610 Medizin, Gesundheit
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Motivation
In order to enable context-aware behavior of surgical assistance systems, the acquisition of various information about the current intraoperative situation is crucial. To achieve this, the complex task of situation recognition can be delegated to a specialized system. Consequently, a standardized interface is required for the seamless transfer of the recognized contextual information to the assistance systems, enabling them to adapt accordingly.
Methods
Our group analyzed four medical interface standards to determine their suitability for exchanging intraoperative contextual information. The assessment was based on a harmonized data and service model derived from the requirements of expected context-aware use cases. The Digital Imaging and Communications in Medicine (DICOM) and IEEE 11073 for Service-oriented Device Connectivity (SDC) were identified as the most appropriate standards.
Results
We specified how DICOM Unified Procedure Steps (UPS), can be used to effectively communicate contextual information. We proposed the inclusion of attributes to formalize different granularity levels of the surgical workflow.
Conclusions
DICOM UPS SOP classes can be used for the exchange of intraoperative contextual information between a situation recognition system and surgical assistance systems. This can pave the way for vendor-independent context awareness in the OR, leading to targeted assistance of the surgical team and an improvement of the surgical workflow.
Purpose
Artificial intelligence (AI), in particular deep learning (DL), has achieved remarkable results for medical image analysis in several applications. Yet the lack of human-like explanations of such systems is considered the principal restriction before utilizing these methods in clinical practice (Yang, Ye, & Xia, 2022).
Methods
Explainable Artificial Intelligence (XAI) provides a human-explainable and interpretable description of the “black-box” nature of DL (Gulum, Trombley, & Kantardzic, 2021). An effective XAI diagnosis generator, namely NeuroXAI (refer to Fig. 1), has been developed to extract 3D explanations from convolutional neural networks (CNN) models of brain gliomas (Zeineldin et al., 2022). By providing visual justification maps, NeuroXAI can help make DL models transparent and thus increase the trust of medical experts.
Results
NeuroXAI has been applied to two applications of the most widely investigated problems in brain imaging analysis, i.e. image classification and segmentation using magnetic resonance imaging (MRI). Visual attention maps of multiple XAI methods have been generated and compared for both applications, which could help to provide transparency about the performance of DL systems.
Conclusion
NeuroXAI helps to understand the prediction process of 3D CNN networks for brain glioma using human-understandable explanations. Results revealed that the investigated DL models behave in a logical human-like manner and can improve the analytical process of the MRI images systematically. Due to its open architecture, ease of implementation, and scalability to new XAI methods, NeuroXAI could be utilized to assist medical professionals in the detection and diagnosis of brain tumors. NeuroXAI code is publicly accessible at https://github.com/razeineldin/NeuroXAI
In order to evaluate the performance of different stapes prosthesis types, a coupled finite element (FE) model of human ear was developed. First, the middle-ear FE model was developed and validated using the middle-ear transfer function measurements available in literature including pathological cases. Then, the inner-ear FE model was developed and validated using tonotopy, impedance, and level of cochlea amplification curves from literature. Both models are based on pre-existing research with some improvements and were combined into one coupled FE model. The stapes in the coupled FE ear model was replaced with a model of a stapes prosthesis to create a reconstructed ear model that can be used to estimate how different types of protheses perform relative to each other as well as to the natural ear. This will help in designing of new innovative types of stapes prostheses or any other type of middle-ear prostheses as well as to improve the ones that are already available on the market.
Simulation models of the middle ear have rarely been used for diagnostic purposes due to their limited predictive ability with respect to pathologies. One big challenge is the large uncertainty and ambiguity in the choice of material parameters of the model.
Typically, the model parameters are determined by fitting simulation results to validation measurements. In a previous study, it was shown that fitting the model parameters of a finite-element model using the middle-ear transfer function and various other measurable output variables from normal ears alone is not sufficient to obtain a good predictive ability of the model on pathological middle-ear conditions. However, the inclusion of validation measurements on one pathological case resulted in a very good predictive ability also for other pathological cases. Although the found parameter set was plausible in all aspects, it was not yet possible to draw conclusions about the uniqueness and the accuracy or the uncertainty of the parameter set.
