- The London Chest Hospital is a tertiary centre for cardiac disease and treats patients from Northeast London through Essex to the coast. It is also an important unit for teaching and training. Professor Martin Rothman has hosted "masterclass" postgraduate courses for many years.
"With superb image quality, open and relaxed audio, and touch panel ease of use, this is a system used by cardiologists to benefit cardiologists."
- One highly developed area of expertise is radiologically guided micro-invasive techniques carried out with real time x-ray as the guiding image. This all comes under the usual term for the high technology room in which such procedures are performed, a "Catheter Laboratory" or Cath Lab.
- In these rooms a patient lies within an x-ray field generated by a large imaging arm, which can track up and down the body and provide the doctor with real time on-screen imaging of the procedure. Treatments include dilating blood vessels with high-pressure balloons, sealing off unwanted vessels and holding open large vessels with spring-metal stents. Most of these devices are introduced to major vessels near the heart by means of long thin tubes call catheters.
- The techniques are complex, time consuming and very visual. There are many measurements and checks along the way and a complete team participates in a technology driven environment. Demonstrating these procedures using live television and data links has proved a very effective way of both sharing new advances with peers and carrying out aspects of the training with junior staff.
- Alistair Holdoway, Managing Director of Video South, explains: "Our job is to create a telepresence of the procedure in a remote seminar room. This is almost total immersion. The trainees need every visual input the demonstrator is using and relaxed open audio between them." The images in play include: a wall-mounted pan/tilt/zoom camera for orientation, room and equipment views, a camera on a ceiling-mounted spring arm to allow close ups of the body surface, catheter introduction and views of miniature tools prior to use.
- Then there are the views being used by the medical team: One or two live x-ray images (some labs screen in two planes simultaneously) and a reference x-ray still image taken as a record and "road map" at points in the procedure. Then there is sometimes an ultrasound screen used to visualize activity in peripheral blood vessels and a haemodynamic display which shows activity and pressures in critical aspects of heart and blood flow. Advanced trainees and colleagues need sight of all of this imaging to understand how the medical team is making decisions as a procedure progresses.
- At the London Chest Hospital, Video South Medical Television has equipped three cath labs with feeds of all the imaging along with two way sound. The current procedures can be viewed in the Institute Lecture Room (80 persons) as well as the department seminar room and Professor Rothman's office.
- The three viewing locations use AMX Modero 8.4 inch wireless touch panels to make the selection of a lab and then selection of imaging within the lab – simplicity itself. The panel offers selection of lab 1, 2 or 3 and a single press of a button sets up default video links and two way audio. Once connected, the viewer can choose images of any two of the above labs to be displayed at any one time. Such is the agility of the system that the viewer can change views from minute to minute as the procedure demands.
- All of this can be done without affecting those working in the cath lab. The open channel two-way audio provides absolutely natural conversation allowing the demonstrator to talk through their technique and decisions as they go. This is decidedly much better than trying to talk to people behind them, while looking over their shoulder.
- A Video South innovation is the addition of a green LED text display in each lab, which lights up with the name of the room that has made a link to them and also lets them know the Professor is watching! This LED display is driven from an output of the AMX processor, which "knows" which link is in progress.
- The hub of the system is an AMX NetLinx 4000 Master Controller communicating with NetLinx 3000s in the Institute and in the department. The hub controls a large video and audio matrix and four picture-in-picture units. One of these is for the output on screen to viewers, the other three feed video system activity back to each lab.
- In a large masterclass meeting, there may be procedures being demonstrated from each lab simultaneously. The audience chairman is able to "hop" from and to another as activity demands. In this circumstance, it is important for each lab to see what others are doing and to follow all dialogue so that they can participate in debate and discussion.
- The control system is programmed to operate in sophisticated "scenarios". That is, complete settings of the entire system are made in the context of overall activity and viewer control. This reduces the need for users to understand how the system operates, just to demand the functions they require by a selection in plain English, and designed for cardiologists.
- The medical staff has found the system easy to operate, requiring no additional audio visual or support staff. The AMX system carries out checks, error correction and sets defaults, which allow users to move from one scenario to another with minimal effort.
- With superb image quality, open and relaxed audio, and touch panel ease of use, this is a system used by cardiologists to benefit cardiologists. Consequently, the first meetings have been a great success.
