Extended Reality Technologies, Medical Robotics Solutions, and Deep Learning in Translational Medicine

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomedical Engineering and Biomaterials".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 10426

Special Issue Editor


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Guest Editor
Department of Information Engineering, University of Pisa, 56122 Pisa, Italy
Interests: augmented reality; computer vision; surgical navigation; surgical simulation; optical tracking; electromagnetic tracking; multimodal tracking; VR/AR/MR technology in medicine; visual perception; human-machine interfaces
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Special Issue Information

Dear Colleagues,

In translational medicine, extended reality, wearable sensing, medical robotics, and artificial intelligence solutions aim to provide new diagnostic and treatment tools through a multi-disciplinary and "bench-to-bedside" approach. The overarching ambition is to seamlessly enrich the perceptive efficiency of the healthcare practitioner through contextually blended computer-generated elements obtained by pre-operative and intra-operative medical imaging, and by processing wearable sensors data. Particularly, augmented reality technology has proven to be a key asset for the development of new image-guided surgery paradigms devoted to improving the accuracy, efficiency, and reproducibility of the surgical act. In addition, augmented reality allows the implementation of efficient user interfaces for surgical simulators capable of providing precise metrics for the evaluation of trainee performance. The joint exploitation of wearable sensing, deep learning, medical robotics, and computer vision solutions is bound to leverage the implementation of new healthcare devices. The purpose of this Special Issue is therefore to connect researchers in these new technologies for the implementation of translational medicine solutions, to share their ideas, and to discuss the recent advances in these research fields.

Dr. Fabrizio Cutolo
Guest Editor

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Keywords

  • extended reality interfaces for surgical navigation and surgical training
  • extended reality interfaces for translational medicine
  • computer vision solutions for healthcare
  • smart sensors for image-guided surgery
  • visual and multimodal tracking algorithms in translational medicine
  • wearable-friendly human-computer interaction solutions in healthcare

Published Papers (6 papers)

