Methods for medical applications

Improvements in software for image analysis have enabled advances in both medical and engineering industries, including the use of medical analysis tools to recreate internal parts of the human body accurately. A research analysis found that FDM-sourced elements have shown viability for a customized and reliable approach in the orthopedics field. Three-dimensional printing has allowed enhanced accuracy of preoperative planning, leading to reduced surgery times, fewer unnecessary tissue perforations, and fewer healing complications. Furthermore, using custom tools chosen for each procedure has shown the best results. Bone correction-related surgeries require customized cutting guides for a greater outcome. This study aims to assess the biopolymer-based tools for surgical operations and their ability to sustain a regular heat-sterilization cycle without compromising the geometry and fit characteristics for a proper procedure. To achieve this, a DICOM and FDM methodology is proposed for fast prototyping of the cutting guide by means of 3D engineering. A sterilization test was performed on HTPLA, PLA, and nylon polymers. As a result, the unique characteristics within the regular autoclave sterilization process allowed regular supplied PLA to show there were no significant deformations, whilst annealed HTPLA proved this material's capability of sustaining repeated heat cycles due to its crystallization properties. Both of these proved that the sterilization procedures do not compromise the reliability of the part, nor the safety of the procedure. Therefore, prototypes made with a similar process as this proposal could be safely used in actual surgery practices, while nylon performed poorly because of its hygroscopic properties.

Keywords: 3D engineering , Cutting guide , FDM , HTPLA , Nylon FDM , Preoperative planning , Sterilization

This experimental study defines the usage of a computer-aided surgical simulation process that is effective, safe, user-friendly, and low-cost, that achieves a detailed and realistic representation of the anatomical region of interest. The chosen tools for this purpose are state-of-the-art Computer Aided Design (CAD) software for mechanical design, and are the fundamental application dedicated to parametric modeling. These tools support different work environments, each one is for a specific type of modeling, and they allow the simulation of surgery. The result will be a faithful representation of the anatomical part both before and after the surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, then he will communicate them to the engineer who, consequently, will correct the antisymmetric issue and regenerate the model. Exact measurements of the mutual positions of the various components, skeletal and synthetic, can be achieved; all the osteosynthesis tools, necessary for the surgeon, can be included in the project according to different types of fracture to perfectly match the morphology of the bone to be treated. The method has been tested on seven clinical cases of different complexity and nature and the results of the simulations have been found to be of great effectiveness in the phase of diagnosis and of preoperative planning for the doctors and surgeons; therefore, allowing a lower risk medical operation with a better outcome. This work delivers experimental results in line with theoretical research findings in detail; moreover, full experimental and/or methodical details are provided, so that outcomes could be obtained.

Keywords: 3D processing , CAD-aided , Customized surgery , Pediatric orthopedics , Preoperative planning , Surgical simulation

This work aims to present the application of mechanical modeling software in three dimensions in the medical field, analyzing the procedures used by the engineer to support the orthopedic surgeon in preoperative planning. The first step of the procedure involves CT examinations in patients selected for surgery: DICOM images are managed in post-processing to obtain multiplanar reconstructions of the bone lesion to be treated. The files are then optimized, made shareable and imported into CREO's work platform; this is part of a family of CAD software products for mechanical design, developed by PTC, and is the fundamental application dedicated to parametric modeling. The result will be a faithful representation of the anatomical part both before and after surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, than he will communicate them to the engineer who, consequently, will correct and regenerate the model. The method finds its power in the dialogue between engineer and doctor: In complex cases closer collaboration is needed while, for the evaluation of less demanding injuries, the exam could be assigned as a remote project which, once completed, is returned to the medical facility of competence.

Keywords: 3D modeling , Computer aided , Parametric software , Preoperative planning , Surgical simulation

Artificial Intelligence (AI) algorithms, together with a general increased computational performance, allow nowadays exploring the use of Facial Expression Recognition (FER) as a method of recognizing human emotion through the use of neural networks. The interest in facial emotion and expression recognition in real-life situations is one of the current cutting-edge research challenges. In this context, the creation of an ecologically valid facial expression database is crucial. To this aim, a controlled experiment has been designed, in which thirty-five subjects aged 18–35 were asked to react spontaneously to a set of 48 validated images from two affective databases, IAPS and GAPED. According to the Self-Assessment Manikin, participants were asked to rate images on a 9-points visual scale on valence and arousal. Furthermore, they were asked to select one of the six Ekman's basic emotions. During the experiment, an RGB-D camera was also used to record spontaneous facial expressions aroused in participants storing both the color and the depth frames to feed a Convolutional Neural Network (CNN) to perform FER. In every case, the prevalent emotion pointed out in the questionnaires matched with the expected emotion. CNN obtained a recognition rate of 75.02%, computed comparing the neural network results with the evaluations given by a human observer. These preliminary results have confirmed that this experimental setting is an effective starting point for building an ecologically valid database.

