The heart of the matter

The cardiothoracic centre at Southampton University, England, has been equipped with a fully integrated system for live viewing and transmission of cardiological procedures. The technical challenge has been to transmit and display the images at high enough quality for display at conferences on large screens. Video South rose to the task.

The largest of Southampton’s hospitals is home to the Wessex Cardiothoracic Centre, one of the largest specialist heart treatment centres in the UK. The consultants at the unit have developed a programme for excellence in the treatments they offer and the way these are delivered to patients. To realise this goal a charitable fund was established called Wessex Heartbeat and, in the eight years since its inception, it has raised some thirteen million pounds.

Part of this money has funded an education centre specifically for the cardiac consultant team and their juniors. Eight years ago, Video South built a high quality AV system into two rooms and installed links for live television to three treatment labs and two operating theatres, systems for which the company is well known for delivering.

In 2005 Heartbeat approached Video South again to install a completely new education centre in a new wing of the hospital. The wing was to have five new catheter labs and a new floor for the education centre, comprising four seminar rooms, a videoconference suite and a 120-seat lecture theatre. Video South’s brief was to provide facilities in all these areas and a live procedure demonstration facility in the lecture theatre.

A catheter is a long thin tube and in a cardiac ‘cath lab’ it is fed into the patient under x-ray guidance until located in the selected vessel. It then allows various physical treatments to be delivered. The images produced by this have always been in non-standard formats, high resolution and refresh rate. These flouro images are then accompanied by high-resolution ultrasound, camera images and XGA-type physiological displays (the line traces beloved of medical drama shows on TV, which tell staff you’re still breathing). Any remotely located student needs access to all of these different images to participate effectively in the procedure.

Video South’s Alistair Holdoway explained both the challenge and the solution: “ The important thing about these laboratories is that technology has really moved on. The situation isn’t as simple as it used to be in terms of the numbers of formats and resolutions we’re dealing with. From each laboratory we were faced with transmitting feeds from several sources including two video cameras, 1125 live images at 110Hz in monochrome colour from the flouro imaging, three or four 1600x1200 images from real time 3-D modelling, one or two XGA feeds and one ultrasound. On top of this we needed two way audio, camera control and image selection.”

“We settled on using Smart-E’s solution to shunt all the video around the various parts of the site. For every source in the laboratory we’ve got a Smart-e encoder bringing the feed into the Autopatch matrix via Cat-5. From that point we use standard connections. After this the matrix signals head to the Extron MGP464 processor. This particular device has been fairly critical to the success of the concept for this project. It’s a 4x4 switcher for both video and VGA, and it can deal with the HD resolutions we need. Furthermore, it can cope with everything up to that resolution as well so you can present with high resolution followed by standard video on the same feed, and it will deal with it.”

In order to present the images effectively to students effectively in the lecture theatre, Video South had established through research that they would need to be able to show three different feeds at once, at sufficient resolution. Originally three projectors had been specified for this purpose, but using the MGP464 video south were able to reduce this to a single HD projector.

The solution chosen was the projectiondesign Cineo3 mounted on a Unicol ceiling bracket. It projects in 16:9 orientation and at full 1080p resolution. Another important feature is its twin lamp lighting system. This can be set to sequential mode so that when one lamp fails, the second will take over at once - very useful on sites where there are no AV professionals.

Having achieved the desired output solution, Video South needed to be able to give cardiologists control of the system so that they would have access to the information and images they needed quickly and easily. To do this, they employed an AMX control set up. A touch panel was supplied in each of the small conference rooms, the lecture theatre and the video conference suite.

“The primary user interface is the AMX control, and it’s a pretty sophisticated set up. We need very lively ways of making sure that you’re looking at the right image at the right time. On the GUI we tend to mimic the screen layout and then if you touch a window you can choose which source appears in it. Also, the AMX is communicating with every lab, which means we can pre-switch feeds if we don’t want too many wires or signal bearers, and we can also control PTZ cameras in the labs and lecture theatre,” added Holdoway.

The final piece of the puzzle is the two-way audio system. Video South made use of Allen & Heath’s iDR system to route and control audio around the site, there are roving Sennheiser radio microphones for the audience, high quality, beyerdynamic SHM805A lectern microphones and personal Sennheiser microphones for the speakers as well.

In the main lecture theatre sound reinforcement comes from Sound Advance flat panel speakers, which are powered by an Inter-M R300. These loudspeakers were used to solve some architectural issues since there were only about two inches between the ceiling tiles and the concrete.

“Two-way sound is absolutely critical in these set ups,” said Holdoway. “Obviously everyone wants to see what is going on, but the whole point of doing these live procedure demonstrations is to talk people through what you’re doing. It’s got to be as close as possible to standing in the room. It’s not supposed to be a cinema experience, where you sit back and watch.”

The main lecture theatre also has a Tandberg 6000 MXP videoconferencing codec, meaning that the feeds can be sent out to anywhere in the world. The return shot from the videoconference can then be shown on the projection screen.

Another video conferencing codec, a smaller 3000 MXP, is located in the special videoconferencing suite. This room has all the same presentation capabilities as the lecture theatre but presentation of the images is on a Samsung SyncMaster 403T TFT display. Kramer video processing equipment is used, aloing with Altinex TNP431 connection points. Audio pick-up for videoconferencing is provided by Audio-Technica AT871R boundary microphones. Elmo PTC 160 cameras are used in the lecture theatre, videoconference room and the catheter laboratories for live video pictures.

In the laboratories themselves there is a Smart-E D/A transmitter attached to each video source along with Extron scan conversion and D/A P2DA2 units. Sennheiser EW352 head-worn microphones allow for easy commentary on what is going on, and JVC LM-17G monitors are used to display the various information feeds to the cardiologist.

The seminar rooms are equipped with AMX MVP 8400 touch panels and Netlinx 3000 controllers with JBL Control 24 ceiling speakers powered by a TOA a1706 amplifier providing sound reinforcement. The display solution here is JVC DLA SX21 projectors throwing onto a Procolour 2000x1500 projector screen.

Speaking for Wessex Heartbeat, Chief Executive Terry Osborne commented: “Since its opening in February by HRH The Countess of Wessex, our Royal Patron, the training centre has been in use all day every day. It represents a massive expansion from one room to seven, and the feed back has been excellent - the staff are blown away by the facilities now available. Alistair and his team have been excellent, delivering the project on time, and on budget.”

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