Augmented and virtual reality in surgery—the digital surgical environment:applications, limitations and legal pitfalls

The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena

nano-tera.ch: Electronic Technology for Health Management

The Swiss Nano-Tera.ch program addresses – among others – issues at the crossing of engineering and medical domains. Specifically, electronic-health (or E-Health) is a broad area of engineering that leverages transducer, circuit and systems technologies for applications to health management and lifestyle. Scientific challenges relate to the acquisition of accurate medical information from various forms of sensing inside/outside the body and to the processing of this information to support or actuate medical decisions. E-health is motivated by the social and economic goals of achieving better health care at lower costs and will revolutionize medical practice in the years to come

Design of a wearable LED-based phototherapy device

This thesis was previously held under moratorium from 23/03/2021 to 23/03/2022The aim of the work described in this thesis is to design a wearable phototherapy device utilising LEDs. Phototherapy is the use of light to treat medical conditions, such as, eczema, psoriasis and newborn jaundice. Treatment usually takes place in a clinical environment, but a recent focus for phototherapy is the development of at-home devices. Currently available technologies consist of rigid LED arrays; identifying the treatment regime with these devices is diffcult due to the non-uniform light distribution. A poten-tial solution to this problem is to create a flexible and conformable device that allows for uniform light distribution over the treatment area by incorporating light scattering features. Broad area LEDs (UV and blue) and blue micro-sized LEDs are utilised as the light source coupled into the end of a thin polydimethylsiloxane membrane. High refractive index nanoparticles are embedded in a substrate and used to extract light from the surface of the membrane. By changing the size of these substrates, or by changing the nanoparticle concentration inside the substrates, uniform irradiance is demonstrated over an area of 15 x 15 mm2. Though not demonstrated in this thesis, there is potential for treatment over larger areas. Colloidal quantum dots can be embedded in elastomeric materials and used to down-convert the LED light into lower energy wavelengths. This is shown with red wavelength emitting quantum dots, producing a uniform red irradiance over the substrate area. A similar technique is shown to produce multi-wavelength blue and red uniform emission over the extraction area. The output of the device can be optimised by adding flexible reflective layers to one side of the membrane. This increases the light output from the extraction substrates, whilst maintaining the device flexibility. The light output can also be increased by adding secondary embedded waveguides into the membrane. These are coupled to the micro-LED light and can potentially produce structured emission over the treatment area. The device platform is also shown to be effective as a fluorescent evanescent waveguide sensor, utilising quantum dots as the fluorescent molecules and a smart phone camera to measure the fluorescence.The aim of the work described in this thesis is to design a wearable phototherapy device utilising LEDs. Phototherapy is the use of light to treat medical conditions, such as, eczema, psoriasis and newborn jaundice. Treatment usually takes place in a clinical environment, but a recent focus for phototherapy is the development of at-home devices. Currently available technologies consist of rigid LED arrays; identifying the treatment regime with these devices is diffcult due to the non-uniform light distribution. A poten-tial solution to this problem is to create a flexible and conformable device that allows for uniform light distribution over the treatment area by incorporating light scattering features. Broad area LEDs (UV and blue) and blue micro-sized LEDs are utilised as the light source coupled into the end of a thin polydimethylsiloxane membrane. High refractive index nanoparticles are embedded in a substrate and used to extract light from the surface of the membrane. By changing the size of these substrates, or by changing the nanoparticle concentration inside the substrates, uniform irradiance is demonstrated over an area of 15 x 15 mm2. Though not demonstrated in this thesis, there is potential for treatment over larger areas. Colloidal quantum dots can be embedded in elastomeric materials and used to down-convert the LED light into lower energy wavelengths. This is shown with red wavelength emitting quantum dots, producing a uniform red irradiance over the substrate area. A similar technique is shown to produce multi-wavelength blue and red uniform emission over the extraction area. The output of the device can be optimised by adding flexible reflective layers to one side of the membrane. This increases the light output from the extraction substrates, whilst maintaining the device flexibility. The light output can also be increased by adding secondary embedded waveguides into the membrane. These are coupled to the micro-LED light and can potentially produce structured emission over the treatment area. The device platform is also shown to be effective as a fluorescent evanescent waveguide sensor, utilising quantum dots as the fluorescent molecules and a smart phone camera to measure the fluorescence

Development of Portable Diffuse Optical Spectroscopic Systems For Treatment Monitoring

