Imaging and the Internet

Live surgery in neurosurgical training courses: essential infrastructure and technical set-up

BACKGROUND

Training courses in neurosurgery are essential educational elements of residency. Teaching methods vary due to cultural differences, monetary restrictions and infrastructure conditions. Anatomical dissection courses combined with annotated live surgeries performed by senior surgeons have proved to be best accepted by students.

OBJECTIVE

In this technical note, we provide detailed information about the necessary requirements, resources and optimal performance of live surgeries in neurosurgical training courses.

METHODS AND RESULTS

From 2007 to 2012, 12 neurosurgical training courses with live surgeries were organised at the Department of Neurosurgery. Here, we share our experience and report the essential set-up for these courses. Our department organised seven skull base, four cervical spine and one spinal cord stimulation hands-on dissection course with live surgeries. The course structure included lectures, cadaver dissections and live surgeries. The technical set-up included video transmission via an IP-based network with fibreglass backbone between the operating theatre (OR) and lecture room. During surgery, bidirectional discussions offered the participants the ability to interject and ask questions. Important issues included the careful selection of live operated patients with clearly presented pathology for the didactic cases used to demonstrate the technique. A live surgery should include the entire procedure: intraoperative set-up, positioning, anaesthesiological procedures and handling of intraoperative situations.

CONCLUSION

A professionally prepared step-by-step educational program including surgical anatomy, cadaver dissection and live surgeries with online discussion offers a high level of training and enriches both the participants and instructors.

Web-based image transmission: a novel approach to aid communication in split liver transplantation

BACKGROUND

Split liver transplantation (SLT) is technically demanding and requires good communication between transplant centers. The recipient surgeon receiving a shipped split liver needs detailed information on allocation of inflow and outflow vessels. We describe the first use of an image transmission system to facilitate SLT.

METHODS

Twenty cadaver livers undergoing ex situ splitting were studied. Fifteen were shared between the geographically separate Birmingham adult and pediatric centers and five were shared with other UK centers.

RESULTS

A total of six to eight images of each split graft were taken with a camera at standardized settings using the National Organ Retrieval Imaging System (NORIS), showing details of appearance, size, and anatomy of allocated inflow and outflow vessels. These were uploaded using a personal digital assistant to a secure website (http://www.noris.org.uk). The remote recipient surgeon then viewed these images by logging onto the password-protected website. Minimum time interval between division of the hilar vessels and completion of the split procedure was two h, allowing remote surgeon to view their allocated "shipped" graft in advance of commencing surgery.

CONCLUSION

This advanced yet simple image transmission system has the potential for routine application in transplant surgery, not only for splitting but also for reporting injuries and graft steatosis.

New Technology for Imaging and Documenting Urologic Procedures

Recent advances in fiber optics and digital technology have dramatically improved the ability of the urologic surgeon to accurately image and document endoscopic and laparoscopic procedures. In addition, the development of digital endoscopes has expanded the armamentarium of the endoscopic surgeon greatly. Finally, new virtual reality technology has allowed increased visualization during surgery and provides excellent training for surgeons. This article details new imaging and documentation technology currently utilized during urologic procedures.

The camera phone: A novel aid in urologic practice

OBJECTIVES

To describe a novel use of the camera phone for efficient, reliable, and cost-effective collection and transmission of medical data in the urologic setting.

METHODS

We used camera phones (Verizon VGA and Sanyo-Sprint PCS) with a resolution of 640 x 480 pixels to capture images in the operating room, as well as in the outpatient clinic. Images were obtained directly from the monitor or the x-ray viewing box. These were then immediately transmitted to the office computer through a secure Internet connection. The images were then incorporated into operative and office notes, as needed.

RESULTS

The images obtained with this method were of adequate quality for demonstration purposes, with the added advantage of allowing secure transmission and storage. The best-quality images were those obtained directly from the x-ray viewing box or from a liquid crystal display monitor. In addition, the images could be edited and labels added with the aid of the software that came with the camera phone.

