The digital operating room integrates computer network technology, automatic control technology, graphic signal processing technology, generic cabling technology and other information and communication technologies, and organically integrates various systems related to the operation process for overall design, so that doctors can obtain a large number of important information related to patients in real time, which is convenient for doctors to operate, improve efficiency and safety, and provide for the whole operation For a more efficient, comfortable, safe and convenient environment.
In October 2015, the new medical complex building of Fuwai Hospital was officially put into use, with 10 interventional catheterization rooms and 16 surgical operating rooms, including 3 compound operating rooms.
In the process of design and construction, the hospital combines the past experience and advanced ideas, prospectively considers the changes of cardiovascular diagnosis and treatment mode in the future, makes innovative attempts in the design of catheter room and operating room, and adopts the construction scheme of digital operating room as a whole. In one year of operation, it not only made great contributions to the treatment of heart disease patients, but also played a good role in teaching and training, international exchange.
Construction concept and goal of digital operating room
Based on the reality of the hospital, the construction objectives of the digital operating room are planned: to establish a decentralized visual audio-visual system for each operating room; to integrate and control the digital audio-visual system in the operating room and the digital conference room in the hospital; to realize complete visualization and digitalization of the image; to transmit various high-definition medical images and Audio is convenient for discussion in the operation room; high-definition image in the operation room can be transmitted to mobile devices, such as tablet computers and smart phones, through local area network and wireless network in the hospital, so as to facilitate consultation and discussion in the operation room, and realize two-way audio and video transmission; large-scale two-way visual medical conference can be held at any time, and multi-channel satellite live broadcast and hospital live broadcast can be carried out at the same time through the dispatch of the management and control center; 4 New technologies such as K × 2k and 3D operation rebroadcast are reserved.

Construction plan

The system architecture is designed by DCS distributed control system, also known as distributed control system, which is a new type of computer control system compared with the centralized control system. It integrates computer, communication, display and control technology. Its basic idea is decentralized control, centralized management, hierarchical management, flexible configuration and convenient configuration.
*Overall construction scheme structure
DCS distributed control architecture is adopted in the system, including centralized management and decentralized control.
**Centralized management
The system uses the hierarchical control idea of large system, and the management and control center of each floor adopts two modes of independent work and mutual backup; the management and control center realizes environmental management, equipment management, audio-visual management and teaching exchange management; the manager enters the system to check the operation site status, and can handle the routine scheduling, arrange work and understand the implementation status before arriving at the site.
**Decentralized control
The host computer of conduct or operating room system is the core equipment to realize decentralized control. Through conduct or, we can realize one-stop integration of various information needs such as live operation, teaching, meeting, etc.; through conduct or, we can control the display route of all kinds of images in the operating room, and release them to the surgeon in charge, assistant doctor, perfusion specialist, equipment nurse and patrol nurse as required. The features are: one button operation, simple operation, what you see is what you get.
*Construction scheme of digital system in operating room
**Scheme of digital system for interventional catheter room
The host computer of the operating room system, conduct or, integrates all medical imaging equipment and digital audio-visual equipment in the operating room, forms a digital "double link" multimedia network with the control room system in the form of network and coaxial cable, to ensure the efficiency and safety of the system. At the same time, Nd3, a full HD video and audio controller in the operating room, is used to connect all audio and video signals in the operating room to the controller, input the instructions through touch mode, or receive the instructions from the remote client, send the image signal after processing to the main knife display in the catheter room and forward it to the matrix equipment in the control center, and at the same time, carry out full HD network transcoding of the image signal to make the image digital Chemical output.
The following issues need to be addressed during operation:
According to the requirements of radiation protection and the convenience of operation, the host computer of the operating room system, conduct or, and the touch control workstation are installed in the control room.
Wireless transmitters are installed on mobile devices such as OCT, IVUS, TTE, tee, etc., wireless receivers are installed on surgical suspension tower in operating room and connected to system host through embedded cables. After the mobile device is pushed into the operating room, the transmitter and receiver automatically connect, transmit the high-definition image signal to the system host, and switch the transmission to any position.
All cables are connected in a concealed way, and the cables are led out in the rubber trunking of the suspension tower to ensure that there is no exposed cables as a whole.
The scene camera is installed about 2.2m above the patient's foot wall. The lens can avoid the block of the boom and tower, and the whole scene of the operation site can be taken.
**Digital visual compound operating room system scheme
The compound operating room breaks the discipline barrier, with the help of the brand-new compound operating facility, takes the patient as the center, the multi-disciplinary Union, organically unifies the advantages of the internal and external treatment; merges the major operations which originally need to be completed in different operating rooms and stages, and completes them in one operating room, so as to reduce the trauma, shorten the time of cardiopulmonary bypass and even avoid the external circulation To improve the overall effect.
