The Next Revolution in Medical Devices: Self-Design and Prototyping

Posted on September 27, 2010 by Steven F. Palter, MD

have just returned from the Maker Faire and have seen the future of medical device innovation, invention, and design– Self-design and rapid home prototyping. For those unfamiliar with the jargon basically technology now exists that can allow the creation of a working prototype of a device from idea to an actual working hand-held version in a physician-inventor’s own home. This has the potential to democratize the process and eliminate previous massive cost and technological barriers that kept the process inaccessible except to large industry or those with substantial capital resources.

One person I spoke with was calling this the Next Industrial Revolution. To me this is clearly the inevitable technological evolution of design and device innovation following in the exact path blazed by desktop publishing, digital video and computer based editing for movie creation to name just two examples. –And once again it is fueled by the exponential progress in computer power –here married to a fanatical base of innovators driving the creation of the raw tools that will be the assembly line of the future.

What is Maker Faire? Maker Fair just had its first NY exhibit and is an offshoot of Make magazine. MAKE brings the do-it-yourself mindset to all the technology in your life. Think of it as technology-hackers. Its like wood-shop for the 21st century hacker who is building his own radio controlled spy drone or augmented reality device instead of oven mitts and hotplate coasters. AS they write “this is a magazine that celebrates your right to tweak, hack, and bend any technology to your own will. For example, in our first volume, we show you how to get involved in Kite Aerial Photography, how to make a cheap but effective video camera stabilizer, and how to build a device that reads the hidden information stored on the magnetic stripes on all your credit cards.”

Homelab laser engraver/cutter. can carve any substance with laser power and precision. cuts out 3D models too.

But that’s just the beginning. The sophistication of the home creation kits is mind-blowing.

This is a beagleboard. It contains all the power of an entire computer. It was running what looked like a normal desktop with a video capture and object recognition on a version of linux. It costs less than $500 and can be the basis for home-made computer intelligent devices. All open source as well.

At the Faire take thousands of people with this mindset, demos, kits, and lessons to “celebrate arts, crafts, engineering, science projects and the Do-It-Yourself (DIY) mindset.” And as usual for my tech crossovers— add one doctor to the group.

What’s The Medical Significance? As usual I search out emerging technologies not yet used in medicine that have the potential to right now change how we do things. What’s struck me with all I saw was the common theme that anything that was a high tech machine now today can be imagined, designed, researched, 3D modeled, and turned into working prototype all in a home workshop on an inventor’s budget. What’s more this now applies to the physical aspects (ie plastic casing and movable parts) and to the electronics being them embedded operating systems or any myriad of sensors. The theme of the day was that you yourself can see these projects through to this stage and there is a thriving community and ground-swell of momentum to build a grass roots infrastructure to help.

Examples of 3D Prototyping/Desktop Manufacturing:

The left image is a makerbot — you build this machine and then it produces 3d models out of plastic from 3D images on you computer. You can anything from an action figure to a device handle to well– the middle images was made on a higher end system like that shown on the right. here the machine first modeled the bones then applied a tissue layer over it. The system right now can take any 3D dataset from an ultrasound MRI or CT scan and reconstruct 3D tissue or organ models. I’ll follow up in a later post how scientists are using such technologies to literally build artificial organs in the lab– they build the structure then seed it with living cells that create the organ. The maker bot replaces a $100,000 fabricator from a decade ago and costs under $1500– and its all open source.

Could You Cure a Disease With a Device Invention? Does Your Child Think He or She Could? You’d be Surprised? The New Inventor’s Mindset for the 21st Century. You probably grew up thinking devices of all sorts and especially electronics were otherworldly gizmos of incomprehensible complexity of design. The workings of a TV, video camera, or electronic medical diagnostic device where the stuff that only biomedical engineer with a pocket protector and a degree from MIT could have created. Your kids think otherwise. They are comfortable with technology and with programming computers when presented with understandable languages. They can make a webpage. They can edit video and retouch photos. They have a myspace page. They may tinker with remote control toys. Many of them with some practice can create 3D computer graphics. Just recently A Russian amateur filmmaker called Alexander Semenov produced this 2.5 minute bootleg Transformers short with a couple of sub-$1,000 cameras, two hours’ of footage and a month in the home desktop editing suite that many think rivals the effects of a million dollar Hollywood blockbuster.

