Frequently Asked Questions

Surgeon Today was created by a team of surgical videographers, a surgical tech, computer programmers, and web designers as a forum for enhancing surgical education all over the world.

Our philosophy advocates openness towards all members of our surgical community to provide better education and patient care for everyone.

ST is designed so that each surgical specialty conducts their forum with the inner circle of their specialty colleagues, but the outer circle of onlookers, such as allied surgical personnel or a member from another specialty, cannot participate in the forum, but can only view programs that are designated as unrestricted by the authors. In turn, this enables a cross-fertilization of ideas to flow between surgical specialties as well, although other specialties have their own forums with their specialty colleagues. With the ability to look on, the whole surgical community is enhanced.

Surgeon Today allows for much of the functionality of a surgeon-only site in that any surgeon can choose to upload their videos for their specialty surgeons only or for private showings. You can set restrictions. But it is not a surgeon-only site strictly speaking. Other specialty members and allied surgical members can view only unrestricted programs but not comment. So the choice is yours, and we think you will see the benefits from knowing that your entire operating room team also has access to view unrestricted video programs, although they cannot participate in the discussions.

Surgeon Today uses a hierarchical set of categories for placing videos in our library. This hierarchy is structured thus: Surgical Specialty>Anatomic Area>Procedural Area. Searches can be conducted using keywords, author names, titles, or any of the words that activate the hierarchical channels, such as “orthopedics,” “knee,” “ACL reconstruction.” Editorial groupings can also be located in this manner.

The company Surgeon Today LLC is solely privately financed and is not financed nor owned by any medical/surgical device company nor directly affiliated with any medical/surgical device company.

Surgeon Today presently gains revenue exclusively through skyscraper advertisements, the sale of video channels and video pages to medical/surgical device companies as well as individuals such as medical graphic artists and animators promoting their services and products.

Surgeon Today does not own or claim ownership on any video content submitted to this site by our Members. Sending and posting video programs, clips, and presentations to this site grants Surgeon Today LLC the right to display and broadcast any video program in which there is a written or verbal agreement between the copyright holder or author and the individual posting the program. Please refer to the copyright statement for a fuller explanation.

Surgeon Today does not sell or give out your email address to any members or anyone else.

If you wish to write an author of a video program privately aside from a Discussions entry, you can click on their name, which will take you to their profile page. From there you can send a private message to the author, but this will not show you their email address.

All members can control their own profile information by clicking on “My Profile” once logged in.

- Contribution to Society
- Fairness and Honesty
- Cooperation and Team Spirit
- Untiring Effort for Improvement
- Courtesy and Humility
- Adaptability
- Gratitude

Surgeon Today is primarily for surgeons to view online video, post video, and discuss video and surgical techniques with other surgeons all over the world through the internet. Each surgical specialty is parsed into its own Specialty Area where members belong in order to take full advantage of all the functionality of that Specialty Area. However, in the spirit of sharing ideas with the greater surgical and medical community, non-surgeon physicians, allied surgical professionals, and some ancillary medical personnel such as AV specialists, medical educators, medical illustrators, and medical animators are able to join the site with limited permissions, yet with full privileges in their own Specialty Areas. As well, surgical device company personnel may also join as guests, but are given view-only permission on video programs designated as such by surgeons. They are not allowed to discuss or view any restricted video programs.

Surgeons join Surgeon Today through their primary Specialty Area, but if they want Tier 1 Membership in a second Specialty Area, all they have to do is request these privileges by writing the Surgeon Today Membership Department at .(JavaScript must be enabled to view this email address).

The public is not allowed to join Surgeon Today. Only surgeons, physicians, and medical personnel can join. Verification may be conducted on new members. This is why we ask for various forms of professional licensing from physicians and medical personnel, so that we can verify.

Surgeon Today needs new members to continue the discourse. Simply click on the link labeled “Tell a Colleague” and enter your colleague’s email addresses, separated by a comma, and we will send them an email asking them to join.

Editorials are collections of multiple video programs grouped together by a surgeon author for the specific purposes of showing variations of surgical techniques on procedures that may be of interest.

