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Wu L, Lu K. Experimental investigation of a new type of driving concept for capsule robot. INTEL SERV ROBOT 2022. [DOI: 10.1007/s11370-022-00443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2
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Garg N, Sinha D, Yadav B, Gupta B, Gupta S, Miah S. ML-Based Texture and Wavelet Features Extraction Technique to Predict Gastric Mesothelioma Cancer. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1012684. [PMID: 35832854 PMCID: PMC9273447 DOI: 10.1155/2022/1012684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Abstract
Microsatellites are small, repetitive sequences found all across the human genome. Microsatellite instability is the phenomenon of variations in the length of microsatellites induced by the insertion or deletion of repeat units in tumor tissue (MSI). MSI-type stomach malignancy has distinct genetic phenotypes and clinic pathological characteristics, and the stability of microsatellites influences whether or not patients with gastric mesothelioma react to immunotherapy. As a result, determining MSI status prior to surgery is critical for developing treatment options for individuals with gastric cancer. Traditional MSI detection approaches need immunological histochemistry and genetic analysis, which adds to the expense and makes it difficult to apply to every patient in clinical practice. In this study, to predict the MSI status of gastric cancer patients, researchers used image feature extraction technology and a machine learning algorithm to evaluate high-resolution histopathology pictures of patients. 279 cases of raw data were obtained from the TCGA database, 442 samples were obtained after preprocessing and upsampling, and 445 quantitative image features, including first-order statistics of impressions, texture features, and wavelet features, were extracted from the histopathological images of each sample. To filter the characteristics and provide a prediction label (risk score) for MSI status of gastric cancer, Lasso regression was utilized. The predictive label's classification performance was evaluated using a logistic classification model, which was then coupled with the clinical data of each patient to create a customized nomogram for MSI status prediction using multivariate analysis.
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Affiliation(s)
- Neeraj Garg
- Department of Computer Science and Engineering, Maharaja Agrasen Institute of Technology, Delhi, India
| | | | - Babita Yadav
- School of Engineering and Technology, MVN University, India
| | - Bhoomi Gupta
- Department of Information Technology, Maharaja Agrasen Institute of Technology, Delhi, India
| | - Sachin Gupta
- School of Engineering and Technology, MVN University, India
| | - Shahajan Miah
- Department of EEE, Bangladesh University of Business and Technology (BUBT), Dhaka, Bangladesh
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3
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Haier J, Schaefers J. Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups. Cancers (Basel) 2022; 14:cancers14133158. [PMID: 35804928 PMCID: PMC9265013 DOI: 10.3390/cancers14133158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care. Abstract Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.
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4
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Ma G, Zuo S, Liu J. Design of Low-Cost Endoscope Based on Novel Wire-Driven Rotary Valve and Water-Jet Mechanism. J Med Device 2021. [DOI: 10.1115/1.4052304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
To improve the prevalence of screening for gastric cancer in low-income areas, a low-cost endoscope based on a novel wire-driven rotary valve and water-jet mechanism is proposed. The primary component of this endoscope is a rotary valve whose core is driven by a stepper motor through a flexible wire, which controls the direction of the water jet. This enables it to reach any point in the workspace by controlling the valve core angle and water-jet intensity. The envelope surface of the endoscope tip trajectory is likely a hemisphere. The horizontal diameter of the working space projection is approximately 350 mm, which is sufficient to observe most parts of the greater curvature of the stomach. The image-acquisition performance of the designed endoscope was satisfactory in a phantom experiment. The introduction of the novel rotary valve greatly simplifies the structure and reduces the cost of the proposed endoscope. With low cost and high portability, this endoscope provides a good alternative for early gastric cancer screening in low- and middle-income areas.
