roll footage of Bob and I walking and talking in front of the hospital and requests for room cam OR footage and my AF surgery footage(all of which I was happy to share with them).

all4.jpgBob Brown, the Producers, and the docinthemachine

The 20/20 show airs this Friday September 7th at 10PM on ABC- check it out!

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