Telehealth on Advanced Networks

We address advanced Internet for complex telehealth applications by reviewing four hospital-based broadband telehealth projects and identifying common threads. These projects were conducted in Australia under a 6-year research project on broadband Internet applications. Each project addressed specific clinical needs and its development was guided by the clinicians involved. Each project was trialed in the field and evaluated against the initial requirements. The four projects covered remote management of a resuscitation team in a district hospital, remote guidance and interpretation of echocardiography, virtual-reality-based instructor-student surgical training, and postoperative outpatient consultations following pediatric surgery. Each was characterized by a high level of interpersonal communication, a high level of clinical expertise, and multiple participants. Each made use of multiple high-quality video and audio links and shared real-time access to clinical data. Four common threads were observed. Each application provided a high level of usability and task focus because the design and use of broadband capability was aimed directly to meet the clinicians' needs. Each used the media quality available over broadband to convey words, gestures, body movements, and facial expressions to support communication and a sense of presence among the participants. Each required a complex information space shared among the participants, including real-time access to stored patient data and real-time interactive access to the patients themselves. Finally, each application supported the social and organizational aspects of their healthcare focus, creating and maintaining relationships between the various participants, and this was done by placing the telehealth application into a wider functioning clinical context. These findings provide evidence for a significantly enhanced role for appropriate telemedicine systems running on advanced networks, in a wider range of clinical applications, more deeply integrated into healthcare systems

Human-Centred Evaluation of Broadband Telehealth for Tertiary Outpatient Consultations: A Case Study Approach

Outpatient consultations form a large part of the healthcare of patients at tertiary hospitals, both as a precursor to in-patient treatment and for the management of on-going health conditions or long-term rehabilitation and monitoring after treatment. These outpatient consultations are generally conducted at the hospitals, most often located in large cities. Patients who live outside these cities face extensive travel to attend these consultations, placing a burden on themselves and on their families or carers. An ability of a tertiary hospital to deliver outpatient consultations in a telehealth mode to regional or remote locations closer to the patients’ homes would potentially relieve much of this burden of travel. ¶ ... ¶ In this thesis I use a case-study-based approach to evaluate the development and pilot trial of a broadband telehealth system in a tertiary paediatric context. I use the data from these case studies to explore the way that a human-centred approach can be used to evaluate outpatient telehealth trials at a tertiary level of healthcare. ..

A Virtual University Infrastructure For Orthopaedic Surgical Training With Integrated Simulation

This thesis pivots around the fulcrum of surgical, educational and technological factors. Whilst there is no single conclusion drawn, it is a multidisciplinary thesis exploring the juxtaposition of different academic domains that have a significant influence upon each other. The relationship centres on the engineering and computer science factors in learning technologies for surgery. Following a brief introduction to previous efforts developing surgical simulation, this thesis considers education and learning in orthopaedics, the design and building of a simulator for shoulder surgery. The thesis considers the assessment of such tools and embedding into a virtual learning environment. It explains how the performed experiments clarified issues and their actual significance. This leads to discussion of the work and conclusions are drawn regarding the progress of integration of distributed simulation within the healthcare environment, suggesting how future work can proceed

Towards Highly-Integrated Stereovideoscopy for \u3ci\u3ein vivo\u3c/i\u3e Surgical Robots