Understand that the next generation of design and creation tools will use these same sorts of visual programming language and are just as accessible. I walked through the exhibits with a 6 and 9 year old. By the end of the day the 6 year old had soldered an LED lit circuit board to make an electronic toy (parts cost $1), both had piloted radio controlled robots complete with sensors, and had begun to design autonomous robotic creatures– and they had never done this before. I was recently asked to give a talk to a group of 4th graders working on the Lego First competition. This is a robotics competition for kids to build working devices. There are more than 10,000 teams competing this year. This year’s theme is biomedical research. They kids were instructed that they have the tools to invent a device that could solve a medical problem. They don’t believe only MIT engineers solve problems. They expect to. Remember who invented youtube and facebook.

home kit for sensor based mobile search and rescue bot. The same sophistication as a military robot and the same technology as in implantable body rovers being developed.

robotic arm prototype- could model prosthetics

home made kit for scanning tunneling microscope for research uses. A scanning tunneling microscope (STM) is a powerful instrument for imaging surfaces at the atomic level. Its development in 1981 earned its inventors the Nobel Prize in Physics in 1986. For an STM, good resolution is considered to be 0.1 nm lateral resolution and 0.01 nm depth resolution.With this resolution, individual atoms within materials are routinely imaged and manipulated. This is now a do-it-yourself kits for under $200 all open source design and technology

First Ever Surgical Video in 4k Ultra High Def- Hollywood and Doctor Team Up for Revolutionary Projects on Future Visualization in Medicine

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

our digital cinema control room- Sony controls

For the first time ever Hollywood’s digital vanguard has teamed up with a surgeon to use tomorrow’s cinematic tools to revolutionize visualization in the operating room. We successfully filmed produced and played a 4k digital cinema movie of a live human surgery. This was an amazing collaboration between a fertility surgeon, the AAGL endoscopy society, Sony Medical & Broadcast divisions, Red Digital Cinema Camera Company, FotoKem, Vincent Pace films, USC professor Richard Weinberg, and the NBA just to name a few! We also showed the largest medical 3d displays ever.

The AAGL reported on this groundbreaking session today . Further details are here and here.

Dual Sony SXRD 4k projectors in 3D scaffold

New cinematic technologies are transforming the film business today. The two major revolutionary developments are 1) ultrahigh definition “4k” technology – which brings resolution to 4 times that of HD and 2) realistic immersive high definition 3D. I set out to introduce these technologies to the medical world and to see if we could for the first time apply them to surgical practice- setting the goal to once again use technological innovation to improve our patient outcomes.

Virtually all of my surgery is endoscopic- performed through tiny telescopes and viewed on a TV monitor. In 2001 I performed the world’s firs HDTV surgery and demonstrated how increased resolution improved the surgeon’s visualization and performance of procedures. For those interested in the history of HDTV surgery and the details of its development further details of my work are here from the New York Times and here from Science Daily and here from MIT Technology Review. Over the past two years I refined this work with even better performing camera systems and this work was featured on 20/20 and on the National Geographic Channel’s first ever HD medical show – Inside the Living Body.

Hollywood is embracing its digital future by adopting (with $1 billion in financing and a follow-up deal by Sony) planned conversion of 20,000 theaters to ultrahigh definition 4k (4096x 2048) video. The revolutionary Red One camera is one of the few that can natively record this type of file. Having heard about it I went to vegas for NAB in April and saw with my own eyes the amazing realistic movies being made with it. While there I met with Ted Schilowitz, Red’s “Leader of the Rebellion” and was ecstatic with his desire to help with with a proof of concept- to film surgery with a 4k camera. I also partnered with Sony’s Medical and Broadcast Divisions who eagerly helped me set up a 4k and 3dHD digital cinema in an international medical conference hall in the Las Vegas Paris Hotel. The theme of my Keynote lecture was “Film and Medicine: From the Past to the Future- Through the 4th Wall.” In this, I traced how cinematic film technology has transformed the teaching and performance of surgery- and how the future will again have revolutionary changes in physician visualization. Our Hollywood partners allowed me to first show jaw-dropping pro-sports and theatrical demos of the technology.

