Download NUCLeUS™ technology explained

NUCLeUS™ Technology Insight
Driving the networked Digital OR to perfection
In 2007, eSATURNUS was the first to offer a Digital Operating Room
entirely running on top of the hospital’s IP network: NUCLeUS™ was
born.
Since then, eSATURNUS has been working relentlessly to optimize
and polish NUCLeUS™. Developers worked in close collaboration
with everyone involved in modern hospitals’ workflows and supply
chains: distributors, clinicians, OR technicians, IT departments, and
hospital management.
Through these experiences, eSATURNUS gained a solid working base,
resulting in several features that really matter. Below we highlight a
small selection of them.
Unified video capture
OR installation engineers and purchase departments have to face it
each time: at install time, the medical equipment to be connected
to the digital OR, outputs a different video signal than was originally
designed; the purchased digital ¬¬OR components do not fit. Moreover, once in use, digital OR configurations and mobile towers are
flexibly rearranged to new and shared medical equipment – often a
hard puzzle for OR technicians.
NUCLeUS™ eliminates that worry now. All video standards and the
whole jungle of custom video modes used by medical equipment:
the new Transmitter HD accepts them, and preserves them at their
original quality.
Unified form factor
All NUCLeUS™ transmitters and receivers share the same form factor.
The compact and completely closed housing has been designed for
optimal hygiene and easy cleaning, maintenance-free operation,
industrial sturdiness and many mounting options. Compact stocking
and easy transport comes as a welcome bonus for distributors and
hospital logistics.
Double consolidation
Once connected to NUCLeUS™, the live image of every single piece
of medical equipment has become available for real-time display
and other media services over the hospital’s Gigabit data network
(IP). Modern corporate data networks are often significantly more
reliable than traditional video cabling networks. Nevertheless, some
people or organizations still have more trust in traditional video
cabling.
NUCLeUS™ now makes this discussion unnecessary: in addition to
the network stream on the UTP cable, every NUCLeUS™ connected
video signal is available over a single coax in HD/3G-SDI.
Both UTP cables and coaxial cables are excellent choices with regard
to price, installation comfort and dependability. Their combination is
even better.
Powered over Ethernet (PoE)
NUCLeUS™ transmitters and receivers are optionally powered over
Ethernet by standards-compliant PoE network switches. This makes
safe and cleaner structured cabling possible, and saves valuable
space and energy.
Moreover, your IT department will like the centralized remote
control and monitoring possibilities offered by PoE.
Many mounting options
The unified and compact form factor of NUCLeUS™ modules allows
a wide range of industrial-strength mounting options: invisible
between a monitor and a boom, against a wall, on a table, in an
endoscopic tower, in a server rack.
Rapid delivery and set-up
NUCLeUS™ keeps the lead as the most complete platform for
digital OR available today: end-user applications, always-on media
services, integration APIs, and installed infrastructure. Every part was
co-designed with the greatest care to work without a glitch as one
product.
Installation profiles have been increasingly standardized: delivery
and installation of a NUCLeUS™ digital operating room can now be
finished one day after purchase.
Quality and flexibility in video
NUCLeUS™ has been made to fit perfectly within common data
networks as found in modern hospitals nowadays: one gigabit
per second to the endpoints, and often higher bandwidths for the
network backbone.
In this context eSATURNUS has started to offer visually lossless
video compression with zero latency for the most-demanding video
standards found in the OR today, without quality loss with respect
to the established NUCLeUS™-native uncompressed streaming
technology. As a result, even with the growing omnipresence of HD
equipment in the OR, NUCLeUS™ keeps offering unsurpassed video
quality on an affordable network infrastructure, while maintaining
the flexibility of all the recording, broadcasting and other media
services over the entire hospital.
NUCLeUS™ Technology Insight
Visual impact: what you see is what you get
In a hospital environment, precision is key. In particular, surgeons,
working in a microscopy environment, need to get a natural visual
feedback. Since procedures in the endoscopic field rely on video,
image quality is a central topic in the debate over the use of video in
the operating room. Moreover, the digital revolution in endoscopy
changes the way surgeons work and communicate, offering great
improvement in the service to patients and referring doctors.
However, this pay-off requires a significant investment of time and
thought on the part of the surgeon. This article deals with some of
these issues.
Digitization of video
To create a digital image, a specific device converts the video
signal into a digital form. The collected information, which needs
to be converted, consist of color models and pixel resolution, both
affecting the file size of the image. A few definitions:
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•
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Color depth: The number of discrete colors available to present
an image.
Pixel density: The number of pixels into which an image is divided by the capturing device. The greater the number of pixels/
unit area the higher the resolution of the image.
File size: The final size of an uncompressed image is calculated
simply by the formula width (in pixels) by height by color depth.
File size affects storage requirements, display delays and transfer
times, and so becomes important in the everyday use of the images.
An uncompressed high definition image (1920x1080 px) requires
1.4 gigabit/s. Storing one video frame would take 5,9MB, so 1GB
takes 5,6 seconds per recorded video. Without compression, this
would give an essential ballast to the hospital disk space and more
importantly, video streams would saturate the hospital network
more quickly. With 4K and even 8K resolutions on the rise, the need
for an efficient digitization system gets bigger.
