Microsoft Research Podcast - Collaborators: Holoportation™ communication technology with Spencer Fowers and Kwame Darko

Episode Date: July 6, 2023

Transforming research ideas into meaningful impact is no small feat. It often requires the knowledge and experience of individuals from across disciplines and institutions. Collaborators, a new Microsoft Research Podcast series, explores the relationships—both expected and unexpected—behind the projects, products, and services being pursued and delivered by researchers at Microsoft and the diverse range of people they’re teaming up with.In this episode, host Dr. Gretchen Huizinga welcomes Dr. Spencer Fowers, a member of the Special Projects Technical Staff at Microsoft Research, and Dr. Kwame Darko, a plastic surgeon in the reconstructive plastic surgery and burns center in Ghana’s Korle Bu Teaching Hospital. The two are among a group working to make specialized medical care more widely available, especially to those in remote or underserved communities. They share how their 3D telecommunication technology helps bring patients and doctors together when being in the same room isn’t an easy option and how the experience is supporting greater patient satisfaction, allowing more time for surgeons to prepare for surgery, and making the assembly of a super team of medical experts from around the globe more feasible.Learn more:3D telemedicine brings better care to underserved and rural communities, even across continents | Microsoft Research Blog, May 2023Microsoft’s Holoportation Communications Technology: Facilitating 3D Telemedicine | Microsoft Research video, May 2023Participatory Development of a 3D Telemedicine system during Covid: the future of remote consultations | Journal of Plastic, Reconstructive & Aesthetic Surgery, October 20223D Telemedicine | Project pageHoloportation | Project pageKorle Bu Teaching Hospital

I work with the team that does moonshots for a living so I'm always looking for what can we shoot for and our goal really is like gosh where can't we apply this technology I mean just anywhere that it is at all difficult to get you know medical expertise we can ease the burden of doctors by making it so they don't have to travel to provide this specialized care and increase the access to health care to these people that normally wouldn't be able to get access to it. So, yeah, the scope is as far as the mind can imagine it. You're listening to Collaborators, a Microsoft Research podcast showcasing the range of expertise that goes into transforming mind-blowing ideas

into world-changing technologies. I'm Dr. Gretchen Huizenga. On this episode, I'm talking to Dr. Spencer Fowers, a principal member of the technical staff at Microsoft Research, and Dr. Kwame Darko, a plastic surgeon at the National Reconstructive Plastic Surgery and Burn Center at the Korlebu Teaching Hospital in Accra, Ghana. Spencer and Kwame are working on 3D telemedicine, a project they hope will increase access to specialized healthcare in rural and underserved communities by using live 3D communication or holoportation. We'll learn much more about that in this episode, but first, let's meet our collaborators. Spencer, I'll start with you. Tell us about the technical staff in the Special Projects Division of Microsoft Research.

What kind of work do you do? What's the research model? And what's your particular role there? Hi, Gretchen. Thanks for having me on here. Yeah. So our group at Special Projects was kind of patterned after the Lockheed Martin Skunk Works methodology. You know, we are very much a sort of try big moonshot projects type group. Our goal is sort of to focus on any sort of pie in the sky idea that has some sort of a business application. So you can imagine we've done things like build the world's first underwater data center or do post quantum cryptography, things like that.

Anything that is a very ambitious project that we can try to iterate on and see what type of an application we can find for it in the real world. And I'm one of the, as you said, a principal member of the technical staff. That means I'm one of the primary researchers. So I wear a lot of different hats. My job is everything from managing the project, meeting with people like Kwame and the other surgeons that we've worked with, and then interfacing there and finding ways that we can take theoretical research and turn it into applied research, actually find a way that we can bring that theory into reality. You know, that's a really interesting characterization because normally you think of those things in two different buckets, right? The big moonshot research has got a horizon, a time horizon that's pretty

far out. And the applied research is get it going so it's productizable or monetizable fairly quickly. And you're marrying those two kinds of research models? Yeah, I mean, we fit kind of a really interesting niche here at Microsoft because we get to operate sort of like a startup, but we have the backing of a very large company. So we get to sort of, yeah, take on these moonshot projects that a smaller company might not be able to handle and really attack it with the full resources of a company like Microsoft. So it's a moonshot project, but hurry up, let's get her done. Right, yeah.