Sony’s digital cinemas allow the next generation of film to be projected at these previously impossible resolutions. We used dual SXRD 4k projectors with linear polarizing filters for 3D HD then went to a single projector for the 4k. 4k footage has to be played off a dedicated media block digital server and we used an LMT-100 like a movie theater would and FotoKem converted the 4k files into a DCP digital cinema package that can be played. For 3d footage we played off an HD SR tape dual stream deck. I’ll post a follow-up explaination of each of these technologies in detail.

By increasing resolution to this level we allow the surgeon to be actually immersed in images that surpass the live surgical experience. The progress from regular surgical film technology is like comparing sitting in an HD home theater to watching a video on a cell phone.

Ultra high resolution digital cameras are transforming the art of cinema. Leading Hollywood directors such as Peter Jackson and Stephen Soderbergh today have just started filming the next generation of cinema blockbusters using cameras with “4K” resolution, four times the resolution of High Definition (HD) with 4096 lines of resolution to give audiences unprecedented realism. The Red One digital cinema camera is the at the forefront of the revolution. Director Soderberg previously described this technology as “This is the camera I’ve been waiting for my whole career: Red is going to change everything….Shooting with Red is like hearing The Beatles for the first time. Red sees the way I see.”

Amazingly, the surgeons in the conference were able to visualize the surgery they were watching better than if they had been in the operating room live. If it can transform the immersive experience of the movies with unprecedented realism wouldn’t you want that degree of vision in your surgeon’s hands? By combining unprecedented resolution and magnification the surgical images were beyond what a surgeon would have standing live in the operating room. Those in the audience predicted this technology would further revolutionize minimally invasive surgery as it becomes incorporated into the OR of the future.

We then projected the largest high definition (HD) 3d surgical images ever. Wearing glasses reminiscent of today’s 3d Hollywood blockbusters U23D and Journey to the Center of the Earth a standing-room only crowd of 1600 surgeons felt as if they could “reach out and join the operation”. These images were enabled by converting Sony’s ultrahigh definition and 3d theatrical systems to show medical footage in what the AAGL called the “Theater of Tomorrow.” A Vince Pace 3D demo reel showed where Hollywood is going as well with Gwen Stefani concert footage, underwater vistas, and movie clips.

Since laparoscopic surgery is performed by a surgeon watching on a video monitor making the images “better than live” may facilitate teaching and procedures in the future.

The 4K system, manufactured by RED Digital Cinema Camera Company, was used to film Jumper, Crossing the Line, and The Argentine. This recording represents its first use for medicine and biology in the world. In addition to a surgery we showed the first ever 4k microscopy images of single cell organisms ever recorded (from USC).

Stay tuned a for a series of posts coming up this week that will review the session, how we managed the collaborations, the difficulty in executing each of the technologies, and where I predict this is going in surgical visualization.

FDA Update: Ophthalmic Device Panel Meeting To Review Implantable Eye Telescope

Posted on April 11, 2008 by Steven F. Palter, MD

The FDA Ophthalmic Devices Panel will meet Apr 24, 08 8:30 AM – 5:00 PM & Apr 25, 08 8:30 AM – 5:00 PM in the Gaithersburg Holiday Inn, Ballroom – 2 Montgomery Village Ave. Gaithersburg , MD

On April 24, 2008, the committee will discuss, make recommendations, and vote on a premarket approval application, sponsored by VisionCare Technologies, Inc., for an implantable miniature telescope (IMT™). The IMT™, a visual prosthetic device, is indicated for monocular implant in patients with stable, moderate to profound central vision impairment due to bilateral central scotomas associated with end-stage macular degeneration with geographic atrophy or disciform scar, foveal involvement and cataract.

Since these diseases lead to central dysfunction of the retina the implantable telescope spreads the visual image over a larger area of normal retina.

