Physiotherapist experiences and acceptability of a clinical sensor-based kinematic feedback toolkit for movement feedback rehabilitation for people following Anterior Cruciate Ligament reconstruction. Background: After knee ligament repair many patients do not recover. Tailored physiotherapy treatments developed from accurate kinematic measurement providing individualised movement feedback may improve outcomes. We have developed a sensor-based kinematic feedback toolkit that generates visual quantifiable data giving precise feedback regarding real time multi-planar kinematic data in the clinical setting and we present physiotherapist opinions about this tool. Objective: To gather physiotherapist experience and acceptance of a sensor-based kinematic feedback toolkit for anterior cruciate ligament injury rehabilitation to inform tool development for clinical practice Design and participants: Semi-structured interviews gathered experiences of twelve physiotherapists who used the toolkit for patients undergoing anterior cruciate ligament rehabilitation Findings: Four themes were identified (1) tool kit usability and future design considerations; (2) clinical integration and decision-making; (3) behaviour change; and (4) future use of biomechanical technology in clinical practice. Conclusion: The sensor-based biomechanical feedback toolkit report was perceived to be usable and acceptable. Physiotherapists could identify biomechanical movement compensations in patients that could lead to a more individualised targeted treatment approach. Barriers focused on file sharing, IT integration, and compatibility to access and view the digital report. Recommendations were to determine patient acceptance and implementation of real-time data collection in clinical settings for patients and Physiotherapists.
Recent advancements in fitness technology have introduced innovative equipment like the A-Trainer, which integrates aerobic and anaerobic exercises for targeted muscle or whole-body engagement. This development holds significant potential for delivering impactful, low-impact, high-intensity workouts, enhancing rehabilitation and overall well-being. The objective of this mixed-method observational study was to evaluate the impact of this novel exercise machine on muscle activation and cardiovascular effects, as well as to understand user perspectives through interviews. Surface electromyography (sEMG) sensors were used to monitor specific upper body muscles, while a physical activity wearable tracker measured heart rate activity. Semi-structured interviews provided insights into participants' experiences with the exercise machine. Fifteen adults participated in this study. Results indicated a significant difference in sEMG muscle activity between the isometric pre-workout and post-A-Trainer workout strength assessments across all muscle groups, suggesting a substantial enhancement in muscular engagement. The wearable tracker also reported considerable calorie burn during short exercise sessions. However, this study focused on a single intensity and resistance level, which limits generalisability. Interviews highlighted the A-Trainer's effectiveness for cardiovascular training and accessibility for all ages.Future research should investigate the A-Trainer's effectiveness across varying intensities and resistance levels to achieve a comprehensive understanding of its benefits.
Radiotherapy dosimetry audit is an important element in the overall quality assurance of radiotherapy delivery and has become established as best practice prior to implementation of new equipment, techniques or clinical trials.The Institute of Physics and Engineering in Medicine (IPEM) Interdepartmental Dosimetry Audit group (IDA) facilitates regional audits across the UK through a network of 8 regional chairs. This is a well-established and successful network utilising local staff resources and dosimetry equipment from each region to conduct audits for new radiotherapy equipment, techniques and annual reference audits. All dosimeters used are traceable to the National Physical Laboratory's (NPL) primary standard.NPL and the National Radiotherapy Trials Quality Assurance Group (RTTQA) perform audits for new techniques and clinical trials in the UK. The IPEM IDA, NPL and RTTQA have a joint vision of a national audit network so that comprehensive audits can be offered to all UK centres and bring together all UK dosimetry audit data within a centralised database to facilitate coordinated national audits. This will also allow centres to access and review their data for anonymous benchmarking against other UK centres to support quality improvement.Increasing the frequency and complexity of national audits to reflect current clinical practice is often inhibited by the cost of purchasing appropriate equipment. IPEM have now funded two phantoms that will enable national audits of gynae brachytherapy and head and neck external beam treatments through 2024–25.The aim of this Position Paper is to provide an update on the activities of the IPEM IDA and present the future vision and roadmap for the three UK dosimetry audit groups.
