Veterans Affairs Palo Alto Hospital

Sharing the Knowledge in HD

A screenshot of Final Cut Pro, used for editing an endoscopy video.

“The basis for upgrading to HD is very simple: how can you diagnose intestinal disease if you can’t see it and don’t know what it looks like? That’s the most important thing we get from HD imaging — an appreciation of endoscopic diagnosis, and of intestinal pathology at an early stage.”

“The basis for upgrading to HD is very simple: how can you diagnose intestinal disease if you can’t see it and don’t know what it looks like?”

Although the new endoscopes provide an HD screen display for examinations, they only enable the capture of single-frame SD images. Soetikno, however, captures HD motion video on Mac systems the same way he does with SD video. The HD playback, using full motion, slow motion, and still-frame video, is a powerful tool when meeting with surgeons about lesions that cannot be treated endoscopically.

”Early gastrointestinal cancers are hard to identify,” says Kaltenbach. “There may only be a subtle change in the appearance of the tissue. Using Mac technology, we can review HD endoscopy images and videos to recognize lesions. When we share the video with surgeons and pathologists, they can appreciate what we see during the procedure. That’s why capturing video of endoscopies is a critical step in patient care.”

All four of the Unit’s endoscopy rooms are now equipped with Mac Pro systems and Apple HD Cinema Displays. iMacs are installed on both mobile endoscopy units for use in the Intensive Care and Radiology departments. An Xserve RAID stores the terabytes of data that the endoscopy team accumulates through its clinical practice. In addition to benefiting their endoscopy, this mountain of visual data has a clear purpose: the sharing of learning, which is Soetikno’s personal passion.

Spreading the Knowledge

Soetikno’s team has much to share with fellow professionals: a library of instructive videos, enthusiasm for HD endoscopy, and a simple way to implement Macintosh capture and playback capability.

Soetikno and his team capture endoscopies at the highest available resolution, usually as QuickTime Pro movies, and assemble and edit them in Final Cut Pro. Their teaching videos are viewed by endoscopists and staff throughout the world and have won several awards from the American Society of Gastrointestinal Endoscopy. HD video will make them even more effective.

“As an endoscopist, the thing I found most frustrating was seeing these beautiful HD images live and in real time on the endoscope screen, then having to show them to surgeons and medical doctors in still-frame SD,” says Kaltenbach. “Sometimes they say, ‘I see,’ but they can’t possibly see, because the details are lost in SD. We’re really excited about using Apple to capture these images in motion HD. It’s such a gain for patient care.”

The VA team also uses its videos for self-learning, and Soetikno uses them to instruct physicians in training. Kaltenbach has taken a course on Final Cut Pro and is now assembling and editing the videos.

“I came to work with Roy because of his vision and enthusiasm,” says Kaltenbach. “He told me that if I didn’t have a Mac, we really wouldn’t work well together. I was not a Mac user, but I now use Macs for everything — movie-making in Final Cut Pro, iTunes, and my Palm. I use it to store all my movies and create talks with Keynote. I use Macs all day, every day.”

iPods, iChat, and Remote Consultation

“We have the hardware, the software, and the knowledge about capturing and sharing knowledge in HD,” says Soetikno. “That’s our message. And that’s why we’re interested in working with Apple technology.”

Soetikno foresees a better way of informing patients about endoscopy procedures: let them play videos on iMacs or iPods, rather than reading about them. Physicians can consult with specialists by sending a few seconds of video and using iChat. The VA team’s self-educational videos are downloadable through iTunes from the Massachusetts General Hospital and the Gastrointestinal Endoscopy journal, of which Soetikno is associate editor.

Roy Soetikno hopes his vision helps other professionals take their practice to another level. “People dream about this,” says Soetikno. “They want to record endoscopy movies, and they just can’t get there. I want to tell them that this is mature technology that any doctor can use. Get a Mac, a FireWire cable, and QuickTime Pro, and you’re set.”

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