Surgeon Today uses a highly adaptable CMS or content management system for running the engine of the video library and discussion groups. Simply write us at .(JavaScript must be enabled to view this email address) and we will adapt! We will, however, consider a consensus over individual requests, should disputing information arise.

The best way to check for updated video programs on Surgeon Today is to first bookmark your Specialty Page, so that you can use this as your portal into Surgeon Today. The Playlist in the right hand column is the primary navigation tool for locating video programs. This Playlist is listed in a hierarchy starting with Specialty>Anatomy>Surgical Procedural Area in that order.

All video programs are placed into the basic hierarchical structure of Specialty>Anatomy>Procedural Area, but may also be searched in several other ways. Programs can also be found through the Author name, through the Search Engine by using keywords, by using the Anatomy>Procedural Area pull-down menu, through the Tab System beneath the Video Player, or through Features and Clips.

Features are the video programs we are all familiar with that are edited programs with a narrative purpose, of longer duration than Clips, and always containing audio. Surgical procedural programs and slide presentations with audio can be found in the Features section and are ordered in the basic hierarchy of Specialty>Anatomy>Procedural Area. Clips on the other hand, may not contain audio, although they frequently do, and are typically small parts of a procedure that a surgeon may post if they want to show some short example of some anatomic anomaly, for example, or are interested in asking the larger audience questions about the Clip.

Surgeon Today always has a call out for submissions of surgical video programs. What better way to reach your colleagues than through online video? And videos don’t have to be Features; they can be submitted as Clips as well.

Uploading a video program can only be done with a single file, which makes DVDs somewhat problematic. There are a few steps and alternatives to uploading a program generated from a DVD. You will notice that you cannot upload whole folders, and that is what a DVD is made of.

If you have ever quit playing a DVD on a computer and opened the DVD disc contents in the same manner you open a CD, you will notice that all DVDs contain two basic folders, the VIDEO_TS folder, which contains a number of other files, and the AUDIO_TS folder which contains nothing at all. This is because for DVDs, the audio and video are on separate tracks, and thus behave as if two separate files. The video tracks are Mpg2 files, and the audio tracks are AIFF or AC3 files.

It is always a good idea to fuse the audio and video tracks together into either a QuickTime file or an Mpg4 file before upload. There are several different software companies that offer software to extract Mpg2 and AIFF files, fuse them together again, and create a file that can be uploaded.

We have worked with a DVD extraction software program called Cinematize and have found it to do the job faithfully. The extracted clips can be saved in formats compatible with popular applications including QuickTime, iMovie, Final Cut, Windows Movie Maker, Adobe Premiere, PowerPoint, even for iPods.

The alternative to extracting a DVD in order to create a single file for upload is to zip the DVD folders, which creates a single file in essence. Then Surgeon Today can take the DVD and conduct the same extraction procedures with Cinematize. And file zipping before upload is probably a good practice anyway. Visit StuffIt for information on file compression software. DVD folders can then be compressed and uploaded easily.  Current versions of Windows and Apple OSX also typically allow you to compress (or archive) sets of files by selecting all the files and folders and right clicking.

Since Surgeon Today advocates putting your best video image foot forward, also read the FAQ titled, “What are the best practices for preparing a video for upload?”.

The Learning Center is the hub of sharing instructional programs posted for teaching all members the nuances of shooting surgical video, editing, adding voice-overs to programs, and encoding video in preparation for uploading onto the Surgeon Today site, or simply to better your surgical video practices. The Learning Center is like a Specialty Area, and typically medical videographers, hospital audio/video personnel, and education specialists will want to contribute their advice to the Learning Center. The goal of the Learning Center is to teach every member the details of producing good surgical video and the associated technology.

Surgeon Today accepts the submissions of most digital video formats: H.264; Mpg4; mpg-1 (which is often called “mpg”); MOV; WMV; mpg-2 along with audio on a separate AIFF, mp3 file; FLV; AVI, just to name a few. Yes there are more. However, the best format you can upload your video in is Mpg4, which is an H.264 container codec. Best practices for preparing the Mpg4 file are coming up.

