Sydney Adventist Hospital’s Integrated Cancer Centre conference room, dubbed the ‘cancer war room’ is a purpose-built facility where clinical multi-disciplinary teams (MDT) meet to discuss cancer patients’ cases. Each meeting is focused on a certain cancer or tumour stream and normally lasts an hour while clinicians work through some 20 cases in that time in the room or remotely via video conferencing equipment.

Formerly, MDT meetings were held in traditional boardroom-style rooms with a couple of screens at the front and a lot of mucking around with keyboards. That was until the new Integrated Cancer Centre was being planned.

Adventist HealthCare manager, information services operations and infrastructure Barbara MacKenzie had a sense that because MDT meetings followed an unusual format they needed special design attention.

WSP technical director and head of technology systems Roneel Singh was engaged to consider the problem as the task at hand wasn’t just a standard boardroom or teaching space.

“I think the light bulb moment came when Roneel said ‘you’re describing a crisis management centre’. That opened up our thinking conceptually and gave the architect a fresh sense of what the space could be,” says Barbara.

Barbara, Roneel and his team embarked on a consultation process that included the clinical leads from each specialty in order to intimately understand the running of an MDT meeting.

“We looked closely at the process the clinicians go through to work out how we could better provide technology to empower them. Our MDT room is the culmination of everything we’ve learnt,” says Barbara.

There were some key points that provided a framework for the MDT room’s AV:

• Although there may be between 10 and 20 doctors and specialists contributing to most MDT meetings, the space needed to cater to up to 40 people — mostly observers, such as students, but also additional contributors in the instance of complex cases.
• The space needed to be entirely ‘democratic’ — everyone around the table must feel they have an equal voice.
• The MDT room needed to function as a VC space to enable clinicians to participate remotely.
• Multiple sources of content needed to be displayed simultaneously (and in a variety of configurations) on the big screen.
• All the audio and video needed to be on the network.

“My view has always been if it’s not IP-based — if it’s not delivered across Ethernet — then it doesn’t belong. That’s a pretty challenging approach to take, especially a few years ago when we first mandated this,” says Barbara.

“I absolutely love the SVSI solution. This is the first time we’ve used a product like this that’s distributed across the network. For example, our Simulation Learning Centre uses a card and frame-based video matrix solution, and it is so inflexible. Utilising a virtualised product instead of hardware-based appliances fits in well with our approach to technology. And SVSI is a mature solution.”

“Barbara’s always maintained she wanted an ‘enterprise solution’. She wanted to standardise and she doesn’t have an AV team or an IT team, she has one team that runs the whole facility,” Roneel says.

“The solution had to sit on the enterprise network and take full HD video with very low latency. SVSI had a product that was tested, proven and we’d used it on a number of other jobs in a similar application, so we were confident in recommending it to the client.

“It also meant we were able to do without a large frame-based solution and put the SVSI system into a compact communications room.

“What’s more, the expansion of the system is relatively easy — in effect, Barbara doesn’t need us back for that.”

A networked, and scalable video-over-IP solution needs an audio solution to match. There are plenty of Dante-based audio conferencing solutions on the market but Barbara and Roneel’s consultations found that on-table gooseneck microphones wouldn’t cut it.

“I didn’t want a ‘mics on tables’ solution because it needed to feel more conversational. In my view, desktop mics foster a ‘one person on the mic at a time’ style of formality that wasn’t appropriate. When the Shure MXA910 ceiling array microphone popped up we were really keen to know more,” says Barbara.

“We’d normally advise against ceiling mics given the room has an open ceiling and the mic is share the ceiling space with the noise of large projectors — regular pendant ceiling mics would sound quite harsh in a space like this,” says Roneel.

“But equally, we knew we needed a broad uniform coverage. Some of the clinicians are very softly spoken — you can’t hear them across the 4m diameter of the horseshoe seating — so sound reinforcement was essential.

“The traditional approach of a series of mix minuses would have been quite cumbersome.”

“Desk microphones also change behaviour. Some people lean right in close to talk into the mic. Some lean way back and mumble. The goal was to provide a more natural experience, where the technology is working for you even if you don’t notice it working for you. That’s my approach to the ideal user experience across the entire hospital,” added Barbara.

With the Shure MXA ceiling mic array coupled with the JBL distributed loudspeaker system, participants can contribute in their normal speaking voice and they don’t even think they’re being amplified or recorded.

“It was beneficial that the products we required were all in the Jands house. This includes the Shure ceiling array microphone and the SVSI solution. From there the BSS Audio processing, JBL loudspeakers and Crown amplification being handled by Jands allowed us to get a whole solution from one distributor, which had distinct advantages,” says Roneel.

“It meant we weren’t locked into products that were sub-standard but still made it easier for the contractor Fredon Technology to order and to have a single point of contact. And when you have a compressed time frame to complete a project, that sort of advantage can be very important.”

The Shure MXA910 ceiling array microphone sits above the horseshoe seating with its lobes programmed to dynamically pick up those seated at the table and eliminate mechanical and ambient noise.

An additional, six Shure MX202 pendant ceiling microphones cover the ‘gallery’ section of the room. Audio from the microphones are fed via Dante to a network of BSS Soundweb London Digital Signal Processors including BLU-806 and BLU-103’s that take care of DSP and acoustic echo cancellation. On the output side, a JBL loudspeaker system ensures a natural sounding speaking environment. A combination of Control 52 and Control 62P loudspeakers cover the room, powered by JBL and Crown amplifiers.

“We attended every MDT meeting for a number of months. The first indication the facility was delivering as we’d planned came after an hour long meeting where 20 cases were being brought for review. The room was full of highly-scheduled specialists, some already in scrubs ready to go straight to theatre afterwards.  One said to me that at least 10 minutes were, allowing each patient to be discussed without rushing.

“An MDT meeting coordinator plays a pivotal role in the meetings’ efficiency. Using a run sheet listing patient cases and clinical information for review, they sit at the control position orchestrating via a touch panel what is displayed. Clinical information, diagnostic imaging, pathology and clinically relevant photos/video is instantly toggled between the big-screen multi-view configurations — at least 50-60 display source changes through the course of each meeting with all different clinical perspectives coming into play with no waiting.

“Because each of the contributors has their own computer, they can be set up, ready to go on cue. No one is waiting their turn for access or restricting anybody else who is contributing digital content.”

Increased efficiency is a big deal when time is limited. But of equal importance — and the reason for so many highly paid, time-poor professionals to be convened in the first place — is the cross-pollination of ideas and information.

“In one meeting a Pathologist when asked for his input on a particular patient’s case said ‘I’m interested to see the radiology imaging presented and hear what they have to say before I finalise my conclusion’. In another instance PET and MRI scans are displayed side by side for review because comparing multiple content sources better informs the clinical decisions being made,” Barbara says.

“It doesn’t sound like much but rather than specialists submitting their comments about a patient in isolation, they’re actually waiting to hear what others have to say to better inform their own conclusion. So you’re really starting to see how the process is moving beyond the sum of the individual specialties.

“I would put it like this; ‘Sydney Adventist Hospital’s Integrated Cancer Service is bringing clinical best practice and combining this with the best technology, elevating the entire process and achieving the best possible outcome for our cancer patients.’”