Methods for medical applications

The development of new bent superconducting magnets together with the optimization of the support structure open the way to a considerable reduction in the weight and complexity of rotating gantries for medical applications. The magnets, which define the transfer line to deliver carbon ions to the patients from different angles, are supported by a rotating structure that should be as rigid and as lightweight as possible. Relative displacements of the magnets due to deformations cause incorrect beam position and consequent errors in hitting the target tissues. This paper describes a possible rotating structure which is considerably lighter than the previous designs. A method to compensate part of the deformation by complementary rotations of the driving motor is proposed. The influence of the construction tolerances and deformations of the supports is also analyzed and alignment and adjustment possibilities are discussed.

Keywords: Curved magnets , Gantry for medical applications , Ion therapy

Background and aim of the work: Implant dislocation in total hip arthroplasties (THA) is a common concern amongst the orthopedic surgeons and represents the most frequent complication after primary implant. Several causes could be responsible for the dislocation, including the malpositioning of the components. Conventional imaging techniques frequently fail to detect the mechanical source of dislocation mainly because they could not reproduce a dynamic evaluation of the components. The purpose of this study was to elaborate a diagnostic tool capable to virtually assess if the range of movement (ROM) of a THA is free from anterior and/or superior mechanical impingement. The ultimate aim is to give the surgeon the possibility to weigh the mechanical contribution in a THA dislocation. Methods: A group of patients who underwent THA revision for acute dislocation was compared to a group of non-dislocating THA. CT scans and a virtual model of each patient was obtained. A software called “Prosthesis Impingement Simulator (PIS)” was developed for simulating the (ROM) of the prosthetic hip. The ROM free of mechanical impingement was compared between the two groups. Results: The PIS test could detect the dislocations with a sensitivity of 71,4%, and a specificity of 85,7%. The Fisher's exact test showed a p-value of 0,02. Conclusion: The PIS seems to be an effective tool for the determination of hip prosthetic impingement, as the main aid of the software is the exclusion of mechanical causes in the event of a dislocation.

Keywords: Dislocation , Impingement , Range of motion , Revision surgery , Software , THA , Total hip arthroplasty

Background: Telerehabilitation represents a new cutting-edge method in the treatment of patients suffering from motor and cognitive disorders caused by stroke. Even if there exist dedicated devices able to track patients' movements to evaluate the performed rehabilitation exercises, they require specific settings necessary for a correct and simple use at the patient's home. If we consider the recent pandemic situation and the lockdown condition, which made difficult the access to these products, post stroke patients may be not able to perform home rehabilitation. Objectives: the goal of this work is the design of a specific method to develop a tele-rehabilitation platform for post-stroke patients using consumer technologies without involving ad-hoc devices. Method: Open-source tools have been investigated for speeding up the development starting with the medical knowledge. Results: a group of four healthcare technologies engineering students with no specific skills about computer science has developed a platform in four months using the design method. Conclusion: the presented method allowed the development of a clinical knowledge-based web platform for post-stroke patients totally based on consumer technology.

Keywords: Rehabilitation Research , Stroke rehabilitation , Telerehabilitation , Virtual Reality Exposure Therapy

Short bowel syndrome is a pathological condition resulting from extensive resection of the intestine, generally performed due to congenital abnormalities, Crohn's disease, mesenteric ischemia, or neoplasms. The main consequence of this syndrome is a reduction of intestinal absorp-tion, which causes malnutrition and dehydration. In the most severe cases, specific and complex surgical procedures are requested to manage the syndrome. Such procedures consist of the intestinal lengthening, with lead to an increase of absorptive mucosal surface and intestinal transit time and an overall enhancement of intestinal absorption. One of the most promising surgical procedures is spiral intestinal lengthening and tailoring, which consists of a spiral incision of the intestinal wall and in the elongation longitudinally of the intestine by sliding one flap over the other. The final intestinal lengthening is strictly dependent on a series of parameters, some of which are defined by the surgeon. The present paper proposes a mathematical model, based on patient specific anatomical data, which aims to help the surgeon in defining the optimal parameters for the intervention and in foreseeing its outcomes from the preoperative planning phase. Such a tool can assist the physician in the surgery room by improving the procedure and reducing surgical times.