When compared to traditional surgery, laparoscopic procedures result in better patient outcomes: shorter recovery, reduced post-operative pain, and less trauma to incisioned tissue. Unfortunately, laparoscopic procedures require specialized training for surgeons, as these minimally-invasive procedures provide an operating environment that has limited dexterity and limited vision. Advanced surgical robotics platforms can make minimally-invasive techniques safer and easier for the surgeon to complete successfully. The most common type of surgical robotics platforms -- the laparoscopic robots -- accomplish this with multi-degree-of-freedom manipulators that are capable of a diversified set of movements when compared to traditional laparoscopic instruments. Also, these laparoscopic robots allow for advanced kinematic translation techniques that allow the surgeon to focus on the surgical site, while the robot calculates the best possible joint positions to complete any surgical motion. An important component of these systems is the endoscopic system used to transmit a live view of the surgical environment to the surgeon. Coupled with 3D high-definition endoscopic cameras, the entirety of the platform, in effect, eliminates the peculiarities associated with laparoscopic procedures, which allows less-skilled surgeons to complete minimally-invasive surgical procedures quickly and accurately. A much newer approach to performing minimally-invasive surgery is the idea of using in-vivo surgical robots -- small robots that are inserted directly into the patient through a single, small incision; once inside, an in-vivo robot can perform surgery at arbitrary positions, with a much wider range of motion. While laparoscopic robots can harness traditional endoscopic video solutions, these in-vivo robots require a fundamentally different video solution that is as flexible as possible and free of bulky cables or fiber optics. This requires a miniaturized videoscopy system that incorporates an image sensor with a transceiver; because of severe size constraints, this system should be deeply embedded into the robotics platform. Here, early results are presented from the integration of a miniature stereoscopic camera into an in-vivo surgical robotics platform. A 26mm X 24mm stereo camera was designed and manufactured. The proposed device features USB connectivity and 1280 X 720 resolution at 30 fps. Resolution testing indicates the device performs much better than similarly-priced analog cameras. Suitability of the platform for 3D computer vision tasks -- including stereo reconstruction -- is examined. The platform was also tested in a living porcine model at the University of Nebraska Medical Center. Results from this experiment suggest that while the platform performs well in controlled, static environments, further work is required to obtain usable results in true surgeries. Concluding, several ideas for improvement are presented, along with a discussion of core challenges associated with the platform. Adviser: Lance C. Pérez [Document = 28 Mb

Quantitative Multimodal Mapping Of Seizure Networks In Drug-Resistant Epilepsy

Over 15 million people worldwide suffer from localization-related drug-resistant epilepsy. These patients are candidates for targeted surgical therapies such as surgical resection, laser thermal ablation, and neurostimulation. While seizure localization is needed prior to surgical intervention, this process is challenging, invasive, and often inconclusive. In this work, I aim to exploit the power of multimodal high-resolution imaging and intracranial electroencephalography (iEEG) data to map seizure networks in drug-resistant epilepsy patients, with a focus on minimizing invasiveness. Given compelling evidence that epilepsy is a disease of distorted brain networks as opposed to well-defined focal lesions, I employ a graph-theoretical approach to map structural and functional brain networks and identify putative targets for removal. The first section focuses on mesial temporal lobe epilepsy (TLE), the most common type of localization-related epilepsy. Using high-resolution structural and functional 7T MRI, I demonstrate that noninvasive neuroimaging-based network properties within the medial temporal lobe can serve as useful biomarkers for TLE cases in which conventional imaging and volumetric analysis are insufficient. The second section expands to all forms of localization-related epilepsy. Using iEEG recordings, I provide a framework for the utility of interictal network synchrony in identifying candidate resection zones, with the goal of reducing the need for prolonged invasive implants. In the third section, I generate a pipeline for integrated analysis of iEEG and MRI networks, paving the way for future large-scale studies that can effectively harness synergy between different modalities. This multimodal approach has the potential to provide fundamental insights into the pathology of an epileptic brain, robustly identify areas of seizure onset and spread, and ultimately inform clinical decision making

Skin Wound Healing Revealed by Multimodal Optical Microscopies

Skin is the largest organ of our body serving as the first line defense against pathogens and toxicity. The skin can heal itself if any damage in it occur. Wounds, if not taken care properly, can become chronic and can even cause death. In the field of cosmetics and plastic reconstructive surgery, wounds, are major cause of trauma and costs, which demand proper diagnosis that can help in appropriate treatment. In conventional medicine, wound diagnosis mostly relied on the expertise and experience of physicians on the basis of non-quantitative observation of clinical signs, or invasive histochemical assessment of biopsies

A virtual university infrastructure for orthopaedic surgical training with integrated simulation

This thesis pivots around the fulcrum of surgical, educational and technological factors. Whilst there is no single conclusion drawn, it is a multidisciplinary thesis exploring the juxtaposition of different academic domains that have a significant influence upon each other. The relationship centres on the engineering and computer science factors in learning technologies for surgery. Following a brief introduction to previous efforts developing surgical simulation, this thesis considers education and learning in orthopaedics, the design and building of a simulator for shoulder surgery. The thesis considers the assessment of such tools and embedding into a virtual learning environment. It explains how the performed experiments clarified issues and their actual significance. This leads to discussion of the work and conclusions are drawn regarding the progress of integration of distributed simulation within the healthcare environment, suggesting how future work can proceed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Using Raman Spectroscopy for Intraoperative Margin Analysis in Breast Conserving Surgery

