Digital video integration and the olv hospital Aalst by eSATURNUS

Better Healthcare through Smart Innovation

Case Study Digital Video Integration and the OLV Hospital Aalst

A tour around the catheterization laboratory, the operating rooms and the Da Vinci 3D Surgical Robot.

Table of contents

# 16 digital operating rooms Minimizing turnover time of surgeries A reliable solution

4-6 7

# 5 catheterization laboratories How to work with more than 10 video sources Live surgery in practice

8-10 11

# 4 Da Vinci robots Working in 3D

12-13

Preface

Surgery is the medical discipline where medical knowledge is combined with great skill and a healthy amount of courage. Luckily, however, great advances in medicine in recent years have ensured that we are not merely dependent upon skill and courage. On the contrary, modern surgery cannot be imagined without the support of hi-tech tools. The OLV Hospital Aalst, bearing ‘Topline Care’ in its logo, continually invests in the best medical knowledge combined with the most advanced technology in order to achieve optimal outcomes for its patients. A prevalent trend in surgery is the evolution to less invasive techniques. This is seen as a shift towards endoscopic procedures and the catheterization lab. And a shift away from the operation room. This trend implies that surgeons become more and more dependent upon the availability of real-time digitized images. The OLV Hospital has therefore engaged in a partnership with eSATURNUS to introduce digitized operation rooms. With a simple touch on a screen, surgeons now have all the information and images they need during the procedure available. And by this we mean, real-time, full quality images, ranging from endoscopy to PACS images. Moreover, surgeons can switch images from one screen to another in order to optimally perform the procedure in the best ergonomic circumstances. Needless to say that recording and storage of live images is also possible. ‘Topline Care’ also implies training and education as a key element in OLV’s mission statement. OLV now frequently utilizes eSATURNUS’ NUCLeUS™ system to train surgeons on live cases. Trainees no longer have to fly in, because live cases are now easily transmitted across the ocean, in full-HD quality. Real-time knowledge sharing, without geographic boundaries, will be fundamental to tomorrow’s global economy. The OLV Hospital Aalst and eSATURNUS happily engage in building this future.

© 2014 by eSATURNUS All Rights Reserved Publisher: eSATURNUS NV Responsible for Contents: Marketing dept. Romeinse straat 12, 3001 Leuven, Belgium E-mail: marketing@esaturnus.com More info: www.esaturnus.com

Steven Creve, Director IT, OLVZ Aalst

DISCLAIMER: Partial reproduction in printed form of individual contributions is permitted, provided the customary bibliographical data, such as author’s name and title of the contribution as well the pages are named. The editors request that two copies be sent to their attention. The consent of the authors and editors is required for the complete reprint of an article. Manuscripts submitted without prior agreement as well as suggestions, proposals, and information are always welcome; they will be carefully assessed and submitted to the editorial conference for attention. Logos are used with the permission of the respective companies. This document is written with the collaboration of OLV Hospital Aalst & Dräger Belgium.

Minimizing turnover time of surgeries

Integrated operating rooms are growing in popularity. The OLV hospital in Aalst has chosen for the NUCLeUS™ multimedia solution. In a digital operating room, surgeons, clinicians and nurses can watch video in real time, record surgical operations and organize these data in central patient records.

‘With a digital operating room, the access to visual data becomes very easy. This technology has been implemented based on our objectives and requirements to maximize productivity.’ explains OR program manager Jan De Veylder. ‘We are moving towards an electronic age where medical recordings and captured endoscopic images, will be managed inside the electronic patient record. Ultimately, these advantages have a proven return on investment, allowing surgeons to get real-time patient information, the ability to maximize patient care and being able to reduce costs.’ De Veylder is satisfied about the successful integration of NUCLeUS™ in their operating rooms. ‘All our surgeons use this system eagerly, but most especially our minimal invasive surgery specialists, working with endoscopic and robotic devices.’ ‘As for the nurse’s perspective, we need to make their lives easier,’ De Veylder continues. ‘The fewer wires and cables they have to deal with the more they can focus on patient care. Driving efficiency and improving patient outcome is clearly the endpoint here. With NUCLeUS™ there is a better way.’ The hospital in Aalst uses all functionalities of the modular system approach of NUCLeUS™. Images can be stored, monitored and streamed inside the hospital. The latter gets special attention from the Aalst’ hospital.