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Affiliation(s)
- Guoyu Ma
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin 300072, China
| | - Siyang Zuo
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin 300072, China
| | - Jianbin Liu
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin University, Tianjin 300072, China
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Eeloscope—Towards a Novel Endoscopic System Enabling Digital Aircraft Fuel Tank Maintenance. AEROSPACE 2021. [DOI: 10.3390/aerospace8050136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this research article, a novel endoscopic system, which is suited to perform a digital inspection of the aircraft wing fuel tanks, is introduced. The aim of this work is to specifically design and develop an assisting system, called `Eeloscope’, to allow accessing and diving through an aircraft kerosene tank in a minimally invasive matter. Currently, mechanics often suffer from the harsh working environment and the arduous maintenance duties within the tank. To address such challenges and derive a tailored solution, an adapted Design Thinking (DT) process is applied. The resulting system enables a fully digital inspection and generation of 3-dimensional structural inspection data. Consequently, devices such as the Eeloscope will facilitate a more efficient and continuous inspection of fuel tanks to increase the transparency regarding the condition of hardly accessible aircraft structures and provide a work relief for mechanics at the same time.
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Novel Clinical Applications and Technical Developments in Video Capsule Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:399-412. [PMID: 33743934 DOI: 10.1016/j.giec.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Video capsule endoscopy is entering its third decade. After slow acceptance, it has become the gold standard in diagnosing small intestinal disorders. This article summarizes new practical applications for capsule endoscopy outside the small intestine. From 2 randomized controlled trials, it is becoming clear that it has a role in the management of patients with hematemesis and nonhematemesis bleeding. Under active investigation are novel applications of capsule technology, including the potential ability to sample luminal contents or tissue, self-propelled capsules, incorporation of other imaging techniques beyond white light, such as ultrasound and fluorescents, and the possibility of drug delivery.
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Liu J, Yin L, Chandler JH, Chen X, Valdastri P, Zuo S. A dual‐bending endoscope with shape‐lockable hydraulic actuation and water‐jet propulsion for gastrointestinal tract screening. Int J Med Robot 2020; 17:1-13. [DOI: 10.1002/rcs.2197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Jianbin Liu
- Key Laboratory of Mechanism Theory and Equipment Design Ministry of Education Tianjin University Tianjin China
| | - Linkun Yin
- Key Laboratory of Mechanism Theory and Equipment Design Ministry of Education Tianjin University Tianjin China
| | - James H. Chandler
- Institute of Robotics, Autonomous Systems and Sensing School of Electronic and Electrical Engineering University of Leeds Leeds UK
| | - Xin Chen
- Tianjin Medical University General Hospital Tianjin China
| | - Pietro Valdastri
- Institute of Robotics, Autonomous Systems and Sensing School of Electronic and Electrical Engineering University of Leeds Leeds UK
| | - Siyang Zuo
- Key Laboratory of Mechanism Theory and Equipment Design Ministry of Education Tianjin University Tianjin China
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Hydro-jet propelled colonoscopy: proof of concept in a phantom colon. Surg Endosc 2020; 35:989-995. [PMID: 33090315 PMCID: PMC7819862 DOI: 10.1007/s00464-020-08089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/03/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Colonoscopy is a widely used and effective procedure, but it often causes patient discomfort and its execution requires considerable skill and training. We demonstrate an alternative approach to colonoscope propulsion with the potential to minimise patient discomfort by reducing the forces exerted on the colonic wall and mesentery, and to reduce the level of skill required for execution. METHODS A prototype colonoscopic device is described, consisting of a tethered capsule that is propelled and manoeuvred through a water-filled colon (hydro-colonoscopy) by an array of water jets. As an initial proof of concept, experiments were performed to assess the ability of the device to navigate through a simplified PVA cryogel human colon phantom arranged in various anatomical configurations. RESULTS The prototype was capable of successfully navigating through three out of four colon configurations: a simple layout, alpha loop and reverse alpha loop. It was unable to negotiate the fourth configuration involving an "N loop", but this was attributed to problems with the colon phantom. In the successful test replicates, mean complete insertion (i.e. caecal intubation) time was 4.7 min. Measured pressures, temperatures and forces exerted on the colon appeared to be within a physiologically acceptable range. The results demonstrate the viability of propelling a colonoscope through a colon phantom using hydro-jets. CONCLUSIONS Results indicate that this approach has the potential to enable rapid and safe caecal intubation. This suggests that further development towards clinical translation is worthwhile.