Breast Conserving Surgery (BCS) in the treatment of breast cancer aims to provide optimal oncological results, with minimal tissue excision to optimise cosmetic outcome. Positive margins due to an inadequate resection occurs in 17% of UK patients undergoing BCS and prompts recommendation for further tissue re-excision to reduce recurrence risk. A second operation causes patient anxiety and significant healthcare costs. This issue could be resolved with accurate intra-operative margin analysis (IMA) to enable excision of all cancerous tissue at the index procedure. High wavenumber Raman Spectroscopy (HWN RS) is a vibrational spectroscopy highly sensitive to changes in protein/lipid environment and water content –biochemical differences found between tumour and normal breast tissue. We proposed that HWN RS could be used to differentiate between tumour and non-tumour breast tissue with a view to future IMA. This thesis presents the development of a Raman system to measure the HWN region capable of accurately detecting changes in protein, lipid and water content, in the presence of highly fluorescent surgical pigments such as blue dye that are present in surgically excised specimens. We investigate the relationship between changes in the HWN spectra with changes in water content in constructed breast phantoms to mimic protein and lipid rich environments and biological tissue. Human breast tissue of paired tumour and non-tumour samples were then measured and analysed. We found that breast tumour tissue is a protein rich, high water, low fat environment and that non-tumour is a low protein, fat rich environment with a low water content, and this can be used to identify breast cancer using HWN RS with excellent accuracy of over 90%. This thesis demonstrates a HWN RS Raman system capable of differentiating between tumour and non-tumour tissue in human breast tissue, and this has the potential to provide IMA in BCS

The Advanced Applications For Optical Coherence Tomography In Skin Imaging

Optical coherence tomography (OCT), based on the principle of interferometry, is a fast and non-invasive imaging modality, which has been approved by FDA for dermatologic applications. OCT has high spatial resolution up to micrometer scale compared to traditional ultrasound imaging. In addition, OCT can provide real-time cross-sectional images with 1 to 2 mm penetration depth, which makes it an ideal imaging technique to assess the skin micro-morphology and pathology without any tissue removal. Many studies have investigated the possibilities of using OCT to evaluate dermatologic conditions, such as skin cancer, dermatitis, psoriasis, and skin damages. Hence, OCT has tremendous potential to provide skin histological and pathological information and assist differential diagnosis of various skin diseases. In this study, we used a swept-source OCT with 1305 nm central wavelength to explore its advanced applications in dermatology. This dissertation consists of four major research projects. First, we explored the feasibility of OCT imaging for assisting real-time visualization in skin biopsy. We showed that OCT could be used to guide and track a needle insertion in mouse skin in real-time. The structure of skin and the movement of needle can be clearly seen on the OCT images without any time delay during the procedures. Next, we tested the concept of performing the punch biopsy using OCT hand-held probe attached to a piercing tip in a phantom. We proved that using the OCT is a reliable technique to delineate the margin of lesion in phantom. And it is possible to perform the punch biopsy with the OCT probe. Second, we tested the performance of contrast-enhanced OCT in melanoma detection in an in vitro study. Melanoma is the most lethal type of skin cancer. Early detection could significantly improve the long-term survival rate of patients. In this initial study, a contrast agent (Gal3-USGNPs) is developed by conjugating melanoma biomarker (Gal3) to ultra-small gold nanoparticles (USGNPs). We showed that the contrast agent can differentiate B16 melanoma cells from normal skin keratinocytes in vitro. To avoid systemic administration of USGNPs, the third project continues to explore the enhanced topical delivery of USGNPs. In this study, we used OCT to monitor the topical delivery of nanoparticles on pig skin over time. And the diffusion and penetration of USGNPs in skin can be improved by applying chemical and physical enhancers such as DMSO and sonophoresis. Finally, in addition to image the cross-sectional structure of skin, we also aim to extract quantitative information from OCT images. The skin optical properties such as attenuation coefficient can be measured from OCT images. We measured and compared the skin attenuation coefficient in the skin of forehead and lateral hip, the skin of three different age groups, and the skin of three different Fitzpatrick types. The statistical analysis showed that epidermis has much higher attenuation coefficient than dermis. And the skin type V & VI have a relatively lower attenuation coefficient than the other skin types. These studies could aid the detection of skin cancer using imaging techniques and provide some new insights into the future applications of OCT in dermatology