New Monitoring System Approved by FDA- Potential for Future Robotic Diagnostics

Posted on April 2, 2008 by Steven F. Palter, MD

The FDA has just approved the FreeStyle Navigator Glucose Monitoring System – a glucose sensor that reports glucose values continuously for up to 120 hours. Here is a copy of the FDA PMA letter. This device is interesting to me since it works with a sensor inserted in either the abdomen or the back of the upper arm. The device then continuous provides glucose readings and updated glucose trend information for viewing and contains a built-in alarm that can be programmed to alert the user when results fall below pre-set values. Other similar devices have been approved that monitor for 7 days.

Potential for Future Robotic Diagnostics I have written before that I predict a whole new field of chip based biologic disease screening and monitoring in the future. This is another step to that result. Here a sensor is placed under the skin that measure blood sugar. In the future minitaturized chips could be placed in any body cavity or organ to sense any imaginable molecule.

Options for Future Diagnostics:

DNA based sensors screen for cancer metastasis or recurrances such as an intrabdomnal ovarian cancer detector.
Sensore that measure drug levels in target tissues – chemotherapy of course comes to mind
protein sensors that look for the earliest stages of disease development.

As personalized genetics becomes more widespread, we will identify individuals at particular risk for particular diseases before they occur. Since the genetic basis of these diseases will be known markers will likely exist. Implanted chip sensors could then be placed to sniff for these markers and wireless transmit the alarm- or even deliver a predetermined treatment agent- all before there is any external sign of the disease. First generation implantable devices such as this for blood sugar monitoring are lisated here (none yet available):

Here are links to some of the technology that will be involved for these future diagnostics including tiny sensors that transmit with RFID, smartdust sensors the size of a speck of dust or less, smart pills that travel through the body transmitting data and the concept of personalized genetic information based diagnostics and personalized genetics in general.

All approved continuouis blood sugar monitoring devices are here and a comparison from a patient site here:

As an aside – in terms of glucose monitoring the use of thse devices may come into question. An ongoing diabetes study called ACCORD was cut short in one treatment arm when it was shown that ultra tight strict blood sugar control in diabetics with heart disease actually WORSENED outcomes!

New Visual Search Engine Debut-Works with a cell phone photo! Medical Uses Next?

Posted on March 4, 2008 by Steven F. Palter, MD

I have been following the consumer device CeBIT show in Germany. Pocket-lint UK reports:

At the CeBIT show in Germany, Vodafone is demonstrating a trial service called “Otello”, which is a search engine that uses images, rather than words. Rather than use a word as a search term, Otello users can send images via MMS from their mobiles and the search service which then returns the results to the user’s phone as an “ordinary” search result.

A picture from a newspaper, billboard, book cover or place are all examples of what can be searched for.

Vodafone is running trials with a German newspaper that lets users find out more about stories by photographing the images that appear in the article and MMSing the images.

There’s no word on breaking this out of trial phase at this stage.

I just had a meeting with reps from a major medical device company where I discussed the potential for smart image tagging and identification in medical imaging. Just think of the potential when this smart technology could be applied to image pattern recognition for skin lesions, radiologic images, and pathology slides. Rural medicine will never be the same! Cell photo snap an image and link to a search engine to get a diagnosis (we know who wants that to happen). Right now the system is prepopulated with images then recognized. In the future neural net and patern recognition technology will take this a step forward. Similar systems already exist for pap smear screening of cytologic abnormalities including a commercially available system papnet (made by Neuromedical Systems, Inc. who filed for chapter 11 and sold their intellectual proprty to Autocyte Inc).

Next Gen Mini-PS3 Cell Chips -Next Medicine Imaging Revolution?

Posted on February 8, 2008 by Steven F. Palter, MD

“ Though sold as a game console, what will in fact enter the home is a Cell-based computer. ” – Ken Kutaragi

“Cell-based computers will revolutionize medical imaging” – Docinthemachine

The IBM Cell graphics processor at the heart of the PS3 is a remarkable chip. Cell is shorthand for Cell Broadband Engine Architecture. It has been described as “seemingly obscene computing capabilities for what will rapidly become a very low price.”

