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PubMed1998

A system for medical consultation and education using multimodal human/machine communication.

Recent developments in networking and computing have enabled collaborative biomedical engineering research by geographically separated participants. One of the most promising goals is to use these technologies to extend human intellectual capabilities in medical decision making. These emerging technologies are poised to drastically reduce healthcare cost by providing service at remote locations. This also increases diagnosis capacity since information is made available to experts at any location. In this paper, we propose a novel application of a recently developed interactive and distributed system in medical consultation and education. Our approach builds on the notion that interactive and distributive capabilities of the system are crucial for medical consultation and education. The presented application uses a multiuser, collaborative environment with multimodal human/machine communication in the dimensions of sight, sound, and touch. The experimental setup, consisting of two user stations, and the multimodal interfaces, including sight (eye-tracking), sound (automatic speech), and touch (microbeam pen), were tested and evaluated. The system uses a collaborative workspace as a common visualization space. Users communicate with the application through a fusion agent by eye-tracking, speech, and microbeam pen. The audio/video teleconferencing is also included to help the radiologists to communicate with each other simultaneously while they are working on the mammograms. The system used in this study has three software agents: a fusion agent, a conversational agent, and an analytic agent. The fusion agent interprets multimodal commands by integrating the multimodal inputs. The conversational agent answers the user's questions and detects human-related or semantic errors and notifies the user about the results of the image analysis. The analytic agent enhances the digitized images using the wavelet denoising algorithm if requested by the user. To show how well the system performs in practice, we used the system for medical consultation on mammograms. Results also show that the relevant information about the region of interest (ROI) of the mammograms chosen by the users is extracted automatically and used to enhance the mammograms.

Education, Distance↗
PubMed2002

Sinusoidal heating method to noninvasively measure tissue perfusion.

Noninvasively measuring the tissue blood perfusion has been an important however difficult problem in the biomedical engineering field. Based on the newly developed phase-shift principle, an improved sinusoidal heating method to estimate the perfusion was proposed in this paper to replace the original heating algorithm. The phase shift between the sinusoidal heat flux and the surface temperature response was both theoretically and experimentally revealed to be a time-dependent value which however will approach a constant value after a sufficiently long time. Only using this constant phase shift can the perfusion be properly estimated. Following the theory, an instrument consisting of low-frequency sinusoidal signal generator, power amplifier, heating plate, temperature and heat flux monitoring unit, as well as the data-acquisition system was carefully constructed. It allows generating a high-quality sinusoidal heat flux whose frequency and magnitude can be easily regulated. An auxiliary heat-conducting plate was introduced to simultaneously measure the surface temperature and the heat flux, which are hard to do otherwise. Experiments on human bodies were performed and the forearm perfusion was estimated and then validated through a constant surface heating experiment. Several issues related to the instrument integration and perfusion measurement were discussed. The instrument was also tested through experiments on nonperfused materials and good results were obtained. These efforts will help to build a compact device for noninvasively measuring the human perfusion, which may have significant applications in future clinics.

Algorithms↗
PubMed2004

BCI2000: a general-purpose brain-computer interface (BCI) system.

Many laboratories have begun to develop brain-computer interface (BCI) systems that provide communication and control capabilities to people with severe motor disabilities. Further progress and realization of practical applications depends on systematic evaluations and comparisons of different brain signals, recording methods, processing algorithms, output formats, and operating protocols. However, the typical BCI system is designed specifically for one particular BCI method and is, therefore, not suited to the systematic studies that are essential for continued progress. In response to this problem, we have developed a documented general-purpose BCI research and development platform called BCI2000. BCI2000 can incorporate alone or in combination any brain signals, signal processing methods, output devices, and operating protocols. This report is intended to describe to investigators, biomedical engineers, and computer scientists the concepts that the BC12000 system is based upon and gives examples of successful BCI implementations using this system. To date, we have used BCI2000 to create BCI systems for a variety of brain signals, processing methods, and applications. The data show that these systems function well in online operation and that BCI2000 satisfies the stringent real-time requirements of BCI systems. By substantially reducing labor and cost, BCI2000 facilitates the implementation of different BCI systems and other psychophysiological experiments. It is available with full documentation and free of charge for research or educational purposes and is currently being used in a variety of studies by many research groups.

