26.03.19

Inside out: Award-winning healthcare AV at the Quadram Institute

Quadram Institute exterior

The new Quadram Institute is a new medical facility aimed at bringing researchers, patients and clinicians under one roof. Paul Milligan speaks to the integrator who helped create the best healthcare project at the 2019 InAVation Awards.

The sheer scale of the brand new Quadram Institute (QI) in Norwich, England is immediately impressive, even before you delve inside its innovative contents. It cost £81 million (€94m) to build and features more than 100 clinicians, more than 300 researchers and is capable of conducting at least 40,000 endoscopies every year, making it one of the largest in Europe. The QI is a British centre for research and training in food science and health and aims to further link health and nutritional science with clinical research under one roof.  The QI brings together research teams from the Quadram Institute, the University of East Anglia’s Faculty of Science and Norwich Medical School, as well as the Norfolk University Hospital’s (NNUH) regional gastrointestinal endoscopy unit.   

Quadram 2

A growing demand for specialist endoscopic delivery, training and innovation has resulted in the NNUH’s new gastroenterology department having double the capacity it had before.  The QI is equipped with 4K infrastructure throughout its endoscopy suites, flexible teaching spaces, meeting and collaboration spaces, all designed by AV/IT consultant Harkwood Services.  Once Harkwood had finished the AV design and specification, it was time to bring in an integrator, and this is where Snelling comes in.  It was first engaged to tender in December 2017, and after successfully beating four other integrators in award categories evaluating experience, capability, value add and service, it began working on the project in January 2018. 

Once testing (more on that phase later) was completed, Snelling was engaged in on-site works until the project’s completion in September 2018.  The brief to the integrator grew as the job progressed says Steve Royans, sales director, Snelling. “The consultants had put together a detailed technical specification, which covered the meeting rooms, then there was a contract addendum which added in the medical section.” The eventual AV remit was for interconnected endoscopy suites, a two-way divisible seminar room, a three-way divisible lecture space, three meetings rooms, and public areas.

As you can imagine, because of the nature of what happens in the QI (live medical procedures) the client and consultant placed ‘very exacting demands’ on Snelling says Royans. For example the entire medical installation consists of fibre optic AVoIP. “As the rooms are used for live medical treatments, all equipment directly connected to any medical equipment that comes into contact with a patient required fibre in place of copper, and medical grade power supplies” explains Royans.  Surgeons can also be very demanding so supplying them with exactly what they required, and getting it right first time was crucial adds Royans. “We held user workshops for the user interface, where we mocked the control system onto an iPad before AV construction started, and received feedback on the form and function etc. The feedback was supplied by Quadram, the NHS and students and surgeons. Is it hard to work for medical experts? Surgeons are specialist in their field and are not always engaged with AV controls, but it was quite refreshing, because they suggested a lot of functionality that was then added.”

Quadram 3

The project, home to the first-ever endoscopic installation run entirely on AVoIP, has earned the distinction of winning the best healthcare project at the 2019 InAVation awards. AV infrastructure at the QI has been developed for two-way interaction to enable live streaming of clinical endoscopic procedures to students or researchers, removing the need for everyone to be in the room, and alleviating overcrowding.  Two-way audio and video, from four sources; EndoCam, Endoscope Guide, wide angle view of the endoscopy suite and Clinician view, allows live interaction between clinicians performing procedures in the endoscopy suites and students in the seminar rooms.  The drive for such high-end corporate-grade video conferencing and collaboration technology was driven in part by the close links the QI has with the food, pharmaceutical and medical industries.

One of the highlights of the project is the interconnected endoscopy suites. This is where clinicians perform investigative procedures on real patients. Royans explains further; “Live feeds from these suites are sent upstairs to a divisible training room, which can be used for standard meetings or live endoscopy sessions.”  Streaming is currently within the building only, but there are plans to expand to stream it across to the NNUH.  All streaming is in 4K, “The driver for 4K was that each video feed is full HD, so when multiple sources such as two cameras and two pieces of content are regularly viewed in quad-split, four 1080p sources equals 4K” explains Royans.  Because the video being streamed is live medical procedures, the client brief stressed the need for real-time high-resolution video without any loss in quality. ZeeVee’s SDVoE ZyPer4K receivers and transmitters were tasked with the job, as they provide very low latency (100 microseconds) uncompressed 4K 60 4:4:4 video over a 10GB Ethernet network across the building. “The streaming is run on a segregated network so we have total control over how the audio and video streams are received” adds Royans.  

In the endoscopy suites the surgeon wears a headset, connected back to the teaching suite, so if they can have a technician at the rear of the space they can talk back to the surgeon if they want to see anything in more detail, or the surgeon can request something from the teaching spaces. “It’s two-way so that if there are any problems with the procedure they can have a live conference discussion between themselves and can always cancel the feed if they want to,” says Royans.  “In medical mode the audio is as important as the video, because of the communication requirement.  The audio can also be used for streaming, to send the feeds around the building if they want, to overflow areas if sessions are busy etc. Because there are two endoscopy suites, it means they can have two live training sessions at the same time, or open one up as a large space.”