Surgeon Today can also accept Sony DVCam as well as standard DV tape, but these will have to be mailed or shipped in to:

Video Submissions
Surgeon Today, LLC
454 Las Gallinas Ave, Suite #360
San Rafael, CA 94903-3618

We cannot accept any other tape formats than DVCam and DV tape.

An important note here—never send an original or the master tape or disc, only copies. Discs can break in shipping.

Surgeon Today does not return any video programs.

First of all, you should strive to upload an encoded program directly from the most original video format that your video was edited in. Every time you make a new codec (encode) from another encoded program, the image quality will diminish significantly.

For the best looking online video, encode your program there, directly from your best footage. The best video codec you can encode your program for Surgeon Today submission is the following:

H.264 as an mpg4 wrapper using an encoder software such as Telestream Episode, Sorenson Squeeze, Apple Compressor, Autodesk Media Cleaner, or QuickTime just to name a few, will produce the best results. There are many other great encoders out there. Episode and the recent Squeeze are two of the best encoders; Apple Compressor field testing does not demonstrate the best image quality in comparison to other encoders when encoding H.264 although it is outstanding for other codecs, such as mpg2 and QuickTime.

Remember that we cannot increase the video quality or resolution better than what we are given. The quality of what you give us will not be improved. This is why it is best to send us an optimized codec.

Start with the best H.264 recipe your encoder provides. Copy it, label your recipe “ST” or “Surgeon Today Widescreen” or “Standard H.264 Codec,” and either/both alter and save the settings in this manner:

Label your video with your last name first and then the procedure with this labeling standard: lastname_procedure_variation_date.mp4. The details of the label don’t always matter, but placing your last name first allows us to find and archive the program quickly.

For HD programs or anamorphic (pixel stretched) programs, keep the widescreen 16x9 aspect ratio.

For SD programs keep the standard 4x3 aspect ratio.

Always keep the same frame rate as the Master or Original being encoded. This means 29.97, or 30 frames, which is common with NTSC countries like the United States, Canada, and Japan, and 50 frames for PAL countries in Europe. Don’t select the 24 frames per second button, unless it was recorded and edited that way.

For resizing video for HD widescreen 640x360 is best; for standard definition 480x360 is best; and anamorphic (widescreen standard definition) then 640x360 is good. However, you may keep your current size for your video if you intend to mail or send it to Surgeon Today and let us codec it here. Unless your program is short enough, you might have to send your program on a thumb drive. Thumb drives will not be returned, unless you send a self-addressed stamped envelope.

Always de-interlace interlaced video only. De-interlacing should only be applied to interlaced programs, where there is an ‘i’ and not a ‘p’ indicating your format. This will help take the “jaggies” out of movement. Video programs recorded in progressive mode(p) are already de-interlaced, so you don’t need to check this box. New HD formats are often set to (p) Progressive and not to (i) Interlaced, but you need to check your equipment to make sure this is the case. (As an aside, if your hand movements are fast, it is always good to record the original footage in 60P rather than 30P, to reduce the smearing artifacts, so tell your videographer.)

Pixel depth should be kept on automatic. Most video contains rectangular pixels and not square pixels (Photoshop files incidentally use square pixels). And to make matters more complicated, HDV video footage uses elongated rectangular pixels, so if you hit the square pixel setting, you can get distortion. Don’t do that for HDV or any other video for that matter.

Set Bandwidth control to VBR using Peak Rate and set the average kbit/s to 2000 and the Peak rate at 2400. This is the setting that has more impact on bandwidth allowance other than the entropy coding settings.

For Keyframe control use Natural and Forced Keyframes set at a distance of 300 frames with 5 reference frames (do not go above this) and 3 B-frames. This setting is for one I-frame every 10 seconds, or one every 300 frames in a 30 fps file, and enable the option to add I-frame at scene changes if that is part of your selection.

Use High Profile with Entropy coding for CABAC instead of Main, CAVLC, or Baseline for sending to Surgeon Today. Baseline is good for codecs that will go onto devices such as iPhones and cell phones. Baseline is a consistent bitrate and can show artifacts when there is a lot of movement in the video. CABAC gives us about 15% better quality.

