Abstract:
A consolidated system for performing, recording, and distributing the performance and/or recordation of medical procedures, including a plurality of computer-controlled medical systems each having one or more input devices; and an aggregation system for aggregating information pertaining to a medical procedure and/or pertaining to the use of one or more of the medical systems to perform a medical procedure, the information having a plurality of sources, forms, and formats. The aggregation system is configured to provide a preview of the information to allow a user to combine and/or edit the information and provide transmission of the combined and/or edited information to one or more recipients via a network.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 61/482, 201, filed on May 3, 2011. The entire disclosure of the above application is incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    This disclosure relates to a medical video production and distribution system. 
         [0003]    Many modern medical procedures involve the use of multiple separate computer-controlled medical systems. These systems have input devices (typically a keyboard and a mouse) and generate a display for the user. While it can be challenging for a physician or other healthcare professional to simultaneously operate these separate programs, at least one system is available that consolidates the displays from each of a plurality of separate computer-controlled medical systems onto a composite display, and provides a single set of control devices, for example, a keyboard, mouse, and/or other controller that will control the separate computer-controlled medical system whose corresponding display on the composite display includes the system cursor. The user can manipulate the cursor to the particular display on the composite display corresponding to the system the user wants to operate, and once the cursor is there, use the set of control devices to operate that separate computer system. An example of such a system is the Odyssey System, available from Stereotaxis, Inc., St. Louis, Mo. 
         [0004]    For a variety of reasons it may be desirable to document the medical procedure by recording the displays of each of the separate computer-controlled medical systems. Systems for capturing and distributing and/or recording the image from the composite screen have also been developed for this purpose. One such system for video storage and distribution is the Odyssey Cinema System, available from Stereotaxis, Inc., St. Louis, Mo. 
       SUMMARY 
       [0005]    Existing composite medical displays that simply aggregate the displays from a plurality of separate medical systems used in performing a medical procedure can provide a lot of useful information about the medical procedure. However, there are a number of shortcomings to simply distributing this composite display. First, in order to preserve useful image quality, it can be desirable to use a proprietary codec to compress the video signal before transmission and storage. However, the use of a proprietary codec normally interferes with the widespread distribution because the recipients usually need corresponding proprietary software or hardware. Second, in distributing the video signal outside of the originating institution, steps must be taken to protect the identity and personal healthcare information of the patient that is embedded within the individual displays comprising the composite display. Third, the raw video of the composite display, while full of information, is not particularly instructive to students and the inexperienced. It is desirable to integrate other relevant video and audio sources to embellish the event and add explanatory information, information from a telepresence system in the procedure room, and/or narration, in real-time. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]      FIG. 1  is a schematic diagram of an existing system for integrating the display and control of a multiple separate computer-controlled medical systems; 
           [0007]      FIG. 2  is a schematic diagram of an embodiment of a medical video production and distribution system, in accordance with the principles of this disclosure; 
           [0008]      FIG. 3  is a flow chart of the implementation of one embodiment of a medical video production and distribution system, in accordance with the principles of this disclosure; and 
           [0009]      FIG. 4  is a schematic diagram of an embodiment of a remote computer for use by a remote participant of the medical video production and distribution. 
       
    
    
     DETAILED DESCRIPTION 
       [0010]    An increasingly important aspect of modern medical procedures is the remote sharing of these medical procedures. Remote sharing allows experienced physicians to share their experience over an unlimited geography, either directly controlling the medical procedure, or simply providing guidance and supervision. Remote share also allows medical students and less experienced physicians to watch medical procedures being conducted by experts, and learn how to perform the procedures themselves. In accordance with various implementations of the disclosure, the remote sharing of medical procedures can be provided with high definition video broadcast easily generated from a variety of sources of video and audio into a single consolidated transmission that can be accessed around the world. A system may be provided to aggregate the sources of information, including PowerPoint, video clips, moderator video, lab video, procedure consolidated view, among other sources along with the audio corresponding with each to form a comprehensive medical collaboration event or Internet broadcast. This can involve the use of a proprietary codec to maintain desired quality, high data transmission rates for high definition video, the editing of the content of a video stream that leaves an institution, an ability to provide commentary and instruction, and an ability to protect patient identity and confidentiality. 
         [0011]    An existing system for the coordinated display and control of multiple separate computer-controlled medical systems is indicated generally as  20  in  FIG. 1 . This system comprises a plurality of separate computer-controlled medical systems  22 A-D. Each of these separate computer-controlled medical systems  22 A-D comprises a processor  24 , a display  26 , and one or more input devices, such as a keyboard  28  and a mouse  30 . These separate computer systems can include, for example a remote navigation system for remotely controlling the position and orientation of the distal end of an elongate medical device in an operating region in a patient; a localization system for determining and displaying the location and/or orientation of the distal end of the medical device in the operating region in the patient; a medical imaging system for imaging the operating region in the patient; and a electrocardiographic system for monitoring electrical activity of the heart. These are just examples, and there could be fewer, additional, and/or different separate computer-controlled medical systems depending upon the nature of the procedure being conducted. 
