State-of-the-art cardiology

The emergence of new procedures and developments in all aspects of imaging and intervention in the field of cardiology have led to greater demand for installations that facilitate live procedure demonstrations.

Adrian Banning conducting Oxford Live from the lab.

The latest systems feature multi-image presentation in a variety of styles.

Dr Suneel Talwar conducts a session in the large lecture theatre.

The audience moderator controls the live session by a touch panel and has open two-way audio with the lab.

The selection of images for the audience is also shown in the lab to keep communication fluent.

Recent installations at John Radcliffe Hospital in Oxford and at the Royal Bournemouth Hospital encompass the latest design features for systems installed by Video South.

These systems can be used to support courses in intervention, CRT, laser therapy, TOE and any procedure with visual elements with which an audience can engage.

The systems are quite complex, as the range of images available grows, but can be operated entirely by local staff and involve very little preparation or work in the lab itself. This is achieved by using touch-panel control in conjunction with an intelligent processor which automates the settings and sequences of the transmission and AV system.

Some key improvements in the technology we can deploy in such systems have proved especially relevant for cardiology procedure demonstrations:

Multi-image display: Now that most projectors and flat-panel monitors are built to display in 16:9 widescreen HD resolution, we can make use of this ubiquitous format to display multiple images simultaneously. The images being generated in labs tend to be 4:3 aspect (nearly square); this applies to fluoroscopy as well as EP modalites and ultrasound. Thus two or three of these can be ‘mapped’ on to 16:9 and then transmitted to the audience. In this format all images are reproduced at good resolution.

Touch-panel control: By adding touch-panel control to this multi-image display ability, the audience moderator has a powerful tool to select the images from the lab and also choose a screen layout for them.

The moderator can select images per window on screen as the procedure progresses. The control is activating image selection and the image layout from equipment at the lab, no matter how distant this is from the audience location. Because this selection and layout is physically at the lab end, it is also a simple matter to have a monitor on the wall of the lab which displays the image selection and layout. Thus the operator is always clear what the audience is seeing. This helps with descriptions of images and explanations and ensures that moderator and operator are working in harmony.

Transmission in HD over fibre: In order to transmit a compiled multi-image and audio to an audience, reliably and without time delay, we needed lower cost fibre-optic equipment designed exactly for this purpose. This is now available and has the added advantage of being completely secure. This type of connection is dedicated to the purpose and not part of a general network or connected to it in any way.

As the demonstrations involve current patients and free discussion between colleagues, being entirely secure is valuable and could even be seen as mandatory. The lack of any time delay in image or audio keeps discussion fluent and helps ensure that the procedure does not take longer than it should just because an audience is involved.

Transmission in HD over fibre also has the advantage that a lossless recording of the multi-image screen and the two-way audio can be made and controlled from the touch panel. Also, a network connection to distant locations can be made from the seminar room and can be under the control of the moderator or the lab.

Thus the advantages of network connections reaching distant global locations can be employed – and since the local connection to labs is lossless, there is no quality issue with this method and security issues can be better controlled for occasional events. Indeed, the John Radcliffe system incorporates this technology. It is used to link the annual intervention event ‘Oxford Live’ from the department to the medical school lecture theatre over the IP network.

A variety of procedures can be demonstrated by these techniques. In all cases, the high-quality, two-way audio is a great benefit, also as a result of using direct wide bandwidth fibre. Demonstrators wear head-clip radio microphones (we recommend Sennheiser). In this way the audio is close up to the operator, without background or room noise. This intimate feel of the audio is better than being in the lab!

On that subject, we now have a system of headsets/microphones that communicate with each other as well as to a remote room. In the United States these ‘teamwork’ headsets are already proving popular, especially with CRT specialists. Even if team members move out of the room, to the technical area say, or even the consumables’ store, they can stay in audible communication with each other at all times.

Intense procedures using lasers or using EP in CRT can be followed better on screen, with open two-way audio, than attending the lab itself. This is the standard we can now reach in these installations and why more and more centres are installing the facility. Cardiology is a progressive and growing discipline that will require considerable training infrastructure in the next ten years.