CONCLUSIONS

This method allows the acquisition of fair-quality digital images of surgical procedures and radiographic studies with simultaneous data transmission and storage for clinical documentation. The technology reduced costs and increased the efficiency of our practice considerably.

Tele-diagnostic and therapeutic guidance in urology

PURPOSE

To design a Web-based network for diagnostic and therapeutic guidance in urology.

MATERIALS AND METHODS

We designed an architectural model of a low-cost multimedia Web platform that runs on a collection of distributed collaborative network nodes to provide a set of urologist-oriented Web-enabled services. Any node of the platform was able to share patient-oriented data via automated processes with appropriate authorization, confidentiality, and high-security protocols. The urologist can show the details of the records of patients and additionally enrich the world experience with his or her own cases. Video clips maintained locally at the nodes will be accessible by clinicians in a trouble-free way with MS Windows Media player and a relatively small amount of source code.

RESULTS AND CONCLUSIONS

The primary advantage of this architectural model is that it provides Web-enabled integrated urologic services while using a distributed storage scheme for urological video files (AVI format) and a global repository of laboratory results using Extensible Markup Language (XML) and Data Grid technologies. In addition, this model provides decision-support services (knowledge from a global database and predefined procedures). The architecture model is based entirely on HTTP, XML, GRID-like environment and DotNet technologies. Finally, the platform provides extensibility and scalability targeted to large-scale Web-enabled global urologic databases.

Advances in video and imaging in ureteroscopy

Advances in image processing and display technologies, such as digital imaging, HDTV, and virtual reality, will ultimately allow integration of endoscopic imaging with diagnosis and therapy during ureteroscopic procedures. Further improvements in simulation technology and telemedicine should improve surgical training and greatly benefit patient care.

Individual differences in children's event memory reports and the narrative elaboration technique

Children between 7 and 8 years old took part in a staged event at school and 1 week later were assessed using a short form of the Wechsler Intelligence scale for children (third edition) and measures of metamemory, narrative ability, and socioeconomic status. Two weeks following the event, children either received narrative elaboration training (NET; K.J. Saywitz & L. Snyder, 1996) and were prompted with the four NET cue cards at interview; received verbal prompts corresponding to the cue card categories, but without prior training; or were presented with the cards at interview without prior training. Children given verbal labels as prompts recalled as much information as children who received NET training and cue cards. Measures of intelligence were predictive of amount recalled for cards-only children but not for the other 2 groups, indicating that differences in recall between low- and high-IQ groups were attenuated when recall was supported by NET training or verbal prompting.

Organizational learning, diffusion of innovation, and international collaboration in telemedicine

The authors analyze competing forces affecting the diffusion of telemedicine practices across organizations, potential learning effects from telemedicine practice, and their implications for the development of telemedicine-based networks. They also speculate on the learning, diffusion, and institutional effects that telemedical collaboration may trigger; five sets of propositions are advanced to explain these effects.

Functional reconstruction and minimally invasive techniques

Recent years have seen notable advances in imaging technologies. Three-dimensional computer-rendered techniques with rapid image acquisition have led to the development of virtual reality imaging. Virtual reality imaging allows interactive intraluminal navigation through any hollow viscus, simulating conventional endoscopy. This technique of virtual endoscopy has been applied to many organs, including the urinary tract. Virtual reality endoscopy is beginning to challenge the gold standard of conventional endoscopic evaluation. Recent advances in laparoscopic surgery are largely attributable to technological improvements in imaging equipment. Laparoscopic ultrasound has become a common adjunct in laparoscopic surgery. In particular, advances in video cameras and digital imaging technology have decreased the steep learning curve associated with laparoscopic procedures. Telerobotic systems offer several advantages to laparoscopic surgery, such as all six degrees of freedom, dexterity enhancement, tremor filtering, and stereovision. In addition, technological breakthroughs allow many procedures to evolve from open operations involving lengthy hospital stays to imaging-guided minimally invasive procedures performed on an outpatient basis. Finally, Internet-based imaging is changing the way in which urology services are delivered, by allowing rapid communication between remote locations.