Algorithms↗
PubMed2005

Implantable cardiac pacemaker electromagnetic compatibility testing in a novel security system simulator.

This paper describes a novel simulator to perform electromagnetic compatibility (EMC) tests for active implantable medical devices (AIMDs) with electromagnetic fields emitted by security systems. The security system simulator was developed in response to over 100 incident reports over 17 years related to the interference of AIMD's with security systems and the lack of a standardized test method. The simulator was evaluated regarding field homogeneity, signal distortion, and maximum magnetic field strength levels. Small three-axis probes and a three-axis scanning system were designed to determine the spatial and temporal characteristics of the fields emitted by 12 different types of walk through metal detectors (WTMDs). Tests were performed on four implanted pacemakers with a saline phantom and correlated to a newly developed test method performed "in air" (without the phantom). Comparison of the simulator thresholds with tests performed in real WTMDs showed that the simulator is able to mimic the pacemaker interference. The interference thresholds found in the simulator indicate that pulsed magnetic fields are more likely to cause interference in pacemakers than sinusoidal fields. The security system simulator will help biomedical engineers, manufacturers of medical devices, and manufacturers of security systems to identify incompatible combinations of WTMDs and AIMDs early in the development stage.

Electromagnetic Fields↗
PubMedDate not supplied

Creating and simulating skeletal muscle from the visible human data set.

Simulation of the musculoskeletal system has important applications in biomechanics, biomedical engineering, surgery simulation, and computer graphics. The accuracy of the muscle, bone, and tendon geometry as well as the accuracy of muscle and tendon dynamic deformation are of paramount importance in all these applications. We present a framework for extracting and simulating high resolution musculoskeletal geometry from the segmented visible human data set. We simulate 30 contact/collision coupled muscles in the upper limb and describe a computationally tractable implementation using an embedded mesh framework. Muscle geometry is embedded in a nonmanifold, connectivity preserving simulation mesh molded out of a lower resolution BCC lattice containing identical, well-shaped elements, leading to a relaxed time step restriction for stability and, thus, reduced computational cost. The muscles are endowed with a transversely isotropic, quasi-incompressible constitutive model that incorporates muscle fiber fields as well as passive and active components. The simulation takes advantage of a new robust finite element technique that handles both degenerate and inverted tetrahedra.

Algorithms↗
PubMed2006

Selection of primary hip and knee arthroplasties for public hospitals in Western Australia: a clinical evidence approach.

BACKGROUND: The Australian Joint Registry records that there are approximately 84 hip stem designs, 71 acetabular designs and 45 knee systems in common use in Australia, giving the surgeon an extensive and often bewildering choices. METHODS: Since the 1990s, there have been several attempts to rationalize the supply of the products of primary hip and knee arthroplasties to the public hospitals in Western Australia. To continue and improve the rationalization process, the recently awarded 'whole of health' tender was based on a thorough clinical and laboratory evaluation process. The method included commercial analysis by Health Supply Western Australia, clinical evaluation by a committee comprised of senior surgeons and technical assessment by biomedical engineers and scientists. The evaluation process was subdivided into qualitative criteria; being the commercial aspects of the tender (50%) and a fitness for purpose assessment comprising clinically based evidence (40%) and laboratory assessment of product quality (10%). RESULT: The tendering process concluded with the recommendation of 12 hip and 5 knee systems. CONCLUSIONS: A comprehensive method primarily based on clinical evidence was used to assess arthroplasty products tendered to Western Australia public hospitals. Generally, there was good compliance with the commercial aspects of the tender. In contrast, however, clinically based evidence assessment of many arthroplasty devices was difficult because of a distinct lack of quality published work. Inadequate quality control of several devices is also of concern. Evaluation of key performance indicators, including cost savings, acceptance by surgeons, tender compliance and revision rates, will determine the success of the tender.