Well, listen, Kwame, you're a plastic surgeon. I think a lot of my passion to become a plastic surgeon came from the fact that at the time we didn't have too many plastic surgeons in Ghana. I mean, at the time that I qualified as a plastic surgeon, I was the eighth person in the country. And at the time there was a population of 20 something million, currently we're around 33 million, 34 million. And we're still not up to 30 plastic surgeons. So there was quite a bit of work to be done. And my work scopes from all the way to what everybody tends to allure plastic surgery with,

cosmetic stuff, across to burns, across to trauma from people with serious accidents that need some parts of their body reconstructed, to tumors of all sorts. One of my fortes is breast cancer and breast reconstruction, but not limiting to that. We also have tumors of the leg, and we also help other surgeons to cover up spaces or defects that may have been created when they've taken off some sort of cancer or tumor or whatever it may be. So it's a wide scope as well as burn surgery and burn care

as well. So that's the scope of the kind of work that I do. You know, this wasn't on my list to ask you, but I'm curious, both of you, Spencer, where did you get your training? What's your background? I actually got my PhD at university in computer engineering, focused on computer vision. So a lot of my academic research was in, you know, embedded systems and low power systems and how we can get a vision based stuff to work without using a lot of processing. And it actually fits really well for this application here where we're trying to find low cost ways that we can bring really high end vision stuff, you know, and put it inside a hospital.

Yeah. So Kwame, what about you? Where did you get your training? And did you start out in plastic surgery thinking, hey, that's what I want to be? Or did you start elsewhere and say, this is cool? So my background is that I did my medical school training here in Ghana at the medical school in Kuala Lumpur and then started my postgraduate training in surgery. Over here you need to do a number of years in just surgery before you can branch out and do

a specific type of surgery. So after my three four years in that I decided to do plastic surgery once again here in Ghana. You spend another up to three years minimum of, four years in that, I decided to do plastic surgery once again here in Ghana. You spend another up to three years, minimum of three years training in that, which I did. And then you become a plastic surgeon. But then I went on for a bit of extra training and more exposure from different places around the world. I spent some time in Cape Town in South Africa working in a hospital called Ruteskin. I've also had the opportunity to work in Glasgow, where this idea all originated from, and various courses in different parts of the world from India, the US and stuff like that. Wow. You know, I could spend a whole podcast asking you what you've seen

in your lifetime in terms of trauma and burns and all that, but I won't. Because let's talk about how this particular project came about. And I'd like both of your perspective on it. This is sort of how I met your mother story. As I understand it, there were a lot of people and more than two countries involved. Spencer, how do you remember the meetup? Yeah, I mean, holoportation has been around since 2015, but it was around 2018 that Stephen Lowe, he's a plastic surgeon in Glasgow, he approached us with this idea saying, hey, we want to use this holoportation technology in a hospital setting. At that point, he was already working with Kwame and other doctors. They have a partnership between the Canies Burn Plastic Surgery Unit in Glasgow and the Korlebu Teaching Hospital in Accra. And he approached us with this idea of saying,

we want to build a clinic remotely so that people can come and see this. There is, like Kwame mentioned, right, a very drastic lack of surgeons in Ghana for the amount of the population. And so he wanted to find a way that he could provide reconstructive plastic surgery consultation to patients, even though they're very far away. Currently, the, you know, the Canisburn unit, they do these trips every year, every couple of years where they fly down to Ghana and perform surgeries. The way it works is basically the surgeons get on an airplane, they fly down to Ghana, and then the next day they're in the hospital all day long meeting these people that they're

going to operate on the next day and trying to decide the day before the surgery what they're going to operate on and what they're going to do and get the consent from these patients. Is there a better way? Could we actually talk to these patients ahead of time? And 2D video calls just didn't cut it. It wasn't good enough. And Kwame can talk more about that. But his idea was, can we use something like this to make a 3D model of a patient, have a live conversation with them in 3D so that the surgeon can evaluate them before they go to Ghana and get an idea of what they're going to do and be able to explain to

