Macquarie University, Australia

Hurrairah bin Sohail explores a unique initiative at Macquarie University to enable flexible, portable conferencing at the cadaver labs in direct response to the challenges caused by Covid-19 restrictions.

Surgery is a skill that is acquired through hours and hours of training. Macquarie University provides this training as Iain Brew, clinical AV coordinator, Faculty of Medicine, Health & Human Sciences, Macquarie University, details: “Our cadaver lab is one of the busiest in the Southern Hemisphere. During the week we teach surgical skills to our students, including the MD program. On the weekend, medical companies will come and use our space and facilities to demonstrate their products. Surgeons can come in and look at the products and train as well. The space can be used to try new techniques and new products for the operating world hands on. And it is not just available for Australia. We have links with Singapore and Japan and other places, and they also leverage our cadaver labs. With Covid-19 we had to find a way to continue these activities but in a safe manner.”

The pedagogy for training for surgery techniques and testing new products is fairly established. However, Covid-19 completely disrupted proceedings. Brew says: “Surgical training in Australia came to a complete halt effectively for two months and it was then that we decided to start exploring alternatives.”

Going virtual and into the realm of videoconferencing was an obvious solution. Associate Professor Richard Appleyard, director of Surgical Skills Training, details the early exploration of this option: “We ran a very rudimentary session over videoconferencing where we had three or four laptops spread across the lab with different webcams and wires going everywhere trying to bring together four different inputs. We used Zoom and that worked out well and from here we decided whether the whole system could be improved.”

The challenge for Brew was to take this working system and convert it into something more elegant. With the choice of the videoconferencing platform locked in Brew expands: “Nowadays you don’t need a physical codec system for videoconferencing. It is actually quite easy to get VC up and running. That is when we thought that Zoom might be a way to reach out and engage a wider audience. However, we would need a system that would be flexible, secure, portable and easy to use.”

Brew’s work led to the creation of what he has dubbed the ‘SiriusVC portable rack’ which can be wheeled around and plugged in to help as needed. Starting with connectivity, the back of the rack features D-plate patch panels which are hooked up to two Gefen scalers. This allows connectivity and support for VGA, DisplayPort, HDMI and even composite. Composite connectivity was required as X-ray machines in use at Macquarie University require it. The rack also features generic HDMI and SDI inputs to support 4K signals as well as video over IP inputs thanks to the inclusion of Gefen receivers.

Video over IP was a crucial component. Brew explains how it made an impact: “We were undertaking this project in-house, so we had a limited amount of manpower and resources. Video over IP helped tackle these issues. If we look at it in terms of programming the system, it took about half an hour to make it work. If it was a traditional matrix switch, we would have needed dedicated ports on the wall for the plug in the rack. And video over IP helped to really keep the cost down. To expand our rack, we just had to get some inexpensive Gefen receivers and that was it. If it was a traditional matrix we would have to worry about the capacity and if that was maxed out, we would have to upgrade the chassis and cabling and the costs would just snowball.”

Macquarie University’s Faculty of Medicine had already deployed Gefen video-over-IP systems and Brew details: “We had deployed the first generation of Gefen video-over-IP products and the results were so good that we built a second space with similar infrastructure and fully upgraded our Simulation Lab. All of our labs at Macquarie University have Gefen video over IP Generation 2.

Each lab has its own Cisco switches and there is a 20 Gb link between each lab so we can route and switch data between the labs as well. We’ve used all the spaces together for big events such as orientations with content being pushed out to all the labs and we could do that with just a few buttons pushed. Equipping the SiriusVC system that we have built with Gefen video-over-IP capabilities means that we can just plug it into our existing video-over-IP system in the spaces. We can access any of the inputs with ease which just makes it a natural extension of the entire system we already have in place.”

Brew believes it was an obvious choice to continue with Gefen: “One of the features that I like on the Gefen product is the fact that with the new firmware update it has the ability to independently route I/O signals and this might be something that we want to explore in the future. Not many video-over-IP products on the market have this feature. The other important thing is that it is IT-friendly which means that if I wasn’t around, or AV support was not present, the IT department could pick up these receivers and follow a one-page set of instructions and be able to operate the system and work on it. Unfortunately, that is not the case for all the video-over-IP products out there and you can get mired in jargon and licenses and all sorts of hassles. And lastly, the support from Gefen and Nortek has always been excellent. They are always willing to engage in a conversation and brainstorm new ideas for how their products can be used.”