(1920x1080) x 3
5,9Mbyte
1024x1024
RGB
Frames ps
30/s
x8x
(1920x1080)
1 frame
resolution
x3
1,4 Gb/s
1024x1024x1024 bit -> byte
Uncompressed video needs min. 1,4 Gb/snetwork
What detail is needed?
In some clinical situations resolution is not important, e.g. a large
mass may be easily identified at low resolution. On the other hand,
subtle findings such as the disruption of the vascular pattern may
require a higher pixel ratio. To show the image on a computer
screen, the resolution of the screen determines the optimal resolution, but for printing e.g. for a journal manuscript, more pixels per
inch are needed.
File compression
For practical purposes, uncompressed images are almost theoretical
relics of the past. With the increasing utility of network-based and
internet-based computer applications, the need for smaller files is
indisputable. Moreover, because of the possibility to use efficient file
compressions, high data rates are no longer acceptable in a modern
hospital environment.
File compression is a computational processing technique that effectively reduces the size of a file by removing redundancies in large
binary data sets. Full motion video requires a minimal display rate of
30 frames/s. As demonstrated earlier, with uncompressed sources,
disk storage would be rapidly exceeded and image transmission even
on high-speed networks would be slow. Compression is measured
as a ratio of the size of the original data divided by the compressed
data.
There are two general categories of compression techniques: lossless
and lossy:
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•
Lossy compression implies that some information is lost in the
compression/decompression process, but algorithms can be
designed to minimize the effect of data loss on the diagnostic
features of the images. In order to achieve practical archival
storage and transmission of medical images, lossy compression
techniques are commonly employed.
Lossless compression techniques preserve all the information
in the compression/decompression process. When images are
used as a means of primary diagnosis, they require lossless
compression, storage and transmission. However, in most cases,
this technique also results in dedicated high-speed network
requirements and high-end hardware infrastructure.
RtoR™ visually lossless compression
NUCLeUS™ video encoding and decoding is based on RtoR™
visually lossless compression. Technically, the original resolution of
1920x1080 pixels, the frame rate and the color space remain the
same in the beginning and the end of the chain. Visual artifacts are
being eliminated without having any form of delay on a standard IP
network, due to the patented RtoR™ technology. In short, the user
will not notice the difference between a visually lossless compression and an uncompressed image.
Also, depending on the surgeons’ preference, photographic
standards can be either lossless or lossy implemented. The patented
RtoR™ image compression provides many advantages over other
uncompressed, lossless or lossy image streams.
Perfect image quality with lots of flexibility
Via NUCLeUS™, the users get a unique feature. The software is
designed keeping in mind that everybody needs high quality images
for presentations. On the other hand, surgeons need to shoot entire
interventions for documentation. Often, this is an unmanageable
compromise.
In NUCLeUS™, a surgeon does not have to choose between high or
low quality. He can record multiple sources in different qualities
at the same time. This also postpones the real-time quality choice,
which can be a stressful and additional decision during surgeries.
A choice of quality
In conclusion, NUCLeUS™ provides a surgeon real-time imaging
without any compromise in quality. The recording of images can be
initiated without any preparatory steps from the surgeon. He can
follow his intuition to record the images in any quality he prefers.
This makes NUCLeUS™ the ultimate platform in- and outside the
operating suite.
NUCLeUS™ Technology Insight
Real to Real (RtoR™) patented technology
milliseconds.
NUCLeUS™ incorporates proprietary and patented RtoR™, based on
a simultaneous encoding and decoding of video slices. The monitor
will display them with no supplementary latency.
Understanding video latency
Each video system consists of at least a camera, a display and appropriate cabling between the two devices. There is a tiny lag between
the occurrence of a movement in the visual scene and the time
when that same movement can actually be displayed on the screen.
This time lag is called latency.
The delay is primarily caused by the image processing hardware in
the camera and in the display.
TM
All surgical procedures require an extremely accurate and efficient
eye-hand coordination. Many of these procedures and those involving endoscopy in particular, rely on video systems to provide visual
feedback to the clinician.
VIDEO OVER IP
This eliminates the ever-growing need for auxiliary video routing and
processing equipment. Therefore it also eliminates the risk, proper
to traditional cabling, that extending the video system increases
latency in an uncontrolled way.
Camera
Image
Encoding and
decoding of the
entire image
Camera
Image
Monitor
Image
RtoR™
encoding
RtoR™
decoding
Monitor
Image
Latency in the operating room
Think of how much more snappy, light, accurate and controlled a
sports car can feel. Compare this with family cars made for the mass
market. Most of this feeling is realized by keeping the time between
the steering action and the consequent movement of the vehicle low
at all times.
In very much the same way, clinicians in the operating room are very
dependent on a highly responsive visual feedback for the accuracy
and efficiency of their actions and decisions. Psycho-visual studies
point out that a latency of 100 milliseconds is the perceptual limit:
below that, it is not felt by humans. Above that point, some people
will start noticing. A delay of 150 milliseconds is perceived by
everyone.
