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

New Program for Centers of Excellence in Minimally Invasive Gynecologic Surgery Launched at International Congress of the AAGL

Posted on November 23, 2009 by Steven F. Palter, MD

BREAKING NEWS: First description- full free slideshow with audio of project and podcast

I am honored to share with you on docinthemachine.com my Presidential Report from the CGE of the launch of the Center of Excellence Program of the AAGL CGE. With 38 years leadership in Gyn Minimally Invasive Surgery the AAGL is uniquely qualified to share its educational mission by verifying those Centers that meet these standards.

The AAGL Global Society for Gynecologic Minimally Invasive Surgery Launches Center of Excellence in Minimally Invasive Gynecologic Surgery Program at Annual Meeting November 16-20, 2009 in Orlando, Florida —dedicated to establish and verify standards at surgical facilities and hospitals.

(click green play arrow to hear presentation audio and automatically advance slides)

The primary objective of the AAGL and its professional interest partner the Council of Gynecologic Endoscopy (CGE) is to promote the adoption of minimally invasive gynecologic surgery with its reduced morbidity, shorter post-operative recovery time, less invasiveness, and reduced costs.

Our Analysis of patient and provider needs worldwide showed that there are widely divergent qualities of practice and that patients and providers have difficulty in identifying excellence. There is a lack of national standards to improve outcomes. While payors seek to control costs/outcomes patients lack access to the educational resources to direct them to the appropriate center to meet their needs in many cases. As I stated in my address:

We recognize in the modern era of health care we have a unique opportunity as well as an obligation to use our educational resources and multidisciplinary expertise to help promote those systems and procedure which can improve patient outcomes in women’s health while reducing costs to both patient, payor, and society as a whole.

The CGE has therefore launched two new programs to address these needs.

First is an individual registry of physicians based upon peer review of operative experience and complications. The CGE, founded in 1996 has over 1100 individual gyn surgeons who have meet its standards. The new program integrates an evaluation based on today’s complexity of procedures in minimally invasive surgery. It is a tiered system with 3 levels of practice (based on procedure complexity) and 4 areas of proactive experience and specialization (General Gynecology Procedures, Fertility Enhancement Surgery Procedures, Repair of Pelvic Floor Defects & Urogynecology Procedures, Gynecologic Oncology Procedures)

Second is a Center of Excellence Program In Minimally Invasive Gyn Surgery. This is in recognition of the modern notion that to achieve best-in classs surgical outcomes requires not only an expert surgeon, but an integrated multidisciplinary surgical facility with systems and procedures in place to maximize quality cost effective safe outcomes for patients.

9 Requirements: Areas of Review To Qualify as a COEMIG:

Institutional Commitment to MIGS
Director of Division
Medical Staff Physician Qualifications
-Dedicated Educational Program
-Formalized Credentialing Guidelines & Systems to Introduce New Procedures
-Procedures for Minimizing Complications
Sufficient Experience with Procedures
A Full Complement of required Non-Surgeon Consultative Staff
Ancillary Staff
-Dedicated Team-Based Concept
-Dedicated non-physician Educational Program
Equipment Guidelines
-Availability & maintenance
Treatment pathways
-Linked to Peer reviewed Practice Guidelines
HIPAA Compliant prospective Outcomes Data Tracking

In my presentation launching this program at the AAGL annual meeting I shared

The AAGL is extremely excited and totally committed to the concept of Gynecologic Minimally Invasive Surgery Centers of Excellence. It represents a unified vision for women’s health that integrates our entire educational mission and expertise over the past 38 years.

First Ever Global Opportunity for Standards of Excellence:I was equally excited to present the concept to the Affiliated Societies of the AAGL which is made of representatives of National Minimally Invasive Gyn Societies from around the World. Our dedication to this concept and recognition of its value was shared by representatives of Partner Societies from South America, Europe, and Asia. We agreed to work together collaboratively to establish a shared Global Standard and to establish a shared program to advance Women’s health under the AAGL CGE COEMIGS program in cooperation with each Nation’s Society.

I will share further details of the program with you here as they are released!