Acute healthcare providers operate large, diverse medical equipment inventories. Resources for managing these inventories is frequently scarce so must be prioritised such that maximum benefit is conferred per unit of expenditure.This review identifies publications which have discussed the clinical value conferred by mechanical ventilation (MV) and by extra corporeal membrane oxygenation (ECMO). Respectively, mechanical ventilators and ECMO units are necessary to deliver these therapies. Systematic searches for publications which discuss the clinical value conferred by MV and by ECMO were conducted.The identified articles included reviews, prospective studies, retrospective studies, and models. Most presented findings in terms of the cost-effectiveness ratio. The patient populations studied, and analytical methods used varied widely. The clinical value conferred by MV varied with dependencies on several factors including the age- and disease- profile of the patient population. It was not possible to infer these dependencies from the literature which exists for ECMO.More relevant literature existed for MV, the more mature technology, than did for ECMO. The ECMO literature also tended to be more recent and included more modelling studies and fewer prospective studies. The data extracted could inform estimates of the clinical value likely to be delivered by mechanical ventilators operated by a specific institution. Estimates for ECMO are likely to carry greater uncertainty than those for MV.
The work described was undertaken to develop a means to estimate the delivered power over the exposed body surface of a neonate receiving phototherapy. Previous work of the group had involved the use of discrete photodiodes distributed over a newborn manikin surface. It was considered that improved accuracy of sensing over curved surfaces would be provided with the use of flexible solar cell elements. A group of products based on amorphous silicon was identified as potentially suitable and a range of its properties investigated. These included the wavelength sensitivity, the relative sensitivity of similar elements and the cosine response of elements. It was identified that with selection of elements of matched sensitivity, specific element types were appropriate for intended use. A total of 44 discrete solar cell elements of three separate sizes was used to cover the previously used manikin surface and a dedicated interface circuit was designed and constructed. A handheld calibrated spectroradiometer provided a means to relate incident irradiance values within specific wavelength bands to corresponding optical power over the manikin surface. Initial use of the system is described together with future potential developments in relation to clinical applications and testing standards for neonatal phototherapy devices.
Nuclear medicine healthcare workers are exposed to the risk of radioactive needlestick injury. To quantify the severity of this risk, the activity deposited into the skin and the injury depth have been experimentally measured for input into skin dosimetry program VARSKIN+. Agar test objects were pierced by hand with a needle containing Tc-99m HMDP. The deposited activity was measured by contamination monitor and converted into deposited volume. Injury depth was measured with a ruler by piercing the test objects with visible dye.The median volume deposited into test objects without gloves was 100 ± 50 nl (standard error) (interquartile range (IQR): 50 - 320 nl). Through one glove, this was reduced to 50 ± 20 nl (IQR: 30 - 140 nl), however, the difference was not significant (p > 0.1). The volume deposited through two gloves was highly variable due to the increased force required to puncture. The median injury depth was 4.0 ± 0.4 mm (standard error).Decontamination efficacy was investigated by rinsing alone, with hand soap and by application of decontamination agent RadiacWash. All decontamination methods were found to significantly decrease the activity deposited (p < 0.001). Test objects rinsed for 60s had a mean reduction of 42% ± 6% (95% confidence interval). There was no significant difference observed between decontamination methods. This may be due to differences in absorption time between the sample groups.Skin dose estimates have been calculated in VARSKIN+ using the results of the experiment. For injuries without gloves, involving 1011 MBq/ml of Tc-99m HMDP, a skin dose of 11 ± 5 mSv (propagated standard error) was calculated. Immediate decontamination under running water is recommended to reduce the dose. Further research is encouraged to investigate the protection offered by gloves.
The development of a flow/pressure measurement system in association with Bronkhorst High-Tech B.V. incorporating a Coriolis flow transducer, provided an opportunity to observe the flow/pressure dynamics of syringe drivers. A model of flow/pressure performance of syringe drivers was established where key variable factors included the compliance of the connected system and the associated line resistance. It was identified that the flow/pressure dynamics observed with the flow measurement system incorporating the Coriolis transducer matched that of the model. In this consideration the dominant compliance contribution related to that of the syringe. The model operates by considering the notional volume change in the residual fluid volume in the syringe with inflow from stepper motor action and outflow in the interval between sequential pulses. While many of the observations in the literature of syringe driver function are qualitative, the model allows a more precise prediction of associated device performance.
