Multimedia Mania
`
`ANTHONYD. MERCANDO
`
`From the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
`
`Introduction
`
`Overthelastyear, frequent reports about mul-
`timedia began to appear in newspapers and on
`television news. Several
`large communications
`companies promised to merge with each other and
`with computer companies to prepare for the com-
`ing of a new agein entertainment, education, and
`communications arts. Several of the mergers and
`plans fell through, possibly because each company
`had a different concept of what the new technol-
`ogy known as multimedia is and will be. Even
`now, many people do notagree on a definition of
`the term multimedia. Since the technologyisstill
`in evolution, any definition of the term should be
`left broad: multimedia technology is the combina-
`tion of sound, graphic images, animation, and
`video presented to a user via computer.Initially,
`this technology was usedto create video games on
`such computers as the CommodoreAtari and later
`on the Apple Macintosh. When multimedia capa-
`bilities were added to the Microsoft Windows en-
`vironment in 1991, the move toward multimedia
`gained momentum. Multimedia presentations
`make extreme demands on computer hardware, so
`its popularity increased only after the hardware
`improved in features and cost in the past 2 years.
`For example, until the price of CD-ROMsfell to
`the range of several hundred dollars, software that
`contained video files of several hundred mega-
`bytes could not be distributed in any reasonable
`manner,
`
`Like most of the rest of the computer world,
`medical computing is beginning to benefit from
`multimedia. In this article, we will explore some
`of the concepts behind multimedia and consider
`some hardware and softwareissues. In a future ar-
`
`Address for reprints: Anthony D. Mercando, M.D., One Elm St.,
`Tuckahoe, NY 10707. Fax: (914) 337-7657.
`
`Received June 28, 1994; accepted June 28, 1994.
`
`ticle, we will examine some specific multimedia
`titles now available in the medicalfield.
`
`Computer Hardware
`Requirements
`
`Recently, I bought my 5-year-old daughter a
`multimedia CD-ROM entitled Just Grandma and
`Me(Broderbund, Novato, CA, USA). This “Living
`Book” is a captivating animated story based on the
`book by Mercer Mayer. It combinesstill cartoon
`images with animated sequences and sound,all
`underthe control of your child (or yourself) work-
`ing the computer mouse. Here are the minimum
`system requirementsfor this child’s storybook (PC
`Version): 386SX or higher computerwith at least
`4 megabytes of random access memory (RAM),
`Windows3.1 or higher, DOS 3.3 or higher, Super
`VGA monitor (640 X 480 with at least 256 color
`capability), a sound card, a mouse, a hard drive,
`and a CD-ROMdrive. Myoffice database of 7,500
`patients and over 150,000 records of information
`can run on less robust hardwarethan that andstill
`provide data access times of <1 second, illustrat-
`ing the computing powerrequired to run even the
`simplest multimedia applications. Here are some
`of the hardware requirements for a Multimedia PC,
`sometimes referred to as MPC (a trademark of the
`Multimedia PC Marketing Council).
`
`Processor, Memory, and Hard Disk
`
`One can never have enough RAM,processor
`speed, or hard disk space. The original MPCspeci-
`fications allowed for a 12 MHz 80286 processor,
`but the current minimumis an 80386 SX running
`at 16 MHz.For displaying video clips, you should
`use at least a 33 MHz 386 DX processor. Recently,
`the 386 computer market has been replaced by 486
`SX, 486 DX, 486 DX2, 486 DX4, and Pentium ma-
`chines. Later this year, the Power PC from Moto-
`rola, already available on the newest Apple Macin-
`
`1548
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`September 1994
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`PACE, Vol. 17
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`
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`Petitioners’ Exhibit 1038
`Page 0001
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`Petitioners' Exhibit 1038
`Page 0001
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`
`MULTIMEDIA
`
`tosh computers and promising to be faster than
`the Intel Pentium, will appear in PC compatible
`machines.