To answer these questions, statistical solution approaches are used in this study. Using the Monte Carlo method, a large number of plausible model data sets are generated that correctly represent the normal and pathological middle-ear characteristics in terms of various output variables like e.g., impedance, reflectance, umbo, and stapes transfer function. Subsequent principal component analyses (PCA) allow to draw conclusions about correlations, quantitative limits and statistical density of parameter values.
Furthermore, applying inverse PCA yields numerous plausible parameterizations of the middle-ear model, which can be used for data augmentation and training of a neural network which is capable of distinguishing between a normal middle ear and pathologies like otosclerosis, malleus fixation, and disarticulation based on objectively measured quantities like impedance, reflectance, and umbo velocity.
The hearing contact lens® (HCL) is a new type of hearing aid devices. One of its main components is a piezo-electric actuator. In order to evaluate and maximize the HCL’s performance, a model of the HCL coupled to the middle ear was developed using finite element approach. The model was validated step by step starting with the HCL only. To validate the HCL model, vibrational measurements on the HCL were performed using a Laser-Doppler-Vibrometer (LDV). Then, a silicone cap was placed onto the HCL to provide an interface between the HCL and the tympanic membrane of the middle-ear model and additional LDV measurements on temporal bones were performed to validate the coupled model. The coupled model was used to evaluate the equivalent sound pressure of the HCL. Moreover, a deeper insight was gained into the contact between the HCL and tympanic membrane and its effects on the HCL performance. The model can be used to investigate the sensitivity of geometrical and material parameters with respect to performance measures of the HCL and evaluate the feedback behavior.
Personalized remote healthcare monitoring is in continuous development due to the technology improvements of sensors and wearable electronic systems. A state of the art of research works on wearable sensors for healthcare applications is presented in this work. Furthermore, a state of the art of wearable devices, chest and wrist band and smartwatches available on the market for health and sport monitoring is presented in this paper. Many activity trackers are commercially available. The prices are continuously reducing and the performances are improving, but commercial devices do not provide raw data and are therefore not useful for research purposes.
Gamification is one of the recognized methods of motivating people in various life processes, and it has spread to many spheres of life, including healthcare. This article proposes a system design for long-term care patients using the method mentioned. The proposed system aims to increase patient engagement in the treatment and rehabilitation process via gamification. Literature research on available and earlier proposed systems was conducted to develop a suited system design. The primary target group includes bedridden patients and a sedentary lifestyle (predominantly lying in bed). One of the main criteria for selecting a suitable option was its contactless realization for the mentioned target groups in long-term care cases. As a result, we developed the system design for hardware and software that could prevent bedsores and other health problems from occurring because of low activity. The proposed design can be tested in hospitals, nursing homes, and rehabilitation centers.
In recent decades, it can be observed that a steady increase in the volume of tourism is a stable trend. To offer travel opportunities to all groups, it is also necessary to prepare offers for people in need of long-term care or people with disabilities. One of the ways to improve accessibility could be digital technologies, which could help in planning as well as in carrying out trips. In the work presented, a study of barriers was first conducted, which led to selecting technologies for a test setup after analysis. The main focus was on a mobile app with travel information and 360° tours. The evaluation results showed that both technologies could increase accessibility, but some essential aspects (such as usability, completeness, relevance, etc.) need to be considered when implementing them.
The digital twin concept has been widely known for asset monitoring in the industry for a long time. A clear example is the automotive industry. Recently, there has also been significant interest in the application of digital twins in healthcare, especially in genomics in what is known as precision medicine. This work focuses on another medical speciality where digital twins can be applied, sleep medicine. However, there is still great controversy about the fundamentals that constitute digital twins, such as what this concept is based on and how it can be included in healthcare effectively and sustainably. This article reviews digital twins and their role so far in what is known as personalized medicine. In addition, a series of steps will be exposed for a possible implementation of a digital twin for a patient suffering from sleep disorders. For this, artificial intelligence techniques, clinical data management, and possible solutions for explaining the results derived from artificial intelligence models will be addressed.
In many cases continuous monitoring of vital signals is required and low intrusiveness is an important requirement. Incorporating monitoring systems in the hospital or home bed could have benefits for patients and caregivers. The objective of this work is the definition of a measurement protocol and the creation of a data set of measurements using commercial and low-cost prototypes devices to estimate heart rate and breathing rate. The experimental data will be used to compare results achieved by the devices and to develop algorithms for feature extraction of vital signals.