A newer miniaturized lower power version has just been announced by ars technica that I predict will make it to medical video and VR processing. I recently led a session on the use of VR in medicine where Andy Van Dam (VR pioneer , professor of computer science at Brown, and founder of Siggraph) and I spoke about the future of VR processing. He predicted that the video grame industry hardware innovations will make the most dramatic strides and that this technology will then trickle down to VR due to its sheer massive computational power- beyond that of the old CAVEs of DARPA.

You may be unaware that this represent a new form of computer processing:

The Cell concept was originally thought up by Sony Computer Entertainment inc. of Japan, for the PlayStation 3. The genesis of the idea was in 1999 when Sony’s Ken Kutaragi “Father of the PlayStation” was thinking about a computer which acted like Cells in a biological system. A patent was applied for listing Masakazu Suzuoki and Takeshi Yamazaki as the inventors in 2002

The architecture as it exists today was the work of three companies: Sony, Toshiba and IBM. Sony and Toshiba previously co-operated on the PlayStation 2 but this time the plan was more ambitious and went beyond chips for video games consoles. The aim was to build a new general purpose processor for a computer.

In lay terms here is the muscle behind the processor:

The setup of the Cell processor is like having a team of processors all working together on one chip to handle the large computational workload needed to run next-generation video games. In order to understand how the Cell processor works, it helps to look at each of the major parts that comprise this processor.

The “Processing Element” of the Cell is a 3.2-GHz PowerPC core equipped with 512 KB of L2 cache. The PowerPC core is a type of microprocessor similar to the one you would find running the Apple G5. It’s a powerful processor on its own and could easily run a computer by itself; but in the Cell, the PowerPC core is not the sole processor. Instead, it’s more of a “managing processor.” It delegates processing to the eight other processors on the chip, the Synergistic Processing Elements.

The computational workload comes in through the PowerPC core. The core then assesses the work that needs to be done, looks at what the SPEs are currently processing and decides how.

Watch out for our robot PS3 overloards. This Chip has the potential to expand itself and distribute workloads over networks. Don’t worry this is not some Singularity scenario where the chips start to think on their own. Here is a review of the potnetial of the chip:

Chip giants such as Intel have already started working on dual-core chips, but Cell goes several steps further by giving processing units a measure of independence. Current multicore chips typically chop a single computing task into parts, which are distributed among processing units. Cell’s processing units–called “software cells”–can handle completely separate jobs.

“The software cells are designed to be kind of self-contained–they can kind of roam around,” Halfhill said.

Cells can even roam over a network, allowing the processor to perform a type of distributed or grid computing, an increasingly popular enterprise technique in which demanding tasks are divvied up among a gang of networked computers. A PlayStation 3 could borrow unused processing power from other consoles on a network, for example, to complete a demanding task such as delivering streaming video.

“The Cell architecture is designed to make grid computing almost universal,” Halfhill said. “It makes distributed processing part of the design. If you have several of these machines on a network, the work can be spread across a network.”

The cell design can allow cooperation between video devices: “This architecture is not fixed, if you have a computer, PS3 and HDTV which have Cell processors they can co-operate on problems. They’ve been talking about this sort of thing for years of course but the Cell is actually designed to do it. According to IBM the Cell performs 10x faster than existing CPUs on many applications. This may sound ludicrous but GPUs (Graphical Processors Units) already deliver similar or even higher sustained performance in many non-graphical applications.”

Medical uses: We are at the cusp of a revolution due to the integration of computer video processing and surgical and radiological imaging. Details of this concept of mine are here and a podcast here. As we move ahead with virtual imaging and newer forms of optical processing it is the computational power of these kinds of chips that will be enabling.

Disclosure: As I previously wrote, I was chosen to be a Sony Medical HD Luminary Site. I receive no financial payment for this relationship which is only with Sony’s Medical division and is part of my medical research work on surgical tools and imaging. Heck- I had to buy my PS3 at Best Buy just like anybody else.

Wireless HDTV- TV Today OR Tomorrow

Posted on January 30, 2008 by Steven F. Palter, MD

Here’s the next installment in my series on HDTV in the OR and the emerging use of HD for endoscopic surgery. Belkin introduced a new device for consumer HD video at CES that uses wireless technology to transmit the signal. In the past the enormous bandwidth of HD precluded the use of wireless transfers.