NUCLeUS™. Doctor Mottrie explains: ‘In the year 2012-2013, we have trained 400 medical doctors in our training centre. For 2014, we expect 450 to 500 subscribers. Our training center is making this rapid growth only through the easy accessibility of the streaming function.’ In the near future, seven more operating rooms will be digitized with NUCLeUS™. This will mean the end of the analog ORs in the OLV Hospital Aalst.

‘NUCLeUS™ is an absolute added value. I see it as an addition to the electronic patients record. It is a reference work which is useful for any surgeon. It is advantageous for both the patient and the physician ‘ OR Program Manager Jan De Veylder

‘Training, education and broadening our expertise, this is why we need NUCLeUS™.’ adds Mottrie, MD. ‘The better you can see, the better you are able to learn.’ With NUCLeUS™|Broadcast, physicians can stream live surgery to an auditorium inside or outside the hospital. Students get the feeling as if they are really present thanks to the high quality images of 5

Hybrid operating room

Photo: Vk studio

Ten operating rooms, each with their own, dedicated devices. In the OLV hospital in Aalst, NUCLeUS™ captures image streams from leading manufacturers.

One NUCLeUS™ IP-cable Connectivity Everywhere HD Monitors

HD Room Camera

A reliable solution Facts & Figures

Avoiding errors is key in healthcare. Whether it concerns surgery, filing patient data or installating the operating rooms, every detail is vital. To strengthen the professional expertise of eSATURNUS, Dräger, took care of the physical installation. Here is how the two companies work together.

Network

1Gb

N° servers

1 rack

Cabling in the OR

UTP + Coax

Cabling outside the OR

UTP + fibre to core switch

Wiring cathlab

350m cat6

Wiring OR

550m cat6 + 100m coax

Based on this assessment, the project was assigned to Dräger in October 2008. NUCLeUS™ was chosen as the digitizing tool for the operating rooms.

Cathlab install time

1 day

From this moment, a Dräger project manager became part of the team to provide guidance from the initial planning through post-construction stages.

OR install time

2 days

# ORs

# endoscopy units

# Cathlabs

# meeting rooms

The integration team In 2008, the hospital opened a tender for 21 new operating rooms using a team approach with input from a variety of sources, with each member contributing to the decision in his or her area of expertise. Biomedical engineering paid attention to space requirements and to the challenge of interfacing clinical devices. IT examined OR integration vendors for the ability to integrate the multimedia solution with the hospital’s network. Clinical specialists commented on the system functionality and ease of use.

(+7 in the future)

Dräger is a leading international company in the fields of medical and safety technology. Our medical focus is on the OR, ICU, ER and Neonatal department. Dräger Belgium performs all project management and service & support. We take the full responsibility on all of our offered and sold products. Besides striving for the highest quality and common interfaces between our products, Dräger also focuses on the protection of our environment and our natural resources. High-Tech with human touch, culture out of tradition, innovations by self-conception, worldwide one vision: Dräger. Technology for Life®

* Dräger is official partner of eSATURNUS in Belgium and Spain.