The concept of quantitative MR (qMR) has existed for over three decades, offering direct access to biology and physiology, yet its implementation is still not straightforward or widespread. It has failed to translate into the clinic. Thus it is important to understand why this might be. Multi-centre studies show large differences between MR machines; good and convenient accuracy (closeness to the true value) and precision (repeatability) remain elusive.The development of suitable phantoms is a key stage in the evolution of qMR, and here a systematic categorisation is proposed. Currently there is much attention paid to creating phantoms containing materials with metrologically traceable values of MR quantities. However these simple phantoms are usually unrealistic; many of the disrupting phenomena present in clinical imaging are absent. These include RF B1 nonuniformity, and are a particular problem in body (as opposed to head) imaging, and at fields of 3T and above.Thus there is a premium on developing realistic phantoms. A proposal made for a realistic body phantom that includes RF B1 imperfections. It consists of lossy annuli placed around a standard head phantom.
Clinical translation of 7 tesla (T) MRI of the brain promises high image quality and potentially improved clinical diagnosis for patients compared to current standard lower field-strength MRI at 1.5 and 3T.Here we describe how physics principles underlying ultra-high field (UHF) strength MRI affect 7T image quality, and how these can be exploited to translate 7T brain imaging into clinical practice. UHF MRI profits from higher inherent signal-to-noise ratio (SNR) and a resultant increase in achievable spatial resolution or acceleration factors; increase in sensitivity to magnetic susceptibility differences and a higher amplitude of the Blood Oxygen Level Dependent (BOLD) signal; increase in longitudinal relaxation time; and increased frequency dispersion and spectral resolution in MR spectroscopy.Examples are presented of different brain pathologies, which are better illustrated on 7T compared to lower field strength by applying sequences and imaging techniques that exploit these intrinsic strengths of 7T MRI. This includes imaging of various vascular pathologies, epilepsy and brain tumours.
A photoplethysmogram (PPG) is an optically-derived signal that records the variation in blood volume within the microvasculature. Certain cardiovascular diseases (CVDs) are symptomatic of damaged blood vessels and problems in blood flow, including hypertension. While software implementations for heart rate and blood pressure estimation exist, point-of-care systems demand hardware-based implementations for real-time estimations to be useful for CVD detection. In this study, digital field programmable gate array (FPGA) based systems are developed for heart rate and blood pressure estimation from PPG signals by means of linear regression. In addition to the blood pressure estimation system, we present a prototype hypertension level detection system that achieves 92.42% accuracy while consuming 0.364 W of power. The Mean Absolute Error (MAE) ± Standard Deviation (SD) for heart rate estimation is 3.17 ± 2.79 beat per minute. The corresponding results for systolic and diastolic blood-pressure estimation are 4.75 ± 2.78 and 3.34 ± 2.60, respectively. The prototype can be further extended to wearable devices and medical equipment in the future.
This paper investigates techniques and materials for making a multi-element ultrasound imaging transducer with craft-based techniques available in resource poor environments. The transducer housing can be conveniently divided into three parts: the body supporting the piezoelectric (PZT) elements and other components; the matching layer between the PZT elements and the human body; and the backing layer behind the PZT elements. Low-cost 3D printing systems based on photopolymers were found to be suitable for manufacturing the body. Finite Element Modelling (FEM) showed that the material characteristics of the backing layer and the thickness of the matching layer were much less critical than predicted by ultrasound plane wave theory and transmission line theory, respectively. The backing and matching layers are normally made from epoxy-tungsten composites that are pourable in the uncured state. However, the composite required for the backing layer was putty-like when uncured. When the tungsten was allowed to settle under gravity during curing, a 20 % by volume uncured tungsten-epoxy composite gave a 30 % by volume concentration of tungsten at the bottom when cured at 20–30 °C. These findings, when coupled with the findings from the FEM modelling, suggests that constructing a multi-element ultrasound imaging transducer using craft-based techniques is feasible.
