An Observational Analysis of a Novel Digital Rectoscope.

BACKGROUND: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view. PRELIMINARY RESULTS: Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a κ of 0.225 (95% CI, 0.144-0.305) when assessing whether the target pathology was adequately visualized. IMPACT OF INNOVATION: The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, "watch and wait," and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.

Performance assessment using sensor technology.

Over the past 30 years, there have been numerous, noteworthy successes in the development, validation, and implementation of clinical skills assessments. Despite this progress, the medical profession has barely scratched the surface towards developing assessments that capture the true complexity of hands-on skills in procedural medicine. This paper highlights the development implementation and new discoveries in performance metrics when using sensor technology to assess cognitive and technical aspects of hands-on skills.

Development of a low-cost, user-customizable, high-speed camera.

High-speed imaging equipment can be an expensive investment, especially when certain applications require custom solutions. In this paper, we present a low-cost high-speed prototype camera built on a low-end Zynq-7000 System-on-Chip (SoC) platform and off-the-shelf components with the aim of removing the entry barrier into various high-speed imaging applications. The camera is standalone (does not require a host computer) and can achieve 211 frames per second (fps) at its maximum resolution of 1280x1024, and up to 2329 fps at a 256x256 resolution. With a current cost of only several hundred dollars and resource utilization of ~5%, the open-source design's modularity and customizability allows users with sufficient hardware or programming experience to modify the camera to suit their needs, potentially driving the cost lower. This can be done by utilizing the large remaining programmable logic for custom image processing algorithms, creating user interface software on the CPU, attaching extensions through the peripheral Module connections, or creating custom carrier or daughter boards. The development and design of the camera is described and a figure-of-merit is presented to provide a value assessment of some available commercial high-speed cameras against which our camera is competitive. Finally, the camera was tested to record low frequency spatial vibration and was found to be useful in investigating phenotypes associated with aging in a leading animal model, the nematode (worm) Caenorhabditis elegans.

A low-cost 2-D video system can accurately and reliably assess adaptive gait kinematics in healthy and low vision subjects.

3-D gait analysis is the gold standard but many healthcare clinics and research institutes would benefit from a system that is inexpensive and simple but just as accurate. The present study examines whether a low-cost 2-D motion capture system can accurately and reliably assess adaptive gait kinematics in subjects with central vision loss, older controls, and younger controls. Subjects were requested to walk up and step over a 10 cm high obstacle that was positioned in the middle of a 4.5 m walkway. Four trials were simultaneously recorded with the Vicon motion capture system (3-D system) and a video camera that was positioned perpendicular to the obstacle (2-D system). The kinematic parameters (crossing height, crossing velocity, foot placement, single support time) were calculated offline. Strong Pearson's correlations were found between the two systems for all parameters (average r = 0.944, all p < 0.001). Bland-Altman analysis showed that the agreement between the two systems was good in all three groups after correcting for systematic biases related to the 2-D marker positions. The test-retest reliability for both systems was high (average ICC = 0.959). These results show that a low-cost 2-D video system can reliably and accurately assess adaptive gait kinematics in healthy and low vision subjects.

A "flexible tripod" mounted video camera: An economical and effective method to record oculoplastic surgeries.

Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.

Comparison of Personal Video Technology for Teaching and Assessment of Surgical Skills.

BACKGROUND: Improvements in personal technology have made video recording for teaching and assessment of surgical skills possible. OBJECTIVE: This study compared 5 personal video-recording devices based on their utility (image quality, hardware, mounting options, and accessibility) in recording open surgical procedures. METHODS: Open procedures in a simulated setting were recorded using smartphones and tablets (MOB), laptops (LAP), sports cameras such as GoPro (SC), single-lens reflex cameras (DSLR), and spy camera glasses (SPY). Utility was rated by consensus between 2 investigators trained in observation of technology using a 5-point Likert scale (1, poor, to 5, excellent). RESULTS: A total of 150 hours of muted video were reviewed with a minimum 1 hour for each device. Image quality was good (3.8) across all devices, although this was influenced by the device-mounting requirements (4.2) and its proximity to the area of interest. Device hardware (battery life and storage capacity) was problematic for long procedures (3.8). Availability of devices was high (4.2). CONCLUSIONS: Personal video-recording technology can be used for assessment and teaching of open surgical skills. DSLR and SC provide the best images. DSLR provides the best zoom capability from an offset position, while SC can be placed closer to the operative field without impairing sterility. Laptops provide best overall utility for long procedures due to video file size. All devices require stable recording platforms (eg, bench space, dedicated mounting accessories). Head harnesses (SC, SPY) provide opportunities for "point-of-view" recordings. MOB and LAP can be used for multiple concurrent recordings.