Latency of video cabling
In its most basic form, traditional video cabling adds almost no
latency to the unavoidable intrinsic system latency of 40 to 60 milliseconds. However, in practice, due to the demand for more flexible
video routing and switching in the operating room, the initial setup
grows. Over time, the video system explodes into a hybrid clutter of
video switches, video signal converters and other related equipment.
These intermediary boxes can easily each add up to 60 milliseconds
of latency to the video systems chain. And from there to a point
where it will be noticed by clinical end-users.
Latency of video over IP
Video for home or office applications is often routed over IP
networks. Their video compression techniques generate considerable latencies that range from 60 milliseconds to even 150 milliseconds.
Not with the video over IP solution of NUCLeUS™. The patented
RtoR™ technique effectively adds no latency to the end-toend visualisation chain and keeps electrical latency around 5
RtoR™ ensures the snappy feeling from basic traditional video
cabling, while still preserving the easiness of use of video over IP. On
average, there is an electrical data delay of 5 milliseconds. RtoR™
adds no delay to this. So NUCLeUS™ can match comparison with any
cabled system but it beats both Video over IP and cable networks
when multiple operating rooms need to be integrated. Therefore
NUCLeUS™ is a fast and future proof piece of equipment for you as a
medical professional.
NUCLeUS™ Technology Insight
Guaranteed safety in a secure environment
High quality images and real-time video have become indispensable
in the modern operating theatre. Images from the operating room
are available throughout the hospital in a superb quality and without
any latency. Obviously, all this would lose its value if uptime of the
system could not be guaranteed at all times. NUCLeUS™ assures
physicians of a constant availability of their video sources by taking
intelligent and preventive measures.
NUCLeUS™ preventive maintenance
A NUCLeUS™ integration is always done in close cooperation with
the hospital. It is of vital importance that all individual IT-pieces are
tuned to each other. eSATURNUS will always analyze the existing
IT-infrastructure, suggest where to improve and validate the result
prior to installation. These steps are compulsory in order to fulfill the
essential quality requirements and guarantee a smooth installation.
After installation, the eSATURNUS support team remotely monitors
the health of the installation. Any performance deterioration is
dealt with before it becomes noticeable by the end-user. Preventive
maintenance and monitoring keep NUCLeUS™ uptime to a maximum.
Server redundancy
NUCLeUS™ allows all servers to be placed in the hospital’s data
center. The mere fact that they are located in an air-conditioned and
dust-free environment will already boost their availability.
NUCLeUS™ servers can be classified in two categories: those
executing management and supervisory tasks and those providing
mere compute power.
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Server virtualization: Obviously, machines running supervisory
tasks may never fail. Supervisory machines are for this reason
virtualized. Virtualization platforms are capable of guaranteeing
extreme levels of availability. Hardware for the host system can
be implemented redundantly, as are the hard-disks and data
stores, network interfaces etc. Moreover, redundant hardware
can be placed in different data-rooms to safeguard against fire
or power outage. Virtual machines migrate automatically to a
redundant server in case of hardware failure.
Hot failovers: A second class of servers in a NUCLeUS™
installation only provides compute power to the system. These
machines are implemented as a pool of low-cost physical
servers. If one server in the pool fails, another one will
immediately take over. Smart dimensioning the pool with only
one server guarantees 100% percent availability.
Network redundancy
The NUCLeUS™ digital operating room concept is based on the
correct functioning of the hospital network. It uses the underlying,
redundant network architecture and assumes sufficient bandwidth
between the OR and the datacenter.
Obviously, a transparent communication between the hospital and
the integrator, is the foundation of a smooth installation, since the
NUCLeUS™ image streams are transported over channels that are
extrinsic of NUCLeUS™. Therefore certain agreements need to be
concluded. All of this is described in an accurate installation guide.
By following this manual, NUCLeUS™ can be implemented to fit the
costumer needs.
Graceful degradation
In the rare case of network or server failure, NUCLeUS™ degrades
gracefully from a digital operating room to a traditional (regular)
operating room.
The primary cable provides a direct video-link between the equipment that does not have its own visualization means and one or
more surgical monitors. The sources that are directly wired are
typically endoscopic cameras.
Whenever a primary wired video source is visualized, NUCLeUS™
instructs the surgical monitor to switch its input to the primary
cable. From now on, network or server problems may compromise
digital OR functionality (recording, videoconferencing etc.) but the
basic functioning of the operating room is never jeopardized.
As an additional safety measure, NUCLeUS™ will also instruct every
surgical monitor to switch its input to the primary cable upon the
detection of network or server malfunction.
As a last resort, the surgical monitors can always be switched
manually to the primary wire.
A safe choice
The NUCLeUS™ concept is more fault-tolerant than any other
solution and inherently safe. Compared to classic AV systems, it
uses significantly less cabling and scales much better. Compared to
other video-over-IP providers, it is safer because of the intelligent
use of server and network power. On top of that, the primary wiring
guarantees visualization of predefined sources, so an ongoing operation will never be stopped. NUCLeUS™ provides the best of both the
AV and Video-over-IP worlds.
* All NUCLeUS™ installations proceed following the requirements described in the network and server
dimensioning guide. Don’t forget to ask for them.