Arthroplasty, Replacement, Hip↗
PubMed1995

Fuzzy logic and control: principal approach and potential applications in medicine.

During the last few years intelligent machines appeared in nearly all technical areas, such as consumer electronics, robotics, and industrial control systems. There are for example washing machines that work very effectively, need comparably less power than in the past, and have short execution times because they adjust their washing cycles to each set of clothes and change their washing strategies as the clothes become clean. These intelligent systems are based on fuzzy control strategies, i.e., common sense rules are used to describe a system's behavior instead of complex mathematical models. We have applied this new technology to control problems as well as to reasoning problems in biomedical engineering where appropriate mathematical models could not be built due to the complexity of the problem. After a short introduction to the concepts of fuzzy logic two approaches in the field are described: a fuzzy control strategy for the pump rate adjustment of a novel total artificial heart and an intelligent alarm system based on fuzzy inference which supports the anesthetist in monitoring and evaluating the hemodynamic state of a patient undergoing cardiac surgery. These examples indicate the inherent reliability and stability of this technique in the field of complex dynamic systems. Such properties are highly significant especially in medical applications.

Anesthesia↗
PubMed2005

Bicycle riding and erectile dysfunction: an increase in interest (and concern).

INTRODUCTION: From 1999 to 2004, there had been 21 publications from multiple medical specialties (sexual medicine, urology, neurology, cardiology, biomedical engineering, sports medicine, emergency medicine, and officials from the National Institute for Safety and Occupational Health) investigating the relationship between bicycle riding and erectile dysfunction (ED). In the previous 18 years, there have been 14 such studies. AIM: The primary aim was to summarize accumulating data on the safety of bicycle riding based on medical evidence categorized by levels of evidence, including case reports, observational studies, case control studies, mechanistic studies, and population-based epidemiologic investigations. The secondary aim was to address the concerns of bicyclists and propose measures to minimize the risk of ED associated with bicycle riding. METHODS: An English-language medical literature review was made of publications in peer review journals from 1981 to 2004, including published abstract presentations at major medical meetings. MAIN OUTCOME MEASURE: Ranked published epidemiologic data on bicycle riding and ED. RESULTS: Bicycle riding more than 3 hours per week was an independent relative risk (RR = 1.72) for moderate to severe ED. In case control studies, the prevalence of moderate to severe ED in bicyclists was 4.2% and 4% vs. age-matched runners 1.1% (P < or = 0.018) and swimmers 2% (P = 0.05), respectively. Therefore, bicycle riders should take precautionary measures to minimize the risk of ED associated with bicycle riding: change the bicycle saddle with a protruding nose to a noseless seat, change the posture to a more upright/reclining position, change the material of the saddle (GEL), and tilt the saddle/seat downwards. CONCLUSIONS: The mechanism is hypothetically related to the rider interaction with the bicycle saddle at the perineum-saddle interface. Straddling bicycle saddles with a nose extension is associated with suprasystolic perineal compression pressures, temporarily occluding penile perfusion and potentially inducing endothelial injury and vasculogenic ED.

Attitude of Health Personnel↗
PubMed2002

Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye.

OBJECTIVE: We have recently discovered that women with primary and secondary Sjögren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the meibomian gland dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate meibomian gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjögren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to meibomian gland dysfunction and evaporative dry eye. The following studies were designed to test these predictions. METHODS: Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques. RESULTS: Our results demonstrate that: (1) androgens regulate the meibomian gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5alpha-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit meibomian glands; and (2) androgen deficiency may lead to meibomian gland dysfunction, altered lipid profiles in meibomian gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with meibomian gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor dysfunction in women with CAIS is associated with meibomian gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human meibomian gland secretions. CONCLUSIONS: Our findings show that the meibomian gland is an androgen target organ and that androgen deficiency may promote meibomian gland dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjögren's syndrome.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2002

Biological basis of hearing-aid design.