the patient what they want to do before the surgery has to happen. Yeah. So Microsoft Research, how did that group get involved? Well, so we started with this technology back in, you know, 2015. And when he approached us with this idea, we were looking for ways that we could apply holoportation to different areas, different markets. This came up as like one of those perfect fits for the technology where we wanted to be able to use the system to image someone. It needed to be a live conversation, not a recording. And so that was right there was where we started working with them and designing the cameras that would go into the system they're using today. Right, right, right. 2D telemedicine, especially during COVID and post-COVID, people have gotten pretty used to

talking to doctors over a screen as opposed to going in person. But there are drawbacks and shortcomings of 2D in your world. So how does 3D fill in those gaps and what was attractive to you in this particular technology for the application you need. Okay, so great. Just as you're saying, COVID really did spark the spread of 2D telemedicine all over the world. But for myself as a surgeon, and particularly so as a plastic surgeon, we're trying to think about how is 2D video going to help me solve my problem or plan towards solving my problem for a patient. And we realized there is a significant shortfall when we're not just dealing with the human being as a 2D object, but 3D perspective is so important. So one of the most common things we've used this system to help us with is when we're assessing a patient to decide

which part of the body we're going to move and use it to fit in the space that's going to be created by taking out some form of tumor and not only taking it out in 2D, 3D for us to know that it's going to fit and be big enough, but also demonstrating to the patient so they have a deeper understanding of exactly what is going to go and be used to reconstruct whichever part of their body and what defect is going to be left behind. So as against when you're just having a straightforward consultation, back and forth, answer and response, question and response, in this situation, we get the opportunity and have the ability to actually turn the patient around and then measure out specific problem parts of the body that we're going to take off and then transpose that on a different part of the body to make sure that it's also going to be big enough to switch around and transpose. And when I'm saying transpose, I'm talking about maybe taking something off from the front part of your thigh and then filling that in with maybe a massive part of your

back muscle. To add on to what Kwame said, for us from Microsoft Research, when Steven approached us with this, I don't think we really understood the impact that it could have. We even asked him, why don't you just use a cell phone or why don't you just use a 2D telemedicine call? Like, why do you need all of this technology to do this? And he explained it to us and we said, okay, like we're going to take your word for it. It wasn't until I went over there the first time that it really clicked for me. And we had set up the system and he brought in a patient that had had reconstructive plastic surgery. She had had a cancerous tumor that required the amputation of her entire shoulder.

So she lost her arm. And this is not something that we think of on a day-to-day basis, but you actually, you can't wear a shirt if you don't have a shoulder. And so he was actually taking her elbow and replacing the joint that he was removing with her elbow joint.

So he did this entire transpose operation. The stuff that they can do is amazing, but he had done this operation on her probably a year before. And so he was bringing her back in for just a post-operative consult to see how she was doing. He had her in the system and while she's sitting in the system, he's able to rotate the 3D model of her around so that she could see her own back. And he drew on her, okay, this is where your elbow is now. And this is where we took the material from and what we did. And during the teleconference, she says, oh, that's what you did. I never knew what you did.

Like, she had had this operation a year ago, never knew what happened to herself because she couldn't see her own back that way and couldn't understand it. And it finally clicked to us, like, oh, my gosh my gosh, this is why this is important. Not just because it aids the doctors in planning for surgeries, but the tremendous impact that it has on patient satisfaction with their operation and patient understanding of what's going to happen. Wow. That's amazing. Even as you describe that, we could go so deep into the strangeness of what they can do with plastic surgery. But let's talk about technology for a minute. This is a highly visual technology, and we're just doing a podcast. And we will provide some links in the show notes for people to see this in action, I hope. But in the meantime, Spencer, can you give us a kind of word picture of 3D telemedicine and the technology behind holoportation? How does it work? Yeah, the idea behind this technology is if we can take pictures of a person from multiple

angles, and we know where those cameras are very, very accurately, we can stitch all those images together to make like a 3D picture of a person. So we're actually using for the 3D telemedicine system, we're using the Azure Connect. So it's like version three of the Connect sensor that was introduced back in the Xbox days. And what that gives us is it gives us not just a color picture like you're seeing on your normal 2D phone call, but it's also giving us a depth picture so it can tell how far away you are from the camera. And we take that depth and that color information from 10 different cameras spaced around the room

and stitch them all together in real time. So while we're talking at normal conversation speed, it's creating this 3D image of a person that the doctor in this case can actually rotate, pan, zoom in and zoom out and be able to see them from any angle that they want without requiring that patient to get up and move around. Wow. And that speaks to what you just said, the patient can see it as well as the clinician. Yeah. I mean, you also have this problem with a lot of these patients, if they've had, had you know a leg amputation or something when we typically talk like we're talking now on like a you know the viewer the

listeners can't see it but a typical 2d telemedicine call you're looking at me from like my shoulders up well if that person has an amputation of their knee how do you get it so that you can talk to them in a normal conversation and then look at their knee you just can't do that on a 2D call. But this system allows them to talk to them and turn and look at their knee and show them, if it's on their bag, wherever it is, what they're going to do and explain it to them. That's amazing. Kwame, this project doesn't just address geographical challenges for remote patients. It also addresses geographical challenges for remote experts. So tell us about the nature and makeup of what you call MDTs or multidisciplinary teams that you collaborate with

and how 3D telemedicine impacts the care you're able to provide because of that. All right. So with an MDT or multidisciplinary team, just as you said, the focus on medicine these days is to take out individual bias in how we're going to treat a particular patient and individual knowledge base so now what we tend to do is we try and get a group of doctors who would be treating a particular ailment more often than not, it's a cancer case. And everybody brings their view on what is best to holistically find a solution to the patient's, the most ideal remedy for the patient. Now, let's take skin cancer, for example. You're going to need a plastic surgeon if you're going to cut it out. You're going to need a dermatologist who's going to be able to manage it. If it's that severe, you're also going to need an oncologist. You may even need a

radiologist and of course a psychologist and your nursing team as well. So with an MDT, you'd ideally have members from each of these specialties in a room at a time discussing individual patients and deciding what's best to do for them. What happens when I don't have a particular specialty? And what happens when even though I am the representative of my specialty on this group, I may not have as in-depth knowledge as is needed for this particular patient? What do we do? Do we have access to other brains around the world well with this system yes we do and just as we we said earlier that unlike where this is just a regular let's say teams meeting or whatever form of telemedicine meeting in this one where we have the 3d edge we can actually have the patient around in the rig and And as we're discussing and talking about,

and people are giving their ideas, we could swing the patient around and say, well, on this aspect, it would work because this is far away from the ear or closer to the ear, or no, the ear is going to have to go with this. It's too close. So what do we do?

Can we get somebody else to do an ear reconstruction in addition? If it's something on the back um if we're taking it all out is this going to involve the muscle as well if so how are we going to replace the muscle um it's beyond my scope but oh what do you know we have an expert who's done this kind of things from let's say korea or singapore and then they would log on and be able to see everything and give their input as well. So this is another application which just crosses boundary borders and gives us so much more scope to the application of this new device. So when we're talking about multidisciplinary teams, and we look at it from an expert point of view of having all these different disciplines in the room from the medical side. Spencer, this collaboration

includes technologists as well as medical professionals, but it also includes patients. You talk about what you call a participatory development validation. What is the role of patients in developing this technology? Well, similar to like that story I was mentioning, right, as we started using this system, the initial goal was to give doctors this better ability to be able to see patients in preparation for surgery. What we found as we started to show this to patients was that it drastically increased their satisfaction from the visits with the doctors because they were able to better understand the operation that was going to be performed. It's surprising how many times like Kwame and Stephen will talk to me and they'll tell us stories about how like they explain a procedure to a patient about what they're going to do. And the patient says, yeah, okay. And then they get done and the patient's like, wait, what did you do? Like that doesn't, I didn't realize

you were going to do that, you know, because it's hard for them to understand when you're just talking about them or whether you're drawing on a piece of paper, but when you actually have a picture of yourself in front of you, that's live and the doctor's indicating on you what's going to happen and what the surgery is going to be, it drastically increases the patient satisfaction. And so that was actually the direction of the randomized controlled trial that we're conducting in Scotland right now is what kind of improvement in patient satisfaction does this type of a system provide? It's kind of speaking UX to me, like a patient experience as opposed to a user experience. Has any of this fed into sort of feedback loop on technology development,

or is it more just on the user side of how I feel about it? As far as like technology that we use for the system, when we started with holoportation, we were actually using kind of research grade cameras and building our own depth cameras and stuff like that, which made for a very expensive system that wasn't easy to use. That's why we transitioned over to the Azure Connect, because it's actually like the highest resolution depth camera you can get on the market today for this type of information. And so it's really pushed us to find what can we use that's more of a compact, you know, all-in-one system so that we can get the data that we need?