The input signals are routed to a DVI matrix. Brew says: “We could have gone with a multi-viewer and pushed the video signals through that, but we would not have the ability to pick or choose or spotlight the video feeds. In surgery, we might want to look at the scope camera and then switch to outside the body to look at the surgeons to see what techniques are being used. With the matrix, we are not restricted in our approach. This is also why we went with individual computers, matrices and capture devices so that we have that granular level of control over the video rather than just being stuck with a particular output. The matrix also has a HDMI-out port which allows us to actually plug it to a projector or another display if needed. We can then just route the Zoom call or any of the matrix sources to this display.”

Brew adds: “A particular challenge that we faced was with the DVI matrix which routed the video for the whole system. The particular product we had on hand was not playing well with the EDID of other components. Gefen are upgrading us to an HDMI matrix to replace it which should solve these issues.”

From the DVI matrix the video signals are sent to Blackmagic web presenters which serve as a method to ingest the signals into six PCs running the Zoom calls. A seventh main PC is connected to a webcam and a touchscreen and it invites all the other PCs to the videoconferencing call which the other six PCs accept automatically.

For managing and routing audio a spare Peavey Digitool DSP is being used. Four headset microphones are used to pick up audio from the surgeons. There are two external microphones as well to enable a lecture style presentation if required. The rack then connects to external speakers in the lab via XLR connections. To control the rack, iRidium Pro software is being run on a PC with a touchscreen serving as the input device.

Brew says: “The whole system was designed so that users would be able to operate it without support or guidance. The user interface and experience follows that available in the labs so it is easy for our end users to understand and operate it and to make sure that the system was user friendly, repeatable and sustainable.”

It is interesting to note that taking into account the business climate created due to the disruption caused by Covid-19, the SiriusVC initiative was undertaken with fiscal prudence. As should be obvious, rather than go to market with a tender Brew undertook the project himself in collaboration with his colleagues. In addition, he made a concerted effort to ensure that products and components were reused and recycled. The DVI matrices, DSP, microphones and so on used to create the SiriusVC had been procured years ago and were not being used. He also converted wireless presentation products to their basic state in an effort to repurpose them and put them to use.

At the same time, he was also battling the disruption to the AV market. He says: “Another big issue was the lead times for delivery which were much longer due to Covid-19. I had to order a particular plate from New York, and these arrived quicker than a product ordered from Queensland, which is just a six-hour drive from New South Wales. So, getting the products here in time, because we had some deadlines, was a challenge.”

But despite the hurdles, Brew persevered and succeeded. He details: “We recently did a workshop between us and New Zealand to showcase a new surgical robot. We were able to plug in the output from the robot and the feed from the camera on the robot transported over IP with the help of Gefen. During the session, the people in New Zealand were able to have a gallery view and see all the elements working together, how the surgery was progressing and have remote control and understand how it translates with respect to the actual surgery. And of course, we were able to record it both through Zoom and our in-lab recording system and share it with all the parties.”

Appleyard gives his thoughts on how the SiriusVC has performed: “Our solution provides an overview of the surgery for a person who wants to be there and wants to see how an expert would perform the techniques but can’t be there in person. However, there is nothing like doing the real thing. I don’t think this will ever replace in-person, physical, actual training. But as an educational tool, it is incredibly powerful because we have the ability to provide a recording of the session as well and this allows them to be able to re-watch and understand the approach to the techniques so that when they do actually go to the cadaver lab, they can maximise the return from the time spent in that environment.”

Looking ahead to the future, Brew believes that the SiriusVC has proven its value: “I don’t think virtual engagement is going away. There was some resistance initially from the companies we work with and they did not actually see the merit. But now when we have shown them this technology and the engagement it delivers; there is high demand for it in the workshops we run to have an interactive videoconferencing feed. What we have noticed at the Faculty of Medicine is that our online events have been very successful, even more so than face-to-face events in some cases.”

He continues: “It has become part of how we conduct our activities, and it will evolve further once Covid-19 restrictions are removed. Our partners and faculty see Zoom now as an extension of the education programme. It gets them access to a wider audience when trying to promote a product and from the surgeon’s perspective it allows them to see how the devices and equipment work without having to trial them in surgeries. Of course, they can follow up with actual trials and physical training.”

Brew concludes: “I think it is a testament to how we have responded to the disruption caused by Covid-19. We are not building this solution as something we will use for six months and then we done with it. I think it will become a part of how we operate.”

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