`Although early MPC specifications stipulated
`2 megabytes of RAM,that is barely enough mem-
`ory to run Windows3.1. Most computers sold at
`this time contain at least 4 megabytes of RAM,and
`that should be considered a minimum. Many Win-
`dows applications, including multimedia ones,
`will run noticeably faster if you have 8 or 16 mega-
`bytes in your machine.
`The original MPC specification for 30 mega-
`bytes of hard disk space is consideredgrossly inad-
`equate by today’s standards. The Windowssoft-
`wareitself occupies over 20 megabytes, and many
`applications do likewise. When purchasing a new
`multimedia computer or when upgrading an older
`one, 200 megabytes should be considered a mini-
`mum. Theprice of drives as large as 540 megabytes
`has come down recently, so purchase the largest
`drive you can afford. Although disk compression
`programs will approximately double the storage
`capacity of your hard disk, they function by using
`processor capacity to compress and decompress
`files in real-time as the files are written to and read
`from the hard disk. This process places
`a
`10% —15% time overhead on your system, whichis
`unacceptable for many multimedia presentations.
`Video playback, especially, may deteriorate to un-
`satisfactory levels when compression softwareis
`used, since most computer video playback proto-
`cols make use of some compression functions
`themselves.
`
`Display
`
`Since displaying graphic images and photo-
`graphs is such an important part of multimedia
`presentations, the computer monitor is an impor-
`tant componentof your system. A computer sys-
`tem should include a ‘‘super VGA” monitor with
`a vertical scan rate of 72 Hz or greater and the capa-
`bility of displaying at least 256 colors at resolu-
`tions of 640 X 480 pixels (picture elements), 800
`x 600 pixels, or higher. Standard 14- and 15-inch
`displays are adequate, but for higher resolutions,
`such as 1,024 X 768 pixels, a 17- or 21-inch moni-
`tor is better. At the higher resolutions, text sizeis
`small on a small screen. The larger monitors are
`
`expensive, with 17-inch modelsretailing for over
`$1,000.00, and 21-inch models over $1,500.00
`The VGA display card that runs the monitor
`should have at least 1 megabyte of memory. More
`memory allows the card to display more colors at
`each given resolution. This memory is indepen-
`dent of the system’s main RAM.Inthefuture,dis-
`play cards will become faster. Presently, many
`VGAcards will fail to send some frames to the
`monitor when displaying full motion videoclips,
`especially when the video picture is meanttofill
`a large partof the screen (moredata to process with
`each frame), Faster cards will solve this problem
`andpermit at least 30 frames per second (current
`television standard) to appear on the full monitor
`screen.
`
`Sound
`
`Although the Apple Macintosh was designed
`to play high quality sound and has hardware to
`accomplishthis built into the system, PC-compati-
`ble computers require an additional sound card
`in order to play high fidelity sound and recorded
`speech. Thesecardsfit into one oftheslots inside
`your computer, and have input/outputjacks on the
`back of the computer for connecting microphones
`and stereo speakers. They also provide a digital
`and often analog audio connection to an internal
`or external CD-ROMdrive. This provides for com-
`munication betweenthe card andthedrive,as well
`as the capability for playing standard audio com-
`pact disks through your computer’s external
`speakers. Although a sound card could produce
`simple soundsthrough the PC’s internal speaker,
`external speakers are recommendedto achievebet-
`ter quality voice and music.
`Sound cards play back either digital sound
`files, or analog audio. There are two types of sound
`files, waveform and non-waveform, and Windows
`3.1 supports both. Waveform files store sampled
`sounddata created by analogto digital conversion.
`These files are usually large, since they contain
`information that was sampledwith a resolution of
`16 bits and as fast as 44.1 kHz for high quality
`stereo sound. Sounds sampledat this resolution
`and frequency producefiles as large as 10.5 mega-
`bytes for each recorded minute. By convention,the
`commontype of waveform file used in Windows
`applications have a file extension of “.WAV”
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`PACE, Vol. 17
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`September 1994
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`1549
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`Petitioners’ Exhibit 1038
`Page 0002
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`Petitioners' Exhibit 1038
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`MERCANDO
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`(sometimes called ‘‘wave’’ files). These files can
`be usedto store any sounds, including voice and
`music. The non-waveform files,
`also called
`“MIDI” files, store information as instructions,
`such as musical notes and their duration, and be-
`cause of this thefile size tends to be much smaller
`than waveformfiles. They can store music or some
`sound effects, but not voice. Many of today’s
`soundcards can play back MIDIfiles,or thefiles
`can be played through an external synthesizer.
`One problem with MIDIfiles is that their playback
`instructionsare device specific. If codes for certain
`instruments are different between two playback
`devices, the notes wil! sound different.
`Besides playback, sound cards allow you to
`record soundsand save theminfiles on your hard
`disk. Using a microphoneorline outputs from an-
`other audio source, and software contained in
`Windows3.1 or sold with the card, you can sample
`soundsand construct “.WAV” files, which can be
`played back later. This is how many voice mail
`systems work. The software also allows you to edit
`the file, often with the aid of a graphical display
`of the waveform data.
`Fortunately, sound cards are now increasing
`in quality and decreasing in price. Popular cards
`include the Sound Blaster series (Creative Labs,
`Inc., Milpatis, CA, USA), and the Pro Audioseries
`(Media Vision, Inc., Freemont, CA, USA), ranging
`in price from about $85 to $300 for a state-of-the-
`art 16-bit model.
`
`CD-ROM
`
`Since image, sound,and videofiles consume
`so muchdisk space, most serious multimediasoft-
`ware is distributed on CD-ROM disks (Compact
`Disk, Read-Only Memory). Think of a CD-ROM
`disk as a large read-only hard drive that can hold
`approximately 600 megabytes of data. Digital in-
`formation is stored on a CD-ROMsimilar to the
`wayit is stored on an audio CD. Most CD-ROM
`drives can read audio CDs. CD-ROM drivesare not
`required for multimedia presentations, but are a
`convenienttoolfor distribution of such programs,
`since the disks can hold so muchinformation. CD-
`ROMdrives can be used by non-multimedia appli-
`cations, and more software applications are begin-
`ning to replace floppy disks with CDsas theirpri-
`mary distribution medium.
`
`External and internal drives are available.
`Usually the drive is connected to your computer’s
`data bus by an SCSIinterface card. These cards
`can control other devices in your computer, such
`as hard drives. Some sound cards contain a built-
`in SCSI adapter for use with a CD-ROM drive. Al-
`though when upgrading a computer, selecting
`each component
`individually allows you to
`choose the highest rated hardware in each class,
`purchasing upgrade kits from one manufacturer
`assuresthat all the componentswill work together.
`Installation of a CD-ROM could bea difficult and
`frustrating undertaking, and hardware incompati-
`bility just compoundsthedifficulties.
`Newerdrives are referred to as double-speed
`or triple-speed CD-ROMsandtheytransfer data at
`300 Kbytes or 450 Kbytes per second rather than
`the older MPC standard of 150 Kbytes per second.
`Data access times havealso been reduced to under
`300 msec, versus the older standard of approxi-
`mately 600 msec. An important feature that has
`emerged overthe past 2 years is support for multi-
`ple session CDs and Kodak Photo CDs. This allows
`your drive to read CDs that were created in more
`than one session. Photo CD is becoming an impor-
`tant graphicstool in the multimedia industry. By
`sending slides or film to Kodak, you can obtain
`high quality Photo CD files of your images. These
`files can be displayed on the computer if your
`drive is Photo CD compatible, or they can betrans-
`ferred to your hard disk or floppies and incorpo-
`rated into presentations.
`The cost of CD-ROM drives has been decreas-
`ing steadily. Double speed drives now cost approx-
`imately $200 to $400 including cables for installa-
`tion. Recordable drives are now available, but cur-
`rent cost is in the range of $3,000 to $5,000, and
`blank media(useable for recording only once)cost
`about $20 per disk.
`
`The Media Componentsof
`Multimedia Software
`
`The major components of a multimedia pre-
`sentation include text files, images, soundfiles,
`and videofiles, all controlled by a software pro-
`gram written in a standard high level computer
`language or in oneof several authoring programs
`that are available.
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`Petitioners' Exhibit 1038
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`MULTIMEDIA
`
`“played” using the multimedia presentation soft-
`ware.
`
`Sound
`
`These files were discussed in the section on
`sound cards. They consist of waveform (“.WAV”)
`and non-waveform (‘.MIDI’’) files.
`
`Video
`
`Text
`
`A majoruse for CD-ROMsis for storageof large
`amounts of reference information. Commercially
`available CD titles include the Bible, several differ-
`ent encyclopedias, the complete Physicians’ Desk
`Reference, the Merck Manual, completetext offive
`American Heart Association journals (including
`Circulation from 1987 to 1993), text and figures of
`2 years of the New England Journal of Medi-
`cine—all on one CD each. While these works do
`not qualify as multimedia, they are usually in-
`cluded in descriptions of multimedia programs
`since they use powerful searching software that
`was written for use with multimedia applications.
`A single CD-ROM holdingeven 1 year of a journal
`can help you save valuable storage space on your
`medical bookshelf, and searching for articles or
`topics electronically is much easier than using a
`paperindex.
`
`Images
`
`This is the componentthatplaces the greatest
`demand on your hardware. Video images from a
`camera or video tape recorderare digitized by the
`author of the multimedia presentation using a
`video capture board. The images are placed in
`audio video interleaved files (with the file exten-
`sion ‘.AVI’’), which contain sound andvideodata.
`The size of an AVI file depends upon the resolu-
`tion of your video images, the size the image occu-
`pies on the computerscreen, and the duration of
`the recording. A single minuteof video can occupy
`more than 20 megabytesof data, so most recording
`and playback systems utilize some form of data
`Graphic images for multimedia presentations
`compression. A video digitizer board is needed to
`come from several sources. Libraries of cartoon im-
`record AVIfiles, but not to play them back.A fast
`ages knownasclip art are now widely available
`computer, a fast CD-ROMdrive, anda fast display
`in all fields, including medicine. These line draw-
`adapterare required to play back videofiles with-
`ings or colorized sketches can be usedto illustrate
`out losing frames. The bottleneck is usually in the
`parts of the anatomy, for example. A photograph,
`transfer of data from the CD-ROMdrive to the com-
`drawing, or x-ray can be scannedintoafile using
`puter’s data bus, so double or triple speed drives
`a flatbed or hand scanner. Because multimedia
`are better suited for video playback.
`computer monitors can display in high resolution
`with 256 or more colors, the images usually con-
`tain enough detail to demonstrate even the most
`intricate points.
`
`Potential in Medicine
`
`The potential uses of CD-ROM and multime-
`dia technology in medical education andasaplat-
`Animation
`form for storing reference material should be ob-
`viousat this point. In a future columnin this series
`wewill examine somespecific programsandrefer-
`ences in detail. Until then, please send me your
`comments or questions via the Internet at ad-
`m4@columbia.edu, or through Prodigy mail at
`JHCV51A.
`
`Computer animation is like a children’s car-
`toon. Graphic images are played in rapid succes-
`sion giving the impression of smooth motion. The
`images (whichare displayed as fast as 30 frames/
`sec)are all stored in a special typeof graphicsfile,
`usually with the extension “.FLI’, and are
`
`PACE, Vol. 17
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`September 1994
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`1551
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`Petitioners’ Exhibit 1038
`Page 0004
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`Petitioners' Exhibit 1038
`Page 0004
`
`