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Campisano F, Remirez AA, Landewee CA, Caló S, Obstein KL, Webster RJ, Valdastri P. Teleoperation and Contact Detection of a Waterjet-Actuated Soft Continuum Manipulator for Low-Cost Gastroscopy. IEEE Robot Autom Lett 2020; 5:6427-6434. [PMID: 39156224 PMCID: PMC11328976 DOI: 10.1109/lra.2020.3013900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Gastric cancer is the third leading cause of cancer deaths worldwide, with most new cases occurring in low and middle income countries, where access to screening programs is hindered by the high cost of conventional endoscopy. The waterjet-actuated HydroJet endoscopic platform was developed as a low-cost, disposable alternative for inspection of the gastric cavity in low-resource settings. In this work, we present a teleoperation scheme and contact detection algorithm that work together to enable intuitive teleoperation of the HydroJet within the confined space of the stomach. Using a geometrically accurate stomach model and realistic anatomical inspection targets, we demonstrate that, using these methods, a novice user can complete a gastroscopy in approximately the same amount of time with the HydroJet as with a conventional endoscope.
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Affiliation(s)
- Federico Campisano
- Science and Technology of Robotics in Medicine (STORM) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Andria A Remirez
- Medical Engineering and Discovery (MED) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Claire A Landewee
- Science and Technology of Robotics in Medicine (STORM) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Simone Caló
- Science and Technology of Robotics in Medicine (STORM) Laboratory UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Keith L Obstein
- Science and Technology of Robotics in Medicine (STORM) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Webster
- Medical Engineering and Discovery (MED) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Pietro Valdastri
- Science and Technology of Robotics in Medicine (STORM) Laboratory UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
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Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies. Cancers (Basel) 2020; 12:cancers12102775. [PMID: 32998213 PMCID: PMC7600666 DOI: 10.3390/cancers12102775] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary With the rapid advancements of medical technologies and patients’ higher expectations for precision diagnostic and surgical outcomes, gastroscopy has been increasingly adopted for the detection and treatment of pathologies in the upper digestive tract. Correspondingly, robotic gastroscopes with advanced functionalities, e.g., disposable, dextrous and not invasive solutions, have been developed in the last years. This article extensively reviews these novel devices and describes their functionalities and performance. In addition, the implementation of artificial intelligence technology into robotic gastroscopes, combined with remote telehealth endoscopy services, are discussed. The aim of this paper is to provide a clear and comprehensive view of contemporary robotic gastroscopes and ancillary technologies to support medical practitioners in their future clinical practice but also to inspire and drive new engineering developments. Abstract Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor–patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists’ and nurses’ burnouts, limited human and/or material resources, and patients’ preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.
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11
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Verra M, Firrincieli A, Chiurazzi M, Mariani A, Lo Secco G, Forcignanò E, Koulaouzidis A, Menciassi A, Dario P, Ciuti G, Arezzo A. Robotic-Assisted Colonoscopy Platform with a Magnetically-Actuated Soft-Tethered Capsule. Cancers (Basel) 2020; 12:E2485. [PMID: 32887238 PMCID: PMC7565775 DOI: 10.3390/cancers12092485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Aims: Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide. Despite offering a prime paradigm for screening, CRC screening is often hampered by invasiveness. Endoo is a potentially painless colonoscopy method with an active locomotion tethered capsule offering diagnostic and therapeutic capabilities. Materials and Methods: The Endoo system comprises a soft-tethered capsule, which embeds a permanent magnet controlled by an external robot equipped with a second permanent magnet. Capsule navigation is achieved via closed-loop interaction between the two magnets. Ex-vivo tests were conducted by endoscopy experts and trainees to evaluate the basic key features, usability, and compliance in comparison with conventional colonoscopy (CC) in feasibility and pilot studies. Results: Endoo showed a 100% success rate in operating channel and target approach tests. Progression of the capsule was feasible and repeatable. The magnetic link was lost an average of 1.28 times per complete procedure but was restored in 100% of cases. The peak value of interaction forces was higher in the CC group than the Endoo group (4.12N vs. 1.17N). The cumulative interaction forces over time were higher in the CC group than the Endoo group between the splenic flexure and mid-transverse colon (16.53Ns vs. 1.67Ns, p < 0.001), as well as between the hepatic flexure and cecum (28.77Ns vs. 2.47Ns, p = 0.005). The polyp detection rates were comparable between groups (9.1 ± 0.9% vs. 8.7 ± 0.9%, CC and Endoo respectively, per procedure). Robotic colonoscopies were completed in 67% of the procedures performed with Endoo (53% experts and 100% trainees). Conclusions: Endoo allows smoother navigation than CC and possesses comparable features. Although further research is needed, magnetic capsule colonoscopy demonstrated promising results compared to CC.