There have been substantial research efforts for algorithms to improve continuous and automated assessment of various health-related questions in recent years. This paper addresses the deployment gap between those improving algorithms and their usability in care and mobile health applications. In practice, most algorithms require significant and founded technical knowledge to be deployed at home or support healthcare professionals. Therefore, the digital participation of persons in need of health care professionals lacks a usable interface to use the current technological advances. In this paper, we propose applying algorithms taken from research as web-based microservices following the common approach of a RESTful service to bridge the gap and make algorithms accessible to caregivers and patients without technical knowledge and extended hardware capabilities. We address implementation details, interpretation and realization of guidelines, and privacy concerns using our self-implemented example. Also, we address further usability guidelines and our approach to those.
The recovery of our body and brain from fatigue directly depends on the quality of sleep, which can be determined from the results of a sleep study. The classification of sleep stages is the first step of this study and includes the measurement of vital data and their further processing. The non-invasive sleep analysis system is based on a hardware sensor network of 24 pressure sensors providing sleep phase detection. The pressure sensors are connected to an energy-efficient microcontroller via a system-wide bus. A significant difference between this system and other approaches is the innovative way in which the sensors are placed under the mattress. This feature facilitates the continuous use of the system without any noticeable influence on the sleeping person. The system was tested by conducting experiments that recorded the sleep of various healthy young people. Results indicate the potential to capture respiratory rate and body movement.
This book contains the proceedings of the KES International conferences on Innovation in Medicine and Healthcare (KES-InMed-19) and Intelligent Interactive Multimedia Systems and Services (KES-IIMSS-19), held on 17–19 June 2019 and co-located in St. Julians, on the island of Malta, as part of the KES Smart Digital Futures 2019 multi theme conference.
The major areas covered by KES-InMed-19 include: Digital IT Architecture in Healthcare; Advanced ICT for Medical and Healthcare; Biomedical Engineering, Trends, Research and Technologies and Healthcare Support System. The major areas covered by KES-IIMSS-19 were: Interactive Technologies; Artificial Intelligence and Data Analytics; Intelligent Services and Architectures and Applications.
This book is of use to researchers in these vibrant areas, managers, industrialists and anyone wishing to gain an overview of the latest research in these fields.
In 2017, Philips' goal was to use innovation to improve the lives of three billion people a year by 2025. To achieve that, the company was shifting from selling medical products in a transactional manner to providing integrated healthcare solutions based on digital health technology. Based on our interviews with 23 executives at Philips, the case examines the two directions of the transformation required by this shift: externally, Philips worked on transforming how healthcare was conducted. Healthcare professionals would have to change the way they worked and reimbursement schemes needed to change to incentivize payers, providers, and patients in vastly different ways. Internally, Philips needed to redesign how its employees worked. The company componentized its business, introduced digital platforms, and co-created integrated solutions with the various stakeholders of the healthcare industry. In other words: Philips was transforming itself in order the reinvent healthcare in the digital age.
Autism spectrum disorders (ASD) affect a large number of children both in the Russian Federation and in Germany. Early diagnosis is key for these children, because the sooner parents notice such disorders in a child and the rehabilitation and treatment program starts, the higher the likelihood of his social adaptation. The difficulties in raising such a child lie in the complexity of his learning outside of children's groups and the complexity of his medical care. In this regard, the development of digital applications that facilitate medical care and education of such children at home is important and relevant. The purpose of the project is to improve the availability and quality of healthcare and social adaptation at home of children with ASD through the use of digital technologies.
The goal of the presented project is to develop the concept of home e-health centers for barrier-free and cross-border telemedicine. AAL technologies are already present on the market but there is still a gap to close until they can be used for ordinary patient needs. The general idea needs to be accompanied by new services, which should be brought together in order to provide a full coverage of service for the users. Sleep and stress were chosen as predominant influence in the population. The executed scientific study of available home devices analyzing sleep has provided the necessary to select appropriate devices. The first choice for the project implementation is the device EMFIT QS+. This equipment provides a part of a complete system that a home telemedical hospital can provide at a level of precision and communication with internal and/or external health services.