For Color Space it is an advantage to know the compression ratio your original footage was shot in, thus 4:2:2 is best for Standard DV footage. For HD footage us 4:2:0 and keep the aspect ratio the same as from Source. If your encoder has a color source image setting that says “Same as Source” then choose that and don’t bother looking any deeper.

In the Advanced settings select 1 Slice and Buffer at 100% and leave IDR Frames at Every.

Always use a 2-Pass setting, which makes a second run over your program to see what more can be compressed. Your 2-pass interval can be set to 500 and use the deblocking filter always. Encoding speed should be set to 90.

If you have a setting for crushing black, or the Black and White Restoration, set the Black for 15, the White for 255.

Unless you are showcasing your musical abilities, you may as well switch stereo to the mono setting and save some digits. Sorry Madonna!
Audio should be at 44K and not 48K, although most video is edited in 48K. 44,100 Hz is another way of expressing this. 16 bit is good, but 8 bit sample rate for mono voice-over often is just fine.

From a file with the above codec settings, we will encode a version that can be played on slower computers as well and this will show up when the Lo button is pushed. Just to reiterate: video quality is always better when encoded directly from the Edited Master, without ‘lossy’ generations of encoded video to work from, such as DVDs.

Surgeon Today cannot take edited Powerpoint or Keynote presentations in that format. All slide presentations must first be converted and edited into video, then submitted as a video program. You will notice that elaborate graphs and charts don’t render well in video. Also, most slides are designed without video in mind, and “bleed” out to the boundaries of the frame past the area video editors call “action safe” and “title safe” areas, which are 5% and 10% in from the edge of the frame. Care should be taken in the editing process to make sure that readability is optimized, which is not always easy. It is always better to submit slide presentations with audio. Presentations without audio will be automatically placed in the Clips sections.

Quick? We are afraid not. A video format typically refers to the tape format or means in which videographers and editors shoot and edit programs. Original footage is the raw footage and the edited master is the master of the completed program.

A codec (“coder/decoder”) is a way of encoding audio or video into a stream of bytes using encoder software, such as QuickTime, Compressor, Episode, Squeeze, or Media Cleaner, just to name a few encoders.

All codecs are encoded or “codeced” using encoder software from the master into another digital “format.” Yes, the word “format” still applies, but it is better to call it a “codeced format.”

A codec is a “lossy” format, which means that it loses information during the encoding process. This information can never be brought back into the codec. What you see at that point is what you get. Surgeons are often shocked at how degraded recordings look that were taken from their new HD endoscopic video systems when the recorder automatically codeced the footage into mpg-2 or mpg-1 formats. “But it looked so good on the screen!” This is why it is important to send Surgeon Today the most original video format as possible, or to follow the Best Practices for sending files.

To further complicate the definition of codecs, there are at least two different types: the container, and the codec(s) used inside that container.

The container describes the structure of the file: where the various pieces are stored, how they are interleaved, and which codecs are used by which pieces. It may specify an audio codec as well as video, as for DVDs, which contain audio on a separate track than the mpg-2 video.

To make life even more confusing, some names, such as “mpeg-4”, describe both a codec and a container, so it’s not always clear from that context which is being used. You could have a movie encoded with an mpeg-4 codec inside an AVI container, for example, or a movie encoded with the Sorenson codec inside an mpeg-4 container.

Common Container Formats:
FLASH: You see it all over the web, and Surgeon Today uses a Flash Player to provide the optimal video viewing experience we can provide.

AVI (.avi): Most commonly contains M-JPEG (especially from digital cameras) or DivX (for whole movies), but can contain nearly any format (not Sorenson). Sometimes you’ll see a reference to the “fourcc”: this is a four-character code (such as “divx” or “mjpg”) inside the AVI container which specifies which video codec is being used.

Quicktime: Most often used for the locked Apple Sorenson codec, which is widely used, or for Cinepak (free), but can also hold other codecs such as mjpeg, etc.

WMV (.wmv): More or less MPEG4; can contain nearly any codec, including several Microsoft spinoffs of MPEG-4 which vary in their freedom and licensing requirements.

ASF (“Advanced Streaming Format”, .asf): a subset of wmv, intended primarily for streaming: an early Microsoft implementation of an MPEG4 codec.

Common Codecs:
MPEG (“Moving Pictures Expert Group”): three video formats, MPEG 1, 2, and 4.

MPEG-1: Old, supported by everything (at least up to 352×240), reasonably efficient. A good format for the web.

MPEG-2: A souped-up version of MPEG-1, with better compression. 720×480. Used in HDTV, DVD, and SVCD.

MPEG-4: A family of codecs, some of which are open, others Microsoft proprietary. This is pesently the best codec you can send Surgeon Today. Take a look at Best Practices.

MPEG spinoffs: mp3 (for music) and VideoCD.

MJPEG (“Motion JPEG”): A codec consisting of a stream of JPEG images. Common in video from digital cameras, and a reasonable format for editing videos, but it doesn’t compress well, so it’s not good for web distribution.

DV (“Digital Video”): Usually used for video grabbed via Firewire from a video camera. Fixed at 720×480 @ 29.97FPS, or 720×576 @ 25 FPS in PAL. We included this, but typically this is not a codeced format, but can be sent on tape in an uncompressed form. But if you try to upload an uncompressed DV file onto the site, go take a weekend vacation after you click Upload.

FLV (“Flash Video”): A commonly used format and one we use in the H.264 codec version for Surgeon Today. Don’t be fooled if your video guy hands you your program on an FLV file and you can’t open it. It can only be played on a Flash Player with “swf” instructions.

H.264: An MPEG-4 standard, also known as MPEG-4 Part 10 (ISO/IEC 14496-10). H.264 delivers excellent video quality across the entire bandwidth spectrum — from 3G (Mobile phones) to HD (Broadcast) and everything in between. H.264 is now mandatory for the HD-DVD and Blu-ray specifications (the two formats for high-definition DVDs) and ratified in the latest versions of the DVB (Digital Video Broadcasters) and 3GPP (3rd Generation Partnership Project) standards. Numerous broadcast, cable, videoconferencing and consumer electronics companies consider H.264 the video codec of choice for their new products and services, including Apple, Sony, Nokia, SanDisk, Palm, Blackberry and even Microsoft. We use the H.264 codec as much as we can for our programs.

WMV (“Windows Media Video”): A collection of Microsoft proprietary video codecs. Since version 7, it has used a special version of MPEG4.

RM (“Real Media”): a closed codec developed by Real Networks for streaming video and audio.

DivX: in early versions, essentially an ASF (incomplete early MPEG-4) codec inside an AVI container; DivX 4 and later are a more full MPEG-4 codec. No resolution limit. Requires more horsepower to play than mpeg1, but less than mpeg2.

Sorenson 3: Apple’s proprietary codec, commonly used for distributing movie trailers (inside a QuickTime container).

QuickTime 6: Apple’s implementation of an MPEG4 codec.

RP9: a very efficient streaming proprietary codec from Real (not MPEG4).

Surgeon Today allows proxy uploaders to be designated by Specialty Members within My Profile page. This is an advantage for busy teaching surgeons, as they can designate residents, fellows, or their AV team to do the uploads for them. Just make sure that all the information for each field is correct for the proxy uploader to use before beginning the process of uploading a video.

You can tell us the time code for the thumbnail shot in the notes section of the upload page. Otherwise we will choose it. We are always inclined to take a thumbnail from the final results of a procedure. Know that taking a still image from a moving video shot results in a flickering image, so it is best to choose a stable and still shot.

Creating surgical video can be anything from simple to monumental, depending on the program and the production values. Too large of a subject to tackle in a FAQ, we recommend that you familiarize yourself with the Learning Center and the advice that is posted there. If there are any topics that you would like to see addressed, please contact us and let us know what those topics are. We may not always be able to accommodate the topics, but we will certainly evaluate it and try.

DVDs have separate audio and video tracks, so when you need to edit the content of a DVD you must recombine the audio and the video into a synchronous clip or clips. For Mac and Windows users, one of the best programs for combining the two tracks into QuickTime files is Miraizon Cinematize at http://www.miraizon.com/products/cine2profeatures.html . Take care to study the best settings for your editor and make sure these settings are matched in the decoder software. Again, although that DVD may look great when you play it alone, you will not be able to increase resolution interpolate missing frames due to a low frame rate setting.