From what I have been told- the technology was developed by Amimon and is called WHDI. They report on the tech that:

WHDI™ – Wireless High Definition Interface sets a new standard for wireless high-definition video connectivity. It provides a high-quality, uncompressed wireless link which can support delivery of equivalent video data rates of up to 3Gbps (including uncompressed 1080p) in a 40MHz channel in the 5GHz unlicensed band, conforming to FCC regulations. Equivalent video data rates of up to 1.5Gbps (including uncompressed 1080i and 720p) can be delivered on a single 20MHz channel in the 5GHz unlicensed band, conforming to worldwide 5GHz spectrum regulations. Range is beyond 100 feet, through walls, and latency is less than one millisecond.

WHDI™ enables a wireless video link that offers the same functionality, cost and quality as a wired link. Practically all of the hundreds of millions of wired connections between video sources and displays today are based on delivery of uncompressed video. In order to replace these wired links, the wireless interface needs to be uncompressed as well.

The problem with traditional wireless modems for video is that they treat ever data bit equally. This new technology does not. WHDI takes the uncompressed HD video stream and breaks it into elements of importance. The various elements are then mapped onto the wireless channel in a way that give elements with more visual importance a greater share of the channel resources, i.e. they are transmitted in a more robust manner.

I presented research a few years ago on the development of a new endoscope that used distal CMOS imaging chios and distal end LED ilumination. The advantage of this is the ability to eliminate light and power cables once it goes battery powered. The developoment of wireless HD video transmission is vital to make the scopes totally wireless. Some details of this project and wireless power charging are here. The technology could also be used to develop real time image review from pill- cams.

You may want to check out past posts on the use of video compression as another tool enabling wireless OR’s.

New 3D Display Technology

Posted on September 6, 2007 by Steven F. Palter, MD

this sure beats the old system!

Better for Creature Features than the OR

Phillips just demo’d an intriguing display at the Berlin consumer-electronics show. It is an amalgam of 9 x 42-inch displays on a grid creating a 132 inch display that reportedly can display 3D images without the need for glasses.

Why this is so important: 3D display technology is badly needed for endoscopic surgery. In order to see in 3D you need stereo vision which requires 2 separate images taken from slighly different angles and them superimposed. You body does this with your 2 eyes slighly separate on your face. In traditional laparoscopic surgery there is a single telescope and a single camera so all the images are in 2D. Unfortunately, depth perception is lost. How does the surgen operate then? What heppens with training and practice is that your brain picks up and other clues primarily shadowing and touch perception from your hands and the surgeon becomes able to interpolate a 3D space even though all of the visual skills are mising. This is one of the hardest if not the hardest step to learn when I teach surgeons to first perform laparoscopic surgery and some people just have a much harder time than others. Interestingly, with HD displays there is a pseudo-enhancement of depth perception that engineers and visual scientists tell me is due to the enhanced color fidelity and resolution and shadowing which allows the brain to pick up more 3D clues of the space from the 2D image! Still, the lack of true 3D data increases the difficulty of the procedures especially complex ones requiring suturing.

What is available today: Currently there are some attempts to address this limitation. They have required the use of head mounted displays with separate displays for each eye and separate imaging chips or lenses on the scopes but these have been heavy and cumbersome to use. Others such as some of the robotic solutions have immersed the surgeon’s head in a remote 2-panel display station but this also is a very complex solution. For years I have seen many many attempts at no-glasses 3D displays from various companies but all suffered from narrow viewing angles or poor resolution or other design issues.

How this solution works. This is a display technology that they call 2D + depth. In order to generate a 3D image, the display requires a regular 2D representation of the image and a depth-map. This depth-map indicates the distance between each pixel and the viewer. The 2D image and the depth-map are used to create images on the screen, and these images are then merged by the viewer’s brain into a 3D sensation.

Lenticular Screen: The system works with lenses on the screen that provide a slightly different view for each eye (without the red-green glasses of the 50′s). A sheet of transparent lenses, is fixed on an LCD screen. This sheet sends different images to each eye, and so a person sees two images. These two images are combined by our brain, to create a 3D effect.