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Affiliation(s)
- Mauro Verra
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy; (M.V.); (G.L.S.); (E.F.)
| | - Andrea Firrincieli
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Andrea Mariani
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Giacomo Lo Secco
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy; (M.V.); (G.L.S.); (E.F.)
| | - Edoardo Forcignanò
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy; (M.V.); (G.L.S.); (E.F.)
| | | | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.F.); (M.C.); (A.M.); (A.M.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy; (M.V.); (G.L.S.); (E.F.)
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da Veiga T, Chandler JH, Lloyd P, Pittiglio G, Wilkinson NJ, Hoshiar AK, Harris RA, Valdastri P. Challenges of continuum robots in clinical context: a review. ACTA ACUST UNITED AC 2020. [DOI: 10.1088/2516-1091/ab9f41] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Alami H, Rivard L, Lehoux P, Hoffman SJ, Cadeddu SBM, Savoldelli M, Samri MA, Ag Ahmed MA, Fleet R, Fortin JP. Artificial intelligence in health care: laying the Foundation for Responsible, sustainable, and inclusive innovation in low- and middle-income countries. Global Health 2020; 16:52. [PMID: 32580741 PMCID: PMC7315549 DOI: 10.1186/s12992-020-00584-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
The World Health Organization and other institutions are considering Artificial Intelligence (AI) as a technology that can potentially address some health system gaps, especially the reduction of global health inequalities in low- and middle-income countries (LMICs). However, because most AI-based health applications are developed and implemented in high-income countries, their use in LMICs contexts is recent and there is a lack of robust local evaluations to guide decision-making in low-resource settings. After discussing the potential benefits as well as the risks and challenges raised by AI-based health care, we propose five building blocks to guide the development and implementation of more responsible, sustainable, and inclusive AI health care technologies in LMICs.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Lysanne Rivard
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Pascale Lehoux
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Steven J. Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts USA
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, Université de Montréal, Montreal, Quebec Canada
- Faculty of Law, Université de Montréal, Montreal, Quebec Canada
| | | | - Mamane Abdoulaye Samri
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
| | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, Quebec Canada
| | - Richard Fleet
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, Quebec Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec Canada
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Calò S, Chandler JH, Campisano F, Obstein KL, Valdastri P. A Compression Valve for Sanitary Control of Fluid-Driven Actuators. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2020; 25:1005-1015. [PMID: 32355440 PMCID: PMC7192551 DOI: 10.1109/tmech.2019.2960308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With significant research focused on integrating robotics into medical devices, sanitary control of pressurizing fluids in a precise, accurate and customizable way is highly desirable. Current sanitary flow control methods include pinch valves which clamp the pressure line locally to restrict fluid flow; resulting in damage and variable flow characteristics over time. This paper presents a sanitary compression valve based on an eccentric clamping mechanism. The proposed valve distributes clamping forces over a larger area, thereby reducing the plastic deformation and associated influence on flow characteristic. Using the proposed valve, significant reductions in plastic deformation (up to 96%) and flow-rate error (up to 98%) were found, when compared with a standard pinch valve. Additionally, an optimization strategy presents a method for improving linearity and resolution over the working range to suit specific control applications. The valve efficacy has been evaluated through controlled testing of a water jet propelled low-cost endoscopic device. In this case, use of the optimized valve shows a reduction in the average orientation error and its variation, resulting in smoother movement of the endoscopic tip when compared to alternative wet and dry valve solutions. The presented valve offers a customizable solution for sanitary control of fluid driven actuators.