We show that we can accurately model the auditory-nerve discharge patterns in response to sounds as complex as speech and ask how we may exploit this knowledge to test new strategies for hearing-aid signal processing. We describe the auditory-nerve representations of vowels in normal and noise-damaged ears. The normal representations are predicted well by a cochlear signal processing model originally developed by Carney (Carney, L. H. J. Acoust. Soc. Am. 93:401-417, 1993). Basilar-membrane tuning is represented by a time-varying narrow-band filter. Outer hair cell control of tuning is exerted by a nonlinear feedback path. We show that the effects of noise-induced outer hair cell damage can be modeled by scaling the feedback signal appropriately and use the model to test one strategy for hearing-aid speech processing. We conclude by discussing some aspects of future trends in biomedical engineering approaches to problems of hearing impairment.

Action Potentials↗
PubMed2004

Feasibility of using orthogonal fluoroscopic images to measure in vivo joint kinematics.

Accurately determining in vivo knee kinematics is still a challenge in biomedical engineering. This paper presents an imaging technique using two orthogonal images to measure 6 degree-of-freedom (DOF) knee kinematics during weight-bearing flexion. Using this technique, orthogonal images of the knee were captured using a 3-D fluoroscope at different flexion angles during weight-bearing flexion. The two orthogonal images uniquely characterized the knee position at the specific flexion angle. A virtual fluoroscope was then created in solid modeling software and was used to reproduce the relative positions of the orthogonal images and X-ray sources of the 3-D fluoroscope during the actual imaging procedure. Two virtual cameras in the software were used to represent the X-ray sources. The 3-D computer model of the knee was then introduced into the virtual fluoroscope and was projected onto the orthogonal images by the two virtual cameras. By matching the projections of the knee model to the orthogonal images of the knee obtained during weight-bearing flexion, the knee kinematics in 6 DOF were determined. Using regularly shaped objects with known positions and orientations, this technique was shown to have an accuracy of 0.1 mm and 0.1 deg in determining the positions and orientations of the objects, respectively.

Adult↗
PubMed1993

The artificial heart: history and current status.

Twenty-years ago groups from California to Massachusetts were actively involved in the development of an artificial heart. From biomaterials development to biomedical power sources, the supporting industry and spin-off benefit was broad indeed. Young people were seeking careers in biomedical engineering and science. The National Institutes of Health was supporting artificial heart research at $10 to $12 million dollar levels. Groups at Andros, Inc. (now Baxter Novacor) and Stanford, Thoratec, Penn State and the Hershey Medical Center, Cleveland Clinic and the Division of Artificial Organs, the University of Utah, the Texas Heart Institute and the Baylor College of Medicine, Thermal Electron Corporation, and many more were the source of research and breakthrough development of pumps and systems for artificial hearts. We reported on performance criteria for an artificial heart pump at the First Biomechanics Symposium in 1973 [1]. By the beginning of the decade of the 90's, thousands of presentations had been made and manuscripts written reporting significant progress in the development of artificial heart pumps and systems. The Heart, Lung and Blood Institute of the National Institutes of Health was supporting an artificial heart contract research and development program at a level of $6 million dollars in 1991 [2]. Broad basic research grant activity also continues. The National Institutes of Health's artificial heart program received renewed support from the Institute of Medicine's special review in 1991 [3]. In December of 1992, the 16th Annual Cardiovascular Science and Technology Conference attracted over 500 attendees. This annual conference has provided a continuing forum for an update on progress in artificial heart development.

Animals↗
PubMed1993

The coronary circulation.

Dramatic advances have been made in the last two decades in the diagnosis and treatment of coronary artery disease. The development of open heart surgical techniques for bypassing occluded arteries made quantitative diagnostic techniques more important. Computer enhanced angiographic methods, together with measurements using tomography, ultrasound and magnetic resonance imaging have greatly improved the precision of the diagnosis. A more complete understanding of coronary mechanics and control has enabled physicians to better interpret the significance of geometric information and to supplement this information with functional assessment of stenosed arteries. Finally, traditional bypass surgery is now supplemented with closed-chest techniques such as balloon angioplasty. Biomedical engineers have been involved in all of these developments. This paper will review these developments and attempt to identify remaining questions.

Biomechanical Phenomena↗