Keywords: 3D facial database , Affective database , Basic emotions , Ecologically-valid data , Facial expression recognition , Human-robot interaction

User eXperience (UX) gains more and more importance due to technological complexity, task specialization, widening of users range, etc. All of this become particularly true in medical contexts, where affordance, empathy with devices, natural interaction, dialogue reliability, real time response, etc., can make the difference for completely successful surgical activities. The PIRG - Product Innovation Research Group and the Clinic of Maxillo-facial Surgery of the University of Udine worked together for investigating about the UX during maxillo-facial surgery planning and implementation. The goal was double-faced: analyze the UX in order to highlight possible needs for improvements and test the evaluation process in terms of tools and activities performed. The outcome consists of suggestions to improve the UX and of a review of the evaluation process.

Keywords: Heuristic evaluation , Maxillo-facial surgery , User eXperience (UX)

This work shows a preoperative simulation procedure with Computer Aided Design (CAD) 3D software for a patient suffering from Ollier's disease. This pathology is very rare and occurs in extremely different ways depending on the case. Consequently, it is difficult to establish a correct surgical strategy that can be applied in a similar way to all patients. Computer Aided Surgical Simulation (CASS) process uses advanced modeling technologies to reproduce bony anatomy and simulate the surgery. The starting point is represented by the 3D digital model of the bone obtained from tomographic images. Through CAD modeling software such as Creo Parametric and following surgeons directives, engineers can provide doctors with orthopedic simulation and expectation of achievable surgical outcome. If virtual surgical prediction doesn't meet doctors requirements, model is regenerated and it is possible to seek for a better solution. CASS process allow for extensive surgical planning, enhancing accuracy in theatre and enriching the amount of medical information that is needed to perform complex orthopedic procedures. In conclusion, the possibility to recognize in advance the overall orthopedic situation and outcoming expectancy represent an extraordinary upgrade of current surgical state of the art, leading to minimally invasive surgeries and patient-specific solutions.

Keywords: 3D modeling , CAD , CASS , Parametric software , Preoperative planning

Autologous ear reconstruction is the preferred treatment in case of partial or total absence of the patient external ear. This kind of surgery can be really challenging since precise replication of complex three-dimensional structure of the ear is crucial to provide the patients with aesthetically consistent reconstructed anatomy. Therefore, the results strongly depends on the “artistic skills” of the surgeon who is in charge to carry out a three-dimensional sculpture, which resembles the shape of a normal ear. In this context, the definition of a preoperative planning and simulation process based on the patient's specific anatomy may help the surgeon in speeding up the ear reconstruction process and, at the same time, to obtain better results, thus allowing a superior surgical outcome. In the present work the main required features for performing an effective simulation of the ear reconstruction are identified and a strategy for their interactive design and customization is devised with the perspective of a semi-automatization of the procedure. In detail, the paper provides a framework which start from the acquisition of 3D data from both a healthy ear of the patient (or, if not available e.g. due to bilateral microtia of the ear of one of his parents or from a template) and of costal cartilage. Acquired 3D data are properly processed to define the anatomical elements of the ear and to find, using nesting-based algorithms, the costal cartilage portions to be used for carving the ear itself. Finally, 3D printing is used to create a mockup of the ear elements and a prototype of the ear to be reconstructed is created. Validated on a test case, the devised procedure demonstrate its effectiveness.

