Surgeon's Point-of-View (POV) Video Recording

Learning how to video record vivid, stable, high-def, and focussed shots from my (surgeon's) point-of-view has not been an easy endeavor due to technology limitations, though things do appear to be slowly improving. There have been pros and cons with most video-recording systems to date which I have summarized below. The "perfect" video-recording system has yet to be developed which must include all these elements:

• Wearable on headlight or glasses
• Camera located between the eyes that is maneuverable to adjust recording angle
• Head-up view to see what is being recorded real-time
• Manual white balance adjustment

• Manual exposure adjustment (bright lights used in surgery often confuse auto-exposure settings which result in washed-out pictures)

• Auto-focussing with adjustable zoom

• VERY good image stabilization

• HD video-recording

General Problems with Head-Mounted Video Recordings

The problem with current head mounted video-recording systems including Google Glass are several-fold. First of all, no matter how good you think you are staying still, there are constant micro-motions/tremors which produce unusable erratic videos. This annoying camera movement becomes even more pronounced when using cameras with longer focal lengths which is why most head-mounted camera systems come with a fixed, wide-angle lens which unfortunately takes away from the narrow-angle, focussed shot a surgeon would like recorded.

Also, the smaller and lighter the camera, the more inferior the optics resulting in poor video quality (compared to high-resolution, 3CCD, HD recordings which is what the surgeon's want).

These short-comings are common with all head-mounted video-recording systems. Unfortunately, there are even more problems depending the camera.

Google Glass (or any eyeglass side-mounted camera)

Typically, when a surgeon operates, the surgical field (green) is a certain distance from the his/her face. When in a comfortable position, wearing any type of head-mounted camera system located on the side like Google Glass unfortunately ends up video-recording a point that is above and to the side (purple) of what is actually desired.

In order to compensate the vertical offset, either the surgeon has to flex the head more or move the eyeglass down towards the lip.

To adjust the horizontal offset, the surgeon would have to turn and move the head to one side such that the camera has a more direct line shot into the surgical field... but that would mean the surgeon would be operating off-centered, almost looking over one shoulder.

Although doable, this is far from perfect or comfortable.

Central Head-Mounted Video Camera Systems

There ARE video-recording cameras that contain a camera that can be placed centrally over the forehead or between the eyes including Luxtec and SurgeonCam which are mounted on the headlight and PivotHead glasses (among others) where the camera is built into the frame between the eyes.

The headlight mounted systems'  camera angle can be adjusted to provide a more precise POV recording, but the general disadvantages of body-worn cameras still apply with constant erratic motion and wide-angle shots that do not specifically focus in on the surgical field.

The PivotHead glasses do provide perfect central shots, but still suffer from a vertical offset (orange) which cannot be adjusted like the headlight mounted systems.

Overhead Mounted Camera Systems

For the same reason the best photos are obtained by cameras fixed to a tripod, the best videos are often obtained by cameras fixed into position by a stationary object.

One object cameras can be attached to are overhead fixtures.. specifically the operating room lights.

Such cameras are attached typically to the light-handle of such overhead operating room lights which are directed down into the surgical field. Such systems provide excellent focussed, stable, high-quality video-recordings with one BIG disadvantage. The surgeon's head keeps getting in the way.

Also, the light-handle is positioned for optimal lighting of the surgical field... not optimal framing for capturing good videos.

Bed-Mounted Camera Systems

Using a Thompson Laparoscopic Retractor System, the video camera can be attached to one of the articulating arms and adjusted sterilely as needed. Using this retractor system can allow the camera to be positioned independently of the overhead operating room lights and to be as close to the surgical field as necessary.

The video is limited by how good the camera is that is attached. The best one I've been able to find is the Sony HXR-MC1 which incorporates a large-sized lipstick camera that is attached to a controller where manual controls for focus, zoom, white balance, exposure, etc can be made. Other than the built-in LCD screen, there are included plugs (Component, RCA, and with adapter S-Video) that allow what the camera is recording to be thrown up onto a large screen.

Other wireless video lipstick cameras are now being produced, but lack manual controls to adjust zoom, white balance, and exposure. Some offer real-time video display so it may be just a matter of time before all other manual controls found with the Sony HXR-MC1 become more widely available.

The main disadvantage with this setup is that the setup itself can get in the way of the surgeon.

Conclusion

So there you have it... No perfect surgical POV video system yet... Maybe in the next few years if technology keeps moving the way it is.

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At-Home Rapid Strep Testing

Rapid strep test kits can be purchased by anybody to be done at home which may save parents/patients a lot of money in doctor visits for those prone to strep infections. Indeed, should a rapid strep test be positive, than you know that a doctor's visit is definitely worthwhile. (A doctor visit may still be worthwhile since a sore throat may be due to something else like cancer, aphthous ulcer, sinus infection, reflux, etc).

Such home kits (which in fact are the same kits used in medical offices) can be purchased online through Amazon. The price is surprisingly affordable at around the cost of a single copay $30 to do 25 tests.

However, with the purchase of such DIY kits, there are some pitfalls patients should be aware of if they decide to proceed.

1) Perform the internal controls that come with the kit!!! The kit may be a dud and needs to be tested against itself to ensure accurate results whether negative or positive. If the controls do not work, throw the whole test kit out and buy another.
2) You must follow the directions precisely, otherwise the test results will be unreliable. In other words, if the directions call for 4 drops, than it MUST be 4 drops (not 3 drops or 5). If directions state to wait 4 minutes... you must wait exactly 4 minutes. This literally is like precision baking.
3) The test strips need to be kept in protected, sealed bag and used immediately after taking one out, otherwise the test results will be unreliable.
4) When swabbing the throat, you MUST get the cotton tip on the tonsil and/or back wall of the mouth which than must be rubbed around a couple times. Getting the tongue or cheek will increase the risk of a false negative. As such, it may be worthwhile to invest in some tongue blades to help push the tongue down in order to perform this test properly.

Should patients elect to start performing home strep tests, please be aware that physicians will be obligated to not only REPEAT the testing but also examine the patient to ensure antibiotics are appropriate. An actual throat culture may be performed as well which is the gold standard test.

1) Repeat testing is required because the patient may not have followed the instructions precisely. For example, the test strips must be read at 5 minutes (variable depending on the kit). If test results are read past 5 minutes, it may incorrectly show a positive result.
2) Some patients unfortunately fabricate test results just so they can get an antibiotic without an office visit.
3) Some patients unfortunately also fabricate test results in order to skip work or school for personal reasons not related to an actual medical condition.
4) There are situations that even though the strep test is positive, no treatment may be recommended. The patient may be a strep carrier for which treatment of any kind is not recommended.

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