Details of the society are are on the website of the AAGL

Information on the CGE

Information and Applications for the COEMIG Program

AAGL CGE COEMIGS Program Launch Information [ 10:57 ] Play Now | Play in Popup | Download

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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Friday Fun Post- Human Statue Video

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

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

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

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

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.

New Laparoscopic Device Stops Harpooning of Patients

Posted on February 6, 2008 by Steven F. Palter, MD

While at the Global Congress of Gyn Endoscopy I saw a really neat new device called LapCap designed to reduce the risk of entering the abdomen in laparoscopic surgery.

What is the problem- why is this needed? In laparoscopy the first step where the surgeon gains access the abdominal cavity is often a blind entry step. There is a risk of injury to internal organs such as the bowel, bladder, or blood vessels. While rare, these injuries can be severe or even life threatening. If you want to read more about laparoscopic access and the risks of entry into the abdomen here is a link to an article I wrote for a Master’s Class in Gyn Surgery on this topic.

What is done in standard surgery: The most common method used by gyn surgeons is the insertion of a needle (the veress needle) which fills the abdomen with carbon dioxide gas (called insufflation). Then a tool called a trocar is inserted into this space and the instruments go through this. The needle insertion step is the most dangerous because it is the blind step. various techniques are used including elevation of the abdominal wall to lift it off of and away from the underlying organs expecially the large vessels like the aorta nad vena cava. The second common method is the open or Hasson technique (invented by my good friend Gyn surgeon Harry Hasson) where the surgeon opens a small 10 mm incision and then inseted the trocar. Injuries occur with all known techniques.

The New System: The LapCap is a new system that puts a plastic dome on the abdomen attached to suction that then pulls a full thickness of the abdominal wall high up into it then allowing the veress needle to be inserted into a potentially larger and they claim safer spot. The LapCap device received 510(k) approval from the FDA and is sold by Aragon Surgical. It won an award from the SLS for new device innovation. Here is a video from the company of it in operation. I know surgeons who have used and were quite impressed and I will likley be involved with surgery using it soon. I know that laparoscopic innovator and friend of mine Camran Nezhat is one of their advisors. I will be speaking with him more about his experience.

Potential problems: Two major issues- first statistical proof of demonstration of increased safety is nearly impossible for access devices such as this because the injury it might reduce so very rarely happens. One study on this problem estimated that it would take a study of more than 200,000 people having the operation to adequately demonstrate reduced injuries statistically. Second- one of the major risks for this sort of injury is when the bowel is adherent to the abdominal wall at the site of entry from previous surgery. I would not expeect this device to help at all in this situation because the adherent bowel will be picked up with the abdominal wall. However it is the vessel injuries that ar emost dangerous and this device might reduce the risk of those if it places the needle much farther away.

About the company: They appear to have acquired the device via an acquisistion of starup Verisure. It was reported last month that they “raised $25 million in a Series B round of venture capital with the hopes of having five products on the market within two years. In a statement on Monday, Jan. 7, Aragon said new investors Bay City Capital of San Francisco and Integral Capital Partners of Menlo Park, Calif., joined original investors Delphi Ventures and Onset Ventures, both of Menlo Park. They formed Palo Alto, Calif.-based Aragon in May 2005 to advance radio frequency technology developed at Stanford University Medical School for use in laproscopic and other surgeries. Bay City Capital was the lead investor in the most recent round.”

I have spoken about the use of RFID for surgical and laproscopic procedures for several years and look forward to seeing where they go with it. I know they also have tissue sealing and dividing technology and are part of the Delphi portfolio. I had a phone call with Delphi last year as part of due diligence they were doing for another company and did think highly of them and their approach. More details of the deal are here.

