Wearable tactile interfaces Using SMA Wires

This paper describes the use of SMA (Shape Memory Alloys) wires to develop wearable tactile interfaces. In this early work, the wearable interface consists of a nylon glove with thin SMA wires stitched on it. The SMA wires provide a tunable pressure sensation when they are electrically actuated appropriately. Each wire is anchored to the fingernail-shaped support via screw clamps to ensure both the electrical continuity of the connections and to efficiently transmit the contraction force on the fingertip. A suitable actuation system of SMA wires has been designed and implemented on an Arduino Uno microcontroller to prevent their overheating. The knowledge of SMA wires mechanical, thermal and electrical properties allowed the implementation of a proper actuation strategy. The interface was characterized in terms of response time and force felt on the fingertip. Ten subjects have positively evaluated the interface in terms of wearability, comfort and tactile sensations. This work paves the way for the development of highly wearable tactile interfaces to be integrated in Virtual Reality (VR) and Augmented Reality (AR) environments

Augmented Reality simulator for laparoscopic cholecystectomy training

Augmented reality (AR) simulation, mixing the benefits of virtual and physical simulation, represents a step forward in surgical education. In preliminary studies, we demonstrated the possibility to correctly show AR information in case of deformations of the physical models thanks to the integration of electromagnetic (EM) tracking technologies into the simulation environment. In this paper, we describe an innovative AR simulator for laparoscopic cholecystectomy and in particular for the isolation of the cystic duct and artery, the most crucial phase of the intervention. The proposed simulator allows the AR visualization of these deformable tubular structures, which are covered by connective tissue and thus are difficult to identify. Moreover it provides an acoustic feedback as an alarm to the user in case of potential surgical errors

Proof of concept: VR rehabilitation game for people with shoulder disorders

Shoulder pain is very common in adult population (16%–26%) and it has several impacts on the Activities of Daily Living (ADLs). In this context, an effective rehabilitation is needed to assist the patients to regain autonomy and improve ADLs. An alternative approach to monotonous traditional rehabilitation can be offered by Virtual Reality (VR) technology and video game console systems. In this paper, we present a proof of concept of a computer game for shoulder rehabilitation. The system consists in a VR application developed with the Unity game engine, and it is currently controlled via mouse interactions; however, the software application has been designed for the Nintendo Wii Remote MotionPlus as the main game controller, but this tool will be integrated in the next development phase. Our goal is to develop a rehabilitation game: suitable to be used both at home and at a hospital, highly motivating for the patient, and requiring low-cost technology (e.g. a consumer-grade tracking system). The game has been tested preliminary with three healthy subjects who agreed that the application is engaging, motivating and intuitive

Wearable augmented reality application for shoulder rehabilitation

Augmented reality (AR) technology is gaining popularity and scholarly interest in the rehabilitation sector because of the possibility to generate controlled, user-specific environmental and perceptual stimuli which motivate the patient, while still preserving the possibility to interact with the real environment and other subjects, including the rehabilitation specialist. The paper presents the first wearable AR application for shoulder rehabilitation, based on Microsoft HoloLens, with real-time markerless tracking of the user’s hand. Potentialities and current limits of commercial head-mounted displays (HMDs) are described for the target medical field, and details of the proposed application are reported. A serious game was designed starting from the analysis of a traditional rehabilitation exercise, taking into account HoloLens specifications to maximize user comfort during the AR rehabilitation session. The AR application implemented consistently meets the recommended target frame rate for immersive applications with HoloLens device: 60 fps. Moreover, the ergonomics and the motivational value of the proposed application were positively evaluated by a group of five rehabilitation specialists and 20 healthy subjects. Even if a larger study, including real patients, is necessary for a clinical validation of the proposed application, the results obtained encourage further investigations and the integration of additional technical features for the proposed AR application

Augmented reality, mixed reality, and hybrid approach in healthcare simulation: A systematic review

Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients

What to trust, psa or [68ga]ga-psma-11: Learn from experience

Brain metastases from prostate cancer typically occur in the more advanced stages of the disease. Clinically, the early diagnosis of visceral disease is crucial, impacting on patient’s management and prognosis. Although magnetic resonance imaging (MRI) is the modality of choice for the detection of brain metastases, it is not routinely performed in the surveillance of prostate cancer patients unless neurological manifestations appear. Prostate-specific membrane antigen (PSMA) is a glycoprotein, a membrane-bound metallopeptidase, overexpressed in more than 90% of prostate cancer cells. This molecular target is a suitable tissue biomarker for prostate cancer functional imaging. We present a case of a 73-year gentleman diagnosed with prostate adenocarcinoma and surgically treated (pT3bN1Mx, Gleason Score of 9) in February 2016. Subsequently, he underwent androgen deprivation therapy because of the occurrence of a bone metastasis. Between 2016 and January 2019 PSA levels were maintained under control. Starting from September 2019, it progressively raised up to 0.85 ng/mL with a doubling time of 3.3 months. Therefore, he performed a [68Ga]Ga-PSMA-11 PET/CT which showed a focal radiopharmaceutical uptake in the right temporal lobe corresponding to the presence of a rounded cystic lesion on brain MRI. The subsequent excisional biopsy diagnosed a prostate adenocarcinoma metastasis. PSMA expression has been reported in brain parenchyma after ischemic strokes and in some brain tumors including gliomas, meningiomas, and neurofibromas. In our case, the lack of symptoms and the relatively low PSA level raised questions about the nature of the lesion, posing the differential diagnosis between brain metastases and primary brain tumor. Finally, our case shows the capability of [68Ga]Ga-PSMA-11 PET/CT to detect metachronous distant brain metastases in a low biochemical recurrent asymptomatic prostate cancer patient, indicating that proper acquisition – from the vertex to thigh – should be always considered, regardless of the PSA level