Game-changer: inside the world’s first 4K over IP operating theatre

Its installation at Oslo University Hospital may have sparked a movement within hospitals around Europe, but bringing the concept for the first 4K over IP operating theatre to life presented many unforeseen challenges. Charlotte Ashley reports on this award-winning project.

“With this project we decided to push our portfolio further to keep one step ahead of the competition,” says Ingo Aicher, managing director at Jones AV, on undertaking the challenge of installing the world’s first 4K over IP fully integrated operating theatre at Oslo’s University Hospital (Riks Hospitalet). The integrator was tasked with the project after beating 13 other companies (including some of the medical industry’s largest corporations) to secure what was the largest integration tender in Europe at the time. The single supplier framework for the hospital outlined upgrades to seventy of its operating theatres, with an option for video over IP.

The hospital’s 4K over IP theatre, OR10, would serve as the showpiece of the integrator’s work at the hospital, and an inspiration for what it could achieve in the future, with all other theatres to be upgraded to be 4K-ready. The integrator planned extensively how it would deploy its own medical AV routing and integrated control suite based on uncompressed video over IP, using Barco Nexxis medical components and an Arthrex 4K endoscope (the world’s first) with fibre optic full 4K video output with drawings and 3D animations. Yet the scale of the challenge ahead was unforeseeable.

“When we won the framework we knew that 4K would come to the operating theatre, but there were no products actually out.”

Jones AV is highly experienced in the sector and the most frequent installer of fully-integrated operating theatre systems in northern Europe. However, the project required the expertise of the integration team (rooted in traditional AV and broadcast systems) to evolve from coax and HDSDI to fibre and IP in a short period of time. “There was quite a bit of homework to do,” recalls Aicher. “Because it was video over IP it was a whole new world, as we had to go into hardware training, find out how to control it and then develop a GUI based on that system.” Each member of the install team took courses in fusion splicing, corning, polishing and fibre maintenance, followed by additional certification for Neutrik opticalCon. Jones AV also had to assemble a team of programmers for software development, while co-ordinating regular contact with manufacturers, surgeons and the operating theatre manager, the hospital’s purchasing department, and members of its technical department. With teams dotted around Europe in Germany, Norway and the UK, virtual collaboration was essential to the planning of the project.

Aicher states that the integration team decided to develop a free-standing piece of routing software, rather than developing a browser-based GUI, as the operating theatre’s windows PC was felt to be enough of a weak link in the space. With this move, the integrator hoped to increase the safety of the system. “I think the single toughest part of the whole project was the video routing, making sure that it was stable and that the control software communicated correctly, the video routing happened, and there was no lag in the switching,” says Aicher.

The entire backbone of the project was based on multicore optics, with each source and destination having sufficient capacity to upgrade from full HD to 4K at any time. Jones AV therefore deployed fibre points, ranging from walls and ceilings to in monitor swing arms and patchfields in racks, with considerable time dedicated to their preparation, splicing, and testing.

The greatest challenge when it came to equipment, however, was the lack of it – or specifications. “When we won the framework we knew that 4K would come to the operating theatre, but there were no products actually out. We installed all the infrastructure for 4K at that point, and then upgraded the specific operating theatre we built once the products became available,” recalls Aicher. Jones AV therefore had to ensure mounting, monitor arms and other equipment was suited the size and weight of 4K equipment, without official product guidelines.

4K over IP equipment close up in Oslo University Hospital operating theatre

Once the infrastructure was deployed and tested with fibre measurement equipment, 10GB fibre layer 3 switch fabric and servers were deployed. In the operating theatres Barco monitors (offering 5ms latency) with inbuilt IP decoders were deployed, whilst at the input columns video over IP to fibre encoders were connected. This innovation from Barco – the first to bring video over IP to the operating theatre (as well as 4K) – made life easier for the integrator. “The neatness is that their medical displays have IP decoders inbuilt so you don’t have a decoder box on the back of the monitor so you can go off an imaging device in the operating theatre – in this case, the Arthrex endoscope - with fibre optics 4K output through the network router with fibre optics into the display.” The imaging device can be changed at the hospital with no programming and system configuration should the hospital want to. 

A busy period of software configuration followed to bring third party device control (via through RS232/442/485, IP ports and more) and point to multipoint routing, for referencing between operating theatres and videoconferencing with hospitals on different continents, into the operating theatre. This is used by the hospital for training and communication when there is a need to transmit what happens in a specific space to a joint course room or out of house.

After contending with a six month delay of the official release of the Barco 4K monitors and signal encoders, that Jones AV had successfully trialled with hospital staff, the integrator delivered 12 4K ready operating theatres (four connected to a meeting room with 4K capacity), and one fully integrated suite in November 2015, just over a year after the onsite delivery of the project began. The reaction to the equipment has since been extremely positive amongst hospital staff. “The picture quality is amazing and the image depths give you better spatial awareness than 3D,” says Bjørn von Gohren Edwin, professor at the Intervention Centre and section manager at Oslo University Hospital.

With other operating theatres integrated into the same switch infrastructure, OR10 was first the significant step for Oslo University Hospital toward a 4K future. “The operating theatre is used as a reference for what they eventually aspire to by upgrading their entire hospital bit by bit.” He adds: “The users love it. There’s quite a demand for that specific operating theatre from surgeons that want to operate in there because of technology. Everybody wants to try it and see as the picture quality it quite something in 4K.” Since the project was completed, the installation has also become a template for other similar installations in Europe. “We’ve done a few more 4K since. We’ve just delivered five in Dublin and two in Vienna. More and more 4K equipment is getting installed now.” Yet 4K still has a way to go before it becomes commonplace in operating theatres around the world according to Aicher. “With the newer projects where we’re looking at 4K systems, medical 4K is still very expensive is comparison to public displays.” He continues: “That comes into play in some hospitals and they have to compromise and say they’ll have a main 4K monitor and than have a slave monitor in HD.” 

Jones AV took home ‘Most InAVative Healthcare Project’ at the last February’s InAVation Awards for the second year in row for its work at Oslo University Hospital.


Audio Technica architectural microphone

Arthrex Synergy 4K UHD endoscope

Barco 24-in display, 32-in surgical displays, MNA series encoders and decoders

B-Tech mounts and accessories

Canvys 21-in medical touch display

DR Mach medical camera

Mills mounts and accessories

Neutrik opticalCon fibre connectors

Samsung 55-in display

Sony dome camera

Xtreme network switches

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