The Future of Medical Video: DITM Reports From NAB 2008

Posted on April 23, 2008 by Steven F. Palter, MD

I had the distinct pleasure of attending the 2008 National Association of Broadcasters (NAB) meeting last week in Las Vegas. As the foremost event for the TV, broadcast, and media industries this is the venue to see and explore the future of all things video and media.

The Floor of the Meeting and a Sea of Humanity- Why I Went

Being probably the only physician in a sea of 105,000 TV and media folks raises the inevitable question- why did I go?

Endoscopic surgery (laparoscopy hysteroscopy arthroscopy etc) all share the common use of video equipment. Since the late 70′s these procedures are performed as remote surgery looking through a thin telescope inserted into a body cavity and observed on a TV monitor.

The progress we make in medical video surgery is a direct trickle down of innovations from the broadcast arena. From the first CCD camera hooked to a laparoscope and suspended from the ceiling via a jerry-rigged boom to the first use of HDTV in the OR – broadcast and TV technology drives innovation in surgical video.

I thrive on researching new technology and then extrapolating new solutions to medical problems using these developments. This meeting provides the raw material for my creative process.

I was honored to accept invitations from several major broadcast, video, computer, and even surgical companies to attend the meeting, walk the floor with them, brainstorm new ways of helping patients with new devices and predict future needs and uses for technology in medicine.

Everybody kept asking me: What was the most important development I saw at the show? What future technology do I predict is poised to transform medicine?

Beyond the entire rooms filled with the latest newschoppers and remote satellite trucks

I was most impressed with the following technologies which have the potential to transform both consumer entertainment and medical devices- I will be posting further about each of these and what I saw (including a series of interviews):

Beyond HDTV- “ultra HD” 4k cameras and displays
3D video technology in SD and HD
OLED display technology

Interactive Objects and Gesture Control-Microsoft Vision of Medical Future

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

Microsoft produced this video as a demo of their vision of the future of healthcare. I was delighted to see that they share so much with my vision of technologies that will be key transformers in the future of medicine.

Key technologies I predict will change health care that I see in the video include:

implantable glucose monitor sensors
display surface
wireless charger
gesture control
interactive smartwalls that become displays
RFID taggged medicine bottles
Digital examination tols interfacing with EMR’s
LCD opaque windows
Digital wallets
Biometrics

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Bizarre Russian Interactive Art is Surgery Control Concept!

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

I have written many times on the concept of what I call “gesture control”. This is the idea of waving your arm or hand in a movement that is picked up by sensors (optical or other tracking) and which is then translated into the movement of a robotic surgical device, OR room or equipment control, or energy delivery system. You can see all these posts by clicking gesture control on the category drop down on the sidebar. Some faves are here here and here.

Lily Chaos has reviewed a bizzare interactive Russian art display that employs gesture control concepts.

She writes

A new video art installation by Russian media artist Sergey Kotsun invites the viewer to become the author and main character of an interactive audio-visual performance.

The viewer’s image is captured via a webcam and thrown up onto a projection screen. On the screen, two lines of transparent square boxes are also displayed, with the lines approaching each other at the top and veering away at the bottom, almost forming two sides of a triangle. Inside the boxes are different geometrical shapes.

As the viewer waves or makes other motions that can be picked up by the webcam, a computer program analyzes those movements. Any time a movement is perceived to intersect with one of the transparent squares, the corresponding geometrical shape displays onscreen and the sound of a musical instrument is played.

The viewer, in effect, becomes the artist as well as an integral part of the performance, creating movements that translate into sounds and abstract compositions of circles, squares, lines and half-moons. Kind of like playing an air banjo from inside a colorful kaleidoscope.

Here is a video of it in play- too Yoko Ono for my musical taste but pay attention to how the participant’s gestures are picked up by the camera and converted into actions- the same principle I advocate in the OR.

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If you have a webcam you can try a home demo!

Army’s Robotic Prosthetic Arm Demo’d

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

I have previously written about the Army’s robotic prosthetic arm projects – run of course through DARPA. You can see my posts and a video fest at Video Fest of Brain-Computer Links & Control.

An equally amazing story is how the project has come to be- DARPA contacted Deam Kamen (and team at DEKA of Segway fame) and challenged him to create this amazing feat of technology. The NYT reports

Eighteen months ago Segway entrepreneur and serial inventor Dean Kamen received a visit from Anthony Tether, the electrical engineer who runs the Defense Advanced Research Projects Agency, the military’s research and development agency.

Mr. Tether had come to Mr. Kamen’s rural western Massachusetts workshop to persuade him to tackle a challenging engineering problem: a robotic arm that would make it possible for any of the 1,600 or more Iraq veteran amputees to resume a semblance of a normal life.

Mr. Kamen, who designed the two-wheeled Segway balancing transporter and several high tech wheel chairs, and who has a wealth of robotic engineering expertise, said that he initially thought the idea “was nuts.”

A more extensive review of the two parts of the project is at Wired’s Danger Room where Noah reports on the two phases of the program.

Project 1 – the Holy Grail: Kuniholm and his fellow engineers at Johns Hopkins University’s Applied Physics Laboratory, or APL, are at work on the most ambitious prosthetics project in history. They seek the field’s holy grail — to build an artificial human arm that acts, looks and feels to its user like his native arm, and to do it with astonishing speed by the end of 2009. (called Revolutionizing Prosthetics 2009)

Project 2- Hedge your bets: The Kamen project: produce the best prosthetic arm possible with currently available technology

For now, both Deka and APL are based on cutting-edge myoelectric control systems pioneered by Todd Kuiken at the Rehabilitation Institute of Chicago, or RIC. Conventional myoelectric controls use electrodes on the surface of the skin to read muscle signals from some part of a user’s body unaffected by his amputation — his back for example — and pass the signal on to an artificial limb. The user twitches her back, and the limb moves in response.

A video has been released of the project’s progress so far in a demo. It was shown at the DARPA tech conference. You can check it out here (sorry can’t get the youare.tv player to run in wordpress blog engine).

Another video is here

Grand Rounds Vol. 3.25 is Up!

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

Grand Rounds 3.25 is up over at Scienceroll. A gret blog I have mentioned before it is run by Bertalan Meskó, a Hungarian Medical Student wit a passion for genetics. Definitely worth checking out there are about 60 posts but excellently organized in categories to make the reading clear and quick. A nice variety.

I am honored that he chose two submissions from docinthemachine (one I submitted and one submitted by somemone else!). There are links to my posts on :

docinthemachine’s first podcast on the coming technological revolution in surgery (in a new web 2.0 section of grand rounds )and also on new regulations to spread information and increase post marketing surveillance of drugs from the FDA

Future Vision in Surgery: Let the Podcasts Begin!

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

Here it is folks, docinthemachine’s first podcast to play on the site. This piece is near and dear to my heart. The Topic is “Future Vision” – and it’s about the coming radical transformation of surgery. I review how endoscopy allowed us to move from invasive to minimaly invasive surgery. What’s next? The transformation to microinvasive surgery (miniaturized robotic rovers inside the body) and non-invasive surgery (3D reconstructed diagnostic imaging and therapeutics via powerful computers).

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This podcast was an interiew I did at the 35th annual AAGL conference in Las Vegas. Coming soon I will post my keynote lecture on this topic with powerpoint and videos along with the entire plenary session on this topic featuring Dr. Chutkin (GI swallowable pill cams), Barish (radiology virtual imaging), and Andy Van Dam (yes the founder of sigggraph on virtual reality data manipulation).

you can read more of my ideas about the future of surgery including alternative visualization (seeing what the eye cannot) here

I hope you enjoy these as much as I did making them!

Video Fest of Brain-Computer Links & Control

Posted on March 5, 2007 by Steven F. Palter, MD

I have written before on direct brain-computer interfaces such as the monkey brain controlled robot arm, a woman with a robotic brain controlled limb, soldiers with brain controlled limbs, a paraplegic with a matrix-neural plug in his grey matter, and a brain cap interface for gaming. Damn- Kurzweil even predicts that once the singularity comes we will all be downloading our brains into computers forming humans v 2.0.

Now techeblog puts all the borg-matrix-brain-computer link videos in one place. Click here to see the future-fest.

New 3D Vapor Displays- OR Versions to Come

Posted on February 28, 2007 by Steven F. Palter, MD

Engadget reports on IO2 Displays new M3 Heliodisplay system. I have written before on these systems and played with them a bit (here is a video of my furry arm in one). They are similar in many ways to fogscreen (video here) in that they all display a pseudo floating image on a film of water vapor fog. Newer versions add gesture controlled interactvity. I cannot stress enought how much I believe gesture control will transform surgery.

The new version claims an improved tri-flow system for increased image stability and uniformity,” enhanced brightness and clarity, a 1,024 x 768 resolution, 16:9 or 4:3 aspect ratios, 2000:1 contrast ratio.

Right now these are party gizmos and great for promotional booths. I predict future implementations of endoscopic surgery will employ floating 3-D images with gesture control. A theme I have been preaching loudly as I write on futuresurgery.

Gesture Control: For the Surgeon and the iPhone

Posted on January 22, 2007 by Steven F. Palter, MD

Engadget reports on how Apple snapped up 2 hot engineers responsible for the Fingerworks device. This was an anazing device that pushed the envelope of computer gesture control with nontouch finger movements directing the show.

As they write:

Word is getting out of John Elias and Wayne Westerman, co-founders of FingerWorks, who were struggling to keep their dream of gesture-operated gadgetry alive when the company suddenly closed up shop a year and a half ago. Few doubt Apple snapped up the pair, and with interesting touchscreen abilities of the iPhone, it looks like it found a use for the men in some secretive underground laboratory. The greatest admission so far to such cahoots comes from Westerman, who said recently: “The one difference that’s actually quite significant is the iPhone is a display with the multi-touch, and the FingerWorks was just an opaque surface. That’s all I’m going to say there. There’s definite similarities, but Apple’s definitely taken it another step by having it on a display.” FingerWorks devices, which included a no-touch keyboard, mouse-less mouse pad and other multi-touch devices, have developed a bit of a cult following from “Fingerfans” on the internets, with people paying upwards of $1,500 for a FingerWorks keyboard that originally sold for $250. The ergonomics and usability enhancements of FingerWorks devices appeal to a small niche right now

Read about the concept of gesture control in medicine here and and see videos here. I am sure this idea will make it to the operating room of the future.

Futuresurgery- The Coming Radical Transformation of Surgery

Posted on November 17, 2006 by Steven F. Palter, MD

What is the future of surgery in the next decade? This will be a series of posts I will write on my vision for the future of surgery 10 years from now. The concepts are based upon the plenary session lecture I gave at the 35th Annual AAGL Global Congress of Gyn Endoscopy 2006 in Las Vegas. The session’s title was “Future Vision”. The core concept is that surgery has undergone a series of advancements over the past 100 years but yet remains essentially the same. That is until the development of laparoscopy which is the key development leading to a paradigm shift. Why? Because for the first time the surgeon’s hands and eyes are not directly linked to the patient. There is a technological interface between doctor and patient- the surgeon operates with remote instruments and views the entire procedure on a video monitor. This sets the stage for radical transformations in the next decade as the full gamut of digital technology steps into that interface. This is not supposition or wild fantasy- I will share with you the real-life examples that exist today or are currently in development that will radically change how all surgery is performed. As I told the audience of surgeons- most of what you do is destined to become obsolete in the next decade. Let’s paint a picture of a future that does not yet exist but for which the signposts are clearly written…

Observation #1: Endoscopic technology is maxed out. Endoscopy transformed medicine by allowing surgery to become less invasive with quicker recovery and lowered costs. Almost 100% of the surgery I perform is laparoscopic or hysteroscopic. For the layperson this is surgery performed with little telescopes passed into a body opening or through a tiny incision in the abdomen. As someone closely involved in instrument and procedure development I have seen that the technology is now mature (after only 20 or so real years of intense use) and little major progress can likely be made with current configurations. Back in 2000 I performed the world’s first HDTV laparoscopy– this pushed image quality to the resolution of the human eye. These systems are commonplace now. Any further increase in electronic resolution is meaningless since it would be beyond what the eye can see. I also worked on developing tinier and tinier microlaparoscopes (down to 0.5 mm) but these cannot get any significantly smaller or they will become so flimsy as to be useless.

Prediction 1: Alternative Visualization: This will be the first radical transformation of surgery. I predict a major revolution in endoscopic surgery will be what I call alternate visualization systems. The concept is to develop scopes that can see beyond what our native eyes can see. When this is achieved the scope becomes not just an extension of our human abilities and senses but augments our native abilities — enabling new and unimagined procedures. One example of this is the autofluorescent laparoscope I used for my recently reported research on endometriosis. Previously used in the lung, I figured out a way to use this system in the pelvis where it allowed the visualization of otherwise invisible endometriosis disease. Until now the scopes just gave us ordinary vision through a tiny incision. For the first time the scope technology now sees more than what the human eye can see by itself. Today surgeons are so excited by the introduction of robots into the OR but these are simply extensions of human hands. Alternative visualization is the first step along the path that will lead to technology and robots with non-human or superhuman abilities. For examples of the augmented visualization see the following posts on:

infrared imaging – available now to see veins through your skin- check out this video of it in action on my arm

near IR imaging– cameras that can see through tissue to locate potentially any hidden organ or disease.

As this series continues I will share with you examples of military and NASA technology for robotic rovers going inside the body, x-ray machines that can provide virtual imaging, and remote controlled surgery without touching a patient, virtual reality gesture control systems and more. Surgery will change from a doctor directly operating on a patient to a doctor coordinating a technologic system that executes the procedure. It’s all becoming real now. More than anything this is an exciting time of unparalled development. Do not fear the technology – be excited about what it will enable.

Update: My podcast from AAGL global congress on this theme now up

Related Posts: Why so much of this med development comes from military research.