Design Once the team was composed, pre-construction planning and design could begin. In general, this covers space for in-room integration, provisions for cabling, power and outlets and HVAC. At the end of 2008, a full 2D / 3D plan was approved and construction could be initiated. Implementation of NUCLeUS™ During the different project phases, almost full-time coordination is necessary to ensure the level of satisfaction the OLV Hospital Aalst and Dräger aim for. Both parties appreciated the technical requirements of NUCLeUS™. ‘Other manufacturers would have at least four different types of cabling. With NUCLeUS™, we only had to use two different cable types.’ explains Dräger project leader Chantal Leonet. ‘This facilitates the full implementation workflow’. Also, the NUCLeUS™ multimedia system is controlled centrally, outside of the operating room and requires minimal OR floor space. Mid 2009, according to the planning and requirements, installation was finalized. Training and support Dräger also continued to arrange the project for all required inspections, certifications and commissioning, Dräger’s project management remains. A training and customerservice framework was implemented prior to making the ORs available for clinical use. 7

How to work with more than 10 modalities

Catheterization laboratories are becoming more and more important in modern healthcare. The OLV Hospital Aalst had a great vision of integrating the cathlab in the entity of the hospital.

During interventions cardiologists rely only on video data. The narrowing of the arteries of the heart are shown by angio scans. The hemodynamic monitor indicates the pressure when the catheter enters the heart. These two sources are the core of the catheterization laboratory and ascertain whether an intervention is successful. A reliable and flexible monitoring system is key for this kind of minimally invasive interventions. Bernard De Bruyne, MD, PhD, explains: ‘NUCLeUS™ determines what and where we see our image feeds. If we want to see something specific on the main display, I can swap personally or I can ask our nurses. Of course, this makes our daily work easier. Otherwise we would have to check the display on each of the cumbersome devices.’ In the Aalst’ hospital fives cathlabs, including two EP labs have been built around a hallway. They are surrounded by large, lead-shielded windows. To protect the clinicians from radiation danger, coming from the X-ray equipment in the cathlab, image streams and monitoring systems are brought outside of the suite. ‘All images are brought together inside this one solution’ tells dr. De Bruyne. ‘Anyone can see ongoing operations anywhere. As head of the cathlab, I can see if there are problems during an intervention from my desk.’

useful to have all sources next to each other. We use NUCLeUS™ for our weekly internal meetings. Based on our recordings we review and discuss our clinical interventions.’ says De Bruyne, MD, PhD. ‘We have guests on a regular basis and can place 15 to 20 persons inside our training room.’ ‘But the enormous revolution is that we can go live, not via satellite, but by using the internet.’ explains the cardiologist. ‘This means we can broadcast on demand. There is a vast demand for these small courses. The era of the gigantic teaching sessions is over.’

‘NUCLeUS™ means an enormous revolution to our trainings. We can go live when we want, not via satellite but via internet. This allows us to do broadcasting to a peer public.’

Bernard De Bruyne, MD, PhD

Els Van Laer, head of nursing, adds another advantage: ‘We have a camera in the aftercare. When a patient signals a problem, we can check who needs help and why. Using NUCLeUS™ really became a habit to the nurses. The first thing we do in the morning is boot the PC and start up the platform.’ Telecollaboration is an important topic in the catheterization laboratory. ‘During training, it is very 9

Catheterization laboratory Five cathlabs, each with their dedicated devices. In the OLV hospital in Aalst, NUCLeUS™ captures image streams from following manufacturers.

PURPLE 01

ROYAL 02

LIME 30

KINGFISHER 03

EMERALD 31

NAVY 04

POPPY 11

BURGUNDY 12

PETROL 33 SILVER GREY 40

Note: this is intended as a guide to the apron colours available. The colour viewed on your computer screen or via a printed version may vary from the actual apron colours.

Photo: Vk studio

If you would like a fabric swatch please contact us here: kenex@kenex.co.uk

Kenex (Electro-Medical) Limited 24 Burnt Mill, Harlow, Essex CM20 2HS United Kingdom t: 0044 (0)1279 417241 f: 0044 (0)1279 443749 e: kenex@kenex.co.uk w: www.kenex.co.uk 300107-02a

Room Camera

One NUCLeUS™ IP-cable

Control Room

HD Monitors Audio Headsets

Live surgery in practice Facts & Figures Date

29/ 11/ 11 -> 8/ 12/ 11

Topic

OCT, CTO, RDT

Audience

10 - 40

Timing

09:00 - 16:00

Image streams

PiP

Sources

Angio-Siemens Artis MacLab-Acertys IVUS-Volcano Radi Analyzer-SJM Overview cam-Sony Ipela hospital PC ...