The goal of this dissertation is to demonstrate the utility of portable, small-scale diffuse optical spectroscopic (DOS) systems for the diagnosis and treatment monitoring of various diseases. These systems employ near-infrared light (wavelength range of 650nm to 950nm) to probe human tissue and are sensitive to changes in scattering and absorption properties of tissues. The absorption is mainly influenced by the components of blood, namely oxy- and deoxy-hemoglobin (HbO2 and Hb) and parameters that can be derived from them (e.g. total hemoglobin concentration [THb] and oxygen saturation, StO2). Therefore, I focused on diseases in which these parameters change, which includes vascular diseases such as Peripheral Atrial Disease (PAD) and Infantile Hemangiomas (IH) as well as musculoskeletal autoimmune diseases such as Rheumatoid Arthritis (RA). In each of these specific diseases, current monitoring techniques are limited by their sensitivity to disease progression or simply do not exist as a quantitative metric. As part of this project, I first designed and built a wireless handheld DOS device (WHDD) that can perform DOS measurements at various tissue depths. This device was used in a 15-patient pilot study for infantile hemangiomas (IH) to differentiate diseased skin from normal skin and monitor the vascular changes during intervention. In another study, I compare the ultra-small form- factor WHDD’s ability to monitor synovitis and disease progression during a patient’s treatment of RA against the capabilities of a proven frequency domain optical tomographic (FDOT) system that has shown to differentiate patients with and without RA. Learning from clinical utility of the WHDD from these two studies, I adapted the WHDD technology to develop a compact multi- channel DOS measurement system to monitor perfusion changes in the lower extremities before and after surgical intervention for patients with peripheral artery disease (PAD). Using this multi- channel system, which we called the vascular optical spectroscopic measurement (VOSM) system, our group conducted a 20-subject pilot study to quantify its ability to monitor blood perfusion before and after revascularization of stenotic arteries in the lower extremities. This proof-of- concept study demonstrated how DOS may help vascular surgeons perform revascularization procedures in the operating room and assists in post-operative treatment monitoring of vascular diseases

Optical Diagnostics in Human Diseases

Optical technologies provide unique opportunities for the diagnosis of various pathological disorders. The range of biophotonics applications in clinical practice is considerably wide given that the optical properties of biological tissues are subject to significant changes during disease progression. Due to the small size of studied objects (from μm to mm) and despite some minimum restrictions (low-intensity light is used), these technologies have great diagnostic potential both as an additional tool and in cases of separate use, for example, to assess conditions affecting microcirculatory bed and tissue viability. This Special Issue presents topical articles by researchers engaged in the development of new methods and devices for optical non-invasive diagnostics in various fields of medicine. Several studies in this Special Issue demonstrate new information relevant to surgical procedures, especially in oncology and gynecology. Two articles are dedicated to the topical problem of breast cancer early detection, including during surgery. One of the articles is devoted to urology, namely to the problem of chronic or recurrent episodic urethral pain. Several works describe the studies in otolaryngology and dentistry. One of the studies is devoted to diagnosing liver diseases. A number of articles contribute to the studying of the alterations caused by diabetes mellitus and cardiovascular diseases. The results of all the presented articles reflect novel innovative research and emerging ideas in optical non-invasive diagnostics aimed at their wider translation into clinical practice

Microfluidic biosensor systems for real-time in vivo clinical bioanalysis

The aim of this thesis was to develop online biosensing systems for dialysate tissue metabo- lite detection in real time, to provide an insight into the health of tissue in various in vivo applications. An autocalibration system was developed using LabSmith programmable components to improve the accuracy of results obtained over long monitoring times. A method of col- lecting dialysate into storage tubes for online analysis while retaining temporal resolution was developed and validated. Microfluidic biosensor systems were developed for online measurement of glucose and lactate. One approach employed the use of biosensors, using a combined needle electrode with enzyme encapsulated in a hydrogel layer. The dynamic range of the biosensors was extended by adding an outer polyurethane layer. An alternative approach used automated syringe pumps and valves to develop a microfluidic system for in-flow enzyme addition to the dialysate stream. The existing rsMD system was applied for detection of tissue ischaemia during and after free flap surgery, by measuring dialysate glucose and lactate levels in real time. The system was able to detect flap failure, both during surgery and afterwards in the intensive therapy unit (ITU), much earlier than traditional methods. The rsMD system was adapted to enable monitoring of lactate levels in two dialysate streams and was applied for monitoring isolated porcine kidneys during two methods of cold preservation and subsequent re-warming. Significant differences in the lactate concentrations were observed between the two techniques. The system was extended for use with human transplant kidneys and with both porcine and human pancreases. A novel 3D printed wearable biosensor system was developed for direct integration with a clinical microdialysis probe. The system considerably improved the lag time and dispersional smearing compared with the existing rsMD system. The device was used in a proof-of-concept study with wireless potentiostats to monitor cyclists during exercise.Open Acces

The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine