Marc Amling, Exec. Director of Surgical Devices & Imaging, discusses the underlying technology and design features that make Rubina™ such a powerful and versatile addition to the IMAGE1 S™ modular endosurgical imaging platform. mark. How's it going? I'm doing good, TJ. How you doing today? I'm doing pretty darn good. How about you? To be honest, I'm I'm a little nervous. What do you nervous of? I'm used Thio designing cameras, not sitting in front of them. Yeah, it's a little different. We got a lot of lights signing out on us. Thousands of people out there taking a look at it. Uh, but that's okay. We can get through this together. All right. Excellent. Sounds good. So how long have you been working at Carl? Stores up in Goleta, California for over 23 years now. Wow. So over 23 years, we heard it from Charlie talking about the evolution over 75. I'm assuming imaging there's been a couple changes over the last 23 years. Yeah, sure sure has. When I started, we started with standard definition video. We evolved to high definition. Most recently are four K product offerings. And in addition to resolution improvements, we also added three D capability and PDD and I C g imaging modalities over the years. Wow. So that sounds like they're not going on. Yeah, uh, one of the things for me that I'm most interested in. I think people on TV are a swell is I was wondering about your design and how you approached it. What were some of the constraints you saw? How did you kind of work from an engineering standpoint? What were the various trade offs that you used to get the image one s with Rubina to the market? Yeah, so we started in a really good position. We have many years of experience in the emerging domain making endoscopic cameras, and we've been defining, refining and defining the image one s platform for a long time. In fact, as part of that several years ago, we introduced in N I. R I C G product, and from there we started talking to physicians. We asked him, What do you like? What do you want to change about the product And some of the feedback we got was that the surgeons told us that they really wanted simultaneous display of the n I are rigged and white light image, and that this would minimize our risk and prove their workflow and reduce their surgical times. All of which is a benefit to the patient and the surgeon. But they emphasized, I think this is really important, that they're not willing to give up things like their four K ultra high resolution, the color accuracy and the low noise image, all of which they've grown accustomed to over the years. They also stressed one last thing here. They stressed the need to minimize additional capital equipment, so ensuring connectivity to the existing camera control units was a must. So what did? How did from a design perspective, how did it work from an engineering stamp? Yeah, So the next thing we did was we went out and as as we do, we serve. We surveyed technology. We we try to understand what's the latest technology out there in terms of image processing displays images themselves. And so, based on these three, the surgeon input the technology survey that we did and our experience in designing endoscopic cameras, we took a step back and we re thought how to develop the best system with the least compromises and t. J. The image one s with Rubina is the result of that. I could definitely see that I can see how it, uh, you took in all of the things that you needed to consider the surgeons feedback what you know, from an engineering standpoint, how you could bring it to fruition. I'm assuming, as you're doing this to, the other thing you kind of looked into was modularity. Charlie brought up that it gives them the opportunity to buy what they want when they need it. But how does that impact you from a engineering standpoint or design? Modularity is at the heart of the image. One asked for being a system. Remember what I said about reducing overall capital cost? And, um, surgeons asked if we could, if they could reuse, therefore use issues and monitors to reduce that cost. And they're Rabin. A camera had does exactly that. It operates with our current for you. CCs are linked modules and are four K monitors. Trust me, it's not the easiest way to develop a product. I mean, you have to be absolutely obsessive about backward and forward compatibility, but we feel that with the rate of technology change, it's the right thing to do for our customers. Just in the five years that I've been here, we've gone from HD to now four K. I c g. So I can completely see how that that works is there's a lot going on from a technological standpoint. I am so excited, and I can't wait any longer. I'd really like to get up and take a look at the image one s for being and get some hands on time with you to go through some of the key components. That sound good? Yeah. All right. Let's go. Yeah. Yes. All right, Mark. Here we are. The key components to the image. One s with Rabin. A system? Exactly. Pretty cool looking, huh? Very nice. Very nice. You should know that you helped design it, so I've seen him. You've been using living and breathing this for a while. Uh, let's walk the audience through some of the key components of the image. One s with Rabin. A system first thing. I think we should start off his. Yeah, let's do the endoscopes. Yeah, let's talk about the I C g. These air BCG endoscopes. They are completely redesigned and optimized using the latest and optical design, including a spherical lenses and new special types of glass. This ensures that the focal point of the white light image and the n i R I C G image are aligned and the benefit to the surgeon is this eliminates the need to refocus when toggling between the white light and the n i. R I c g mode This and this is T. J the first significant improvement, providing a clear, crisp image in both modes. Without surgeon intervention, I can completely see that I spend a lot of time in the operating room, and the last thing a surgeon wants to have to do is refocus right. They always complain about that. So designing this scope so that it could be in focus no matter if I'm in I c g mode or white like mode, that's amazing. That's awesome. The next part of the optical chain that I wanted to dive into is gonna be the camera head. Can you walk us through some of the cool things that you got inside that camera? Yeah, this is packed full of technology. If you remember, our surgeons told us that they needed to maintain their current for white light for you camera performance, so that's set the first clear design requirement we needed to start it with the newest, most recent four K imager with improved performance. And we did that. And from here there's a few ways that you can combine a white light and an i. R I C G image. You can cycle between the two images. White light and I are rigged with either a single chip or a three chip camera head. But this reduces that image refresh rate, and it feels like the images air, not a line, and they're lagging one another, always one after the other. Another approach is to use a four chip camera head. In this case, you have one dedicated toe ir. This reduces that lag feeling but also normally reduces the resolution. In other words, it's not true. Four. K. Well, you already said that they wanted true four K, and you already said that the surgeons don't want lag right? So I'm assuming we did something a little different here. So our our design approach was we took the best of both worlds. We started with custom designed to chip prism assembly, one ship solely dedicated thio white light and one for N. I. R i C g. Both four k resolution operating at 60 frames a second. Wow, Both images are acquired at the same time. So the overlay of the white light and the n i r I. C G is perfectly aligned. It's super cool. So all of that's in that camera head right here. That's pretty cool. Well, one of the things that before we jump into here I wanted to bring up is you know, Carl Stores has pioneered the cold light source, right? And what they have done since then is keep on improving the technology in the light source. I'm assuming that's the same case here with this led light source. Yes. So this is the Rabin a light source. And I gotta tell you, our engineers out did themselves with this one. Normally, light source design is really based on two type of technologies. Either laser or led lasers. Nice because it has high power output. But the drawback is that it's a laser. Yeah, I've heard of the nurses Say they got enough training, right? They don't wanna have to do more training to use a product of the operating room, so exactly, But what if you could use the power of a laser but without the hassle of a laser. And that's what we did. We built an led light source optimized for the I. R. I C application. It has a custom optical assembly in it that's capable of mixing two leads, one for broadband white light and one for the N. I. R I C G. And as an added bonus, TJ, using dual led s extends the life of the light source to 30,000 hours there. 39,000 hours. And that's more than most surgeons will spend in the or in their entire life. That's pretty nuts, Z. So what? Whoa, there's one. Wait, there's more. There's more. There's one more cool thing about this. This is the first product to use our brand new Ethernet based communication network. We call the Chaos hive, as you're probably familiar with the Karl starts communication bus. This replaces that this is gonna allow us new features, new capabilities, stuff that we're really excited about introducing the market in the future. You mean to tell may not only is this light source all led, but it's also we're changing the way that it's communicating in the operating room. Wow, this is groundbreaking stuff, so we're almost to the end of the optical chain. I think one of the things that Carl Stores has been known for up to this point has been it's exquisite image processing things like Clara, things like chroma that our customers have come to love. Do you mind? Spend a little time kind of walking through how image processing impacted Rubina. Our image processing processing engineers went to work here too, you know, they had to maintain that four K white light image, including both Clara and Chroma and adding on top of that. Now the new I c E n i r I c g image. So they went from processing 14 K images 60 frames a second to processing to simultaneously four K images at 60 frames a second. This increase the bandwidth of our module from five gigabits per second to 10 gigabits per second bits and yeah, and what's interesting about that is we knew this was coming back in 2018 when we designed that module and we were thinking ahead and how to prepare for that back then. And I could tell you were thinking about how to prepare for the next product products in the future. I totally agree, Mark. It gives them the opportunity to buy what they want when they need it. Not when Carl Store says they need it. Right. Exactly. So you're not paying for technology you're not going to use, right? You're not having excess technology that you're not able to take advantage of. So when we talk about technology, we did a really good deep dive on that. But I want to know we talked about the surgeons a little bit at the beginning, you know? What does the surgeon want to see? You're gonna have to wait for the next segment with Dr Libby for that. Give me a little bit. Mark, please. No, no. All right. All right. We'll give you a little bit. All right. We're offering four visualization boats in the new system. The first is a white light only image. The second is an I R i C g image. Basically a black and white image. The third is a white light image perfectly over laid with that n i r I c g image which the surgeon can select green or blue. So green or blue It's up to you. It's up to you like it. And the final mode is a white light image over laid with the N i. R I C G image and a colored intensity map showing the intensity by the color. Wow, I can't I can't wait to see this little more in depth. So you say Next segment next segment. That's right. So there's a lot of technology packed in all this. I'm assuming I gotta buy a whole new tower and I got to get all these. Can you just walk me through? What do I need to get this into my operating? Yeah, it's pretty straightforward, TJ, if you're in existing image one for you. Customer. There's only three pieces of equipment that you need. You need the I C G scope, the new camera and the new light source. That's it. A software update for your your current system. That's pretty straightforward to Dio, but there's nothing else that you need. Wow. I mean, this is amazing, right? Every other time we come out, I hear other companies come out with new technology. Gotta buy all new tower, right? Don't just add on three simple components to make this whore. This really is amazing. There's nothing else out there on the market today On the market with Rubina we re envisioned, we redesign and we optimized every aspect of the system, considering our search and feedback that we got the technology readiness and building on our history of developing high quality endoscopic cameras. How well, Mark, I cannot thank you enough for doing this deep dive peeling back the onion a little bit toe, Let us see and how you go in through developing all of these amazing products. This was truly an eye opening experience. Thank you so much for your time, Mark. I really appreciate it, E.