Using information literacy to teach medical entrepreneurship and health care economics.

OBJECTIVE: Entrepreneurship and innovative product design in health care requires expertise in finding and evaluating diverse types of information from a multitude of sources to accomplish a number of tasks, such as securing regulatory approval, developing a reimbursement strategy, and navigating intellectual property. The authors sought to determine whether an intensive, specialized information literacy training program that introduced undergraduate biomedical engineering students to these concepts would improve the quality of the students' design projects. We also sought to test whether information literacy training that included active learning exercises would offer increased benefits over training delivered via lectures and if this specialized information literacy training would increase the extent of students' information use. METHODS: A three-arm cohort study was conducted with a control group and two experimental groups. Mixed methods assessment, including a rubric and citation analysis, was used to evaluate program outcomes by examining authentic artifacts of student learning. RESULTS: Student design teams that received information literacy training on topics related to medical entrepreneurship and health care economics showed significantly improved performance on aspects of project performance relevant to health care economics over student design teams that did not receive this training. There were no significant differences between teams that engaged in active learning exercises and those that only received training via lectures. Also, there were no significant differences in citation patterns between student teams that did or did not receive specialized information literacy training. CONCLUSIONS: Information literacy training can be used as a method for introducing undergraduate health sciences students to the health care economics aspects of the medical entrepreneurship life cycle, including the US Food and Drug Administration regulatory environment, intellectual property, and medical billing and reimbursement structures.

Development of a surrogate biomodel for the investigation of clubfoot bracing.

Congenital talipes equinovarus (clubfoot) is a complex deformity of the lower extremity and foot occurring in 1/1000 live births. Regardless of treatment, whether conservative or surgical, clubfoot has a stubborn tendency to relapse, thus requiring postcorrection bracing. However, to date, there are no investigations specifically focused on clubfoot bracing from a bioengineering perspective. This study applied engineering principles to clubfoot bracing through construction of a surrogate biomodel. The surrogate was developed to represent an average 5-year-old human subject capable of biomechanical characteristics including joint articulation and kinematics. The components include skeleton, articulating joints, muscle-tendon systems, and ligaments. A protocol was developed to measure muscle-tendon tension in resting and braced positions of the surrogate. Measurement error ranged from 1% to 6% and was considered variance due to brace and investigator. In conclusion, this study shows that surrogate biomodeling is an accurate and repeatable method to investigate clubfoot bracing. The methodology is an effective means to evaluate wide ranging brace options and can be used to assist in future brace development and the tuning of brace parameters. Such patient-specific brace tuning may also lead to advanced braces that increase compliance.

Biomedical Engineering Professional Skills Development: The RADxSM Tech Impact on Graduates and Faculty.

There are many benefits of the RADxSM Tech initiative worth exploring beyond that of the current acceleration of diagnostic tests being developed and deployed to the nation. One of those benefits has been the impact on work readiness for recent biomedical engineering (BME) graduates who have been hired by RADx Tech as Assistant Project Facilitators (APFs) and to the students and faculty members on applicant teams. This paper includes a literature review of the current status of BME professional skills development in traditional academic and clinical settings. The organizational structure of RADx Tech teams is described, including how recent BME graduates are integral to the process. Opportunities are discussed on how the RADx Tech structural model can be leveraged to improve professional skills education. It is concluded that the RADx Tech organizational structure and process including APFs may be replicable. Further research is planned to explore its impact.

An observer study evaluating dual-plane circular-orbit cone-beam brain SPECT.

UNLABELLED: Dual-plane circular-orbit cone-beam (DPCB) SPECT uses a pair of dissimilar cone-beam collimators to expand the axial field of view for brain SPECT. We applied observer study methodology to evaluate the improvement in detection of small defects in brain perfusion provided by DPCB SPECT, compared with conventional parallel-beam imaging. We also evaluated the effect of changing the radius of rotation on DPCB imaging. METHODS: Images were realistically simulated using a brain phantom. High-count Monte Carlo simulations were performed for 4 imaging configurations: low-energy high-resolution parallel-beam imaging at a radius of rotation of 18 cm and DPCB imaging (52-cm focal length) at radii of rotation of 20, 24, and 28 cm. These distances corresponded to those required for our camera to clear the shoulders of a patient in the 5th, 50th, and 95th percentiles of shoulder width. Perfusion defects of approximately 1.8-cm diameter were simulated at 4 locations in the brain. Poisson noise was simulated, and images were reconstructed to create a set of 200 images for each of the 4 configurations. All reconstructions used ordered-subset expectation maximization with attenuation modeling. Eight observers viewed images on which the possible location of the defect was marked. The observers were trained using 384 images, were tested using 416 images, and rated on a continuous scale their confidence about the presence of a defect. RESULTS: Using a paired t test for the estimated areas under the receiver operating characteristic (ROC) curve for each observer, we found that all 3 DPCB configurations resulted in higher areas under the ROC curve than did the parallel-beam configuration. Further, area under the ROC curve for the DPCB configurations improved with decreasing radius of rotation. All comparisons were significant at P < 0.05, except for DPCB 20 cm to DPCB 24 cm (P = 0.089). CONCLUSION: Use of a dual-plane cone beam is feasible for brain SPECT and better detects small perfusion defects than does a parallel beam, despite the possibility that the radius of rotation will need to be increased significantly to clear the patient's shoulders. A dual-plane cone beam should be used with the shortest radius of rotation possible to maximize the detectability of small perfusion defects.

A Monte Carlo investigation of dual-planar circular-orbit cone-beam SPECT.

We use Monte Carlo simulations to study the imaging properties of a design for a dual-planar cone-beam (DPCB) single-photon emission computed tomography (SPECT) system. A dual-planar system uses a dual-camera SPECT system and two cone-beam collimators with foci in different axial planes to increase the effective axial field of view (FOV). We simulated nearly noise-free projection data from a computerized brain phantom and a phantom consisting of a series of points. Four configurations were simulated: parallel-beam low-energy high-resolution (LEHR) as a standard for comparison and DPCB at three radii of rotation (ROR) corresponding to the smallest, average and largest ROR required to clear patients' shoulders based on ergonomic data. We compared global measures of average resolution and total acquired counts for the four configurations. We also estimated local spatial frequency response for reconstructions of point sources. Finally, we estimated a local noise power spectrum by simulating 1000 noise realizations of the brain phantom and estimating a local noise covariance at selected points. The noise power spectra were used to estimate spectral signal to noise ratio (SNR) for each configuration. The resolution in the reconstructed image space ranges from 7.2 mm full-width at half-maximum (FWHM) at the minimum ROR to 9.4 mm FWHM at the maximum ROR. The efficiency is inversely related, ranging from 1.5 times that of parallel LEHR at minimum ROR to 2.5 times that of LEHR at maximum ROR. Estimates of system frequency response roughly correspond to the global resolution estimates, but the cone-beam techniques exhibit an unusual secondary peak in the axial-direction response. Estimates of spectral SNR show that the cone-beam configurations almost always result in higher SNR at all spatial frequencies regardless of ROR. The very largest ROR may be an exception. A larger ROR results in significantly higher SNR for low spatial frequencies with small reductions in SNR for mid-range frequencies. We conclude that the DPCB design allows significant improvements in both resolution and noise as compared to conventional parallel designs and that optimizing the ROR for the cone-beam system may improve the performance of certain imaging tasks.