Right, right, right. Well, Kwame, at about this time, I always ask what could possibly go wrong. But when we talked before, you kind of came at this from a cup-half-full outlook because of the nature of what's already wrong in digital health care in general, but particularly for rural and underserved communities. And you've kind of said what's wrong is why we're doing this. So what are some of the problems that are already in the mix and how does 3D telemedicine mitigate any of them? Things like privacy and connectivity and bandwidth and cost and access and hacking, consent, all of those things that we're sort of like concerned about writ large. All right. So when I was talking about the CAF being half full in terms of all of these issues, it's because these problems already exist. So this technology doesn't present itself and create

a new problem. It's just going to piggyback off the solutions of what is already in existence. All right. So you mentioned most of them anyway. I mean, talking about patient privacy, which is number one, all these things are done on a hospital server. They are not done on a public or ad hoc server of any sort. So whatever fail-safes that are within the hospital in itself, whichever hospital network we're using,

whether here in Ghana, whether in Glasgow, whether somewhere remotely in India or in the US, it doesn't matter where, it would be piggybacking off a hospital server. So those fail-safes are there already. So if anybody can get into the network and observe or steal data from our system, then it's because the hospital system isn't secure. Not because it's our system, if in a manner of speaking, it's not secure.

And then when I was saying that it's half full, it's because whatever lapses we have already in 2D telemedicine, this supersedes it. And not only does it supersede the 2D lapses, it goes again and gives significant patient feedback. Like we were saying earlier, and what Spencer also alluded to, is that now you have the ability to show the patient exactly what's going on. And so in previous aspects where, think about it, even if it's an in-person consultation where I would draw on a piece of paper and explain to them, well, I'm going to do this, this, this, and that. Now I actually have the patient's own body, which they're watching at the same time, being spun around and indicating that this is the actual spot I was talking about. And this is how big my cut is going to be. And this is what I'm going to move out my cut is going to be and this is what

i'm going to move out from here and use to fill in this space so once again um i my inclination on this is that on our side we can only get get good as against to looking for problems the problems i admit will exist but not as a separate entity from regular 2D medicine that's OM or 2D videography that we're already encountering. So you're not introducing new risks with this. You're just sort of serving on the other risks. We're adding to the positives, basically. Right. Yeah, Spencer, in the what could go wrong bucket on the other side of it, I'm looking at healthcare and the cost of it, especially when you're dealing with multiple specialists and complicated surgeries and so on. And I know healthcare policy is not on your research roadmap necessarily, but you have to be thinking about that as you're going on how this

will ultimately be implemented across cultures and so on. So have you given any thought to how this might play out in different countries? Or is this just sort of, we're going to make the technology and let the policy people and the wonks work it out later? Yeah, it's a good question. And I think it's something that we're really excited to see how it can benefit. Luckily enough, where we're doing the test right now, like in Glasgow and in Ghana, they already have partnerships. And so there's already standards in place for being able to share doctors and technology across that. But yeah, we've definitely looked into like, what kind of an impact does this have? is using something like 3D telemedicine even to provide greater access for specialty doctors in places like rural or remote United States where they just don't have access to those

specialists that they need. I mean, you know, Washington State where I am has a great example where you've got people that live out in Eastern Washington, and if they have some need to go see like a pediatric specialist, they're going to have to drive all the way into Seattle to go to Seattle Children's to see that person. What if we can provide a clinic that allows them to, you know, virtually through 3D telemedicine interface with that doctor without having to make that drive and all that commute until they know what they need to do. And so we actually look at it as being beneficial because this provides greater access to these specialists to other regions. So it's actually improving healthcare reach and accessibility for everyone. Yeah. Kwame, can you speak to accessibility of these experts?

