Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators

The Toowoomba adult trauma triage tool

Since the introduction of the Australasian Triage Scale (ATS) there has been considerable variation in its application. Improved uniformity in the application of the ATS by triage nurses is required. A reproducible, reliable and valid method to classify the illness acuity of Emergency Department patients so that a triage category 3 by one nurse means the same as a triage category 3 by another, not only in the same ED but also in another institution would be of considerable value to emergency nurses. This has been the driving motivation behind developing the Toowoomba Adult Trauma Triage Tool (TATTT). It is hoped the TATTT will support emergency nurses working in this challenging area by promoting standardisation and decreasing subjectivity in the triage decision process

Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Numerical investigations on bubble-induced jetting and shock wave focusing: application on a needle-free injection

The formation of a liquid jet into air induced by the growth of a laser-generated bubble inside a needle-free device is numerically investigated by employing the compressible Navier–Stokes equations. The three co-existing phases (liquid, vapour and air) are assumed to be in thermal equilibrium. A transport equation for the gas mass fraction is solved in order to simulate the non-condensable gas. The homogeneous equilibrium model is used in order to account for the phase change process between liquid and vapour. Thermodynamic closure for all three phases is achieved by a barotropic Equation of State. Two-dimensional axisymmetric simulations are performed for a needle-free device for which experimental data are available and used for the validation of the developed model. The influence of the initial bubble pressure and the meniscus geometry on the jet velocity is examined by two different sets of studies. Based on the latter, a new meniscus design similar to shaped-charge jets is proposed, which offers a more focused and higher velocity jet compared to the conventional shape of the hemispherical gas–liquid interface. Preliminary calculations show that the developed jet can penetrate the skin and thus, such configurations can contribute towards a new needle-free design

More than skin deep: body representation beyond primary somatosensory cortex

The neural circuits underlying initial sensory processing of somatic information are relatively well understood. In contrast, the processes that go beyond primary somatosensation to create more abstract representations related to the body are less clear. In this review, we focus on two classes of higher-order processing beyond somatosensation. Somatoperception refers to the process of perceiving the body itself, and particularly of ensuring somatic perceptual constancy. We review three key elements of somatoperception: (a) remapping information from the body surface into an egocentric reference frame (b) exteroceptive perception of objects in the external world through their contact with the body and (c) interoceptive percepts about the nature and state of the body itself. Somatorepresentation, in contrast, refers to the essentially cognitive process of constructing semantic knowledge and attitudes about the body, including: (d) lexical-semantic knowledge about bodies generally and one’s own body specifically, (e) configural knowledge about the structure of bodies, (f) emotions and attitudes directed towards one’s own body, and (g) the link between physical body and psychological self. We review a wide range of neuropsychological, neuroimaging and neurophysiological data to explore the dissociation between these different aspects of higher somatosensory function

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room

Advanced manufacturing development of a composite empennage component for L-1011 aircraft. Phase 2: Design and analysis

The composite fin design consists of two one-piece cocured covers, two one-piece cocured spars and eleven ribs. The lower ribs are truss ribs with graphite/epoxy caps and aluminum truss members. The upper three ribs are a sandwich design with graphite/epoxy face sheets and a syntactic epoxy core. The design achieves a 27% weight saving compared to the metal box. The fastener count has been reduced from over 40,000 to less than 7000. The structural integrity of the composite fin was verified by analysis and test. The static, fail-safe and flutter analyses were completed. An extensive test program has established the material behavior under a range of conditions and critical subcomponents were tested to verify the structural concepts

Assessment of surgical performance

Surgical patient outcomes are related to technical and non-technical skills of the surgeon. Trauma patient operative and management experience has declined since trainee duty-hour restrictions were mandated in 2003 resulting in less experience in technical surgical skills. The Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based course, teaching vascular exposure and haemorrhage control, was developed to fill this training gap. The aim of this Thesis is to develop surgeon performance metrics and to test surgeons before and after taking the ASSET course to determine whether such training improves performance of peripheral vascular control. The importance of training in surgical vascular control in both civilian and military practice, and a description of current surgical training for trauma are described in Chapter 1. Reviews of existing trauma training courses and surgical performance metrics are provided in Chapters 2 and 3, and show limited testing of training courses and lack of trauma surgical performance metrics. Data collection methods, evaluator training and analysis are described in Chapter 4. Chapter 5 evaluates self-confidence of surgeons performing the vascular control procedures in cadavers compared to the performance evaluated by trained evaluators. Preliminary validation of vascular-control performance metrics and testing of a standardized script with item analysis and inter-rater reliability are discussed in Chapter 6. Testing 40 surgeons performing 3 extremity vascular control procedures before and after training is reported in Chapter 7. ASSET training improves performance, but large performance variability, repeated errors and no improvements were found in some surgeons. Chapter 8 reports how blind video analysis checklist, global rating metrics, error occurrence and recovery show convergent validity with co-located evaluators. Chapter 9 identifies the key findings and implications, innovation of the work described in the Thesis and concludes with the potential impact on military readiness and my personal reflection on what I learnt.  Open Acces

The roots of self-awareness

In this paper we provide an account of the structural underpinnings of self-awareness. We offer both an abstract, logical account-by way of suggestions for how to build a genuinely self-referring artificial agent-and a biological account, via a discussion of the role of somatoception in supporting and structuring self-awareness more generally. Central to the account is a discussion of the necessary motivational properties of self-representing mental tokens, in light of which we offer a novel definition of self-representation. We also discuss the role of such tokens in organizing self-specifying information, which leads to a naturalized restatement of the guarantee that introspective awareness is immune to error due to mis-identification of the subject