The following issues need to be paid attention to in the specific implementation:
Due to the requirements of radiation protection, the system host cabinet is installed on the wall of the control room, the system host is installed in the cabinet, all audio and video signals are connected to the system host cabinet, and then distributed from the system host to each display device, and transmitted from the system host to the conference room and the management and control center on this floor;
The main and auxiliary shadowless lamps are installed above the operating table, and the auxiliary shadowless lamps are equipped with built-in cameras;
The double screen display arm of the main knife and the camera arm of the side operation field are installed on the same base. They are installed on the same base with the large screen display arm of DSA, making the most of the limited space. At the same time, the position of the large screen display of DSA and the main knife display can be adjusted quickly and easily during the conversion of catheter operation and surgical operation;
In view of the fact that the perfusion division usually adopts sitting posture when working, the display of the perfusion division is installed on the extracorporeal circulation tower through a special bracket in the system design, which can rotate and adjust the pitch angle, so that the perfusion division can observe the image without adjusting the sitting posture.
**Management control part
***Management control center
The management control center is set up in the surgical operating room (four floors of the new building) and the catheter room (three floors of the new building) as the centralized control center of the distributed control digital system to realize environmental management, equipment management, audio-visual management and teaching exchange management. Establish independent work and mutual backup dual mode work. The two control centers can manage the internal affairs of their own floors independently without interference. At the same time, the two control centers can backup each other through the connection of the core equipment matrix to improve the stability. The management and control center of each floor is respectively connected with the external optical fiber link for satellite broadcasting, which can carry out satellite broadcasting for two operations at the same time, without mutual interference.
***Management Office
The manager enters the system to check the condition of the operation site, and can handle the routine scheduling, arrange the work and understand the implementation situation before arriving at the site. Realize the operation of the entire operating room, paperless record of the operation process, cost accounting and real-time monitoring of the operating room efficiency, and provide evidence for standardized operation. Through the study of surgical records to promote standardized operation, so as to solve the problem of surgical quality control. Surgical records can also be used to deal with medical disputes.
***Lecture hall, demonstration room, etc
Control room shall be set in the report hall, and audio and video matrix and control equipment of the report hall shall be installed on the cabinet of the room. Three 3g-sdi cables are laid from the management and control center to the lecture hall and directly connected to the audio and video matrix in the cabinet of the lecture hall. Multiple images from the operating room can be directly switched to the large screen. At the same time, a scene camera with 28 times optical zoom is installed at a proper position on the roof of the conference room, which can take the panorama of the conference room, the panorama of the rostrum and the speakers, connect to the client host and send it back to the operating room, so as to facilitate the interaction between the operating room personnel and the participants during the discussion.
The client host is installed in the control room and connected with the audio and video matrix in the cabinet of the report hall. In order to ensure the smooth progress of large-scale meetings, it can be used in emergency to ensure the smooth progress of key relay. At the same time, the client can also reverse control the image switching of the operating room, as well as the scene camera and field camera of the operating room.
***Broadcasting and remote teaching in and out of the hospital
The signal transmission of the remote teaching module is mainly realized by the Internet and local area network. As long as there is a place where the network is connected, not only the meeting rooms, offices and study rooms of the hospital can be connected to the operating room for live broadcast, relying on the special broadband network cooperation of e-mail service providers such as China Mobile and China Telecom to connect the hospital and the conference rooms in other places through the public network Then, we can broadcast the operating room of our hospital to other conference rooms outside the hospital.
***Family talk area
The family talk area of the catheter room and the family talk area of the operating room are two-way communication bridges between doctors and patients' families. When the operation mode needs to be changed, the operator and the patient's family can communicate effectively. The operator can timely and accurately compare the basis of intraoperative diagnosis, change of operation mode, common complications, costs and risks of operation with the changes of preoperative communication, communicate with the patients' families, listen to the opinions and choices of the patients' families, and get the understanding and cooperation of the patients' families. It not only ensures the right to know of the patient's family, but also makes synchronous recording and video recording of the conversation process of both parties. It is very convenient to query and retrieve, which can effectively avoid doctor-patient disputes.
Goals achieved
Through the above construction scheme, the following objectives have been achieved:
*Serve the artist
It can instantly access all the images needed to the front of surgeons, assistant doctors, perfusion doctors, anesthesiologists, patrol nurses and equipment nurses; it can digitally control the surgical equipment, realize the change of surgical process, physiological indexes of patients and the digital integration of all examination results, so that communication is not limited by national boundaries, time and distance.
*Service for doctor-patient communication
At any time, the operator can be arranged to communicate with the patient's family members.
*Serving teaching and research
It can arrange live operation at any time, record, store and edit the operation process for academic exchange and medical research.
*For management
The whole operation and operation process of the operating room realize paperless record, cost accounting and real-time monitoring of operating room efficiency, providing evidence for standardized operation. By studying the operation record, we can promote the standardized operation and solve the problem of operation quality control. Surgical records can be used to deal with medical disputes.
*For telemedicine services
Carry out real-time academic exchange, live operation and operation guidance with branch hospitals or cooperative hospitals.
The core purpose of constructing digital operating room in our hospital is to build a world leading digital and visual operating room system, make digital technology serve for cardiovascular surgery, improve operation efficiency, train operation talents, strengthen communication between operators and patients' families, and enhance medical communication. In the future operation and management, our hospital will continue to make efforts to make greater achievements in operation quality, teaching and training, international exchange, etc (edited by LV Zhixin)
Song Xiaodong, Tang Xiaowei, Zhang Tengcheng, Fang Dian, sun Peishan, Hu Daotao, Fuwai Hospital, Chinese Academy of Medical Sciences
Source: Chinese hospital building and equipment
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