I mean, you would want them all on your team for a 3D telemedicine call, but how hard is it to get them all on the same? I mean, it's hard to get people to come to a meeting, let alone, you know, a big consultation. Does that enter the picture at all? It does. It does. And I think COVID is something else that's really changed how we do everyday routine stuff so for example we here in Ghana have a weekly departmental meeting and within the plastic surgery department and also within the greater Department of Surgery weekly meeting everything became remote so yeah all of a sudden people who may not be able to make the meeting for whatever reason are now logging on so it's actually made accessibility to them much much easier and swifter i mean where they are what they're doing at the time we have no idea but

it just means that now we have access to them so extrapolating this this onto us getting in touch with specialists, if we schedule that timing right, it actually makes it easier for the specialist to log on. Now, earlier we spoke about international MDTs, not just local, but then have we thought about what would have happened if we did not have this ability to have this online international MDT. We're talking about somebody getting a plane ticket, sitting on a plane, waiting in airports, airport delays, et cetera, et cetera, and flying over just to see the patient for 30 minutes and make a decision that, well, I can or cannot do this operation. So now this jumps over all of this and makes it much, much easier for us. And now when we move on to the next stage of consultation, after the procedure has been done, when I'm talking about the surgery,

now the patient doesn't need to travel great distances for individual specialist review. Now in the case of plastic surgery, this may cover not only the surgeon but also the physiotherapist. And so it's not just before the consultation, but also after the consultation. Wow. Spencer, what you're doing with 3D telemedicine through holoportation is a prime example of how a technology developed for one thing turned out to have incredible uses for another. So give us just a brief history of the application for 3D communication and how it evolved from where it started to where it is now. Yeah, I mean, 3D communication, at least from what we're doing,

really started with things like the original Xbox Kinect, right? With a gaming console and a way to kind of interact in a different way with your gaming system. What happened was Microsoft released that initial Connect and suddenly found that people weren't buying the Connect to play games with it. They were buying to put it on robots and buying to use, you know, for different kinds of robotics applications and research applications. And that's why the second Kinect, when it was released, they had an Xbox version and they actually had a Kinect for Windows version because they were expecting people to buy this sensor to plug it into their computers. And if you look at the form factor now with the Azure Kinect that we have, it's a much more compact unit. It's meant specifically for using on computers and it's built for robotics and

computer vision applications. And so it's been really neat to see how this thing that was developed as kind of a toy has become something that we now use in industrial applications. Right. Yeah. And I, this is sort of the thing, the serendipitous nature of research, especially with, you know, big moonshot projects. It's like, this is going to be great for gaming. And it's actually turns out to be great for plastic surgery. Who'd have thunk? Kwame, speaking to where this lives in terms of use, where is it now on the spectrum from lab to life, as I like to say? So currently, we have a rig in our unit, the plastic surgery unit in the

Quality Teaching Hospital. There's a rig in Glasgow and there's a rig over in Microsoft Office. So currently, what we've been able to do is to run a few tests between Ghana, Seattle and Glasgow. So basically we've been able to run MDTs and we've been able to run patient assessments, pre-op assessments, as well as post-operative assessments as well. So that's where we are at the moment. It takes quite a bit of logistics to initiate,

but we believe once we were on a steady roll we'll be able to increase our numbers that we've been able to do this one i think currently those we've operated and had a pre-op assessment and post-op assessment have been about six or seven patients and it was great basically we've done mdts across with them as well So the full spectrum of use has been done pre-op, MDT, and post-op assessments. So, yeah, we have quite a bit more to do with numbers and take out a few glitches, especially with remote access and stuff like that. But, yeah, I think we're making good progress. Yeah. Spencer, do you see or do you know of hurdles that you're going to have to jump through to get this into wider application? For us from a research setting, one of the things that we've been very clear about as we do this is that while it's being used in a medical setting, 3D telemedicine is actually just a communication technology, right? It's a team's call. It's a communication device. We're not actually performing surgery with the system, you know,

or it's not diagnosing or anything. So it's not actually a medical device as much as it's a telecommunication device that's being used in a medical application. Well, as we wrap up, I like to give each of you a chance to paint a picture of your preferred future. If your work is wildly successful, what does healthcare look like in five to 10 years? And maybe that isn't the time horizon. It could be two to three, it could be 20 years, I don't know. But how have you made a difference in specialized medicine with this communication tool? Like going off of what Kwame was saying, right, back in November, when we flew down and were present for that first international MDT, it was really an eye-opening experience.