Inputs

Outputs

Transmission

realtime, full hd

Receiver 1

Cathlab meeting room, double projector

Receiver 2

Cathlab conference room, double projector

Reveiver 3

Cathlab, 6 displays

Video control

web based

Audio

NUCLeUS™ chat room

Audio groups

Preparation time

< 1 week

Three different workshops were organized by the catheterization laboratory in the OLV Hospital Aalst. During different teaching sessions, the public could watch the interventions real-time and interact with the cardiologists. Bernard De Bruyne, MD, PhD was the project-lead. Digitally integrated cathlabs are normally not trivial, given the wide variety and large number of sources. However, NUCLeUS™ acquired up to fifteen image feeds, ranging from real-time angiography to planning data. The medical data was not only offered for switching and visualization in the cathlab, but also made available to a conference room in the hospital. All data streams were sent via the hospital network. Video workshops - audio communication ‘Video quality was impeccable and the system performed extremely smoothly.’ were the first comments of De Bruyne, MD, PhD, afterwards. The audience, ranging between 10 to 40 attendees, could see two images in high definition at the same time, using two projectors. With control over the images, the users in the conference room can decide independently from the cardiologists which images they want to display. The live interaction with the cardiologists makes the user experience complete. Inside the catheterization laboratory, four users with wireless headsets were connected inside one virtual chat room. The audience was able to talk with the experts using a hand microphone. Amazingly, 99% of the event was based on the default AV installation, which is always present in all five of the cathlabs. Cathlab technician Olivier Nelis says: ‘The NUCLeUS™ system scales beyond imagination and is intuitive.’ One centralized control NUCLeUS™ uses nothing more than small transmitters and receivers, which are linked to the default network infrastructure. The conversion from AV to network streams explains why NUCLeUS™ can transport images much more flexibly than any other system. The network is omnipresent so any person can pick-up the stream in full quality using a receiver, or in reduced quality using a web browser. All processing happens in the hospital datacenter, completely independent from the location of the procedure room. This central intelligence opens a variety of possibilities such as broadcasting, recording and integration with PACS systems. The future of knowledge acquisition With these workshops, NUCLeUS™ proves once more that it is able to create a new level of integration and education. In today’s world, knowledge is everywhere and sharing content is standard practice. To come to a network of knowledge in a clinical environment, telemedicine needs to rely on a flawless and user-friendly system.

ÂŠ2012 Intuitive Surgical, Inc.

Working with Da Vinci in 3D

Without any doubt, the Intuitive Surgical Da Vinci is a highly advanced surgical robot which reduces patient trauma by enabling surgery with minimal incisions. To optimize diagnostics, the robotic device uses auto-generated 3D images, based on video feeds.

Doctor Alex Mottrie, MD and European president for robotic surgery, says: ‘Da Vinci really is the future. It is like laparoscopic surgery but without counter effects.’ Inside the Da Vinci console, the surgeon sees various image sources to have a complete overview of the situation. Besides the stereoscopic image, he also sees the room camera image, the CT-images and the ultrasound images. ‘We use NUCLeUS™ to extend the added value of the Da Vinci surgical system.’ continues dr. Mottrie. ‘Since NUCLeUS™ and the Da Vinci unit are connected, we can spread the experience inside and outside the hospital.’ The OLV Robotic Surgery Institute is globally renowned for its practical training. They are active in the fields of urology, gynaecology, cardiovascular, endocrinology and general surgery. The center is experimenting with the transmission of 3D images, auto-generated by the robotic device. ‘It goes without saying that it is advantageous for the audience to have a 3D image feed.’ says doctor Mottrie. The need for reliable and lagless information is very important, both for training and during the intervention itself. Being in the middle of the medical device users, eSATURNUS develops useful and unique features, tailor-made to fit the surgeon’s need.