Quadram 4

Each endoscopy suite features a Panasonic HD PTZ camera to view the operator of the endoscopy during the procedures fed to the seminar room.  It is controlled locally within the treatment room and remotely from the seminar room.  The suites also include an Olympus endoscopy visualisation system with 2x HD-SDI outputs, and a 32-in iiyama 4K monitor which mirrors the output of the main feed out per room.  Four Bose ceiling speakers relay audio from Shure wireless head-worn cardioid mics.  Crestron amplifiers and Avia DSP (with Dante) handle the audio conferencing interface.  AV control in the suites is via a Crestron 10-in touchpanel.

Two side-by-side two-way divisible seminar rooms, which can also be used as a single room for larger audiences, are interconnected with the endoscopy suites.  These feature independent 5,000 lumens Epson projectors (with 4K enhancement) and 109-in Da-Lite projection screens, which makes it possible to display separate or duplicate video content in each space.  Mirroring the endoscopy suites, each seminar room features a Panasonic HD camera and iiyama 4K monitor, Bose ceiling loudspeakers, Shure ceiling array mics, and Crestron amps and DSP. The seminar rooms also feature two Barco ClickShare systems and two Cabletime Mediastar decoders and IPTV receivers.  The whole system is configured for control via two 10”, and one 15” Creston touchpanels installed in room with one-touch mode election. ZeeVee Zyper 4K encoders and Netgear SDVoE fibre switch completes the tech in the seminar rooms.  

Because of the critical nature of the procedures, all technology had to meet stringent medical requirements, and all equipment in the endoscopy suites directly connected to the endoscopic equipment have medical grade power supplies, galvanised isolation and anti-bacterial coating.

A 3-way divisible lecture space has a capacity of up to 100 participants. It can work as three smaller spaces, two medium spaces or as one large space. Because of the three-way nature of the room it features three different projectors, two 6,000 lumens Epson models with 130-in Da-Lite projection screens, and one 5,000 lumens Epson unit projecting onto a 94-in Da-Lite screen. A Panasonic PTZ camera sits within the space for lecture capture and streaming. Six Bose Panaray line arrays, Bose PowerMatch amp, Crestron DSP and Shure wireless hand-held mics all handle the audio.  Four Crestron 10-in touchpanels take care of the control element of the lecture space.

Finally, three meetings rooms (for Quadram Institute use) each feature NEC 70-in displays with wall-mounted speakers for video and audio conferencing.  Barco ClickShare presentation system, Cabletime Mediastar encoders and TeamMate collaborative furniture complete the equipment list.  The public areas (café, main reception area and endoscopy waiting area) feature NEC 55-in and 80-in displays, Onelan digital signage and Cabletime IPTV and streaming media players. To add the flexible nature of the project, Snelling has also ensured the QI has ability to stream content from any divisible space to these screens as overflow if necessary.

The critical nature of this project meant that Snelling had to undergo a month of testing, with much of it conducted off-site before it was ready to begin the on-site install. Royans details Snelling’s process; “We had factory acceptance testing at our premises, where we set the rooms up in their entirety.  Every connection was tested, every function of the control system was tested.” Doing it this way made commissioning easier towards the end of the project says Royans “because AV always get squeezed at the end of fit-out projects. As we were employed on the job quite late on in the project’s timeline did provide the biggest challenge for Snelling” says Royans.  But you wouldn’t know it to look at the project.  The attention to detail, flexibility of the spaces, strict adherence to the brief for an exacting client and consultant are in no small part why this new project is already an award-winner. And to top it all off, the client is extremely happy; “Snelling has proven it merit as a technology partner who has helped us reach realise our vision with zero compromise. Not only was Snelling able to provide us with what we requested but also found innovative ways to increase the capabilities in ways we weren’t aware were possible,” said David Mann, projector director, Quadram Institute.

 

Kit List

Audio/Accessories

Bose Panaray Modular line arrays, PowerMatch amplifiers, ceiling speakers
Crestron Avia DSP, amplifiers
Shure MX wireless mics, bodypack transceivers

Control/Video

Barco ClickShare
Cabletime Mediastar decoder
Crestron 10-in touchpanel, 16x16 DigitalMedia switcher
Da-Lite 94-in, 130-in projection screens
Epson 5,000 and 6,000 lumens projectors
Extron event recording and live streaming
Iiyama 4K monitors
LifeSize video and audio conferencing
NEC 55-in, 70-in, 80in displays
Netgear SDVoE fibre switch
Onelan digital signage players
Panasonic HD PTZ cameras
ZeeVee Zyper 4K encoders/decoders