The prosthetic telescope, together with the cornea, acts as a telephoto system to enlarge images 3X or 2.2X, depending on the device model used. The telephoto effect allows images in the central visual field (‘straight ahead vision’) to not be focused directly on the damaged macula, but over other healthy areas of the central and peripheral retina. This generally helps reduce the ‘blind spot’ impairing vision in patients with AMD

New Technique Sees Inside Blood Vessels in a Microsecond

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

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.”

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!

How Smartdust, Souveillance, Web 3.0, and Personalized Genetics Will Transform the Future of Medical Diagnostics

Posted on February 25, 2008 by Steven F. Palter, MD

There has been a flurry of debate in the military, industrial, and privacy sectors on “smartdust” and the concept of “souveillance” – but no one has yet realized this technology is poised to springboard into medicine and transform medical diagnostics. Here I wanted to give you an overview of what this idea is and why you should keep your eye on it.

First the general concept background:

“Smartdust” refers to micro devices (called motes) which are detection microchips each potentially the size of a speck of dust. These grains of sand however can automatically self-network. So far people have conceived of these low-power distributed sensing networks as having functions for climate control systems, entertainment devices and especially for big brother type surveillance systems.

Wikipedia wrote “the smartdust concept was introduced by Kristofer S. J. Pister (University of California) in 2001 , though similar ideas existed in science fiction before then. A recent review discusses various techniques to take smartdust in sensor networks beyond millimeter dimensions to the micrometre level. A typical application scenario is scattering a hundred of these sensors around a building or around a hospital to monitor temperature or humidity, track patient movements, or inform of disasters, such as earthquakes. In the military, they can perform as a remote sensor chip to track enemy movements, detect poisonous gas or radioactivity. The ease and low cost of such applications have raised privacy concerns.” Beyond web 2.0 vast networks of these real time sensors are once possible technology leap of the yet inknown web 3.0.

General concept – What is Souveillance?: is a term from Steve Mann that refers to “bottom up” surveillance using smart dust as opposed to “top down” big brother networks looking at us little people. Here instead activities are recorded from the “perspective of a participant in the activity, typically by way of small portable or wearable recording devices that often stream continuous live video to the Internet.” Remember the impact of the Rodney King video and of all the user generated video content on the web. Now fast forward to a world where a large segment or even a majority of the populice had real time streaming video devices on all the time (no we are not going to discuss the porn angle on this). This has also been called “inverse surveillance”.

Privacy advocates have been debating the merits or horrors of this type of sensor technology. I serve on the Scientific Advisory Board of the Lifeboat Foundation which is dedicated to protecting us from future technological threats through advocacy research and education. They have been having a heated debate on the “paradox of smart dust: we may not live without the greater security provided by smart dust, but many think they could not live with smart dust impinging on our privacy.’

Medical Implications: I have a vision that once this type of low power networked microsensor technology exists it will logically lead to medical sensor technology. Potential uses I see include:

mass screening for infectious disease or bioterror agents. Subjects walking into screening areas could be checked for signature molecules associated with infectious agents. Just as we have metal detectors and now have molecular signature detectors (the litle wipe test for explosives at the airport) we will have such biological screening techology.
The next step will be similar screening for disease states. Metabolomics is one such technology. Metabolomics is the study of the small-molecule metabolite byproducts left behind from cellular processes. In simple terms it’s like examining poop. The concept is that by measuring the collection of all the byproducts of the cells metabolism you can get a snapshot of the physiology of a cell or organism that translates to health. One such sensor is being developed as a breath sensor for disease. This could lead to Star Trek like medical sensors.
Similarly, such technology will lead to individual genetic screening for disease risk using chips that interact with the tiny bits of DNA we shed every time we touch something. Companies commercializing this approach also already exist and have products.
Taking a clue from smart dust we will then inject such sensors into our bodies where thy could circulate in the bloodstream or sit in the abdminal cavity silently sensing for disease, infectious agents, or the DNA or signature molecules of a cancer cell. Alternative chips could exist that sit and slowly release drugs when such cell reappear once a patient is diagnosed.

I will be writing more about the details of these concepts and devices being developed in future posts now that I have introducted the concepts. Let me know what you think!

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.

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!

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.

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

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Category Archives: Robotics