Keywords: Additive manufacturing , Autologous ear reconstruction , Microtia , Preoperative planning , Reverse engineering

The increasing availability of 3D anatomical models obtained from diagnostic images exploiting Reverse Engineering techniques allows the application of statistical analysis in the quantitative investigation of anatomical shapes variability. Statistical Shape Models are a well-established method for representing such variability, especially for complex forms like the anatomical ones. Not by chance, these models are widely used for medical applications, such as guiding segmentation of the diagnostic image and virtual reconstruction of incomplete anatomic region. The application of a statistical analysis on a set of shapes representing the same anatomical region essentially requires that shapes must be in correspondence, i.e. constituted by the same number of points in corresponding position. This work aims to compare two established algorithms, namely a modified version of the Iterative Closest Point and the non-rigid version of the Coherent Point Drift, to solve the correspondences' problem in the construction of a Statistical Shape Model of the human cranium. The comparison is carried out on the models using the standard evaluation criteria: Generalization, Specificity and Compactness. The modified version of the Iterative Closest Point delivers a better Statistical Shape Model in terms of Generalization and Specificity, but not for Compactness, than the Coherent Point Drift-based model.

Keywords: Computer-Aided Technologies , Correspondences' problem , Reverse Engineering , Statistical Shape Analysis , Statistical Shape Model

Disruptive 3D technologies, such as reverse engineering (RE) and additive manufacturing (AM), when applied in the medical field enable the development of new methods for personalized and non-invasive treatments. When referring to the monitoring of pectus excavatum, one of the most common thoracic malformations, 3D acquisition of the patient chest proved to be a straightforward method for assessing and measuring chest deformation. Unfortunately, such systems are usually available in a dedicated facility, can be operated only by specialized doctors with the support of engineers and can be used only with patients on site. It is therefore impossible to perform any routine check-up when the patient is unable to reach the outpatient clinic. The COVID19 pandemic situation has placed even greater restrictions on patient mobility, worsening this problem. To deal with this issue, a new low-cost portable optical scanner for monitoring pectus excavatum is proposed in this work. The scanner, named Thor 2.0, allows a remote diagnostic approach, offering the possibility to perform routine check-ups telematically. Usability tests confirmed the user-friendly nature of the devised system. The instrument was used at the Meyer Children's Hospital (Florence, Italy) chest-malformations center to treat PE patients. The performed measurements proved to be in line with the current state of the art.

Keywords: Handheld scanner , Intel RealSense , Optical chest index , Pectus excavatum , Telemedicine , Usability test , Vacuum bell

The growing interest in the auricular anatomy is due to two different strands of research: 1) in the medical field it is associated with autologous ear reconstruction, a surgery adopted following trauma or congenital malformations; 2) in surveillance and law enforcement the ear is used for human detection and recognition. Alternative systems of ear analysis can be differentiated for the type of input data (two-dimensional, three-dimensional or both), for the type of acquisition tools (3D scanner, photographs, video surveillance, etc.) and finally for the adopted algorithms. Although the segmentation and recognition of the ear from the face is a widely discussed topic in literature, the detection and recognition of individual anatomical elements has not yet been studied in depth. To this end, this work lays the foundation for the identification of the auricular elements through image processing algorithms. The proposed algorithm automatically identifies the contours of the main anatomical elements by processing depth map images. The algorithm was tested qualitatively and quantitatively on a dataset composed of 150 ears. The qualitative evaluation was performed with the collaboration of medical staff and the quantitative tests were performed using manually annotated ground truth data.

Keywords: Depth map , Ear biometrics , Ear dataset , Ear reconstruction , Ear segmentation , Microtia

The major breakthroughs in the fields of reverse engineering and additive manufacturing have dramatically changed medical practice in recent years, pushing for a modern clinical model in which each patient is considered unique. Among the wide spectrum of medical applications, reconstructive surgery is experiencing the most benefits from this new paradigm. In this scenario, the present paper focuses on the design and development of a tool able to support the surgeon in the reconstruction of the external ear in case of malformation or total absence of the anatomy. In particular, the paper describes an appositely devised software tool, named G-ear, which enables the semi-automatic modeling of intraoperative devices to guide the physician through ear reconstruction surgery. The devised system includes 3D image segmentation, semi-automated CAD modelling and 3D printing to manufacture a set of patient-specific surgical guides for ear reconstruction. Usability tests were carried out among the surgeons of the Meyer Children's Hospital to obtain an assessment of the software by the end user. The devised system proved to be fast and efficient in retrieving the optimal 3D geometry of the surgical guides and, at the same time, to be easy to use and intuitive, thus achieving high degrees of likability.