         [0012]    Each of these separate computer-controlled medical systems  22 A-D is preferably connected to a consolidating and controlling computer system  34 . This consolidating and controlling computer system  34  can comprise a processor  36 , a display  38 , and one or more input devices, such as a keyboard  40  and a mouse  42 . The consolidating and controlling computer system  34  consolidates the individual displays from the separate computer-controlled medical systems  22 A-D onto a composite display on display  38 . The consolidating and controlling computer system  34  also allows control of each of the separate computer-controlled medical systems  22 A-D with the keyboard  40  and mouse  42 . The consolidating and controlling computer system  34  is preferably programmed, so that the keyboard  40  and mouse  42  automatically control the separate computer-controlled medical system  22  whose display on the composite display  38  displays a cursor. An example of such a system is disclosed in U.S. Pat. No. 7,567,233, Global Input Device For Multiple Computer-Controlled Medical Systems, the entire disclosure of which is incorporated herein by reference. Such a system can also be adapted for the simultaneous control of two or more computers. An example of such a system is disclosed in U.S. Pat. No. 7,747,960, entitled Control For, And Method Of, Operating At Least Two Medical Systems, the entire disclosure of which is incorporated herein by reference. 
         [0013]    The video signal from the display  38  is transmitted to an encoder/decoder  44  that converts the video signal into an ip packet based video stream, preferably using a codec that emphasizes frame quality over frame rate, with low latency. The converted video signal can be transmitted over an existing local area network to a server  46 , which can store the signals in their converted form and/or distribute the converted signal to the computers of others in real-time via the local area network or a virtual private network. 
         [0014]    In accordance with a preferred embodiment of the systems and methods of this disclosure, the ip packet based video stream can be provided to a studio production console which facilitates collaboration, broadcasting, and presentation editing. The studio production console  50  comprises a processor  52 , first and second displays  54  and  56 , and input devices, such as keyboard  58  and mouse  60 . In addition, the console could include additional or alternative input devices, such as a pen tablet which could be used with telestrator software during collaboration and broadcast events. The studio production console  50  may also integrate with the video and audio of a telepresence system and a conventional web camera  62  and a microphone  64 , so that the user can add video and audio annotations to the video or audiovisual signal from the display  38  of the system  34  of the lab staff and moderator, respectively. 
         [0015]    The studio production console  50  can access the consolidated procedure information in the form of an ip packet based video stream consisting of live or recorded images from the server  46 , via an encoder/decoder  64  that decodes the ip packet based video stream into a displayable image on the studio production console. 
         [0016]    The processor  52  can include video editing software, such as Cam Studio available at http://camstudio.org/, Camtasia Studio available from TechSmith Corporation, or Adobe Premier available from Adobe Systems Incorporated, or other custom developed presentation editing software which captures the displayable images, and allows the images to be combined with additional visual and audio images. In accordance with one aspect of this disclosure, the studio production console includes a plurality of displays (preferably two) which are set-up so that display  54  acts as a preview display and display  56  acts as a transmit display. The processor  52  is setup so that the user can size and position a plurality of different content sources on the preview display  54  during a collaboration and broadcast event which will not be seen by the remote audience. The user can move these sources across the desktop from the preview display to the transmit display  56  at any time during the collaboration and broadcast event sizing and positioning each source for the remote audience to see. The processor  52  is designed to send the contents of the transmit display to the remote audience. The audio of each of the corresponding sources is enabled and disabled by the studio production console, such that all enabled audio sources are combined and delivered synchronously with the video of the transmit display. In accordance with the principles of this disclosure, the user can select from and arrange at least one of (a) A procedure video or an audiovisual system signal representing a composite of the displays of a plurality of computer based medical systems used in conducting the procedure; (b) A procedure room video or audiovisual signal from a procedure room telepresence system; (c) A local video or audiovisual signal from a local telepresence system or a web camera and/or microphone.; (d) Various supplementary content, including web pages, PowerPoint slides, images, audio files, video files and images, among other relevant audio/video sources. The user can arrange this visual data on the transmit display and can select or combine the various audio sources for this collaboration or broadcast event, for example, selectively combining the procedure visual or audiovisual signal with the procedure room video or audiovisual signal and/or narration from the local video or audiovisual signal, to create a produced video or audiovisual signal. 