Starting from the recently published idea of the “perfect machine”, we argue that quantitative MRI (qMRI) supported by a rigorous metrological framework could not only drastically improve reproducibility in MRI and support large-scale studies, there is also scope to accredit individual MRI scanners in particular applications via a suitable accreditation scheme. We present the idea of the perfect diagnostic imaging machine, including describing the background of the ideas and how they lead to the idea of accreditation in qMRI. The scheme presented here is not intended to be the last word in accreditation, but to stimulate debate in the idea and whether or not is has merit for qMRI and its clinical and research context.
AI segmentation has been recently introduced in the local department for delineation of targets and organs-at-risk (OAR) for a wide range of tumour sites. For breast radiotherapy, AI segmentation can provide target delineation (breast and lymph nodes) and required OAR, and this has enabled a stepwise series of improvements to the local planning technique.Clinician feedback deemed 67 - 89 % of nodal target volumes required no edits or only minor edits, so AI breast and lymph nodes volumes were first used to guide tangent and supraclavicular field placement, instead of a bony-anatomy based technique.Next, evolution from anatomical field-placement to true inverse optimised planning was introduced using AI to create the required target volumes. For internal mammary node (IMN) treatments, the previous 3-field technique prohibited Deep Inspiration breath-hold (DIBH), due to the couch rotation used to match field edges. The roll-out of VMAT (volumetric-modulated arc therapy) with DIBH enabled by AI therefore resulted in a dose reduction to ipsi-lateral lung, and in mean heart dose compared to the old 3-field technique. Median time from CT scan to VMAT IMN plan approval reduced from 12 days (with manual contouring) to 7 days using reviewed and edited AI-generated volumes.Consistent, high-quality contours for 9 OAR and breast PTVs for all patients facilitates comparison with NHS-E scorecards as a benchmark for plan quality. Workflows have been simplified, with significant time-savings. DIBH radiotherapy is now available to more patients, further improving dose sparing for heart and lung.
•Carbon footprint studies necessary to ensure route to net zero is evidence-based.•Carbon footprint of travel to the satellite centre and main centre were 116.0 kgCO2e and 176.2 kgCO2e.•The carbon footprint of building a 2-linac satellite centre between 1103 and 618 tCO2e.•It would take 5.6 – 10.0 years to offset the embedded carbon footprint of the new building.
•A method for geometric and dosimetric analysis of AI auto-contours is proposed.•The best geometric results were attained by the brainstem.•The poorest geometric results were found for the cord.•The change in plan metrics when using auto-contours was not statistically significant.•Auto-contours could be used as a starting point, reviewed and edited if necessary by the clinician.
Objectives: There is an urgent need for technologies which can reduce the impact of airborne disease transmission. Far-UVC (200–230 nm) is a range of wavelengths growing in relevance for airborne virus disinfection in occupied public spaces. These wavelengths quickly and efficiently inactivate airborne pathogens, while to current knowledge remaining low risk to room occupants. If there is ever to be an effective widespread implementation of these technologies in public spaces, it is important to assess public opinion to ensure appropriate use and understanding of the technology. Methods: A self-administered survey was distributed through social media channels with several questions to gather opinions on using Far-UVC. The survey was distributed between September 2021 and January 2022. Outcome measures included how safe respondents would feel with or without Far-UVC in indoor spaces and how acceptable the technology would be in certain indoor spaces. Results: There were 111 respondents to the survey. The median age range of the respondents was 36–45, most respondents had never studied biology or related science subjects beyond school level (68%, n = 76), and 87% (n = 97) were indoor workers or attended formal education. Less than one-third of respondents had heard of the term ‘Far-UVC’. Though, on learning about the core principles of Far-UVC, respondents became more supportive of its use in public spaces. Acceptance of Far-UVC was strongest in areas where a higher benefit-risk ratio was perceived, such as in hospitals. Conclusion: We have shown that when the basic concepts of Far-UVC are clearly communicated, public opinion on its adoption improves. Without such a general understanding amongst members of the public, Far-UVC may then face challenges in gaining widespread adoption. The assessment of public opinion presented here will help to determine where primary concerns lie, and the actions needed to address these.
