Abstract:
The invention relates generally to a medical apparatus and method of using the same for receiving and transmitting streaming medical imagery and audio signals in real time, and allowing remote operators to annotate and telestrate with same. The invention acquires streaming medical imagery and audio signals through a telestreamer input device, allowing users to electronically collaborate, generally by telestrating, annotating, and sketching image overlays on streaming medical imagery. Video images of streaming imagery data displayed on a monitor are superimposed onto a virtual mesh projected via computer graphics. The vertices of the mesh move according to equations of motion based on a computational physics engine. Virtual tools are projected above the mesh via computer graphics. These virtual tools interact with the virtual mesh according to the physics engine. The superposition of the video images onto the virtual mesh makes it appear that points within the video image are moving in a realistic manner and reacting to the virtual tools with a realistic response. The invention allows for recursive superposition of mesh layers, also known as ‘surgi-skins’, and creation of a multi-layered virtual mesh. Multi-layered surgi-skins synthesized from multi-modal streaming medical imagery and saved together with multi-dimensional [4-D] virtual mesh and multi-sensory annotation in single file format as DICOM files are also known as ‘DICOM mesh’ or ‘haptic holograms’.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of: 
         [0002]    U.S. Provisional Application No. 61/745,383 filed Dec. 21, 2012 entitled “SYSTEM AND METHOD FOR SURGICAL TELEMENTORING USING VIRTUALIZED TELESTRATION,” naming as inventors, G. Anthony Reina and James Omer L&#39;Esperance, which is incorporated herein by reference in its entirety. 
         [0003]    This application may be related to the following commonly assigned and commonly filed U.S. patent applications, each of which is incorporated herein by reference in its entirety:
       1. U.S. patent application Ser. No. US 2011/0282141 A1 entitled “METHOD AND SYSTEM OF SEE-THROUGH CONSOLE OVERLAY”, naming as inventors Itkowitz et al., filed on 17 Nov. 2011.   2. U.S. patent application Ser. No. US 2011/0282140 A1 entitled “METHOD AND SYSTEM OF HAND SEGMENTATION AND OVERLAY USING DEPTH DATA”, naming as inventors Itkowitz et al., filed on 17 Nov. 2011.   3. U.S. patent application Ser. No. US 2010/0164950 A1 entitled “EFFICIENT 3-D TELESTRATION FOR LOCAL ROBOTIC PROCTORING”, naming as inventors Zhao et al., filed on 1 Jul. 2010.   4. U.S. patent application Ser. No. 8,169,468 B2 entitled “AUGMENTED STEREOSCOPIC VISUALIZATION FOR SURGICAL ROBOT”, naming as inventors Scott et al., filed on 1 May 2012.   5. U.S. patent application Ser. No. US 2009/0036902 A1 entitled “INTERACTIVE USER INTERFACE FOR ROBOTIC MINIMALLY INVASIVE SURGICAL SYSTEMS”, naming as inventors DiMaio et al., filed on 5 Feb. 2009.   6. U.S. patent application Ser. No. US 2011/0107238 A1 entitled “NETWORK-BASED COLLABORATED TELESTRATION ON VIDEO, IMAGES, OR OTHER SHARED VISUAL CONTENT”, naming as inventors Liu and Zhou, filed on 5 May 2011.   7. U.S. patent application Ser. No. 7,492,363 B2 entitled “TELESTRATION SYSTEM”, naming as inventors Meier et al., filed on 17 Feb. 2009.   8. Patent application Ser. No. CA2545508 C entitled “CAMERA FOR COMMUNICATION OF STREAMING MEDIA TO A REMOTE CLIENT”, naming as inventors Kavanagh et al., filed on Oct. 7, 2003.   9. U.S. patent application Ser. No. US 20090210801 A1 entitled “N-way multimedia collaboration systems”, naming as inventors Bakir et al., filed on 19 Feb. 2008.   10. U.S. patent application Ser. No. US 20060122482 A1 entitled “Medical image acquisition system for receiving and transmitting medical images instantaneously and method of using the same”, naming as inventors Mariotti et al., filed on 22 Nov. 2004.   11. U.S. patent application Ser. No. US20110126127 A1 entitled “System and method for collaboratively communicating on images and saving those communications and images in a standard known format”, naming as inventors Mariotti et al., filed on 23 Nov. 2009.       