The metric and qualitative analysis of models of the upper and lower dental arches is an important aspect of orthodontic treatment planning. Currently available eLearning systems for dental education only allow access to digital learning materials, and do not interactively support the learning progress. Moreover, to date no study compared the efficiency of learning methods based on physical or digital study models. For this pilot study, 18 dental students were separated into two groups to investigate whether the learning success in study model analysis with an interactive elearning system is higher based on digital models or on conventional plaster models. The results show that with the digital method less time is needed per model analysis. Moreover, the digital approach leads to higher total scores than that based on plaster models. We conclude that interactive eLearning using digital dental arch models is a promising tool for dental education.
OR-Pad - Entwicklung eines Prototyps zur sterilen Informationsanzeige am OP-Situs : meeting abstract
(2019)
Hintergrund: Oftmals werden Informationen aus der Krankenakte oder von Bildgebungsverfahren nur auf recht weit vom Operationsgebiet entfernten Monitoren, außerhalb der ergonomischen Sichtachse des Operateurs, dargestellt. Dies führt dazu, dass relevante Informationen übersehen werden oder ihr Informationspotenzial nicht ausgeschöpft werden kann. In Papierform mitgenommene Notizen befinden sich während der OP außerhalb des sterilen Bereichs und sind dadurch für den Operateur nicht ohne Weiteres zugänglich. Auch bei intraoperativen Einträgen für die OP Dokumentation ist der Operateur auf die Mithilfe der Assistenz angewiesen. Durch die zusätzlichen Kommunikationswege entstehen dabei ein personeller und zeitlicher Mehraufwand und das Fehlerpotenzial nimmt zu. Das anwendungsorientierte Forschungsprojekt OR-Pad - Nutzung von portablen Informationsanzeigen im Operationssaal - soll dem Operateur zu einem verbesserten Informationsfluss verhelfen. Die Idee entstand aus der klinischen Routine der Anatomie und Urologie des Universitätsklinikums Tübingen und wird nun durch Fördermittel vom Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg sowie vom Europäischen Fonds für regionale Entwicklung an der Hochschule Reutlingen zu einem High Fidelity-Prototypen weiterentwickelt.
Ziel: Ziel des OR-Pad Projekts ist es, während einer OP zum aktuellen Zeitpunkt klinisch relevante Informationen in unmittelbarer Nähe zum Operateur darzustellen. Mithilfe des Systems soll der Informationsfluss zwischen dem Eingriff sowie dessen Vor- und Nachbereitung optimiert werden. Der Operateur soll vorab relevante Informationen, wie aktuelle Röntgenbilder oder persönliche Notizen, zur intraoperativen Anzeige auswählen können, die dann am OP-Situs auf einer sterilen Informationsanzeige dargestellt werden. Durch die Positionierung soll eine ergonomische Sichtachse sowie die direkte Interaktion mit dem System ermöglicht werden. Kontextrelevante Informationen sollen basierend auf dem aktuellen OP-Verlauf durch die Entwicklung einer Situationserkennung automatisch bereitgestellt werden. Zur Optimierung des Informationsflusses gehört ebenfalls die Unterstützung der OP-Dokumentation. Für diese sollen während des Eingriffs manuell vom Operateur sowie automatisch vom System Einträge, wie Zeitpunkte oder intraoperative Aufnahmen, erstellt werden. Aus diesen soll nach dem Eingriff die OP-Dokumentation generiert und damit der Prozess qualitativer und zeiteffizienter gestaltet werden.
Methodik: Zur Erreichung des Ziels werden zunächst die klinischen Anforderungen spezifiziert und in ein Lastenheft überführt. Hierfür werden Interviews und Beobachtungen bei mehreren Interventionen durchgeführt. Nach dem User-Centered-Designprozess werden Personas und Nutzungsszenarien entworfen und mit klinischen Projektpartnern in mehreren Iterationen evaluiert. Es gilt eine Informationsarchitektur aufzubauen, die eine Einbettung klinischer Informationssysteme sowie Bild- und Gerätedaten aus dem OP-Netzwerk erlaubt. Eine Situationserkennung, basierend auf Prozessmodellen, soll zur Abschätzung des Operationsfortschritts entwickelt werden. Zur Befestigung der Informationsanzeige sollen geeignete Haltemechanismen eingesetzt werden. Das OR-Pad System soll laufend im Lehr- und Forschungs-OP der Hochschule Reutlingen getestet und im Sinne agiler Produktentwicklung mit den klinischen Projektpartnern abgestimmt werden. Der finale Funktionsprototyp soll abschließend in den Versuchs-OPs der Anatomie Tübingen getestet und evaluiert werden.
