Augmented reality system for digital rectal examination training and assessment: system validation

Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients. Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers. Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system. Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group. Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness

Standardizing bimanual vaginal examination using cognitive task analysis.

OBJECTIVE: To create a standardized universal list of procedural steps for bimanual vaginal examination (BVE) for teaching, assessment, and simulator development. METHODS: This observational study, conducted from June-July 2012 and July-December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis (CTA) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. RESULTS: BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9-27.9, 53%-93%). CONCLUSION: This approach identified 30 essential steps for performing BVE, producing a new technique and standardized tool for teaching, assessment, and simulator development

Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators

Robotic Ultrasound Imaging: State-of-the-Art and Future Perspectives

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques.Comment: Accepted by Medical Image Analysi

Digitalization in orthopaedics: a narrative review

Advances in technology and digital tools like the Internet of Things (IoT), artificial intelligence (AI), and sensors are shaping the field of orthopaedic surgery on all levels, from patient care to research and facilitation of logistic processes. Especially the COVID-19 pandemic, with the associated contact restrictions was an accelerator for the development and introduction of telemedical applications and digital alternatives to classical in-person patient care. Digital applications already used in orthopaedic surgery include telemedical support, online video consultations, monitoring of patients using wearables, smart devices, surgical navigation, robotic-assisted surgery, and applications of artificial intelligence in forms of medical image processing, three-dimensional (3D)-modelling, and simulations. In addition to that immersive technologies like virtual, augmented, and mixed reality are increasingly used in training but also rehabilitative and surgical settings. Digital advances can therefore increase the accessibility, efficiency and capabilities of orthopaedic services and facilitate more data-driven, personalized patient care, strengthening the self-responsibility of patients and supporting interdisciplinary healthcare providers to offer for the optimal care for their patients

Chest ultrasound in italian geriatric wards: Use, applications and clinicians’ attitudes

Background and aims. Bedside chest ultrasound has emerged as a versatile and accurate diagnostic tool for the management of respiratory conditions in several clinical settings, integrating traditional imaging. The current utilization of this technique in geriatric hospital wards is still unknown. Our aim was to assess availability, uses and applications of chest ultrasonography in a convenience sample of 25 Italian geriatric wards. Methods. A questionnaire, based on the current literature state-of-the-art, was e-mailed to head doctors of geriatric wards of Italian hospitals. The questionnaire explored ultrasound equipment availability, practice of chest ultrasound, expertise of ward physicians, clinical indications, and perceived impact on patient care. Results. Ultrasound equipment was available in 92% of wards, and chest ultrasound was performed in 82% of cases. Among the wards where chest ultrasound was performed, it was considered as routine assessment in only 52% of cases, mainly for diagnosis of pleural effusions (95%) and acute heart failure (89%), assessment of volemic state (79%), and assistance to invasive procedures (79%). It was used in emergency/ urgency assessment of acute dyspnea in only 53% of cases. In most wards, only three or less physicians were able to perform chest ultrasound. In 53% of cases, head doctors declared that they perceived benefits of chest ultrasound in patient care in only selected cases. Conclusions. Chest ultrasound utilization in Italian geriatric wards is inhomogeneous, and the number of trained physicians is still limited. Geriatricians’ attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice

Pocket Size Ultra-Sound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort

Background: Pocket-size ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students. Methods: A prospective cohort study was conducted among subjects with and without clinically relevant valve dysfunction. Inclusion criteria for subjects with a clinically relevant valve dysfunction was based on the presence of at least one moderate severity valve pathology identified by echocardiography. Three final-year medical students examined the patients. Each subject underwent auscultation and a POCUS using a pocket-size ultrasound machine. Sensitivity and specificity were calculated. Results: The study included 56 patients. In 18 patients (32%) no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the entire cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation, respectively, and specificity was similar. The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, students identified valvular pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation. Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies

Ultrasound Imaging

Ultrasound Imaging - Current Topics presents complex and current topics in ultrasound imaging in a simplified format. It is easy to read and exemplifies the range of experiences of each contributing author. Chapters address such topics as anatomy and dimensional variations, pediatric gastrointestinal emergencies, musculoskeletal and nerve imaging as well as molecular sonography. The book is a useful resource for researchers, students, clinicians, and sonographers looking for additional information on ultrasound imaging beyond the basics

Role of Ultrasonography in Diagnosis of Palpable Breast Lumps: One Year Cross Sectional Study

AbstractBackground: The breast is commonest site for development of cancer in female and accounts for around 1/5 of all malignancies in the sex. In the past few years ultrasonography of the breast for evaluation of radiologically dense breasts or cysts has been become the 1st line of investigation.Aims and Objectives: To assess the role of ultrasonography in diagnosis of palpable breast lumps.The most important clinical use of ultrasound imaging is its ability to differentiate between solid and cystic masses, benign and also by knowing the prior diagnosis the need for open biopsy and followed by surgery, the cost and time involved can be saved. In patients with dense breasts the FNAC may not hit the exact site of mass and can give inconclusive diagnosis. When Ultrasonography can pick up abscess of breast, needle aspiration can be done instead of incision and drainage. Breast ultrasonography should be considered as an extension of physical examination and it will improve the care available to patients and subsequently improve outcomes. Ultrasonography can expedite both diagnosis and treatmentResults: On analysis, 68 patients were included in study.  The sensitivity of ultrasonography for malignancy was 89.47%. The specificity of ultrasonography was malignant & benign lesions 100%. The positive predictive value of ultrasonography was 100%.Conclusion: Ultrasound has higher sensitivity in diagnosing malignant lesions hence should be considered as first line diagnostic tool for breast lesions. Keywords: Ultrasonography, Breast lum

How Useful are Localization Techniques in Botulinum Toxin Injections for Dystonia and Spasticity Indications?

There is irrefutable evidence for the effectiveness of botulinum toxin (BoNT) in the treatment of various disorders associated with excessive muscle contraction or autonomic dysfunction. One of the earliest indications as well as the most common BoNT treated movement disorder is dystonia, predominantly its focal forms, including blepharospasm, oromandibular, spasmodic, cervical and limb dystonia. Spastic disorders comprise another area where BoNT treatment has proved beneficial. Optimal therapeutic results, however, depend on several factors, including the BoNT serotype, dose, concentration, injected volume, frequency of application, as well as precise localization of the muscles producing the abnormal movement. The accuracy in targeting muscle localization is considered to be a key factor for determining the outcome of BoNT injections, even more important than dilution volume and dose. Various techniques to find the best injection site for the delivery of BoNT have been described in the literature. An attempt was made to summarize in one place the available evidence, and when possible to compare and point out the advantages and disadvantages of different techniques for localization of BoNT injections. The widely applied clinical indications for dystonia and spasticity have been specifically chosen as our focus in this present work