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.

Docinthemachine is Back!

Posted on January 29, 2008 by Steven F. Palter, MD

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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.

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!

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…

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

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 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.”

The 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).

Directing 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.

Showing 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).

Bob Brown, the Producers, and the docinthemachine

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

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.

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.

HD Endoscopy Series Coming

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

I have been inundated with requests for information and critiques of Medical HD endoscopy/laparoscopy systems. To meet the rising tide of demand for information I will begin an ongoing series of posts of HDTV in surgery, laparoscopy and endoscopy. You can read about my testing of the World’s Highest Resolution HDTV Surgical Camera – Ever! – First Exclusive Evaluation here.

New HD Photo Compression System Could Help Surgical Archiving

Posted on August 3, 2007 by Steven F. Palter, MD

Microsoft on Tuesday announced that the Joint Photographic Expert Group (JPEG) is considering standardization of the company’s HD Photo file format. Tentatively titled “JPEG XR,” HD Photo was introduced with the release of Windows Vista.

Medical Opportunity?While not as glamarous as a fashy new gizmo the file format could provide an opportunity to obtain very high resolution photos with better color reproduction with higher compresion and imaged and archived faster. All of this will benefit our ability to image from endoscopic surgery and help propel the OR to a wireless environment.

You can read about operating room surgical image archiving and what I have been doing with HD video here and about recording video in HD from the OR here

HD Photo – once known as Windows Media Photo is a new file format for digital photography that Microsoft claims offers better image fidelity, higher image compression efficiency more flexible editing features. It supports both lossy and lossless compression. Microsoft claims that HD Photo offers image comparable to JPEG-2000 with less performance and memory drain, and that it can deliver better quality images than JPEG at less than half the file size. They also claim”

The HD Photo image-coding technology, incubated in Microsoft Research and developed by Microsoft’s Core Media Processing team, offers a host of new features and benefits focusing on the current and emerging needs of digital photography. The technology, which shipped in Windows Vista^®, is a new file format for end-to-end digital photography that offers better image fidelity, higher image-compression efficiency and flexible editing features benefiting today’s and tomorrow’s digital-imaging applications. This next-generation digital image format unlocks new potential for digital photography capture, printing and display devices as well as applications and services.

and further ” “Higher compression efficiency offers faster wireless uploads for longer battery life and an enhanced dynamic range that will help improve photographs taken in low-light conditions with a mobile phone or digital camera that does not offer sufficient flash assistance.”

here

How We Recorded the World’s Highest Resolution Surgical Footage

Posted on August 2, 2007 by Steven F. Palter, MD

My last post outlines the equipment I used to perform the world’s highest resolution endoscopic surgery. Here I wanted to share what we had to do the record the footage at full HD resolution to get it to National Geographic for their HD feature “Inside the Living Body”. Archiving HD surgical footage has been a significant shortcoming of many of the existing systems.

First some historical background on archiving endoscopic surgery stills and videos. Surgical endoscopy is archived mainly via still photos. Surgeons keep a few shots of the main pathology seen or a few before and after shots. Those who like to keep videos have mainly used simple consumer VHS (there is a huge medico-legal debate in the field if it is protective or dangerous to record all of your surgeries but that is another discussion). You can imagine the nightmare of storage of a library of tapes that accumulate over the years! For more than 10 years I have used S-VHS to get a slightly higher resolution capture. I was limited since the OR systems best output was S-VHS. For years (sadly more than 10 years) I have been trying to get the surgical equipment companies to put a firewire IEEE 1394 output on the camera units. This would allow me to hook up either a mini-DV deck or digital disk based recorder that did not require analog capture and digitization. They never went this route. I wanted to use miniDV because of its higher resolution, ease of digital editing, and smaller form factor than VHS. Remember back when this started there were not small affordable devices that could capture analog video on the fly and convert to digital as there are now.

Next, the surgical video companies went to digital capture and archiving. I loved the digital still capture that let me capture photos for lectures or the patient’s chart and burn it to a CD-R or DVD-R (actually when this started we were using horrible proprietary strange disk formats now extinct unreadable and sitting in my archives). The captures are ok JPEG or TIFFs. I wish they captured at higher resolution with less compression artifacts. One problem I have seen in some ORs is that the machines are actually set for a low resolution capture which makes no sense at all. They then added direct digital video capture and recording onto the same disks. The quality of these captures is hugely variable between systems. Some capture full motion 30 fps video at a decent resolution whereas others look like blocky jerky garbage. Sadly, I usually have to jump into the capture system’s configuration menu before I start a case in many OR’s. Just today I was working with a state-of-the-art system installed in one of my local hospitals just last week. It was one of the newest HD systems. In fact the manufacturer’s rep was in this morning doing an in-service and configuring the system for optimal use. As usual, once in the configuration menu I found the still captures configured for the lowest resolution 640 x 480 BMP and the video on its lowest MPEG-1 setting. As usual, configured for the lowest quality settings.

New HD Recording System we used: Since we were operating in 1920 x 1080p for my HD project we needed something that could digitally record at this high resolution. We chose the new Sony XDCAM HD Professional Disc Recorder. This systems records 1080/59.94i, which Sony calls 1080 60i.

Because our camera outputs true 1080p, in order to record we first have to scale the image down to 1080i using a Gefen DVI to HD SDI scaler. The resultant 1080i signal is what is input to and recorded with the XDCAM HD deck to a proprietary Sony Professional Disc that is actually based on a Blu-ray disk (sorry won’t play on your PS3 – the disk is in a protective hard shell holder and recorded with a different format than consumer Blu-ray).

The XDCAM HD records HD input in MPEG2 HD, a Sony format. This MPEG HD 1) is designed to yield high-quality video and audio recording and playback. The MPEG HD 1) codec provides video compression compliant with the MPEG-2@HL standard. It enables HD 4:2:0 digital compression recording in the 1080i (1,180 effective scanning lines, interlaced) format currently in use in many broadcast facilities.

There are three selectable video bitrates: HQ at 35 Mbps, SP at 25 Mbps, and LP at 18 Mbps. The resultant “clip” is an MPEG HD file which bears the suffix .MXF.

Another aspect of this recording medium is that it converts the input 16:9, 1920 x 1080 video to a 4:3 1440 x1080, then stretches the output back to 16×9 using non-square pixels (1:1.33). this is similar to the way DV format handles wide screen in Standard Definition.

Next I had to get an exact copy of this disk to National Geographic in HD. As Eric Portlow the video engineer wrote me “We can create a 1:1 copy of the original disc. Because the Deck captures an MPEG HD file to disc and can be accessed as one would an external hard drive using File Access Mode (FAM) via an firewire interface, it is possible to create duplicate discs by importing all content from one disc to the computer, then exporting all files and directories to a blank disc. The result is a lossless copy of the original. If you would like to have an exact duplicate of the original footage in XDCAM HD format, we could do this but it would require your having access to an XDCAM HD deck to view or access the file.

Our other option would have been to use HDCAM SR, DVCAM or DVCPRO

Stay tuned for the next post on HD in the OR hype vs reality