smart image processing, designed to simplify the surgeon’s job. In the near future, the software will be able to constantly look for the best level of contrast. The auto-rotate function will keep the surgeon oriented by turning the image around a predefined center of the image. Finally, the eSATURNUS research department and the OLV hospital have successfully tested a 3D HDTV broadcast over the IP network. NUCLeUS™ is thus the system for transport of stereoscopic images, without having to change infrastructure cabling. Now the market will decide how fast the adaptation of 3D will follow.

‘Since NUCLeUS™ and the Da Vinci unit are linked, we can spread our experiences inside and outside the hospital.’

European President for robot surgery Alex Mottrie, MD.

The vascularisation filter for example, is made in close collaboration with physicians and is currently undergoing clinical trial. ‘This filter shows the blood vessels in real time in a digitally modified video overlay.’ says eSATURNUS CTO, Bob Koninckx, Msc MTE, PhD. ‘This way, surgeons can operate more precisely.’ Through the company’s connection with academic research centers, new technologies are continuously being examined. There are ongoing experiments with 13

HOSPITAL INSIGHTS

Since the OLV Hospital Aalst succeeded in the first Belgian heart surgery in 1948. The center has only gained more respect. Their wonderful reputation arises from innovative ideas, future-proof investments and their aim to provide the best qualitative care. Since then, the hospital has been managed by a non-profit organization and has grown steeply, not only in terms of accommodation but also on a medical level. In order to provide top healthcare, the OLV hospital continuously invests in new technologies, proven by their four da Vinci surgical robots. In 2009, the hospital started building a new wing. All new technologies are integrated and only the best material has been tested and approved for investment. Today, there are more than 2 500 people working in the hospital. In daycare, OLV hospital Aalst has over 100 beds, in classic hospitalisation nearly a 1000. With more than 48 500 interventions in the operating rooms this healthcare enterprise is one of the most respected in Belgium. Education holds a central position in the philosophy of the Aalst’ hospital. With the establishment of the Robotic Surgery Institute, they proved that education and innovation go hand in hand.

OLV Aalst holds the eSATURNUS academic licence* for its excellence in training, research and robotic surgery.

* eSATURNUS supports research and development. University hospitals, training centers and research institutes can enjoy serveral benefits

COMPANY PROFILE eSATURNUS is a Belgium-based, vendor-neutral company, providing healthcare information technology services in Europe and beyond. The company offers a range of system integration solutions in the operating room, enabling full operating room digitization. The product portfolio also includes medical video documentation solutions - both stand-alone and integrated with the HIS - and multimedia distribution and archiving solutions. NeBULA™ records HD video from any video source including endoscopes, arthroscopes, surgical cameras, ultrasounds, etc. The solution consists of a hardware unit that connects the device to a local computer. The user-friendly NeBULA™ software interface allows clinicians to start recording as soon as the installation is done, without the need for training. NUCLeUS™ is the smart digital operating room. It is a videoover-ip based solution for OR system integration. By using this technology, NUCLeUS™ creates advantages for the hospital which are impossible to achieve with classic AV solutions, both on managerial and infrastructure as well as on the medical level. In short, every medical device is connected to a transmitter which encodes the video stream to a digital format. Each monitor is linked with a receiver which decodes the digital format to a video signal compatible with the specific monitor. A web-based software, mostly made available on a touch panel, acts as the OR control panel which can include following functionalities: »»

Routing every video source to every screen

»»

Recording of each video source with central archiving

»»

Broadcasting within the hospital network environment

»»

Broadcasting outside of the hospital network

These functionalities are implemented by a central server system, entirely software-based. Integration with planning systems, PACS and EPR is provided using international standards, such as DICOM and HL7.

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Better Healthcare through Smart Innovation

ÂŠ 2014 eSATURNUS