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Affiliation(s)
- Simone Calò
- STORM Lab UK (Science and Technology of Robotics in Medicine), School of Electronic and Electrical Engineering, University of Leeds, LS2 9JT, Leeds, UK
| | - James H Chandler
- STORM Lab UK (Science and Technology of Robotics in Medicine), School of Electronic and Electrical Engineering, University of Leeds, LS2 9JT, Leeds, UK
| | - Federico Campisano
- STORM Lab USA (Science and Technology of Robotics in Medicine), Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Keith L Obstein
- STORM Lab USA (Science and Technology of Robotics in Medicine), Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Pietro Valdastri
- STORM Lab UK (Science and Technology of Robotics in Medicine), School of Electronic and Electrical Engineering, University of Leeds, LS2 9JT, Leeds, UK
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Mahmood S, Schurr MO, Schostek S. Predictive Tilt Compensation for Robot Assisted Magnetic Capsule Endoscope. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3697-3702. [PMID: 31946678 DOI: 10.1109/embc.2019.8857294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Wireless capsule endoscopes provide a painless and non-invasive alternative to the flexible endoscope in various applications of the gastrointestinal tract diagnosis. Operating a wireless capsule endoscope in the colon may benefit from an active position control as the large colon diameter can lead to uncontrollable and unpredictable capsule trajectory. Robot assisted magnetic steering is an attractive technique that is being explored by researchers worldwide. This paper presents the implications of a novel capsule geometry to markedly improve capsule stabilization and locomotion compared to the cylinder-based capsule geometry that is commonly used.
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Yin L, Wang S, Zuo S. Water-jet outer sheath with braided shape memory polymer tubes for upper gastrointestinal tract screening. Int J Med Robot 2018; 14:e1944. [PMID: 30105839 DOI: 10.1002/rcs.1944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Flexible endoscopes have become an important tool for the diagnosis and treatment of gastric cancer. However, there are several limitations to the use of endoscopes in rural areas, including their high cost, poor portability, and unstable platform. METHODS This paper presents a novel low-cost outer sheath for stomach screening. The sheath uses braided shape memory polymer (SMP) tubes with a water-jet to control the stiffness and bending motion. The insertion part of the prototype is 250 mm long with a maximum outer diameter of 16 mm and incorporates an internal charge-coupled device camera. RESULTS We have tested the workspace and stiffness of the outer sheath. The prototype has also been validated with phantom and ex vivo porcine stomach experiments. CONCLUSIONS By controlling the water-jet and temperature of the braided SMP tubes, the outer sheath achieves a large workspace and a remarkable variability in stiffness, demonstrating the potential clinical value of the outer sheath system.
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Affiliation(s)
- Linkun Yin
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Shuxin Wang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Siyang Zuo
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
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17
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Guo J, Li B. The Application of Medical Artificial Intelligence Technology in Rural Areas of Developing Countries. Health Equity 2018; 2:174-181. [PMID: 30283865 PMCID: PMC6110188 DOI: 10.1089/heq.2018.0037] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Artificial intelligence (AI) is a rapidly developing computer technology that has begun to be widely used in the medical field to improve the professional level and efficiency of clinical work, in addition to avoiding medical errors. In developing countries, the inequality between urban and rural health services is a serious problem, of which the shortage of qualified healthcare providers is the major cause of the unavailability and low quality of healthcare in rural areas. Some studies have shown that the application of computer-assisted or AI medical techniques could improve healthcare outcomes in rural areas of developing countries. Therefore, the development of suitable medical AI technology for rural areas is worth discussing and probing. Methods: This article reviews and discusses the literature concerning the prospects of medical AI technology, the inequity of healthcare, and the application of computer-assisted or AI medical techniques in rural areas of developing countries. Results: Medical AI technology not only could improve physicians' efficiency and quality of medical services, but other health workers could also be trained to use this technique to compensate for the lack of physicians, thereby improving the availability of healthcare access and medical service quality. This article proposes a multilevel medical AI service network, including a frontline medical AI system (basic level), regional medical AI support centers (middle levels), and a national medical AI development center (top level). Conclusion: The promotion of medical AI technology in rural areas of developing countries might be one means of alleviating the inequality between urban and rural health services. The establishment of a multilevel medical AI service network system may be a solution.