OCR to the Rescue: Device Reads Any Text for Blind

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

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

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

Kurzweil recalls the invention of the First OCR Reader in 1974

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

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

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

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

DARPA’s Battlefield Robot Medic to Deploy in 2009

Posted on August 8, 2007 by Steven F. Palter, MD

This year is the 50th anniversary of DARPA, or the Defense Advanced Research Projects Agency, the Pentagon research arm who turns science fiction fantasy into military reality. DARPA conducts high-risk military research and in the process develops amazing medical technology. To kick things off right at their 3-day DARPA tech conference (or official site here) they announced the upcoming deployment of the remote battlefield medic/surgeon Trauma Pod robotic system by 2009! Surgical robotics was initially conceived by DARPA as remote battlefront or space surgical robots and this technology is now widely available in the DaVinci surgical robots.

As Popular Mechanics reported from the Conference: (skip to the end for links to videos)

the first portable, self-contained surgical robot will be deployed in the next two years. Brett Giroir, director of the research agency’s Defense Sciences Office also announced that the system, called Trauma Pod, has successfully “treated” a mannequin during a test, with no complications.

A single human will operate the robot remotely during surgery, but Trauma Pod will be able to perform a number of functions, such as fluid administration and surgical assistance, autonomously. The goal is to stabilize injured soldiers as quickly as possible, and previous Trauma Pod designs have included related systems that evacuate the patient. Giroir said that a prototype will be delivered to troops within two years.

Details of the System and its Use:

According to DSO Director Brett Giroir, the goal of the Trauma Pod is to conduct “emergency control surgery.” That means diagnosing and treating major trauma, focusing on airway management, head wounds and, as Giroir put it, “controlling uncontrollable bleeding.”

And while a surgeon will be controlling some of the Pod’s functions, such as the more invasive procedures, the system relies heavily on autonomous control. The robots in the Pod would insert breathing tubes and IVs, but the surgeon would direct the scalpel. Even during remote operation, auto-targeting systems will assist the surgeon, completing or fine-turning certain actions. “It’s not doing surgery the way a person is,” Giroir said. Instead of an exercise in advanced telepresence, the Trauma Pod is a synthesis of human judgement and robotic precision. Much of the surgeon’s input will be to tell the robots not to do something, such as inserting a breathing tube. Many of the systems are still up in the air, but Giroir expects the Pod to rely on CT scans for diagnosing trauma, and various surgical instruments that, as depicted in the video, the robots will literally grab out of a rack. It might incorporate technology from other programs, such as a device that triggers coagulation in a severed artery through high-intensity focused ultrasound.

Getting the patient off the battlefield and into a hospital is another matter. While the Pod is supposed to eventually meet certain size and weight restrictions, there are no plans yet to incorporate specific vehicles. Giroir does believe it will be compact enough to fit in the back of a Stryker vehicle, for example, and the experimental model that will be delivered in two years might still need to be trimmed down. The Trauma Pod is expected to be used by the Army initially, with possible, full-production deployment happening between 2011 and 2013. That’s a very rough estimate from Giroir, and much of the timing will depend on how quickly the system can be miniaturized, and whether it actually works.

Giroir was also excited about the Pod’s potential civilian use, for when trauma centers are often too far away to save a patient’s life. Local hospitals could stock a single Trauma Pod, and have a surgeon thousands of miles away assist in stabilizing the patient.

They say there are no video or photos available but here at docinthemachine I posted a report and videos of the systems concept and prototypes back last year. You see the post and all the clips at Awesome Army Videos-Terminator 2025 Battlefield Surgery Built NOW!

For Those Who Want More DARPA Hi Tech Medical Information: I have prevously written about DARPA and the medical offshoots of its research . You can read about why DARPA can take the big risks in medical development private industry won’t in Risky Business:Why DARPA Does What Medical Industry Won’t. Be sure to read Army Axing High-Tech Soldier of Tomorrow- MedTech Losses Predicted for all ofthemedicalbenefits of the Soldier of Tomorrow “Land Warrior” Program. You can read about the history and future projects planned by DARPA in 2007 in DARPA Releases Strategic Plan 2007 and about it’s amazing array of projects in DARPA 2007 Pt2: Major Achievements, Future Plans, & Medical Benefits (including Newton’s Laws for Biology, Prosthetics, Biological Warfare Defense, and Real-Time Accurate Language Translation).

Come back tomorrow for my next post reviewing the other robots they showcased…

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