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Research

13 pages, 1887 KiB  
Article
Effect of 3-Dimensional Robotic Therapy Combined with Electromyography-Triggered Neuromuscular Electrical Stimulation on Upper Limb Function and Cerebral Cortex Activation in Stroke Patients: A Randomized Controlled Trial
by Seo-Won Yang, Sung-Ryong Ma and Jong-Bae Choi
Bioengineering 2024, 11(1), 12; https://doi.org/10.3390/bioengineering11010012 - 22 Dec 2023
Viewed by 859
Abstract
(1) Background: This study investigated the effect of 3-dimensional robotic therapy (RT) combined with electromyography-triggered neuromuscular electrical stimulation (RT–ENMES) on stroke patients’ upper-limb function and cerebral cortex activation. (2) Methods: Sixty-one stroke patients were assigned randomly to one of three groups. The stroke [...] Read more.
(1) Background: This study investigated the effect of 3-dimensional robotic therapy (RT) combined with electromyography-triggered neuromuscular electrical stimulation (RT–ENMES) on stroke patients’ upper-limb function and cerebral cortex activation. (2) Methods: Sixty-one stroke patients were assigned randomly to one of three groups. The stroke patients were in the subacute stage between 2 and 6 months after onset. The three groups received 20 min of RT and 20 min of electromyography-triggered neuromuscular electrical stimulation (ENMES) in the RT–ENMES group (n = 21), 40 min of RT in the RT group (n = 20), and 40 min of ENMES in the ENMES group (n = 20). The treatments were for 40 min, 5 days per week, and for 8 weeks. Upper-extremity function was evaluated using the Fugl–Meyer assessment for upper extremity (FMA-UE), Wolf motor function test, and action research arm test (ARAT); cerebral cortex activation and motor-evoked potential (MEP) amplitude were evaluated before and after the study. (3) Results: The analysis showed significant changes in all evaluation items for all three groups in the before-and-after comparisons. Significant changes were observed in the FMA-UE, ARAT, and MEP; in the posttest, the RT–ENMES group showed more significant changes in the FMA-UE, ARAT, and MEP than the other two groups. (4) Conclusions: The study analysis suggests that RT–ENMES effectively improves upper-limb function and cerebral cortex activation in patients with stroke. Full article
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17 pages, 4373 KiB  
Article
Implementation of a Virtual Reality Based Digital-Twin Robotic Minimally Invasive Surgery Simulator
by Xiaoyu Cai, Zijun Wang, Shijie Li, Junjun Pan, Chengli Li and Yonghang Tai
Bioengineering 2023, 10(11), 1302; https://doi.org/10.3390/bioengineering10111302 - 9 Nov 2023
Viewed by 1431
Abstract
The rapid development of computers and robots has seen robotic minimally invasive surgery (RMIS) gradually enter the public’s vision. RMIS can effectively eliminate the hand vibrations of surgeons and further reduce wounds and bleeding. However, suitable RMIS and virtual reality-based digital-twin surgery trainers [...] Read more.
The rapid development of computers and robots has seen robotic minimally invasive surgery (RMIS) gradually enter the public’s vision. RMIS can effectively eliminate the hand vibrations of surgeons and further reduce wounds and bleeding. However, suitable RMIS and virtual reality-based digital-twin surgery trainers are still in the early stages of development. Extensive training is required for surgeons to adapt to different operating modes compared to traditional MIS. A virtual-reality-based digital-twin robotic minimally invasive surgery (VRDT-RMIS) simulator was developed in this study, and its effectiveness was introduced. Twenty-five volunteers were divided into two groups for the experiment, the Expert Group and the Novice Group. The use of the VRDT-RMIS simulator for face, content, and structural validation training, including the peg transfer module and the soft tissue cutting module, was evaluated. Through subjective and objective evaluations, the potential roles of vision and haptics in robot surgery training were explored. The simulator can effectively distinguish surgical skill proficiency between experts and novices. Full article
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14 pages, 3225 KiB  
Article
Evaluation of Augmented Reality Surgical Navigation in Percutaneous Endoscopic Lumbar Discectomy: Clinical Study
by Xin Huang, Xiaoguang Liu, Bin Zhu, Xiangyu Hou, Bao Hai, Shuiqing Li, Dongfang Yu, Wenhao Zheng, Ranyang Li, Junjun Pan, Youjie Yao, Zailin Dai and Haijun Zeng
Bioengineering 2023, 10(11), 1297; https://doi.org/10.3390/bioengineering10111297 - 9 Nov 2023
Cited by 2 | Viewed by 1041
Abstract
Background: The puncture procedure in percutaneous endoscopic lumbar discectomy (PELD) is non-visual, and the learning curve for PELD is steep. Methods: An augmented reality surgical navigation (ARSN) system was designed and utilized in PELD. The system possesses three core functionalities: augmented reality (AR) [...] Read more.
Background: The puncture procedure in percutaneous endoscopic lumbar discectomy (PELD) is non-visual, and the learning curve for PELD is steep. Methods: An augmented reality surgical navigation (ARSN) system was designed and utilized in PELD. The system possesses three core functionalities: augmented reality (AR) radiograph overlay, AR puncture needle real-time tracking, and AR navigation. We conducted a prospective randomized controlled trial to evaluate its feasibility and effectiveness. A total of 20 patients with lumbar disc herniation treated with PELD were analyzed. Of these, 10 patients were treated with the guidance of ARSN (ARSN group). The remaining 10 patients were treated using C-arm fluoroscopy guidance (control group). Results: The AR radiographs and AR puncture needle were successfully superimposed on the intraoperative videos. The anteroposterior and lateral AR tracking distance errors were 1.55 ± 0.17 mm and 1.78 ± 0.21 mm. The ARSN group exhibited a significant reduction in both the number of puncture attempts (2.0 ± 0.4 vs. 6.9 ± 0.5, p = 0.000) and the number of fluoroscopies (10.6 ± 0.9 vs. 18.5 ± 1.6, p = 0.000) compared with the control group. Complications were not observed in either group. Conclusions: The results indicate that the clinical application of the ARSN system in PELD is effective and feasible. Full article