An assessment of the utility and functionality of wearable head impact sensors in Australian Football.

OBJECTIVES: To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. DESIGNS: Laboratory tests and prospective observational study. METHODS: Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. RESULTS: Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p<0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95-100% of respondents. CONCLUSIONS: This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.

Low-Cost Stereoscopic Recordings of Neurologic Surgery Operative Microscopy for Anatomic Laboratory Training.

OBJECTIVE: Stereoscopic video recordings of operative microscopy during neuroanatomic dissections are an important component of surgical training and research in well-financed medical schools and teaching hospitals. However, the high cost of the latest operative microscopes with integrated video recording equipment can be a limiting factor in their worldwide use. The aim of the present work is to provide a simple low-cost 3-dimensional (3D) stereoscopic operative microscope recording system that can be used even in economically and resource-limited locations. This is achieved by using readily available smartphones, smartphone accessories, and computer software. METHODS: Stereoscopic recording is accomplished by attaching and aligning matched or similar smartphones to the eyepieces of an operative microscope using readily available smartphone mounting connectors. Video recordings from the smartphones are then transferred to a personal computer and processed with a video-editing software to generate stereoscopic movies that are viewed on a smartphone using virtual-reality glasses. RESULTS: The setup time to mount and align the smartphone cameras typically requires 15-30 minutes. Video image quality and 3D depth presentation is more than sufficient for surgical training and research purposes. The implementation cost ranges from $1,315-$7,066, or much less if smartphones and a computer are already available. CONCLUSIONS: The 3D video system demonstrated herein can be implemented on any type of operative microscope, including older units for which commercial stereo recording systems are not available. The system and method presented herein can be readily and affordably implemented in low-budget environments for clinical training and research.

Nonrigid reconstruction of 3D breast surfaces with a low-cost RGBD camera for surgical planning and aesthetic evaluation.

Accounting for 26% of all new cancer cases worldwide, breast cancer remains the most common form of cancer in women. Although early breast cancer has a favourable long-term prognosis, roughly a third of patients suffer from a suboptimal aesthetic outcome despite breast conserving cancer treatment. Clinical-quality 3D modelling of the breast surface therefore assumes an increasingly important role in advancing treatment planning, prediction and evaluation of breast cosmesis. Yet, existing 3D torso scanners are expensive and either infrastructure-heavy or subject to motion artefacts. In this paper we employ a single consumer-grade RGBD camera with an ICP-based registration approach to jointly align all points from a sequence of depth images non-rigidly. Subtle body deformation due to postural sway and respiration is successfully mitigated leading to a higher geometric accuracy through regularised locally affine transformations. We present results from 6 clinical cases where our method compares well with the gold standard and outperforms a previous approach. We show that our method produces better reconstructions qualitatively by visual assessment and quantitatively by consistently obtaining lower landmark error scores and yielding more accurate breast volume estimates.

Low-Cost Self-Made Arthroscopic Training Camera Is Equally as Effective as Commercial Camera: A Comparison Study.

PURPOSE: To assess the effectiveness of a low-cost self-made arthroscopic camera (LAC) in basic arthroscopic skills training compared with a commercial arthroscopic camera (CAC). METHODS: One hundred fifty-three orthopaedic residents were recruited and randomly assigned to either the LAC or CAC. They were allocated 2 practice sessions, with 20 minutes each, to practice 4 given arthroscopic tasks: task 1, transferring objects; task 2, stacking objects; task 3, probing numbers; and task 4, stretching rubber bands. The time taken for participants to complete the given tasks was recorded in 3 separate tests; before practice, immediately after practice, and after a period of 3 months. A comparison of the time taken between both groups to complete the given tasks in each test was measured as the primary outcome. RESULTS: Significant improvements in time completion were seen in the post-practice test for both groups in all given arthroscopic tasks, each with P < .001. However, there was no significant difference between the groups for task 1 (P = .743), task 2 (P = .940), task 3 (P = .932), task 4 (P = .929), and total (P = .944). The outcomes of the tests (before practice, after practice, and at 3 months) according to repeated measures analysis of variance did not differ significantly between the groups in task 1 (P = .475), task 2 (P = .558), task 3 (P = .850), task 4 (P = .965), and total (P = .865). CONCLUSIONS: The LAC is equally as effective as the CAC in basic arthroscopic skills training with the advantage of being cost-effective. CLINICAL RELEVANCE: In view of the scarcity in commercial arthroscopic devices for trainees, this low-cost device, which trainees can personally own and use, may provide a less expensive and easily available way for trainees to improve their arthroscopic skills. This might also cultivate more interest in arthroscopic surgery among junior surgeons.