I’ll have to get ahold of one of these displays to see if it holds promise for the OR…

DITM NG Special Website up- Interview with Wired Magazine

Posted on September 6, 2007 by Steven F. Palter, MD

I previously wrote about the upcoming National Geographic Special Inside the Living Body and my work featured in the special. I was also interviewed by Wired Magazine about the show and the technology behind it. You can read their take on it here (note – I have to email the author Sonia and explain that it is not a good idea to use the descriptor “Organ Porn” in conjunction with the work of gynecologist!).

One of the CG shots from the show

National Geographic has set up a website dedicated to the show with photos videos and facts. Lot’s of fascinating info and images to check out! They write:

From our first cry to our last breath, our bodies undergo a continuous second-by-second transformation. Every move we make and every outside stimulus triggers a reaction through the skin, bones, organs, muscles and cells. We breathe, on average, 700 million breaths in a lifetime; an adult skeleton is replaced every seven to 10 years; we shed as many as 30,000 dead skin cells every minute; and the food we eat travels 30 feet (9 meters) on its journey through our bodies. Now, the National Geographic Channel (NGC) takes you beneath the skin to reveal how our bodies evolve from birth to old age, and the amazing biological systems we need to thrive.
From the producers of NGC’s critically acclaimed In the Womb series, Inside the Living Body traces one “everywoman’s story”, using milestones to examine the everyday workings of a living, functioning body in ways not seen on television until now. Cutting-edge miniature endoscopic HD cameras delve deep inside the mouth, throat, heart, lungs, digestive tract, brain and reproductive organs to shed new light on how and why our bodies do what they do. Stunning photography in this two-hour special reveals universal moments in human development at the most minute level, providing insight into both our own individual metamorphosis and our shared human experiences.

(the bold is my part!)

The Show airs September 16th on the National Geographic Channel (and the NG HD channel!) at 8PM.

OCR to the Rescue: Device Reads Any Text for Blind

Posted on August 21, 2007 by Steven F. Palter, MD

Chalk up another innovation to Ray Kurzweil America’s leading inventor (and Lifeboat Foundation Advisor along with me). This one is a simple and elegant solution to help the visually impaired.

Developed in conjunction with the National Federation of the Blind, the device (The Kurzweil-National Federation of the Blind Reader) is a digital camera that can photograph any text or sign and then digitally OCR it and read it outload to the user! Quite a simple concept.

Kurzweil recalls the invention of the First OCR Reader in 1974

“In 1974, computer programs that could recognize printed letters, called optical character recognition (OCR), were capable of handling only one or two specialized type styles. I founded Kurzweil Computer Products, Inc. that year to develop the first OCR program that could recognize any style of print, which we succeeded in doing later that year. So the question then became, ‘What is it good for?’ Like a lot of clever computer software, it was a solution in search of a problem…I had found the problem we were searching for—we could apply our ‘omni-font’ (any font) OCR technology to overcome this principal handicap of blindness.

New System is Portable “The National Federation of the Blind (NFB) and Kurzweil Technologies, Inc. (KTI) have created the world’s first portable OCR device, that allows an ordinary page of text to be photographed and subsequently translated into voice. Over the last three decades there have been several computer-based solutions for translating OCR to voice, but none of them are portable.”

Click here for video of the device in action[wmv width="375" height="211"]http://mfile3.akamai.com/12032/asf/kurzweil.download.akamai.com/12032/knfbr/CNN_Device_opens_the_world_for_blind.asf[/wmv]

New Flexible Biodegradable Battery Invented

Posted on August 13, 2007 by Steven F. Palter, MD

ars technica reports on the invention of a paper thin flexible biodegradable battery.

Researchers from Rensselaer Polytechnic Institute and MIT have developed a new material that eliminates the need for a multilayer battery. They grew carbon nanotubes on a silicon substrate and impregnated the gaps between the tubes with cellulose—that’s right, plain old paper. The cellulose also covered the ends of the nanotubes, but once it had dried, the paper material could be peeled off of the silicon substrate, leaving one end of the carbon nanotubes exposed to form an electrode.