 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0015]    Not applicable. 
       REFERENCE TO SEQUENCE LISTING, A TABLE, OR A COMPUTER PROGRAM LISTING COMPACT DISC APPENDIX 
       [0016]    Not applicable 
       BACKGROUND OF THE INVENTION 
       [0017]    1. Field of Invention 
         [0018]    Aspects of this invention are related to telestration for remote video collaborating with streaming medical imagery and are, more specifically, related to enhancing a remote telementor&#39;s ability to annotate and interact with the images in a more realistic, yet virtualized manner through simulating the movement and reaction of the displayed images according to a computational physics model. 
         [0019]    2. Description of Related Art 
         [0020]    Industries that develop, manufacturer, and maintain complex products often find an insufficient number of employees with extensive training and experience to meet demand. This is particularly relevant as businesses become more geographically diverse. It is inefficient (and sometime physically impossible) to deploy an expert “into the field” on every occasion at a moment&#39;s notice. Rather, companies typically deploy technicians with relative degrees of experience who collaborate with the expert remotely. For example, a multi-national aerospace company might have local technicians in an Italian production plant conferring with senior designers in the United States regarding the fabrication concerns for a specialized airframe. Similarly, technicians on an ocean oil rig may consult with shore side experts to address problems with specialized drilling machinery. Traditionally, video monitoring, as described in previous art, has been instrumental in achieving this collaboration. 
         [0021]    Conventional tele-monitoring (aka teleconferencing) allows real-time audio and video tele-collaboration to improve education, training, and performance in many fields. Current collaboration methods include telestration, which can be performed either locally or remotely to identify regions of interest within the video images. For example, television personalities routinely annotate video of live or replayed video broadcasts to highlight their commentary. Similarly, flight engineers can remotely inspect possible damage to space vehicles using telestrated, high-definition images of the equipment while it is still in orbit. In short, expert know-how can be maintained at a centralized location while being mobilized anywhere at a moment&#39;s notice. 
         [0022]    Current telestration techniques, as defined in prior art, primarily display freehand and other two-dimensional drawings over a video image or series of images. However, true collaboration is better achieved if the remote expert can demonstrate information through movement and manipulation of the images. In this invention, a computer simulation of the objects within the video images is constructed so that they can be manipulated in a more realistic manner. 
       Medical Imaging and Medical Information Technology 
       [0023]    The promotion of electronic medical records has spurred the expansion of healthcare information technology (HIT) infrastructure and led to the growth of medical information technologies, such as networked medical imaging and virtual reality (VR). 
         [0024]    Traditionally, a medical image is produced when an operator or technician conducts a scan of the patient with a medical imaging apparatus. Medical imaging modalities include X-ray, CT, MRI, and ultrasound scanners. The operator uses the imaging apparatus to save the image (in still or motion video format) onto a hard copy (e.g. film), into the memory, or into an image storage database or repository, such as, a Picture Archiving and Communications System (PACS). PACS is a storage and management system for multiple medical imaging modalities. These images, such as X-rays, MRI and CAT scans, generally require a greater amount of storage than images in non-medical industries. An operator, or user, such as a surgeon, can use PACS to retrieve the saved images either locally or remotely and conceivably use them for navigational or interventional guidance during a surgical procedure. 
         [0025]    Digital Imaging and Communications in Medicine (DICOM) is a standard for managing medical data, including medical imaging. DICOM has many roles in healthcare information technology: It is a standard for exchanging digital information which ensures interoperability between medical imaging equipment (such as radiological imaging) and other systems. It is a protocol for medical device communication over a network, defining syntax and semantics for commands and associated information that can be exchanged. It is a file format and medical directory structure to facilitate access to images and related information stored on media that shares information. It is a printing and display standard to ensure that medical imagery is uniformly presented independent of the device. 
       Application of Virtual Reality (VR) Technologies in Healthcare 
       [0026]    Virtual reality applications in the healthcare industry are associated with many areas of medical technology innovation including robot-assisted surgery, augmented reality (AR) surgery, computer-assisted surgery (CAS), image-guided surgery (IGS), surgical navigation, pre-operative surgical planning, virtual colonoscopy, virtual surgical simulation, and virtual reality exposure therapy (VRET). In addition to intraoperative surgical navigation and guidance, VR tools are often used for medical data visualization, including multi-modality image fusion and advanced 2D/3D/4D image reconstruction. Education and training applications include virtual surgical and procedural simulators. Patient use of VR tools find application in rehabilitation and therapy, including immersive VR systems for pain management, behavioral therapy, psychological therapy, physical rehabilitation, and motor skills training Clinical benefits of healthcare VR technology include improved patient outcomes, reduced medical errors, improved minimally-invasive surgical (MIS) technique, improved physician collaboration in diagnosis, and improved psychological and motor rehabilitation. 
       BRIEF SUMMARY OF THE INVENTION 
       [0027]    The invention relates generally to a multimedia collaborative teleconferencing system and method of using the same for generating telestrations and annotations on streaming medical imagery and saving same for tele-consultation, tele-collaboration, tele-monitoring, tele-proctoring, and tele-mentoring with others users. 
         [0028]    The apparatus includes a medical image acquisition system adapted for receiving and transmitting medical images, constructed from a computer having communications capability adapted for acquisition and transmission of a plurality of medical imaging and video signals. Wherein the medical image and video signals are acquired at the medical device&#39;s native resolutions, the apparatus transmits the signals at their native resolutions and native frame rates to a receiving device, receiving the medical imaging video signals in analog or digital form, and if required, compressing and/or scaling the signal, converting the signal to digital form for transmission, and transmitting the digital signals to a display device. 
         [0029]    A computer can be defined as typically made of several components such as a main circuit board assembly having a central processing unit, memory storage to store programs and files, other storage devices such as hard drives, and portable memory storage, a power supply, a sound and video circuit board assembly, a display, and an input device such as a keyboard, mouse, stylus pen and the like allowing control of the computer graphics user interface display, where any two or more of such components may be physically integrated or may be separate. Any user on the network can store files on the server and a network server is a computer that manages network traffic. 
         [0030]    The medical image acquisition system is capable of acquiring signals from a plurality of medical imaging systems including but not limited to, ultrasound, computer tomography (CT) scan, fluoroscopy, endoscopy, magnetic resonance imaging, nuclear medicine, echocardiogram ultrasound and microscopy. The medical receiving device acquires the video image signal from a plurality of video sources, including but not limited to, S-video, composite color and monochrome, component red blue green video (RGB, three additive primary colors), Digital Visual Interface (DVI), any video transport protocol including digital and analog protocols, high definition multimedia interface (HDMI, compact audio video interface uncompressed digital data), serial digital interface (SDI), and DICOM video in their native, enhanced or reduced resolutions or their native, enhanced or reduced frame rates. 
         [0031]    The apparatus includes a storage device adapted for archiving the video signal in a predetermined digital format, including Digital Imaging and Communications for Medicine (DICOM). Data is transmitted using secure encryption protocols and video signal resolution is transmitted at the same resolution as the received signal. In one illustration, a remote location communicates with the networked computer, for the purpose of collaborating and conferencing. 
         [0032]    The present invention improves on existing telestration techniques via the addition of virtual telestration tools that can physically manipulate the video images in a natural way based on a physics model of the object(s) being displayed. Telestration techniques described in prior art rely on freehand drawing of lines or shapes which are then displayed as overlays onto the video images. In the current embodiment, the user controls virtual tools which are able to cut, push, pull, twist, and suture the video images as if they were actually manipulating human tissue. 
         [0033]    While the current embodiment is a natural fit for telestrating/telementoring over real-time or stored medical images, such as with surgical telemedicine, the method can be applicable to any telestration requiring one user to demonstrate the use of a tool to an operator who is actually using the tool at that time. Although this technique is naturally suited to such remote student-mentor scenarios, it can also be applied to single-user interfaces. Most notably, with the application of the computational physics model included in the current invention, the user can practice a technique in a virtualized manner on live video images prior to actually performing the maneuver. 
         [0034]    This flexibility makes the technique adaptable for the use in remote fieldwork. For example, a telecommunications technician working in a remote location can receive realtime guidance from an expert located elsewhere. Through virtual tool telestration, the expert can annotate which segments to push, pull, twist, and cut in a realistic, but still virtualized manner. The local technician can also use the same annotation tools to practice the task under the guidance of the expert before actually performing the task. By adjusting parameters of the virtual video mesh and computational physics model described below, these annotation techniques can be applied to approximate any objects displayed within the video. 
         [0035]    The present invention is accomplished using a combination of both hardware and software. The software used for the present invention is stored on one or more processor readable storage media including hard disk drives, RAM, ROM, optical drives, and other suitable storage devices. In alternative embodiments, some or all of the software may be replaced with dedicated hardware, including custom integrated circuits and electronic processors. 
         [0036]    The novelty of this invention is:
       (1) the ability to create and modify ‘synthetic’ DICOM information objects. These objects, referred to as ‘surgi-skins’, are multi-modal, multi-layer virtual meshes synthesized from streaming medical imagery.   (2) the ability to encapsulate ‘surgi-skins’ with user metadata, synchronized audio annotations, and haptic annotation, plus save that data together in a single file format structure based on DICOM and referred to as the ‘DICOM Mesh’.       
 
         [0039]    The advantages and novelty of the present invention will appear more clearly from the following description and figures in which the preferred embodiment of the invention is described in detail. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING 
       Description List 
         [0040]    Within the figures, the following reference characters are used to refer to the following elements of the exemplary system illustrated in the drawings.
     10  is an exemplary video stream.     12  is a 3D mesh object virtual tool exemplification.     14  is a tele-video mesh overlay.     16  is an exemplary mesh deformation.     18  is an exemplary mesh tear.   
 
         Figures 
         [0046]      FIG. 1  is a detailed view of the virtual mesh telestration. In this example, a rectangular 12-column grid ( 14 ) of equilateral triangles (aka virtual mesh) is constructed via computer graphics. Each vertex (black circle) is connected to another via a computational physic model (spring) which calculates the vertex&#39;s three-dimensional position using pre-programmed parameters, including a spring constant, gravitational acceleration, and a damping factor. The border vertices (black squares) remain in fixed positions. The video image of an outstretched left arm ( 10 ) is superimposed onto the virtual mesh. A virtual scalpel ( 12 ) is superimposed over both  10  and  14 . 
           [0047]      FIG. 2  is a detailed view based on  FIG. 1  after the virtual scalpel has been moved to the left which simulates a cut to the virtual mesh ( 12 ′→ 12 ). The vertices of the virtual mesh ( 14 ) move according to the computational physics engine and create new sub-triangles within the mesh ( 16 ). This movement creates a void ( 18 ) in the mesh. The superimposed video image of the outstretched left arm ( 10 ) moves according to the displacement of the associated vertices of the virtual mesh and gives the appearance that the virtual scalpel ( 12 ) has in fact “cut” the arm in a realistic manner. Nevertheless, although the original video image is displayed in a distorted manner, the data (and the actual arm) remain unchanged. 
           [0048]      FIG. 3  is a detailed view of the virtual mesh telestration using a forceps tool ( 12 ). As with  FIG. 1 , the virtual mesh is constructed with a 12-column rectangular arrangement of equilateral triangles ( 14 ) whose vertices move according to a computational physics model (spring). A video image of an outstretched left arm ( 10 ) is superimposed onto the virtual mesh. 