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Affiliation(s)
- Jonathan Guo
- Department of Social Medicine, Washington Institute for Health Sciences, Arlington, Virginia
| | - Bin Li
- Department of Social Medicine, Washington Institute for Health Sciences, Arlington, Virginia
- Department of Neurosciences, Georgetown University Medical Center, Washington, District of Columbia
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18
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da Silva RE, Amato AA, Andrade DDBC, Leite e Silva AV, de Carvalho MR, Novaes MRCG. Research Priorities and Resource Allocation in the Investigation of New Drugs for Cancer in Least Developed Countries. JOURNAL OF ONCOLOGY 2018; 2018:8092702. [PMID: 30057606 PMCID: PMC6051037 DOI: 10.1155/2018/8092702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 12/14/2022]
Abstract
Cancer incidence has increased significantly in low- and middle-income countries. The priorities of international health research are not always aligned with the global burden of cancer. This study aims to analyze global tendencies in clinical trials in oncology and discuss research priorities and resource allocation in the investigation of new drugs for cancers that significantly affect the least developed countries. This was a retrospective and analytical study that included data collected from the World Health Organization's International Clinical Trials Registry Platform (ICTRP) in 2014. According to our results, there was a tendency for clinical trials involving breast and lung cancer to be conducted in countries with a lower level of economic development. On the other hand, cervical, stomach, and liver cancer, despite the significant burden that these place on middle- and low-income countries, were studied little among the countries selected. In conclusion, the organizations that most fund research to develop new drugs for cancer treatment continue to show little interest in prioritizing resources to fund research for certain types of cancer such as those of the cervix, stomach, and liver, which have a significant impact in low- and middle-income countries.
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Affiliation(s)
- Ricardo Eccard da Silva
- Office of Clinical Trials, Brazilian Health Regulatory Agency (ANVISA), Setor de Indústria Trecho 5, Área Especial 57, 71205-050, Brasília, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
| | - Angélica Amorim Amato
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
| | | | - Alessandra Vanessa Leite e Silva
- Hospital de Base, Secretary of Health, Government of the Federal District, SMHS, Quadra 101, Área Especial, s/n, Asa Sul, 70330-150, Brasília, Brazil
| | - Marta Rodrigues de Carvalho
- School of Medicine, Health Science Education and Research Foundation (FEPECS), SMHN Quadra 03, Conjunto A, Bloco 1, Edifício FEPECS, 70.710-907 Brasília, Brazil
| | - Maria Rita Carvalho Garbi Novaes
- Faculty of Health Sciences, University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, Brazil
- School of Medicine, Health Science Education and Research Foundation (FEPECS), SMHN Quadra 03, Conjunto A, Bloco 1, Edifício FEPECS, 70.710-907 Brasília, Brazil
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19
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Shamsudhin N, Zverev VI, Keller H, Pane S, Egolf PW, Nelson BJ, Tishin AM. Magnetically guided capsule endoscopy. Med Phys 2017; 44:e91-e111. [PMID: 28437000 DOI: 10.1002/mp.12299] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/22/2017] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
Wireless capsule endoscopy (WCE) is a powerful tool for medical screening and diagnosis, where a small capsule is swallowed and moved by means of natural peristalsis and gravity through the human gastrointestinal (GI) tract. The camera-integrated capsule allows for visualization of the small intestine, a region which was previously inaccessible to classical flexible endoscopy. As a diagnostic tool, it allows to localize the sources of bleedings in the middle part of the gastrointestinal tract and to identify diseases, such as inflammatory bowel disease (Crohn's disease), polyposis syndrome, and tumors. The screening and diagnostic efficacy of the WCE, especially in the stomach region, is hampered by a variety of technical challenges like the lack of active capsular position and orientation control. Therapeutic functionality is absent in most commercial capsules, due to constraints in capsular volume and energy storage. The possibility of using body-exogenous magnetic fields to guide, orient, power, and operate the capsule and its mechanisms has led to increasing research in Magnetically Guided Capsule Endoscopy (MGCE). This work shortly reviews the history and state-of-art in WCE technology. It highlights the magnetic technologies for advancing diagnostic and therapeutic functionalities of WCE. Not restricting itself to the GI tract, the review further investigates the technological developments in magnetically guided microrobots that can navigate through the various air- and fluid-filled lumina and cavities in the body for minimally invasive medicine.