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26 pages, 6862 KiB  
Article
A Novel Registration Method for a Mixed Reality Navigation System Based on a Laser Crosshair Simulator: A Technical Note
by Ziyu Qi, Miriam H. A. Bopp, Christopher Nimsky, Xiaolei Chen, Xinghua Xu, Qun Wang, Zhichao Gan, Shiyu Zhang, Jingyue Wang, Haitao Jin and Jiashu Zhang
Bioengineering 2023, 10(11), 1290; https://doi.org/10.3390/bioengineering10111290 - 7 Nov 2023
Cited by 1 | Viewed by 1411
Abstract
Mixed Reality Navigation (MRN) is pivotal in augmented reality-assisted intelligent neurosurgical interventions. However, existing MRN registration methods face challenges in concurrently achieving low user dependency, high accuracy, and clinical applicability. This study proposes and evaluates a novel registration method based on a laser [...] Read more.
Mixed Reality Navigation (MRN) is pivotal in augmented reality-assisted intelligent neurosurgical interventions. However, existing MRN registration methods face challenges in concurrently achieving low user dependency, high accuracy, and clinical applicability. This study proposes and evaluates a novel registration method based on a laser crosshair simulator, evaluating its feasibility and accuracy. A novel registration method employing a laser crosshair simulator was introduced, designed to replicate the scanner frame’s position on the patient. The system autonomously calculates the transformation, mapping coordinates from the tracking space to the reference image space. A mathematical model and workflow for registration were designed, and a Universal Windows Platform (UWP) application was developed on HoloLens-2. Finally, a head phantom was used to measure the system’s target registration error (TRE). The proposed method was successfully implemented, obviating the need for user interactions with virtual objects during the registration process. Regarding accuracy, the average deviation was 3.7 ± 1.7 mm. This method shows encouraging results in efficiency and intuitiveness and marks a valuable advancement in low-cost, easy-to-use MRN systems. The potential for enhancing accuracy and adaptability in intervention procedures positions this approach as promising for improving surgical outcomes. Full article
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17 pages, 3924 KiB  
Article
Overground Robotic Gait Trainer mTPAD Improves Gait Symmetry and Weight Bearing in Stroke Survivors
by Danielle Marie Stramel, Lauren Winterbottom, Joel Stein and Sunil K. Agrawal
Bioengineering 2023, 10(6), 698; https://doi.org/10.3390/bioengineering10060698 - 8 Jun 2023
Cited by 2 | Viewed by 1708
Abstract
Stroke is a leading cause of disability, impairing the ability to generate propulsive forces and causing significant lateral gait asymmetry. We aim to improve stroke survivors’ gaits by promoting weight-bearing during affected limb stance. External forces can encourage this; e.g., vertical forces can [...] Read more.
Stroke is a leading cause of disability, impairing the ability to generate propulsive forces and causing significant lateral gait asymmetry. We aim to improve stroke survivors’ gaits by promoting weight-bearing during affected limb stance. External forces can encourage this; e.g., vertical forces can augment the gravitational force requiring higher ground reaction forces, or lateral forces can shift the center of mass over the stance foot, altering the lateral placement of the center of pressure. With our novel design of a mobile Tethered Pelvic Assist Device (mTPAD) paired with the DeepSole system to predict the user’s gait cycle percentage, we demonstrate how to apply three-dimensional forces on the pelvis without lower limb constraints. This work is the first result in the literature that shows that with an applied lateral force during affected limb stance, the center of pressure trajectory’s lateral symmetry is significantly closer to a 0% symmetry (5.5%) than without external force applied (9.8%,p<0.05). Furthermore, the affected limb’s maximum relative pressure (p) significantly increases from 233.7p to 234.1p (p<0.05) with an applied downward force, increasing affected limb loading. This work highlights how the mTPAD increases weight-bearing and propulsive forces during gait, which is a crucial goal for stroke survivors. Full article
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13 pages, 1070 KiB  
Article
Therapeutic Effects of Robotic-Exoskeleton-Assisted Gait Rehabilitation and Predictive Factors of Significant Improvements in Stroke Patients: A Randomized Controlled Trial
by Yi-Heng Lee, Li-Wei Ko, Chiann-Yi Hsu and Yuan-Yang Cheng
Bioengineering 2023, 10(5), 585; https://doi.org/10.3390/bioengineering10050585 - 12 May 2023
Viewed by 2993
Abstract
Robotic-exoskeleton-assisted gait rehabilitation improves lower limb strength and functions in post-stroke patients. However, the predicting factors of significant improvement are unclear. We recruited 38 post-stroke hemiparetic patients whose stroke onsets were <6 months. They were randomly assigned to two groups: a control group [...] Read more.
Robotic-exoskeleton-assisted gait rehabilitation improves lower limb strength and functions in post-stroke patients. However, the predicting factors of significant improvement are unclear. We recruited 38 post-stroke hemiparetic patients whose stroke onsets were <6 months. They were randomly assigned to two groups: a control group receiving a regular rehabilitation program, and an experimental group receiving in addition a robotic exoskeletal rehabilitation component. After 4 weeks of training, both groups showed significant improvement in the strength and functions of their lower limbs, as well as health-related quality of life. However, the experimental group showed significantly better improvement in the following aspects: knee flexion torque at 60°/s, 6 min walk test distance, and the mental subdomain and the total score on a 12-item Short Form Survey (SF-12). Further logistic regression analyses showed that robotic training was the best predictor of a greater improvement in both the 6 min walk test and the total score on the SF-12. In conclusion, robotic-exoskeleton-assisted gait rehabilitation improved lower limb strength, motor performance, walking speed, and quality of life in these stroke patients. Full article
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