Keywords: Intestinal failure , Intestinal lengthening , Pediatric , Preoperative planning , Short bowel syndrome , Surgical simulation

Liver cells cultured in 3D bioreactors is an interesting option for temporary extracorporeal liver support in the treatment of acute liver failure and for animal models for preclinical drug screening. Bioreactor capacity to eliminate drugs is generally used for assessing cell metabolic competence in different bioreactors or to scale-up bioreactor design and performance for clinical or preclinical applications. However, drug adsorption and physical transport often disguise the intrinsic drug biotransformation kinetics and cell metabolic state. In this study, we characterized the intrinsic kinetics of lidocaine elimination and adsorption by porcine liver cells cultured in 3D four-compartment hollow fiber membrane network perfusion bioreactors. Models of lidocaine transport and biotransformation were used to extract intrinsic kinetic information from response to lidocaine bolus of bioreactor versus adhesion cultures. Different from 2D adhesion cultures, cells in the bioreactors are organized in liver-like aggregates. Adsorption on bioreactor constituents significantly affected lidocaine elimination and was effectively accounted for in kinetic analysis. Lidocaine elimination and cellular monoethylglicinexylidide biotransformation featured first-order kinetics with near-to-in vivo cell-specific capacity that was retained for times suitable for clinical assist and drug screening. Different from 2D cultures, cells in the 3D bioreactors challenged with lidocaine were exposed to close-to-physiological lidocaine and monoethylglicinexylidide concentration profiles. Kinetic analysis suggests bioreactor technology feasibility for preclinical drug screening and patient assist and that drug adsorption should be accounted for to assess cell state in different cultures and when laboratory bioreactor design and performance is scaled-up to clinical use or toxicological drug screening.

Keywords: Adsorption , Bioreactor , Elimination , Kinetics , Lidocaine , Liver cells , Tissue engineering

In the current research, an optimization design strategy for additive manufacturing processes based on extrusion/injection methods was extended to the fabrication of poly(ε-caprolactone) (PCL)/iron oxide (Fe3O4) scaffolds for tissue engineering. The attention was focused on four parameters: process temperature (PT), deposition velocity (DV), screw rotation velocity (SRV), slice thickness (ST). Specifically, PCL/Fe3O4 scaffolds were manufactured varying iteratively one parameter, while maintaining constant the other three parameters. A further insight into the influence of process parameters on the morphological features and mechanical properties of PCL/Fe3O4 scaffolds was provided.

Keywords: Design for additive manufacturing , Magnetic nanocomposite scaffolds , Mechanical and morphological properties , Tissue engineering

The special issue focuses on different features related to the design of additively manufactured lattice structures for biomedical applications. In many cases, the process-structure- property relationship and technical features are discussed from a morphological, mechanical, and functional point of view. In particular, an overview of the Additive Manufacturing processes, software methods, and design criteria, which allow the direct fabrication of 3D porous structures and lattices with tailored properties, are reported. Accordingly, the current special issue aims at providing new insights into the development of advanced devices and illustrates theoretical/experimental approaches used by researchers working in the field.

Nowadays, technology in sport plays an important role to help training and judgement processes. This study proposes the use of a wearable inertial system to derive novel biomechanical indices for the assessment of performance and infringements in race-walking. These indices are built from five inertial-based parameters: loss of ground contact time, loss of ground contact step classification, step length ratio, step cadence and smoothness. The biomechanical indices are customized for elite race-walkers, and represented on a radar chart for an intuitive analysis of performance and infringements. From the radar chart, a synthetic index regarding the athlete's overall gesture is derived. The validation of the biomechanical indices is carried out in field tests, involving nine elite race-walkers wearing an inertial sensor located at the end of the column vertebra (L5–S1). A statistical analysis is used to determinate the quality and reliability of the proposed indices and of their representation. The results show that these biomechanical indices can be implemented on a wearable inertial system for assistance in training and judgement in race-walking.

Keywords: Biomechanics , Field tests , Graphical data analysis , Infringements , Performance , Race-walking , Wearable sensors

In this paper we present novel biomechanical indices for site-specific assessment of injury risk in cycling. The indices are built from a multifactorial analysis based on the kinematics and kinetics of the cyclist from the biomechanical side, and muscle excitations and muscle synergies from the neurophysiological side. The indices are specifics for three body regions (back, knee, ankle) which are strongly affected by overuse injuries in cycling. We use these indices for injury risks analysis of a recreational cyclist, who offered to participate in the experiments. The preliminary results are promising towards the use of such indices for planning and/or evaluating training schedule with the final goal of reducing non-traumatic injuries in cycling.