         [0017]    Thus, the procedure video or audiovisual system signal can be easily transmitted with supplementary audio and/or video signals from the procedure room, from the operator of the production system or from other sources simply by positioning sources in the transmit display. The operator of the production system can edit the information being transmitted from the institution, and provide contextual and explanatory information. 
         [0018]    The procedure video or audiovisual signal can be provided by using a proprietary codec to communicate the video or audiovisual signal via a network. This network is preferably a preexisting wireless or wired conventional network in the healthcare facility, but could be a special network established from this purpose. Similarly, the procedure room video or audiovisual signal can be provided by a propriety or conventional codec to communicate the video or audiovisual signal via a network. 
         [0019]    The resulting produced video or audiovisual signal from the transmit display of the studio production console can be communicated by a conventional mean or preferably a proprietary codec via a virtual private network (vpn) to a central network gateway  70 . While other means of communication could be used, this allows wide distribution of the produced video or audiovisual signal through a single vpn from each institution to the central network location, rather than requiring the establishment of multiple vpn&#39;s at each source institution, one with each recipient. 
         [0020]    The gateway  70  can provide the video or audiovisual signal to the proprietary codec to others who have an established vpn with the gateway, and simultaneously encode the video and/or audiovisual signal to a conventional video Internet format for transmission over the worldwide web. In a preferred embodiment as shown in  FIG. 2 , the gateway  70  includes a server  72  and a processor  74 . The server stores or distributes the video stream to other users, including the processor  74 . The processor  74  decodes the video signal into a DVI signal, which is provided to a scan converter  76 . The scan converter converts the DVI signal to a broadcast signal, for example, HD-SDI, and provides it to a standards-based video codec, such as h.264 or mpeg-4. This signal is then transmitted to a content delivery network, such as Akamai and Limelight, for distribution to one or more computers for viewing with a web browser via the Internet. 
         [0021]    The signal arriving at the gateway  70  can also be directly communicated by the gateway in its proprietary encoding to one or more computers that receive the signal, decode it, and allow a remote user to participate in the procedure using their own computer  100  ( FIG. 4 ). The computer  100  preferably includes a processor  104 , a display  106 , and one or more input devices, such as a keyboard  108  and a mouse  110 . The remote user can use the keyboard  108  and the mouse  110  to issue commands which are communicated back to the consolidating and controlling computer system  34  to operate the various separate computer-controlled medical systems  22 A-D. 
         [0022]    In accordance with another aspect of this disclosure, a system can be provided, for example, as part of the studio production console, the system can anonymize regions of the video sources which the moderator would like to block from the audience. This can be used to limit the visibility of patient information making the collaboration and broadcast events HIPAA compliant. The anonymization feature would preferably be enabled or disabled by the moderator at will. In one embodiment, the size and position of every video window within the consolidated view is tracked in real-time by virtue of the system which consolidates the video source sending this information through an interface. The moderator could ahead of time define regions to block or crop in each video window or alternatively, use the defaults that have been defined for typical areas to block in each window type. Default positions can be predetermined for the systems commonly used, and provided in a look-up table that the user can select when setting up the system. With the location of patient data known, the privacy of this data can be assured by obscuring the image in the critical locations. When anonymization is enabled, the real-time size and position of each window is used to calculate the size and position of each defined anonymization region for blocking or cropping in real-time while viewing the information. 
         [0023]    Alternatively, OCR text recognition of the procedure video or audiovisual signal can be used to identify the regions to block or crop. Text recognized can then be compared to a list of standard medical terms expected to be on the display, and any unrecognized text can be obscured to prevent disclosure of private patient information. Alternatively, text recognized can be compared to a list of personal information about the patient, and matching text can be obscured to prevent disclosure of private patient information. 
         [0024]    The studio production console can be integrated with telepresence systems which contain bi-directional audio/video from the procedure room (or control room) to the studio console. In one embodiment, a lab telepresence endpoint is connected to an input of the video consolidation system in the procedure room or control room. The lab telepresence system also connects to another studio telepresence endpoint in a remote location of the hospital adjacent to the studio production console with its audio output connected to the studio production console. The telepresence systems facilitate bi-directional audio/video communication from the lab to the studio console, while the video of the lab telepresence system is integrated into a studio collaboration and broadcast event, by receiving the video integrated in the consolidated procedure view and the audio from the output of the studio telepresence endpoint for transmission to a global audience. 
         [0025]    The studio production console includes a moderator&#39;s chat panel which allows viewers to enter comments and questions from their standard Internet web browser. No other viewer is able to see their questions or comments, giving the moderator full control to respond verbally or in written form back to the global audience. This panel also shows when participants enter and exit the event to give a sense of who is viewing.