Ergebnisse: Über eine erste Datenerhebung mittels Contextual Inquiry konnten erste Anforderungen an das OR-Pad System erfasst werden, woraus ein Low-Fidelity-Prototyp resultierte. Die Evaluation über Experteninterviews führte in die zweite Iteration, in der das Konzept entsprechend der Ergebnisse angepasst wurde. Über Hospitationen am Uniklinikum Tübingen fand eine weitere Datenerhebung zur Erstellung von Szenarien für die intraoperativen Anwendungsfälle statt. Anhand der Anforderungen wurde ein Konzept für die Benutzerschnittstelle entworfen, die im weiteren Verlauf mit den klinischen Projektpartnern evaluiert wird.
Die Erholung unseres Körpers und Gehirns von Müdigkeit ist direkt abhängig von der Qualität des Schlafes, die aus den Ergebnissen einer Schlafstudie ermittelt werden kann. Die Klassifizierung der Schlafstadien ist der erste Schritt dieser Studie und beinhaltet die Messung von Biovitaldaten und deren weitere Verarbeitung. Das non-invasive Schlafanalyse-System basiert auf einem Hardware-Sensornetz aus 24 Drucksensoren, das die Schlafphasenerkennung ermöglicht. Die Drucksensoren sind mit einem energieeffizienten Mikrocontroller über einen systemweiten Bus mit Adressarbitrierung verbunden. Ein wesentlicher Unterschied dieses Systems im Vergleich zu anderen Ansätzen ist die innovative Art, die Sensoren unter der Matratze zu platzieren. Diese Eigenschaft erleichtert die kontinuierliche Nutzung des Systems ohne fühlbaren Einfluss auf das gewohnte Bett. Das System wurde getestet, indem Experimente durchgeführt wurden, die den Schlaf verschiedener gesunder junger Personen aufzeichneten. Die ersten Ergebnisse weisen auf das Potenzial hin, nicht nur Atemfrequenz und Körperbewegung, sondern auch Herzfrequenz zu erfassen.
Diese Arbeit liefert einen Konzeptentwurf, der die Integration verschiedener Systeme mit prozessrelevanten klinischen Diensten gewährleistet. Chirurgische Abläufe werden in Form von Prozessen modelliert. Die Wahl der Notation und die Art der Modellierung dieser Prozesse spielt in der heutigen Forschung in diesem Gebiet eine zentrale Rolle. Sind diese Prozesse modelliert, besteht die Möglichkeit, diese in einer Workflow-Engine automatisiert auszuführen. Im Rahmen der Entwicklung eines Workflow-Managment-Systems stellt sich die Frage, wie die Anbindung dieser Workflow-Engine mit anderen Systemen erfolgen soll. In der Arbeit werden Schnittstellen abstrakt in der Web Services Description Language (WSDL) definiert. Darum werden automatisiert Artefakte erzeugt. Auf der Grundlage dieser Artefakte erfolgt die Integration der Systeme. Die Workflow-Engine kommunizieren über SOAP-Nachrichten (Simple Object Access Protocol) mit den entsprechenden Systemen. Dieser Ansatz wurde mithilfe eines Prototyps validiert und umgesetzt.
This paper contributes to the automatic detection of perioperative workflow by developing a binary endoscope localization. Automated situation recognition in the context of an intelligent operating room requires the automatic conversion of low level cues into more abstract high level information. Imagery from a laparoscope delivers rich content that is easy to obtain but hard to process. We introduce a system which detects if the endoscope's distal tip is inside or outsiede the patient based on the endoscope video. This information can be used as one parameter in a situation recognition pipeline. Our localization performs in real-time at a video resolution of 1280x720 and 5-fold cross validation yields mean F1-scores of up to 0,94 on videos of 7 laparoscopies.