Take Two Streams: Streaming Video on the Rise in Modern Medicine
Take two streams and call me in the morning,” said no doctor ever.
And yet, the growth of streaming in both the medical and pharmaceutical industries means that more patients are interacting with medical professionals remotely, bringing with it the potential of better healthcare for rural areas as well as better training for specialists around the globe.
This article explores five broad uses of streaming. We’ll start with its use as a training aid for surgeons, then talk about its use in continuing education for medical personnel, observation of patients in rural locations, virtual house calls, and clinical trials.
The use of live video for training surgeons has often been limited to a single location, with an operating room and an adjacent auditorium. While this is common practice in many medical schools, especially those that focus on training medical doctors for specialties like surgery, radiology, and pathology, most of the video delivered from the operating theater to the auditorium would run across baseband video feeds (e.g., RGB over HDMI or SDI cabling) for distances of 300 feet or less and therefore did not require streaming.
The advent of optical fiber-based video transceivers has even allowed baseband video to be pushed more than a half-mile within a single-campus environment. Where there’s potential for streaming, though, is when the video needs to move beyond the confines of a single location.
London-based The Streaming Co. has worked with a number of implementations of streaming for medical training. It offers streaming to multiple locations for training purposes, including instances in which latencies are critical. CEO Ben Kittow notes that The Streaming Co. provides streaming for auctions and gambling—two market verticals “where live ultra-low-latency is essential”—but he offers an example in which medical training needs to be provided across a wide geographic area.
London-based The Streaming Co. streams surgeries from operating theaters to auditoriums for training and surgical team decision making.
As part of a 3-day symposium called The College of Phlebology International Veins Meeting, The Streaming Co. not only live streamed conference sessions, but also live streamed an operation to “showcase modern procedures and medical equipment as used by surgeons” for an audience of surgeons interested in learning about these new techniques.
The event involved tying together a medical theater and a remote auditorium across London via two-way ultra-low-latency connectivity to allow a surgeon in the operating theater and in the auditorium to be connected audibly and visually, says Kittow. Surgeons performing in the operating theater guided viewers through procedures, while answering questions fed to the surgery team via a moderator in the auditorium. The Streaming Co. also delivered video to external viewers.
Kittow provides another example in which streaming in a single-campus environment makes more sense than a traditional baseband video feed. A case study from 2018 involved training surgeons for the U.K.’s National Health Service (NHS) using an open operating theater during a Stage 2 cancer surgery to gauge the spread of cancer within the walls of the patient’s prostate.
The case study, NHS NeuroSAFE Pathology, notes, “During an operation to remove a cancerous prostate, the prostate is taken for analysis to see if the cancer has spread further into the walls.” While the patient and surgery team awaited results in the open theater in order to determine whether additional immediate surgery was required, The Streaming Co. streamed “video footage from monitors and the surgeons working in [the] theatre to an auditorium where other trainee surgeons [were] able view the proceedings & discuss.”
When I asked Kittow whether streaming across a single campus was “overkill,” he explained that baseband video distribution wasn’t sufficient. “The buildings were in different parts of the hospital campus straddling two networks,” he said, noting that each of the two networks was managed by separate contractors whose network solutions didn’t play well together. “We were unable to use any element of their network architecture cross-campus largely due to time constraints.
“If it were in the same location, we would normally avoid streaming,” says Kittow, “but in this instance, we ended up streaming out of one part of the campus (uplink and ingest to our CDN) and streaming via a channel link by downlinking the stream in another campus.”
Kittow notes that the issue, even for a single-campus location, often rests in the client’s ability to carve out a part of the network. “The client in this test case did not have access, time, nor the budget to involve our high-end engineers,” he says, “and the local network manager/staff are suspicious of video on their network due to vital data as opposed to video services (patient data, military, financial etc).”
Faced with the fact that an additional outside contractor handling the change request was unable to implement it within the event timeline, The Streaming Co. bypassed the network completely by using streaming uplink and downlink through its own CDN.
“It sounds mad but is surprisingly a common problem,” says Kittow of the continuing mistrust of video on an enterprise network. “When we do not wish to start interfering with someone else’s network, even though we have Cisco/Juniper skills in house (our CDN is built on them), we offer this type of uplink-downlink CDN solution for low-latency delivery across a single campus.”
Continuing Medical Education (CME)
In the U.S., medical doctors are required to attend a certain number of conferences and to go to educational seminars to receive continuing medical education (CME) credits. Most physicians are quite busy, enough so that some CME providers host their events in exotic locations, allowing physicians to combine family vacation plans with conference attendance. In the past, this gave rise to questions about whether or not CME conferences were necessary—and whether physicians were actually attending the courses or using their time for other pursuits. Either way, the time that it takes for physicians to travel to these events cuts into their time in the office.
Continuing medical education conferences are often held in exotic locations like this one in Hawaii, but more and more physicians are viewing sessions from their home office via streaming from the Continuing Education Co.
To minimize the amount of time physicians are out of the office, live streaming of conference proceedings has become a popular option for them to still meet CME requirements.
One of the major players in this live streaming of CME events is the Continuing Education Co. (CEC), a 501(c)(3) nonprofit continuing medical education organization. CEC hosts onsite CME training at conferences as well as a few live-streamed conferences. Through its website, CMEmeeting.org, the company also offers online on-demand courses.
CEC’s president, Walter Ejnes, noted in an email exchange that he was “currently in Seattle getting [ready] for a conference we are holding on an Alaska cruise” that would “not have the best internet access” while the conference was underway. That limited connectivity may explain why CEC only live streams conferences from particular locations.
According to CEC’s website, conferences are hosted in Maui, Hawaii; Santa Fe, N.M.; San Diego; New Orleans; several places in Florida; and several in South Carolina. Live-streaming events are only offered from a subset of those locations, including the Westin and Omni hotels in San Diego and a resort in Duck Key, Fla.
For the busy physician who wants to view the live stream instead of physically attending the conference, the cost of each webcast is a reasonable $525, which CMEMeeting.org notes “includes live conference streaming and access to online course materials.”
Observation and Telemetry
While remote observation of patients, at least in terms of checkups after a medical operation, has been available as “telemedicine” for the past decade, recent years have brought increased interest in augmented reality (AR) for use in medical procedures, in which instructions, patient vital signs, and other necessary details are available in the form of a heads-up display (HUD) for members of the surgical and support team.
We covered a bit of this in a recent article on the use of streaming in manufacturing, in which using AR in maintenance and repair showed benefits for more than just one person in the maintenance process.
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