Keywords: biomechanics , cycling , electromyography , injury risk , laboratory test

This paper shows how studies on the biomechanics and neuroscience of human movements might be used for the design of wearable systems customized for humans. Such design is driven by key biomechanical and neuromuscular parameters extracted from accurate measurements made on the human body motion, as well as by subjective data collected from the end-users of the products through questionnaires. We present three case studies developed at ERGOS Lab: a wearable system for sports performance analysis; a synergy-based approach for industrial wearable robots; a soft wearable robotic glove for hand rehabilitation.

Keywords: Biomechanics , Design methods , Neuromuscular activity , Wearable technology

In the last two decades, osseointegrated prostheses have been shown to be a good alternative for lower limb amputees experiencing complications in using a traditional socket-type prosthesis; however, restraining biomechanical issues, such as peri-prosthetic bone fractures or loosening, are present. To better understand and overcome these limiting issues, and thus reduce the number of implant failures, many studies have investigated the stress distribution on bone and implant during normal daily activities. The aim of this study was a biomechanical analysis of two different osseointegrated implants, a screw-type (OPRA) and a press fit system (OPL, Osseointegrated Prosthetic Limb), to evaluate the stresses generated in bone and prosthesis during a fall. In particular, four scenarios have been experimentally reproduced to determine the loads on the limb during different kinds of fall. For this purpose, a motion capture system and a force plate have been used. Numerical FEM (Finite Element Method) simulations have been performed to compare the behaviour of the OPRA and OPL systems in different fall scenarios. The obtained results showed that a fall backwards due to balance loss is the most stressful scenario among the ones analysed. As regards the comparison between OPRA and OPL devices, it emerged they have similar behaviours in terms of peak values of the stress, but the OPL implant generates larger high-stress areas in the distal femur as compared with the OPRA system. © 2020 by the authors.

Keywords: CAD , Finite element analysis , OPL osseointegrated prosthesis , OPRA , Transfemoral amputee

In physical rehabilitation, motion capture solutions are well-known but not as widespread as they could be. The main limit to their diffusion is not related to cost or usability but to the fact that the data generated when tracking a person must be elaborated according to the specific context and aim. This paper proposes a solution including customized motion capture and data elaboration with the aim of supporting medical personnel in the assessment of spinal cord-injured (SCI) patients using a wheelchair. The configuration of the full-body motion capturing system is based on an asymmetric 3 Microsoft Kinect v2 sensor layout that provides a path of up to 6 m, which is required to properly track the wheelchair. Data elaboration is focused on the automatic recognition of the pushing cycles and on plotting any kinematic parameter that may be interesting in the assessment. Five movements have been considered to evaluate the wheelchair propulsion: the humeral elevation, the horizontal abduction of the humerus, the humeral rotation, the elbow flexion and the trunk extension along the sagittal plane. More than 60 volunteers with a spinal cord injury were enrolled for testing the solution. To evaluate the reliability of the data computed with SCI APPlication (APP) for the pushing cycle analysis, the patients were subdivided in four groups according to the level of the spinal cord injury (i.e., high paraplegia, low paraplegia, C7 tetraplegia and C6 tetraplegia). For each group, the average value and the standard deviation were computed and a comparison with similar acquisitions performed with a high-end solution is shown. The measurements computed by the SCI-APP show a good reliability for analyzing the movements of SCI patients' propulsion wheelchair.

Keywords: Automatic pushing analysis , Markerless motion capture , RGB-D sensors , SCI patients

Motion capture (Mocap) is applied to motor rehabilitation of patients recovering from a trauma, a surgery, or other impairing conditions. Some rehabilitation exercises are easily tracked with low-cost technologies and a simple Mocap setup, while some others are extremely hard to track because they imply small movements and require high accuracy. In these last cases, the obvious solution is to use high performing motion tracking systems, but these devices are generally too expensive in the rehabilitation context. The aim of this paper is to provide a Mocap solution suitable for any kind of exercise but still based on low-cost sensors. This result can be reached embedding some artificial intelligence (AI), in particular a convolutional neural network (CNN), to gather a better outcome from the optical acquisition. The paper provides a methodology including the way to perform patient's tracking and to elaborate the data from infra-red sensors and from the red, green, blue (RGB) cameras in order to create a user-friendly application for physiotherapists. The approach has been tested with a known complex case concerning the rehabilitation of shoulders. The proposed solution succeeded in detecting small movements and incorrect patient behavior, as for instance, a compensatory elevation of the scapula during the lateral abduction of the arm. The approach evaluated by medical personnel provided good results and encouraged its application in different kinds of rehabilitation practices as well as in different fields where low-cost Mocap could be introduced.