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Affiliation(s)
- Naveen Shamsudhin
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Vladimir I Zverev
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Henrik Keller
- KUKA Roboter GmbH, Zugspitzstrasse 140, Augsburg, 86165, Germany
| | - Salvador Pane
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Peter W Egolf
- Institute of Thermal Sciences and Engineering, University of Applied Sciences of Western Switzerland, Yverdon-les-Bains, CH 1401, Switzerland
| | - Bradley J Nelson
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Alexander M Tishin
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia.,Pharmag LLC, Promyshlennaya st 4, Troitsk, Moscow, 142190, Russia
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20
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Campisano F, Gramuglia F, Dawson IR, Lyne CT, Izmaylov ML, Misra S, De Momi E, Morgan DR, Obstein KL, Valdastri P. Gastric Cancer Screening in Low?-Income Countries: System Design, Fabrication, and Analysis for an Ultralow-Cost Endoscopy Procedure. IEEE ROBOTICS & AUTOMATION MAGAZINE 2017; 24:73-81. [PMID: 28959118 PMCID: PMC5613747 DOI: 10.1109/mra.2017.2673852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Federico Campisano
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Francesco Gramuglia
- Dept. of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20100, Italy
| | - Imro R Dawson
- Surgical Robotics Lab, Dept. of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Christopher T Lyne
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Michelle L Izmaylov
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Sarthak Misra
- Surgical Robotics Lab, Dept. of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Elena De Momi
- Dept. of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20100, Italy
| | - Douglas R Morgan
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Keith L Obstein
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Pietro Valdastri
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
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21
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Ciuti G, Caliò R, Camboni D, Neri L, Bianchi F, Arezzo A, Koulaouzidis A, Schostek S, Stoyanov D, Oddo CM, Magnani B, Menciassi A, Morino M, Schurr MO, Dario P. Frontiers of robotic endoscopic capsules: a review. JOURNAL OF MICRO-BIO ROBOTICS 2016; 11:1-18. [PMID: 29082124 PMCID: PMC5646258 DOI: 10.1007/s12213-016-0087-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - R Caliò
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - D Camboni
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - L Neri
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy.,Ekymed S.r.l., Livorno, Italy
| | - F Bianchi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - A Arezzo
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - A Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | | | - D Stoyanov
- Centre for Medical Image Computing and the Department of Computer Science, University College London, London, UK
| | - C M Oddo
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | | | - A Menciassi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - M Morino
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - M O Schurr
- Ovesco Endoscopy AG, Tübingen, Germany.,Steinbeis University Berlin, Berlin, Germany
| | - P Dario
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
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22
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Ching HL, Hale MF, McAlindon ME. Current and future role of magnetically assisted gastric capsule endoscopy in the upper gastrointestinal tract. Therap Adv Gastroenterol 2016; 9:313-21. [PMID: 27134661 PMCID: PMC4830104 DOI: 10.1177/1756283x16633052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Capsule endoscopy first captivated the medical world when it provided a means to visualize the small bowel, which was previously out of endoscopic reach. In the subsequent decade and a half we continue to learn of the true potential that capsule endoscopy has to offer. Of particular current interest is whether capsule endoscopy has any reliable investigative role in the upper gastrointestinal tract. Much research has already been dedicated to enhancing the diagnostic and indeed therapeutic properties of capsule endoscopy. Specific modifications to tackle the challenges of the gut have already been described in the current literature. In the upper gastrointestinal tract, the capacious anatomy of the stomach represents one of many challenges that capsule endoscopy must overcome. One solution to improving diagnostic yield is to utilize external magnetic steering of a magnetically receptive capsule endoscope. Notionally this would provide a navigation system to direct the capsule to different areas of the stomach and allow complete gastric mucosal examination. To date, several studies have presented promising data to support the feasibility of this endeavour. However the jury is still out as to whether this system will surpass conventional gastroscopy, which remains the gold standard diagnostic tool in the foregut. Nevertheless, a minimally invasive and patient-friendly alternative to gastroscopy remains irresistibly appealing, warranting further studies to test the potential of magnetically assisted capsule endoscopy. In this article the authors would like to share the current state of magnetically assisted capsule endoscopy and anticipate what is yet to come.
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Affiliation(s)
| | - Melissa Fay Hale
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Mark Edward McAlindon
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
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