By putting two sheets of paper together with the cellulose side facing inwards (and a drop of electrolyte on the paper), a supercapacitor is formed. These supercapacitors retain the flexibility of normal paper, but they have a rating that is comparable to that of standard commercial hardware.
By putting a drop of electrolyte on a single sheet and then putting a metal foil consisting of lithium and aluminum on each side, a lithium ion battery is formed. Researchers indicate that small prototypes could already power small mechanical devices like fans. These batteries operate over a wide range of temperatures, with the research showing that they can operate between -78–150°.

Potential Medical Applications: Its been reported that bodily fluids can act as the electrolyte. The capacitor would be put into a patient fully charged but dry, and when more power was needed, bodily fluids would be allowed into the device to allow it to discharge.

HD in the OR: The AVCHD Video Recording Format

Posted on August 13, 2007 by Steven F. Palter, MD

Can we go from this to this?

This post continues my series HD in the OR examining the current and future use of High Definition video in the Operating Room- as well as current and future HD technology. You can read background on my OR HD testing here. This was a big week – after working with the Stryker HD system in the OR a few days ago I operated in a new hospital today and walked right into a Linvatec HD system trial. Review info coming soon.

In this post I want to review the new HD video recording format AVCHD for you and explore if it has a potential space in the OR (sneak peak- the answer is a qualified “yes”).

First a bit of video in the OR history: One area that is relatively ignored is archiving video. As I have written before, for years the standard video archive format was simple consumer VHS, and for those of us who wanted the highest possible resolution of our archives- S-VHS. The use of consumer DV was never really widely adopted in the OR. I do remember a single Sony DVCAM based recorder that never really made it to widespread installations. If I recall correctly, it was Karl Storz who offered it briefly. I really wanted to use this format since it provided higher resolution (500 lines) and native firewire output for direct digital input into my computer for editing. Our only option for getting the video into these decks was S-video input since none of the major companies offered firewire output on their OR cameras (despite my requests).

What is AVCHD? Briefly, AVCHD is a relatively new digital compression and recording format for high definition video being promoted primarily by Panasonic and Sony.

How is AVCHD Better than Other HD Recoding Options?: The main difference is that the MPEG-4 technology that fuels AVCHD is roughly twice as efficient as the MPEG-2 technology used in HDV (the other consumer tape based HD recording options). What this means is that files are 1/2 the size but retain the same high quality. This compression is so effective that new camcorders have been developed that can directly record HD video in real time to a hard drive or even flash- based memory card (Panosonic has introduced a consumer AVCHD HD recorder that saves to SD cards and Sony one that saves to Memory Sticks). – And as I keep advocating- if video can be highly compressed and retain quality then wireless systems can be enabled or internet-based recording and archiving options. This is the Holy Grail for the surgeon in terms of documentation- online access to HD footage from the OR from the office.

Technical Details of The AVCHD Compression Format: Digitalcontentproducer has reviewed the format. AVCHD stands for Advanced Video Codec High Definition, and it’s based upon the AVC codec, a joint standard of the ITU (International Telecommunications Union) and ISO (International Standardization Organization) groups. It’s also called H.264. AVC/H.264 is an advanced subset of MPEG-4 compression. H.264 is a very hot topic lately in the broadcast and internet video worlds.

AVCHD is Based on the Same Codec Used in Your IPOD: They comment also that while AVCHD is relatively new, AVC is an established standard—particularly in streaming video and it is the primary codec for iPod video. AVC is also starting to displace MPEG-2 in the cable TV and satellite TV markets, and it’s one of the three technologies available for HD DVDs (along with MPEG-2 and Microsoft’s VC1). Even the Sony PS3 will play it natively.