The advantages of additive manufactured scaffolds, as custom-shaped structures with a completely interconnected and accessible pore network from the micro- to the macroscale, are nowadays well established in tissue engineering. Pore volume and architecture can be designed in a controlled fashion, resulting in a modulation of scaffold's mechanical properties and in an optimal nutrient perfusion determinant for cell survival. However, the success of an engineered tissue architecture is often linked to its surface properties as well. The aim of this study was to create a family of polymeric pastes comprised of poly(ethylene oxide therephthalate)/poly(butylene terephthalate) (PEOT/PBT) microspheres and of a second biocompatible polymeric phase acting as a binder. By combining microspheres with additive manufacturing technologies, we produced 3D scaffolds possessing a tailorable surface roughness, which resulted in improved cell adhesion and increased metabolic activity. Furthermore, these scaffolds may offer the potential to act as drug delivery systems to steer tissue regeneration.

Keywords: additive manufacturing , mechanical analysis , mesenchymal stem cells , microparticles , polymers , tissue engineering

The concept of magnetic guidance has opened a wide range of perspectives in the field of tissue regeneration. Accordingly, the aim of the current research is to design magnetic responsive scaffolds for enhanced bone tissue regeneration. Specifically, magnetic nanocomposite scaffolds are additively manufactured using 3D fibre deposition technique. The mechanical and magnetic properties of the fabricated scaffolds are first assessed. The role of magnetic features on the biological performances is properly analyzed.

Keywords: bone tissue engineering , design for additive manufacturing , magnetic nanocomposite scaffolds , mechanical and functional properties

Patients with severe facial deformities present serious dysfunctionalities along with an unsatisfactory aesthetic facial appearance. Several methods have been proposed to specifically plan the interventions on the patient's needs, but none of these seem to achieve a sufficient level of accuracy in predicting the resulting facial appearance. In this context, a deep knowledge of what occurs in the face after bony movements in specific surgeries would give the possibility to develop more reliable systems. This study aims to propose a novel 3D approach for the evaluation of soft tissue zygomatic modifications after zygomatic osteotomy; geometrical descriptors usually involved in face analysis tasks, i.e., face recognition and facial expression recognition, are here applied to soft tissue malar region to detect changes in surface shape. As ground truth for zygomatic changes, a zygomatic openness angular measure is adopted. The results show a high sensibility of geometrical descriptors in detecting shape modification of the facial surface, outperforming the results obtained from the angular evaluation.

Keywords: 3D face analysis , Geometrical descriptors , Malar augmentation , Orthognathic surgery , Soft tissue prediction , Zygomatic osteotomy

Background: The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery. Materials and methods: From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes. Results: Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr – Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR). Conclusion: The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.

Keywords: Malar augmentation , Orthognatic surgery , Zygomatic osteotomy

Statement of problem: New polyvinyl siloxane (PVS) materials with enhanced properties have been developed to improve and facilitate implant impression techniques. However, studies on their accuracy are lacking. Purpose: The purpose of this in vitro study was to determine the accuracy and precision of implant impressions made with some recently introduced materials on a simulated patient requiring an all-on-4 implant-supported prosthesis. Well-established polyether materials were also evaluated as a comparison. The variables considered were material type, consistency, splinting or not splinting techniques, and implant angulation. Material and methods: A reference master model was made by inserting 4 implants at angles of 0, 5, and 10 degrees. Eighty impressions were made at 37 °C in wet conditions by using a standardized technique. Eight groups (n=10) were created using monophasic, single-viscosity materials (Hydrorise Implant Medium, HIM-ns; Hydrorise Implant Medium, HIM; Honigum Mono, HM; Impregum, IMP), and 2-viscosity materials (Hydrorise Implant Heavy+Light-ns, HIH+L-ns; Hydrorise Implant Heavy+Light, HIH+L; Honigum Heavy+Light, HH+L; and Permadyne and Garant [Heavy+Light, PeH+L]). Hydrorise materials were used with splinting and not splinting (ns) techniques. The reference points located on the connecting platforms of the transfer copings (TCP) were compared with the same points on the implant connecting platforms (ICP) located in the reference model. The accuracy and precision of the impressions were determined as linear 3D errors and standard deviation between each TCP-ICP couple by using an optical coordinate measuring machine (OCMM). Results: PVS materials were generally better than polyether materials, with Hydrorise materials (HIM and HIH+L) showing significantly better accuracy and precision (30.9 ±14.4 μm and 28.7 ±15.5 μm, respectively) than IMP and PeH+L polyethers (44.2 ±16 μm and 43.8 ±17.6 μm, respectively; P<.001). Honigum materials were statistically similar to Hydrorise materials (P=.765). The values shown by Hydrorise nonsplinted groups (HIH+L-ns and HIM-ns) were not statistically different from those of the splinted polyether impressions (P=.386). The viscosities (monophasic or heavy+light) had no effect on accuracy, but monophasic material positively influenced precision (HIM and HIH+L, P=.001). No correlation was found between implant angulation and accuracy (multilevel analysis and Kendall rank correlation coefficient=-0.065; P=.133). Conclusions: Recently introduced materials designed for implant impressions showed significantly higher accuracy and precision; even with the unfavorable nonsplinting technique, the new materials performed similarly to, or better than, polyether materials. Although the transfer coping splinting technique generally improved the accuracy and precision of Hydrorise materials, the effect was significant only within HIH+L groups.