Keywords: Artificial intelligence , Engineering informatics , Human computer interfaces/Interactions

3D digital models of the upper limb anatomy represent the starting point for the design process of bespoke devices, such as orthoses and prostheses, which can be modeled on the actual patient's anatomy by using CAD (Computer Aided Design) tools. The ongoing research on optical scanning methodologies has allowed the development of technologies that allow the surface reconstruction of the upper limb anatomy through procedures characterized by minimum discomfort for the patient. However, the 3D optical scanning of upper limbs is a complex task that requires solving problematic aspects, such as the difficulty of keeping the hand in a stable position and the presence of artefacts due to involuntary movements. Scientific literature, indeed, investigated different approaches in this regard by either integrating commercial devices, to create customized sensor architectures, or by developing innovative 3D acquisition techniques. The present work is aimed at presenting an overview of the state of the art of optical technologies and sensor architectures for the surface acquisition of upper limb anatomies. The review analyzes the working principles at the basis of existing devices and proposes a categorization of the approaches based on handling, pre/post-processing effort, and potentialities in real-time scanning. An in-depth analysis of strengths and weaknesses of the approaches proposed by the research community is also provided to give valuable support in selecting the most appropriate solution for the specific application to be addressed.

Keywords: Body scanner , Depth cameras , Handheld scanner , Stationary scanner , Structured light scanning , Upper limb 3D scanning

Pectus Arcuatum (PA) is a congenital chest wall deformity which produces a superior manubrial and sternal protrusion, particularly at the sternal angle. PA surgical correction to reduce the angle of the sternum always includes the removal of bone portion by means of horizontal sternal osteotomies, resection of deformed rib cartilage and finally stabilization of the anterior thoracic wall. Within this process an incorrect assessment of the sternotomy angle during the procedure may lead to the need for bone or cartilage grafts to fill the left voids. This problem has been addressed with a patient-specific cutting template, realized with Reverse Engineering and Additive Manufacturing techniques, which proved to be a key element to simplify the procedure and avoid the occurrence of this type of complications. In this work is presented and validated a procedure that, through common CAD operations, realizes in a completely automatic way the CAD model of the custom cutting template, so as to make non-expert users independent in the realization of the medical device.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been recently heralded as the operations of the Century. Large improvements in mobility and patient-reported outcomes are typically observed compared with the small-to-moderate effects experienced with non-surgical interventions. Following surgery, physiotherapy-led exercise-based rehabilitation is often prescribed to yield better gait-related outcomes. Nevertheless, outpatient rehabilitation is expensive and heavily burden the national health service. When specific machines are not needed during the physiotherapy, patients, if assisted, can perform a home program. The purpose of this paper is to qualitatively investigate the applicability of a self-managed, home-based system for the automated evaluation of a home physiotherapy rehabilitation after TKA and THA. The system leverages the cost effectiveness and the versatility of a RGB-Depth camera system together with a commercial skeleton tracking system to analyse specific exercises. A novel computation of lower limb movements and related angles is proposed to evaluate the quality of the daily exercises. The laboratory experimental campaign, envisaged the analysis of the rotation angles of hips and knees; a lower limb schematic model is considered to estimate both knee and hip angles during ab/adductor and flex/extension movements. A novel real time calculation of the hip bone plane is proposed to assess the joint angles during specific exercises performance. A qualitative data analysis of each exercise has been performed. Results on the system usability in a domestic environment are reported as well as a visual comparison of the analysed output.