More Technical Details on The Video Files Produced: The AVCHD specification itself supports scalable frame sizes from 720×480 up to 1920×1080 in either 4:3 or 16:9 aspect ratios. Like HDV, AVCHD video uses the 4:2:0 sampling format, which is superior to the 4:1:1 used in DV camcorders (less artifact and better color fidelity). AVCHD uses an MPEG-2 transport stream “wrapper,” and it is scalable up to 18Mbps

What is HDV – Why Not Use It?: HDV is the first consumer High Definition Video format released. It allowed the recording of HD footage on standard miniDV tapes. Unfortunately, its MPEG-2 based format still creates huge files and is not compatible with a disk (non-tape) based recording format. More on this format to follow in upcoming posts…

The Editing Quagmire: Editing is the current AVCHD shortcoming. Many software based NLE programs cannot edit AVCHD video leaving the recorded files of limited use in presentations inthe medical world. I predict this will change in the next 2 years. Today Vegas 7+ supports AVCHD editing (of course it does as a Sony product since they are backing this format in the consumer realm). Adobe Premiere still does not support the format and the message board logs are full of people being told by Adobe don’t hold your breath. Apple Final Cut Pro has announced support on the Mac side. Third party tools exist to transcode the video to allow any program to edit it but that is a royal pain. Both Ulead VideoStudio 11 Plus and Pinnacle Studio 11 support AVCHD and even Blu-ray disc burning. Nero Ultra Edition Enhanced can process it as well.

Will We See AVCHD In The OR?- My Inside Insight: I have spoken to several Medical Video device companies and as of today there is no development in this area. Even a discussion I had with sources in the Medical Imaging Division of Sony would suggest this is not a format being aggressively pursured. If anyone is could push this technology into the Medical arena it could be Sony. They have the medical video hardware and the consumer AVCHD technology- and they are globally committed to AVCHD technology and HD medical video. For now the mainstay of documentation in the OR remains MPEG-2 based DVD recorders for at least the next two years is what you will see. (hint: and next blu-ray - more to come on this soon)

Then What are the OR advantages of AVCHD?

High HD video quality
smallest HD captured video file size
ability to archive in HD not SD
ability to record on removable flash media or a disk drive
ability to edit by surgeon with consumer software
potential for wireless streming and archiving HD systems

Quality Concerns: All early reviews of the AVCHD HD camcorders have however noted quality flaws when compared with their comparable HDV based tape systems. The errors seen have been primarily lower light sensitivity and moting artifacts and flaws (as expected with higher compressions codecs). This concerns me enough to delay upgrading my camcorder and I don’t want them in the OR until it is settled. The software will need to be tweaked at minimum.

I’ll post a line-up of the consumer AVCHD camcorders next

Then exciting insight from suprise trials this week of the latest HD systems from Stryker and Linvatec. Details coming from Docinthemachine HD OR system testing.

New video Connector Solution for the OR? Displayport!

Posted on August 9, 2007 by Steven F. Palter, MD

Continuing in my HD in the OR Series I wanted to share a video connection option for the future. Most current systems offer simple S-video or component video. As usual, the OR equipment lags a generation behind consumer video. This has has been my experience with the major consumer video and surgical video companies over the past 10 years. I can understand their viewpoint (a little). In the OR most want broad interconnectivity backwards compatibility and standards. The latest and greatest electronics is not what most OR committees demand. On the flip side, the video companies focus rightfully so on consumer video because that is where the market is. I had this discussion with JVC and SONY in 2000 when I first began my HDTV surgery project at Yale. The entire medical video market is but a tiny blip compared to home TV’s and camcorders.

Where are we today? SVIDEO and Component. What is used in the bleeding edge for your computer, home theater, or professional HD video studio? NONE OF THESE! The standard connections there include DVI, HDMI and High Definition Serial Digital Interface (HD-SDI) for the pros. The consumer formats have copy protection as one of their major design requirements (movie studios don’t want you copying their HD moves). However the pro HD-SDI is the industry state of the art.

What’s next in the comsumer arena?

Engadget writes

industry’s move to DisplayPort is hotting up with AMD announcing ATI Radeon graphics processors supporting DisplayPort 1.1 in the “early 2008 timeframe.” Just in time to support Samsung’s new 30-inch panel scheduled to see production in Q2 2008. In fact, AMD just completed successful interoperability testing of their presumably “next-generation graphics processor” toting a native DisplayPort 1.1 transmitter.

Its advantages are another all-in-one audio video connector with high signal quality. Unfortuantely it also has copy protection as a major requirement. DisplayPort supports full bandwidth transmission over 3 meter (10ft) cable, and a maximum of 1080p resolution at 24bpp, 50/60Hz over a 15 meter cable.

Extensive technical details are here.