           [0049]      FIG. 4  is a detailed view based on  FIG. 4  after the virtual forceps have moved a vertex up and to the left ( 12 ′→ 12 ). With this tool movement, no vertices are created nor destroyed, but instead move according to the computational physics model (stretched and squeezed springs). The superimposed video image of the outstretched left arm ( 10 ) moves according to the displacement of the associated vertices of the virtual mesh and gives the appearance that the virtual forceps has pulled a section of the arm up and to the left. Nevertheless, although the original video image is displayed in a distorted manner, the data (and the arm) remain unchanged. 
           [0050]      FIG. 5  is a workflow diagram of the application and method. An imaging device (e.g. video camera) (# 4 ) is captured by a Surgicom Telenetwork server (# 3 ) and sent to the Surgicom Telestreamer (# 2 ) which digitizes its content and transmits it over telecommunication lines in realtime. A 3D virtual tool telestrator (# 1 ) receives the video telestream and allows the client to annotate the video images as described in  FIGS. 1 and 2  using virtual telestration tools. These annotations are streamed back to the Surgicom Telestreamer (# 2 ) which updates the original video source device stream (# 1 ) with the annotated version. Note that multiple 3D virtual tool telestrators (# 1 ) may act as clients to the Surgicom Telestreamer (# 2 ). All clients view the same video images and can annotate them independently. Also, note that the Surgicom Telenetwork server (# 3 ) is able to save, store, and transmit data to the Surgicom Telestreamer (# 2 ) from recorded sources. 
           [0051]      FIG. 6  is a network diagram of the “Surgicom Telementoring Network” consisting of a Surgicom Telenetwork server, Surgicom Streamer Stack, Local (O.R.) clients, LAN, WAN, and web-based tele-proctors and clients. 
           [0052]      FIG. 7  is a workflow diagram of the Surgicom P.A.C.S. and Holographic systems connected to the Surgicom Streamer Stack and the Surgicom Telenetwork Server. 
           [0053]      FIG. 8  is an exemplar of the haptic holographic display using a virtual mesh and virtual 3D tools. 
           [0054]      FIG. 9  is a workflow diagram of a Surgicom Surgical Telementoring Session. 
           [0055]      FIG. 10  is an exemplar of the Surgicom Console session.  FIG. 10A  (“See One”) shows how pre-operative surgical planning, review, road map, and holographic ‘priors’ can be accessed from the system.  FIG. 10B  (“Do One”) shows how a surgeon can simulate alternative approaches with virtual ‘cuts’ and synthesize into haptic holograms.  FIG. 10C  (“Teach One”) shows how to annotate and save haptic holograms as teaching files with mulit-modal medical imagery and send to PACS. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0056]    In the following description, a preferred embodiment of the invention is described with regard to process and design elements. However, those skilled in the art would recognize, after reading this application, that alternate embodiments of the invention may be implemented with regard to hardware or software without requiring undue invention. 
       General Features of the Method and System 
       [0057]    There are 3 main components to this method:
   (1) the virtual mesh   (2) the UV texture map   (3) the virtual tools.   
 
       Virtual Mesh 
       [0061]    The virtual mesh is a computer graphics representation of a video display where each vertex of the mesh corresponds to a position within the video image. In a static display, the virtual mesh is analogous to a pixel map of the video image. In this invention, however, the vertices of the virtual mesh are not necessarily aligned with the pixels of the video image. More importantly, the locations of the vertices are not fixed in space, but rather can move with respect to one another as if each vertex were a physical object (or a part of a physical object) in the real world. 
         [0062]    In the current instantiation, the virtual mesh is constructed using equilateral triangles arranged in a 12-column grid ( FIG. 1 ). Equilateral triangles were chosen because they are computationally easier to sub-divide than other geometric shapes. Nevertheless, any shape (2D or 3D) can be used to create the mesh. In addition, multiple meshes of varying configurations can be produced to represent features and objects within the streamed imaging modality. Further, the overall mesh is rectangular in shape because video images are usually displayed in this manner; but, the shape of the mesh can changed to conform to the needs of the telestration. 
