Mount Sinai Medical School, Anesthesiology Department

For doctors entering into the field of anesthesiology, Mount Sinai offers a hands on program where medical students learn the skills by participating in “real life” simulations where they need to react to situations that can occur while a patient is sedated. Two operating rooms complete with interactive life sized “High Fidelity Human Patient Simulator” and a complete array of life support equipment are used by the students to revive a patient that has had a cardiac arrest or other conditions and to monitor them while sedated.
Because of the limited space in the “mock” operating rooms, groups of students can observe from a conference room adjacent to the operating room on several LCD screens, or in the case of overflow for a larger group, content can be sent simultaneously to a smaller conference room across the hall.

As part of a major renovations of the 8th floor Sim Labs to be scheduled during winter recess of 2019, the legacy system which we installed in 2010 was beginning to shows sign of age, in both technology, and wear and tear causing failures of equipment that was out of warrantee. The previous system which consisted of a Crestron DM32X matrix, Extron Quad Processors, and NLE format recorders (which were never used) not to mention that the floor mounted 36” deep and 42RU tall, took up a lot of valuable “real estate” in Sim Lab 1.

The only gear that we would repurpose for the legacy system are the cameras as they were 1080P (Vaddio RoboSHOT’s), the 4 control processors (they were 3 series) and the ceiling speakers. Because of the reduction in the amount of equipment used (matrix switching was replaced by IP encoding and streaming content) we were able to fit everything into a wall mounted rack. After re-arranging the furniture, the end result freed up a lot of floor space in Sim lab 1 for additional students.

Additionally, the faculty instructors were already quite familiar with user interface from the legacy system, although we were upgrading the equipment, the lessons and simulations were pretty much the same, over the years faculty had come up with “work-arounds” and other “creative solutions” (i.e., point a camera at a medical display to see it on the projector). One of the goals was to restore this functionality with the new system “transparently” to the end users.

I’m writing this article on November 9th, 2020; who would have known that exactly a year ago when we started to install the updated system exactly how timely and contemporary the system turned out to be. The client had still been using Cisco Video conferencing, and one of the goals for the system was to be able to broadcast programs and classes to a remote audience over Zoom, and to be able to record and archive content, and stream to the Mount Sinai network.

Before I get into the inner workings of the system, I would like to tell you how timely this system was – we completed the system and had trained the client days before we were locked down for Covid. The doctors at Mount Sinai were able to use the system to record and stream and meet with people remotely over zoom to develop the methods for two people to share a single respirator done in conjunction with Nasa JPL in Pasadena.

Link to Nasa JPL Video

As things started getting back to normal around July / August 2020, Mount Sinai knew that they would have students returning back to school under restricted conditions. The classes would be reduced in size by 50% and the students would alternate between attending classes or working from home. With the new system upgrade, Mount Sinai has the resources in place to support “hybrid learning” and “recording / streaming” of content that the students can download and view at any time.

Briefly, the system consists of the following devices and technologies to accomplish the goals of the system with as minimal amount of equipment possible, also being contemporary in its design using the latest technology vs the tail end of legacy technology which are acceptable common practices. Most of the equipment are fully updatable via software updates as released, and most likely will be the last microphone, speakers, or DSP they will ever purchase.

3 Epiphan Pearl 2 – used for routing, streaming, recording
8 Vaddio RoboSHOT ceiling and wall mounted cameras
2 Logitech Rally 4K USB3.0 Cameras
8 Shure MXA910 Beamforming Mics – used for voice lift, recording, and transmission to far end
8 Extron Flat Felid Ceiling Speakers (from legacy System)
1 Biamp Tesira DAN and Biamp 8 Channel Amplifier
4 Crestron CP3N Control Processors (from legacy system)
1 Kramer 8×8 HDMI Matrix (2RU) – real time routing to local displays
10 Mersive Solstice Pods (allows anyone to connect their personal device wirelessly, display and medical monitor on the network as a content). BYOM Video Conferencing and room sharing.
Displays of various sizes including 100” laser projection
1 Wired HDMI input at table for guests not on MS network
5 iPad Control panels installed in Heckler wall mounted enclosures with GB Ethernet and PoE

The system is used for a variety of lesson simulations and procedures in which the content is somewhat choreographed; images and camera shots displayed to the students with “live” narration by the instructor. A handful of students participate “hands on” by being in the Sim Lab with the instructor; other students observe and participate from an adjacent conference room. Typically, a 2nd instructor inside the conference room can also switch what the students are looking at to support what is being discussed.

The instructor in the Sim Lab speaks in his normal speaking voice; the Shure Beamform mics have been configured for voice lift; his voice is heard back over the ceiling speakers in the conference room(s); sent to the far end (over zoom), and / or simultaneously being recorded.

Students in the conference rooms can ask the instructor in the lab questions, beamform mics in the conference room ceiling are also used for voice lift and transmits the questions to the speakers in the Sim Lab, by using a PTS (push to talk) button on the control panel.

The (3) Epiphan Pearl 2’s provide a high degree of functionality, flexibility and features for the system that will continue to benefit Mount Sinai and their ability to manage and control content. The Epiphan Pearl 2’s enables the following functionality and features:

• By use of “layouts” in Epiphan provides the end user with the ability to pre-setup screen shots consisting of multiple cameras and recall of their positions and lens setting presets.
• Ability to record (6) simultaneous “streams”; content that can be used later in post-production for editing the final presentation video
• By using Epiphan “Live” software enable the instructor to remotely control the recording and capture functions from a user interface that can be operated for any place in the space.
• Epiphan can record and stream is several formats making it extremely flexible and easy to use.

In summary, VideoSonic was able to deliver a contemporary system that was able to exceed the clients goals and deliver a product on time without exceeding the budgets, if fact, the cost of the project was only 25% of the cost for the legacy system purchased on 2010 – It was a win-win for all and the client is extremely satisfied with the results.

Wall Mounted Rack in Sim
Wall Mounted Rack in Sim
Sim lab 1
Sim lab 1
Wall mounted rack, swings open to access equipment
Wall mounted rack, swings open to access equipment
Original rack from 2010 legacy system, decommissioned and replaced by wall mounted rack
Original rack from 2010 legacy system, decommissioned and replaced by wall mounted rack
NY Times, April 23rd, 2020 – Using space to simulate two patents sharing a ventilator
NY Times, April 23rd, 2020 – Using space to simulate two patents sharing a ventilator
NY Times, April 23rd, 2020 – Using space to simulate two patents sharing a ventilator
NY Times, April 23rd, 2020 – Using space to simulate two patents sharing a ventilator
Camera control panel
Camera control panel
Large Conference Room – setup for Zoom meeting
Large Conference Room – setup for Zoom meeting
Conference / Classroom – Students are able to view procedures from Sim Labs
Conference / Classroom – Students are able to view procedures from Sim Labs
Conference Room Classroom showing instructors position near room control panel
Conference Room Classroom showing instructors position near room control panel
Sim Lab 1 with Sim Lab 2 in background
Sim Lab 1 with Sim Lab 2 in background
Infant simulator
Infant simulator
Audio Control panel - press “On Air” button to route push to talk-back to Sim lab or Small Conference room.
Audio Control panel – press “On Air” button to route push to talk-back to Sim lab or Small Conference room.
Students using throat simulator, Solstice app installed on simulator allows displayed to be shared as content to any screen in space, or recorded
Students using throat simulator, Solstice app installed on simulator allows displayed to be shared as content to any screen in space, or recorded
High Fidelity Human Patient Simulators
High Fidelity Human Patient Simulators

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