Sharing Surgical Knowledge with Video and the Mac

Creating End-to-End Case Histories with iMovie

Langer performing brain surgery. The most significant moments will be captured for editing in iMovie. Photo: Robert Waterman/Valerie Waterman

Langer uses iMovie to build visual case histories of his patients for giving talks, instructing students, and informing patients about pathologies and procedures. He also uses them to instruct himself, reviewing his procedures to sharpen his technique.

Working on a 30-inch Apple Cinema Display, he uses QuickTime Pro to convert clips of the operation from .wmv files to .mov files, then drags them into an iMovie project for editing. When he has the video sequence he wants, he adds still-frame images and text to create a complete visual record of his patient in a single electronic file.

“The beauty of iMovie,” says Langer, “is that you can put pretty much anything into it.”

Magnetic resonance imaging (MRI) or computerized tomography (CT) scan images – two-dimensional black-and-white slices – of the patient’s brain are stored by the hospital’s radiology department as electronic files. Langer accesses these files, which are in industry-standard DICOM medical image format, over the hospital network, and extracts pre- and post-operative images of the affected area.

“Capturing DICOM images on the Mac is fast and simple,” says Langer. “I run Virtual PC, which allows me to use the hospital’s DICOM viewer to bring the images up on the screen. Once they’re on the screen, I use the Mac OS screen-capture keyboard function to save them. If I was working on a PC, I’d need a separate program to do that.” File conversion software converts the screen-captured DICOM images to .bmp or .jpg files, which open automatically on Langer’s Mac Pro. He imports them into iPhoto and drags them into iMovie.

In fact, whatever the still-frame image – DICOM, graphic, photo, or even a frame from a paused movie – if Langer can see it on his screen, he can add it to his case history and use iMovie effects to add visual interest. iMovie lets him fade it in, zoom in on it, or highlight an area of interest with a Ken Burns movement.

Introducing Ground-Breaking Neurosurgery with iMovie

A video posted on the New York Times website on December 19, 2006 documented an operation in which Langer, with a surgical technique that had never been used before in the U.S., saved a young father’s life. The breakthrough technique, known as ELANA, was developed in the Netherlands and is described on Langer’s website. Simply stated, it enables neurosurgeons to bypass and remove a brain aneurysm without interrupting blood flow through the damaged vessel – a potential cause of brain damage.

“We’re the only place in the U.S. that uses ELANA,” says Langer. “We’ve done four of these operations in our hospital now. I’m using Apple technology to educate doctors, and patients especially, about its uniqueness. I edit videos of the operations in iMovie and add information I’ve pulled off the Internet with the Mac. It allows me to do a better job of elucidating what the procedure does.”

Langer is also using iMovie to spread the word about a new software technology that measures flow in cranial blood vessels using MRI image data. He creates instructional videos explaining it.

Langer’s constant use of the Mac betrays a long-standing affinity.

“I started using Apple computers when I was in college, and I’ve always been biased towards Apple products because of their ability to manage movies and photographs,” he says. “They’re just more efficient and more fun. In the end, they make it easy to get creative, to educate yourself, and to share knowledge.”

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