         [0063]    Machine vision techniques may be applied to sub-divide the mesh according to objects within the video image. For example, a mesh displaying a video of an automobile could be sub-divided into body, wheels, and background—with each sub-segment of the mesh being programmed to mimic the physical characteristics of the objects they represent. This would compensate for any relative movement among the camera, objects, or field of view. 
         [0064]    In the current embodiment, a surgeon could identify regions of interest within the image (e.g. major organs, nerves, or blood vessels) by encircling them with conventional freehand drawing telestration. An optical flow algorithm, such as the Lucas Kinade method, could be used to track each region of interest within the realtime video. The virtual mesh would be continually updated to change the parameters of the sub-meshes based on the regions of interest. This would ensure, for example, that a cut in the mesh which was made to overlay the prostate would keep the same relative position and orientation with respect to the prostate regardless of movement. 
         [0065]    The vertices of the virtual mesh are interconnected in movement using a computational physics model of the object being represented. In the current instantiation, the physics model assumes that vertices are connected via springs which obey the physical constraints of Hooke&#39;s Law and gravitational acceleration. By changing the parameters, such as spring constant, gravitational acceleration, and damping factor, the behavior of the virtual mesh can be adjusted between various levels of fluidity. For example, the current embodiment can be made to approximate human skin, but different types of human tissue could also be represented in the same telestrated video. The properties for both the virtual mesh and physics model can be stored in a standard known format, such as the Collaborative Design Activity (COLLADA). 
         [0066]    It should be noted that although the computational physics model is currently formulated to simulate movement in typical environments, it could be equally used to simulate movement of objects in exotic environments, such as in space or underwater by computationally changing the nature of the virtual mesh. 
       UV Mapping 
       [0067]    UV mapping is a three-dimensional (3D) modeling process which maps a two-dimensional (2D) image onto the three-dimensional surface. Other patents and techniques sometimes refer to this technique as “texture mapping”. Every 3D object in computer graphics is made up of a series of connected polygons. UV mapping allows these polygons to be painted with a color from a 2D image (or texture). Although in its current instantiation the virtual mesh is a 2D object, it can be texture mapped with a 2D video image in the same manner. Further, using the UV mapping, the same technique can be applied to true 3D virtual meshes of any configuration. 
         [0068]    By superimposing the video image onto the virtual mesh using a UV map, the video image will be distorted whenever the virtual mesh is distorted. In effect, the process allows points and segments of the video image to move and react to the telestration. In fact, if polygons within the virtual mesh are deleted (e.g. cutting the mesh as in  FIG. 2 ), the projected video image will not display the area which is mapped to those polygons. Similarly, if the polygon changes shape (e.g. pulling the mesh as in  FIG. 4 ), the projected video image will display the area mapped to that polygon with precisely the same geometric distortion. 
       Virtual Tools 
       [0069]    Virtual tools are computer-generated objects which are programmed to interact with the virtual mesh according to a computational physics engine. In the current instantiation, the invention uses three virtual tools: a virtual scalpel, a virtual forceps, and a virtual suture. All three tools are programmed to push, pull, and twist the virtual mesh according to the physics engine using standard ray-casting techniques and colliders. 
         [0070]    The virtual scalpel separates the connections between the triangles that are in contact with the scalpel tip. This results in a void between those triangles and makes the video image appear to have been cut in the mapped area. Further, if an entire section of the virtual mesh is “cut” from the existing mesh, the UV mapped area of the video image will appear to be physically removed from the remainder of the video image. The edge of the cut mesh then acts as an edge of tissue; so the edge of the cut surface will deform when manipulated, independent of the other side of the cut mesh. 
         [0071]    The virtual forceps attaches to the triangle closest to the forceps tip when activated. It creates an external force on the attached triangles within the computation physics model of the virtual mesh. The forceps can be used to drag the attached triangles ( FIG. 4 ) and gives the illusion that the video image is being grabbed by the forceps in a realistic manner. After the forceps is deactivated, the external force is removed from the computational physics model. The affected triangles will continue to react to internal (reaction) forces until they eventually return to a steady-state position. 