Distraction osteogenesis (DO) is a classical surgical technique for limb lengthening and reconstruction (LLR). Most existing DO devices for LLR are operated manually, and the accurate DO process is user dependant, which could affect new bone formation. Recently, automated devices have been introduced for continuous DO processes to aid in tissue healing. To the best of our knowledge, few automated continuous distraction osteogenesis (ACDO) devices have focused on DO surgery for the long bones of the extremities and monitoring of their status during the surgical process. This study presents a novel ACDO device, which is driven by a deceleration stepper motor for further reduction in total mass and amplification in distraction force, including a precise and programmable man–machine-interaction system to allow surgeons to control and monitor the treatment remotely. The mechanical device was verified to be capable of generating a continuous and controllable distraction force and rate. The proposed man–machine-interaction system possesses the functions of customizing and following up on treatment plan by clinicians, including setting the DO process, measuring and displaying parameters, and uploading DO information to the data cloud. During electromechanical system simulation and prototype experiments, the performance of the proposed system was consistent with the setting DO parameters and treatment plan.
Artificial intelligence and machine learning applications are increasingly prevalent in the healthcare industry. In some cases, medical devices use sensor-collected data to feed into algorithms which generate scores or risk assessments that are used to inform patient care. The process of determining sensor accuracy requirements which will ensure that the algorithm generates reliable scores is not straightforward or well-defined. In this paper, we describe a simulation-based method to characterize sensor accuracy requirements for a device that uses a machine-learning algorithm to generate a postural stability score – the ZIBRIO Stability Scale. The results of the simulation are described, as is the application to sensor selection in preparation for manufacturing of the device. Other medical device developers may be able to use this method or similar methods in their requirements engineering process.
Telemedicine has been an essential form of care since the onset of the COVID-19 pandemic. However, telemedicine may exacerbate disparities for populations with limited digital literacy or access, such as older adults, racial minorities, patients of low income, rural residences, or limited English proficiency. From March 2020 to March 2022, this retrospective cohort study analyzed the use of in-person, phone/message, and telemedical care at a single tertiary care center in an oncology department. We investigated the association between economic, racial, ethnic, socioeconomic factors and forms of care, including in-person visits, telemedicine-based visits, and telephone/messages. The study results show that telemedicine utilization is lower among patients 65 and older, female patients, American Indian or Alaska Native patients, uninsured patients, and patients who require interpreters during clinical visits. As a result, it is unlikely that telemedicine will provide equal access to clinical care for all populations. On the other hand, in-person care utilization remains low in low-income and rural-living patients compared to the general population, while telephone and message use remains high in low-income and rural-living patients. We conclude that telemedicine is currently unable to close the utilization gap for populations of low socioeconomic status. Patients with low socioeconomic status use in-person care less frequently. For the disadvantaged, unusually high telephone or message utilization is unlikely to provide the same quality as in-person or telemedical care. Understanding the causes of disparity and promoting a solution to improve equal access to care for all patients is critical.
Accurately identifying needle tip and seed positions for low dose rate prostate brachytherapy on MRI images is challenging. Uncertainties in locating needle tip positions can lead to misplacement of seeds compared to planned coordinates. Furthermore uncertainty in establishing true seed positions on the images, leads to uncertainty in the dose distributions. In this study, a novel phantom has been designed for the analysis of I-125 seed and needle tip detection and tip image distortion. The phantom utilises a gel that mimics prostate tissue in MRI, to evaluate the uncertainty in establishing seed and needle tip positions. Reults are reported for the IsoSeed (Bebig) source, in clinically relevant seed arrangements, and for a novel nitinol needle. The choice of MRI sequence impacts the accuracy of detecting the needle tips and seeds. This is most prevelant when the seeds are in clusters, at the boundary of the prostate and at 90˚ to the long axis of the scanner. Detected needle tip position, when the MRI metal artefact correction algorithm was used, was measured consistently inferior to the actual position (mean tip at -2.3 ± 1.5 mm (k = 2), p = 0.03). We have demonstrated the design of a phantom that can be used to quantitatively assess seed and needle tip positions simultaneously, to establish the accuracy of detection, or presence of artefacts on MRI.