I mean, these doctors normally, they just get on an airplane, they fly down, and they meet these patients for the first time probably the day before they've had surgery. And this time they were able to meet them and then be able to spend time before they flew down preparing for this surgery. And then they did the surgeries, they flew back and normally they would fly back. They wouldn't see that patient again with 3d telemedicine. They jumped back on a phone call and there was the person in 3d and they were able to talk to them, you know, turn them around, show them where the procedure was, ask them questions, and have this interaction that made it so much better of an experience for them and for the doctors involved. So when I look at kind of the future of where this goes, you know, our vision is where else do we need this? Right now,

it's been showcased as this amazing way to bring international expertise to one operating theater, you know, with specialists from around the world as needed. And I think that's great. And I think we can apply that in so many different locations, right? Rural United States is a great example for it. We hope to expand out what we're doing in Scotland to rural areas of Scotland that, you know, it's very hard for people in the Scottish Isles to be able to get to their hospitals and, you know, it's very hard for people in the Scottish Isles to be able to get to their hospitals. And, you know, other possible applications like can we make this system mobile? You can imagine like a clinical unit where this system drives out to remote villages and is able to allow people that can't make it in to a hospital to get that initial consultation to know whether they should make the trip or whether they need other work done before they

can start surgery. So kind of the sky's the limit, right? I mean, it's always going to look at like, what's it, I work with a team that does moonshots for a living. So I'm always looking for what can we shoot for? And our goal really is like, gosh, where, where can't we apply this technology? I mean, just anywhere that it is at all difficult to get, you know, medical expertise, we can ease the burden of doctors by making it so they don't have to travel to provide this specialized care and increase the access to health care to these people that normally wouldn't be able to get access to it. Kwame, what's your take? So for me, I just want to describe what the current situation is and what I believe the future situation would be. So the current situation, and like Spence was saying, this just doesn't apply to Ghana alone. It can apply in some parts of the US and some parts of the UK as well, where a patient has a problem, is seen by a GP in the local area, has to travel close to 24 hours, sometimes sleep over somewhere

just to get access to a specialist to see what's going on. The specialist now diagnoses, sees what's happening, and then runs a barrage of tests and makes a decision, well, you're going to have an operation and the operation is going to be in, let's say, four weeks, six weeks. So what happens? The patient goes, spends another 24 hours plus going all the way back home, waiting for the operation day or operation period, and then traveling all the way back. You can imagine the time and expense. And if this person can't travel alone, that means somebody else needs to take a day off work to bring the person back and forth. So now what would happen in the future if everything goes the way we're

planning, we'd have a rig in every, let's say, district or region. The person just needs to travel, assumedly, an hour or two to the rig, gets the appointment. Everything is seen in 3D. All the local blood tests and stuff that can be done would be done locally. Results sent across, book a theater day. So the only time that the person really needs to travel is when they're coming for the actual operation. And once again, if an MDT has to be run on this patient, it will be done. And they would be sitting in their rig remotely in the town or wherever it is. Those of us in the teaching hospitals across the country would also be in our places and we'd run the MDT to be sure.

Post-operatively, if it's a review of the patient, we'd be able to do that. Even if it's an MDT review as well, we could do that. And the extra application, which I didn't highlight too much and I mentioned it, but I didn't highlight, is that if this person needs to have physiotherapy and we need to make sure that they're succeeding and doing it properly we can actually do it through a 3D corp and actually see the person walking in motion or wrist movement or hand extension or neck movements whatever it is we can do all this in 3D so yeah the the the scope is is as far as the mind can imagine it. You know, I'm even imagining it, and I hate to bring up the Jetsons as, you know, my anchor analogy.

But, you know, at some point way back, nobody thought they'd have the technology we have all in our rooms and on our bodies now. Maybe this is just like the beginning of everybody having 3D communication everywhere and no one has to go to the doctor before they get the operation. I don't know. Spencer Fowers, Kwame Darko, this is indeed a mind-blowing idea that has the potential to be a world-changing technology. Thanks for joining me today to talk about it. Thanks for having me.