         [0072]    The virtual suture allows the telestrator to add connections between triangles. The suture is modeled by a spring. When activated, the suture tool adds a spring to the computational physics engine between any two points specified. This tool can be used to join previously cut sections of the virtual mesh. 
         [0073]    Although in its current instantiation the virtual tools are limited to these three, the flexibility of the computational physics engine allows the technique to be readily expanded to include the use of any tool or object which can be modeled, including drills, retractors, stents, and suction devices. It also allows for multisensory annotations, including haptic and audio feedback from tool use, to be realistically modeled and stored. 
         [0074]    In addition, the parameters for the virtual tools, mesh, and physics engine can be saved along with multi-sensory (e.g. haptic) data in standard known 3D file formats, such as the Collaborative Design Activity (COLLADA) and Immersion Force Resource (IVS/IFR) specification, and Haptic Multimedia Broadcasting formats, such as MPEG-4 Binary Format for Scene (BIFS) and the University of Iowa&#39;s 3D Holovideo format. 
       Application 
       [0075]    In order to illustrate the method proposed in this invention, consider the field of surgery. Adequate surgical collaboration requires one practitioner demonstrating a technique to another practitioner. Current telestration techniques are unable to demonstrate surgical techniques, such as dissection, clamping, and suturing. It is not sufficient to know simply where or when to cut; the surgeon must be able to also demonstrate how to cut—how to hold the instrument, how hard to push, and how quickly to move. These limitations of conventional telestration as described in prior art are exacerbated in situations where the practitioners may be in different locations. These telestration techniques are insufficient for true surgical telementoring or any video annotation requiring a procedure to be demonstrated especially when complex techniques are being demonstrated to new students. 
         [0076]    Virtual tool telestration, as described herein and which makes up at least a part of the present disclosure, may allow the mentoring surgeon to interact with a virtual video-overlay mesh of the operative field and mimic the technique needed to perform the operation. The surgeon mentor can demonstrate suturing and dissecting techniques while they are virtually overlaid on a video of the actual operative field. Notably, the mentoring surgeon can demonstrate the surgical technique effectively without actually changing the operative field. 
         [0077]    Current telestration methods have limited conventional telemedicine to non-surgical fields of medicine. However, with the system and method of the present disclosure, it may be possible that telemedicine/telementoring will become crucial to surgical practice and, indeed, any field where collaboration requires demonstrating rather than merely describing an idea. 
         [0078]    In fact, there is growing concern that the advance of minimally invasive surgery (MIS) is grossly outpacing the evolution of surgical training This application will assist in bridging the learning curves for surgeons performing the MIS procedures. In addition, as live video and other imaging modalities become more prevalent in clinical practice, the telestration described herein will become inherent to all forms of medicine. A virtual tool telestrator is the critical element to enable adequate surgical telestration. Such a telestrator may be adapted to work in a 2-D or a 3-D video environment with applications not just with visible light images, but with other modalities, including (but not limited to) fluoroscopy, tomography, and magnetic resonance imagery. 
         [0079]    Additionally, telestration is currently used in a number of non-medicine fields. The most common application is with professional sports broadcasting whereby sports commentators can “draw” on the televideo and emphasize certain elements of the video, such as the movement of the players. Adding 3D virtual telestration tools, as described herein, to these existing telestration devices and tools could be invaluable to such modalities. For example, bomb disposal experts could use virtual tools to interact with the remote video signal transmitted by ordinance disposal robots to signal the robot to push or pull certain areas of the field of view. Sculptors could use virtual hands to indicate to their student the proper finger position on a piece of unformed clay—and demonstrate how the clay should move without actually affecting the real world object. Any real world object that can be imaged can be transmitted and manipulated in a collaborative, yet virtualized manner. Such a method and device would be a natural fit for wearable computers or head-mounted displays, such as Google Glass and the Occulus VR Rift, to provide better augmented reality solutions. 