Presently the disc recorders on HD endoscopic video towers provide only a reduced video image in recording. We know those systems look wonderful on screen, but don’t be shocked if your disc footage is disappointing. The endoscopic video companies are providing disc recorders for convenience and not necessarily for image quality. HD video is often codeced downwards into Mpg-1 and Mpg-2 formats, and sometimes at 15 frames per second. It is best to raise the quality of your recordings in every way you can. If you want to get as close to the original quality of your image, you might think about using a HDV recorder, which records on DV or HDV tape and allows you to take the tape home for editing. Presently there simply is no way to get HD quality onto discs, although there will be alternatives soon.

Voice-overs are actually simple to do at your computer with a microphone/headset like the DSP-400 Foldable PC Headset (PLNDSP400) http://www.plantronics.com/north_america/en_US/products/computer/voip-headsets/audio-400-dsp . Most editing programs have a means of conducting voice-over sessions through this mic/headset.

If you don’t go with a recording system like this, high cordiod and what they call “dead mics” are best. These type of microphones only pick up sound facing the direction of the voice and reduce room sound. Omni microphones or speakerphones should always be avoided.

Several words about the best techniques for conducting a voice-over:

Technical settings for audio in editing programs are best at 16 bit sample rate and 48K, although most editors will accept 44K. Later when the video gets encoded, it will be encoded to 44K, but for now, 48K is best. Also, there is no need to record stereo, so switch it to mono and save some disc space.

The best VU meter level for recording is anywhere between -12db and -20db. When recording audio in the field, we always use -12db, but never go above that level, because you will “peak” the audio and distort it, and therefore ruin it for good. In the old days of analog audio, engineers would set their audio at zero, but not with digital audio! You need the headroom, so -12dbs or lower only. Likewise, use or adjust your audio to -12dbs in editing as well. If you make a recording at a level that you would like to boost later, boost the audio clip before you edit it. Then make your cuts and it will all be at the same level.

Stand up if your voice is too sleepy when you sit. Sit erect. Try to speak in a commanding manner.

Drink warm water to open your voice. Coffee isn’t bad if caffeine doesn’t give you the jitters, which can contract your voice. Likewise, a warm room is advantageous too.

Never use patient names or refer to anything that might identify a patient, especially if they are famous.

Microphones placed in front of the lips tend to produce plosives. Place the microphone at a 45 degree angle away from the lips at the left or right cheek. Proximity is everything for a microphone, so getting it close to the sound is also important.

You should always, always monitor your recordings while you record. This is why a microphone/monitor in one headset is good.

Record the voice-over sentence by sentence, phrase by phrase, and always edit the audio first, not the video first. Audio dictates the visual content, not the other way around. So pro-editors will lay down patches of audio and then fit the video to that audio, unless they are using synchronous audio. If you watch television carefully, you will notice this technique is used all the time.

Do not try doing the voice-over while watching the video you want to fit it to. People tend to drift, and their voices do as well when they watch video. Stop and start the video, and stop it before recording each sentence. People tend to “ah” a lot or the timing slips when they try watching active motion video at the same time as giving a sentence. It is better to deliver the sentence with the memory of the video shot, than trying to chase it. So stop that shot each time, then deliver the sentence. You can do each sentence at a time, and this will sound a lot better. Also, it actually makes for less editing work later as well. Clean audio is the best foundation for fast editing. You can always fit the video to the audio, unless it is synchronous audio.

Make action statements before concept statements. There is nothing worse for an editor than a statement that gives the reason why a certain action is conducted, and then a statement as to what instrument is used for that. What is the editor supposed to do with that 30 second sentence when an 18 gauge spinal needle is advanced through skin in 5 seconds and the statement for that doesn’t come until 24 seconds? So turn that sentence around, describe action first, then comment. You can better buy time at the tail end of a video clip.

Editing may seem intimidating, but you can really get hooked on it when you get going. It’s fun! We suggest you ingest some of the instructional programs posted on the Learning Center. You will be up to speed in no time.