The conventional camera-based systems and electronic gloves for gesture recognition are limited by the influence of lighting conditions, occlusions, and movement restrictions. A wearable smart band with integrated nanocomposite pressure sensors has been developed to overcome these shortcomings. The sensors consist of homogeneously dispersed carbon nanotubes in a polydimethylsiloxane polymer matrix prepared by an optimized synthesis process. The sensor band can actively monitor contractions/relaxations of muscles in the arm due to the sensor's high sensitivity in the low forces and stability. The band has eight sensors placed on a stretchable adhesive textile material and connected to a data logger with a multiplexed sensor interface and wireless communication capabilities. The novel smart band was validated by measurements on ten subjects to perform numerical gestures in American sign language from 0 to 9 with ten trials each. The data were recorded at 100 Hz, and a total of 100 datasets were generated for each subject. By feeding the datasets to an extreme machine learning algorithm that selects features, weights, and biases to classify the gestures, an overall gesture recognition accuracy of 93% could be achieved.

Keywords: American sign language , gesture recognition , polymer carbon nanocomposite (PCN) pressure sensors , Sensor applications , wearable smart band

The cooling of a melt corresponding to the eutectic between wollastonite (CaSiO3) and diopside (CaMgSi2O6) determines the synthesis of an interesting example of alkali-free bioactive glass, easily converted into glass-ceramics featuring two silicate phases, coupled also with åkermanite (Ca2MgSi2O7), by sinter-crystallization of fine glass powders at 1000°C. The fabrication of scaffolds by digital light processing of glass powders suspended in a photo-curable, sacrificial binder, is a well-established technique; the present paper aims at disclosing novel approaches, concerning the topology of scaffolds, offering components with remarkable strength, especially in bending conditions. As an alternative, glass-ceramic foams were fabricated by the firing of porous precursors derived from the gelation of suspensions of glass powders in alkali-free basic aqueous solution.

Keywords: additive manufacturing , alkali-free bioactive glasses , bioactive glass-ceramics , gel casting , scaffolds , sinter-crystallization

Additive manufacturing technologies, compared to conventional shaping methods, offer great opportunities in design versatility, for the manufacturing of highly porous ceramic components. However, the application to glass powders, later subjected to viscous flow sintering, involves significant challenges, especially in shape retention and in the achievement of a substantial degree of translucency in the final products. The present paper disclosed the potential of glass recovered from liquid crystal displays (LCD) for the manufacturing of highly porous scaffolds by direct ink writing and masked stereolithography of fine powders mixed with suitable organic additives, and sintered at 950◦C, for 1–1.5 h, in air. The specific glass, featuring a relatively high transition temperature (Tg~700◦C), allowed for the complete burn-out of organics before viscous flow sintering could take place; in addition, translucency was favored by the successful removal of porosity in the struts and by the resistance of the used glass to crystallization.

Keywords: Additive manufacturing , Direct ink writing , Glass recycling , LCD glass , Scaffolds

The miniscrew-assisted rapid palatal expansion approach has given new opportu-nities for the treatment of maxilla transverse deficiency by providing an alternative to the surgical approach for adult patients. However, the presence of a thin palatal bone can compromise the success of such approach. Recently, the digital planning of the miniscrew-assisted appliances has offered unique advantages in terms of safety and accuracy of the overall process. The aim of this study is to describe the digital planning and MSE fabrication with cad-cam technology using 6 mini-screws in cases with a palatal bone thickness of less than 2.5 mm.

Keywords: Digital orthodontics , MARPE , Maxillary transverse deficiency , MSE , Palatal expansion