         [0080]    Virtual tool telestration may be equally effective in a 2-D or a 3-D environment or representation and differs from what currently exists in the field of telestration. It is typically constructed from three components ( FIG. 5 ): 
         [0081]    1. a 3D virtual tool telestrator 
         [0082]    2. a Surgicom Telestreamer 
         [0083]    3. a Surgicom Telenetwork server 
         [0084]    These elements (as demonstrated in the drawings) may be related to each other in the following exemplary and non-limiting fashion. 
         [0085]    The Surgicom Telestreamer (# 2 ) may be a computer networking device which allows for audio and video signals to be sent in realtime to remote viewers. In one embodiment, the Surgicom Telestreamer captures streaming medical imagery and transmits it over the internet using a real-time streaming protocol (RTSP) in a H.264 video compression/decompression (codec) format at 1080p resolution of 60 frames per second. 
         [0086]    The 3D virtual tool telestrator (# 1 ) may be a computer program which displays the Surgicom telestream (# 2 ) as a 3D mesh object on a video monitor, allows for a remote users to overlay virtual 3D tools (e.g. forceps, scalpels) which can be moved by the remote user and which can interact with the video mesh. For example, the remote user may virtually grab a section of the video mesh with the forceps and that part of the mesh will move in a manner similar to that of the actual object being displayed in the video (e.g. a section of the bladder neck during prostate removal). 
         [0087]    The 3D Virtual Tool Telestrator (# 1 ) will transmit the virtualized surgical telestration of the remote user back to the source Surgicom Telestreamer (# 2 ) for display. To conserve transmission bandwidth, the 3D Virtual Tool Telestrator (# 1 ) only sends the position and orientation of the virtual tools and the virtual mesh to the Surgicom Telestreamer (# 2 ) along with the timestamp of the current video frame. In this manner, bandwidth requirements and latency are minimized. 
         [0088]    The 3D virtual tool telestrator (# 1 ) may be comprised of computer software written, by way of an exemplary and non-limiting example, with mostly open-sourced software development packages, such as by using a programming environment like but not limited to C++, C#, Mono, Silverlight, and Unity3D. The telestrator may include 3D graphics rendering engine, such as but not limited to Unity3D, which may be used to display the 3D virtual tools and a virtual mesh with triangular vertices. The telestrator may also include a physics simulator, such as but not limited to PhysX, to handle the virtual simulation and interaction between the virtualized 3D tools and the video mesh. The telestrator may also include a multimedia player, such as but not limited to AVPro LiveCapture, which may be used to overlay a video input stream from # 2  onto the virtual mesh to create a virtual operative field. The telestrator will use human input devices, such as the Razer Hydra joystick or the Geomagic Touch to control movement of the virtual tools in a natural way. 
         [0089]    A similar computer program exists on the Surgicom Telestreamer (# 2 ). However, unlike the 3D virtual tool telestrator (# 1 ), this program renders the graphics without the computational physics engine. Instead, the position and orientation of the virtual tools and virtual mesh that were passed back from the virtual tool telestrator (# 1 ) are used to create an exact rendering of the virtual tool telestration at that timestamp. In this way, the Surgicom Telestreamer (# 2 ) can display an exact rendering of the 3D virtual tool telestration to all clients simultaneously. 
         [0090]    While the invention has been described with reference to preferred embodiments, it is to be understood that the invention is not intended to be limited to the specific embodiments set forth above. Thus, it is recognized that those skilled in the art will appreciate that certain substitutions, alterations, modifications, and omissions may be made without departing from the spirit or intent of the invention. Accordingly, the foregoing description is meant to be exemplary only, the invention is to be taken as including all reasonable equivalents to the subject matter of the invention, and should not limit the scope of the invention set forth in the following claims. 
         [0091]    The Surgicom Telenetwork server (# 3 ) can save and store the medical images having the overlaid drawn annotated and telestrated images in a PACS using the DICOM format, and saving the session information that includes the collaboration session ID, client information, image information including associated metadata, and date and times of the session