Keywords: 3D , Body tracking , RGB-D camera

In patients affected by craniosynostosis, i.e. a congenital cranial defect, diagnostic evaluation for a prompt surgical treatment is performed using low-dose three-dimensional computer tomography (CT), characterized by a poor spatial resolution (in terms of slice thickness). The limited number of CT images reduces the accuracy of the 3D reconstruction of the skull and leads to a coarser segmentation and modelling. In this paper, Motion Compensated Frame Interpolation (MCFI) techniques are applied for an effective axial interpolation of tomographic images sequences, with the main objective of obtaining a refined 3D reconstruction. The performance of the proposed method was assessed by using high-resolution CT sequences. After downsampling along the axial direction, the missing slices were recovered by using the proposed algorithm, to obtain an estimate of the original sequence. The experimental results show that the 3D models obtained from the downsampled/interpolated sequence are very close to those obtained from the original one thus providing a high-quality 3D skull reconstruction.

Keywords: 3D modeling , CT slices , Interpolation , Motion compensation

Histological evaluation plays a major role in cancer diagnosis and treatment. The appearance of H&E-stained images can vary significantly as a consequence of differences in several factors, such as reagents, staining conditions, preparation procedure and image acquisition system. Such potential sources of noise can all have negative effects on computer-assisted classification. To minimize such artefacts and their potentially negative effects several color pre-processing methods have been proposed in the literature—for instance, color augmentation, color constancy, color deconvolution and color transfer. Still, little work has been done to investigate the efficacy of these methods on a quantitative basis. In this paper, we evaluated the effects of color constancy, deconvolution and transfer on automated classification of H&E-stained images representing different types of cancers—specifically breast, prostate, colorectal cancer and malignant lymphoma. Our results indicate that in most cases color pre-processing does not improve the classification accuracy, especially when coupled with color-based image descriptors. Some pre-processing methods, however, can be beneficial when used with some texture-based methods like Gabor filters and Local Binary Patterns.

Keywords: Color , H&E staining , Histology images , Texture

In this paper, we investigate the role of shape and texture features from 18F-FDG PET/CT to discriminate between benign and malignant solitary pulmonary nodules. To this end, we retrospectively evaluated cross-sectional data from 111 patients (64 males, 47 females, age = 67.5 ± 11.0) all with histologically confirmed benign (n = 39) or malignant (n = 72) solitary pulmonary nodules. Eighteen three-dimensional imaging features, including conventional, texture, and shape features from PET and CT were tested for significant differences (Wilcoxon-Mann-Withney) between the benign and malignant groups. Prediction models based on different feature sets and three classification strategies (Classification Tree, k-Nearest Neighbours, and Naïve Bayes) were also evaluated to assess the potential benefit of shape and texture features compared with conventional imaging features alone. Eight features from CT and 15 from PET were significantly different between the benign and malignant groups. Adding shape and texture features increased the performance of both the CT-based and PET-based prediction models with overall accuracy gain being 3.4–11.2 pp and 2.2–10.2 pp, respectively. In conclusion, we found that shape and texture features from 18F-FDG PET/CT can lead to a better discrimination between benign and malignant lung nodules by increasing the accuracy of the prediction models by an appreciable margin.

Keywords: Radiomics , Shape , Solitary pulmonary nodule , Texture

Mapping facial skin in terms of its biophysical properties plays a fundamental role in many practical applications, including, among others, forensics, medical and beauty treatments, and cosmetic and restorative surgery. In this paper we present an in vivo evaluation of the water content, trans-epidermial water loss and skin thickness in six areas of the human face: cheeks, chin, forehead, lips, neck and nose. The experiments were performed on a population of healthy subjects through innovative sensing devices which enable fast yet accurate evaluations of the above parameters. A statistical analysis was carried out to determine significant differences between the facial areas investigated and clusters of statistically-indistinguishable areas. We found that water content was higher in the cheeks and neck and lower in the lips, whereas trans-epidermal water loss had higher values for the lips and lower ones for the neck. In terms of thickness the dermis exhibited three clusters, which, from thickest to thinnest were: chin and nose, cheek and forehead and lips and neck. The epidermis showed the same three clusters too, but with a different ordering in term of thickness. Finally, the stratum corneum presented two clusters: the thickest, formed by lips and neck, and the thinnest, formed by all the remaining areas. The results of this investigation can provide valuable guidelines for the evaluation of skin moisturisers and other cosmetic products, and can help guide choices in re-constructive/cosmetic surgery.

Keywords: Face , Skin , Skin layers , Thickness , Trans-epidermal water loss , Water content