Three-dimensional cameras and skeleton pose tracking for physical function assessment: A review of uses, validity, current developments and Kinect alternatives.

BACKGROUND: Three-dimensional camera systems that integrate depth assessment with traditional two-dimensional images, such as the Microsoft Kinect, Intel Realsense, StereoLabs Zed and Orbecc, hold great promise as physical function assessment tools. When combined with point cloud and skeleton pose tracking software they can be used to assess many different aspects of physical function and anatomy. These assessments have received great interest over the past decade, and will likely receive further study as the integration of depth sensing and augmented reality smartphone cameras occurs more in everyday life. RESEARCH QUESTION: The aim of this review is to discuss how these devices work, what options are available, the best methods for performing assessments and how they can be used in the future. METHODS: Firstly, a review of the Microsoft Kinect devices and associated artificial intelligence, automated skeleton tracking algorithms is provided. This includes a narrative critique of the validity and clinical utility of these devices for assessing different aspects of physical function including spatiotemporal, kinematic and inverse dynamics data derived from gait and balance trials, and anatomical assessments performed using the depth sensor information. Methods for improving the accuracy of data are examined, including multiple-camera systems and sensor fusion with inertial monitoring units, model fitting, and marker tracking. Secondly, alternative hardware, including other structured light and time of flight methods, stereoscopic cameras and augmented reality leveraging smartphone and tablet cameras to perform measurements in three-dimensional space are summarised. Software options related to depth sensing cameras are then discussed, focussing on recent advances such as OpenPose and web-based methods such as PoseNet. RESULTS AND SIGNIFICANCE: The clinical and non-laboratory utility of these devices holds great promise for physical function assessment, and recent developments could strengthen their ability to provide important and impactful health-related data.

A low-cost towed video camera system for underwater surveys: comparative performance with standard methodology.

Technological advances in the field of underwater video have led to an exponential increase in the use of drifting cameras (DC) and remotely operated vehicles (ROVs) to monitor the diversity, abundance, and size structure of marine life. Main advantages of DCs relative to ROVs are their lower costs and the much simpler logistics required to operate them. This study compares the performance of a new low-cost DC system equipped with a novel measuring device with that of a standard DC bearing an array of laser pointers. The new DC, which can be operated from a small boat, carries a pair of parallel steel "whiskers" that are dragged on the seabed within the field of view of the camera, providing a scale for measuring and estimating the density of benthic biota. An experiment conducted using an array of objects of known sizes laid on the bottom showed that its performance in terms of both size and density estimation was similar to that of the standard technique based on laser pointers. Measurement errors had a negligible negative bias (- 2.3%) and a standard deviation that ranged between 13 and 8% for objects from 25 to 110 mm in size. The whiskers offered a simplified method for density estimation that avoids the need to calculate the width of the field of view, thus reducing the video processing time by around 60% with respect to the standard method. Briefly, the new system offers an efficient low-cost alternative for benthic ecology studies conducted on soft or non-irregular bottoms.

Inexpensive, scalable camera system for tracking rats in large spaces.

Most studies of neural correlates of spatial navigation are restricted to small arenas (≤1 m2) because of the limits imposed by the recording cables. New wireless recording systems have a larger recording range. However, these neuronal recording systems lack the ability to track animals in large area, constraining the size of the arena. We developed and benchmarked an open-source, scalable multicamera tracking system based on low-cost hardware. This "Picamera system" was used in combination with a wireless recording system for characterizing neural correlates of space in environments of sizes up to 16.5 m2. The Picamera system showed substantially better temporal accuracy than a popular commercial system. An explicit comparison of one camera from the Picamera system with a camera from the commercial system showed improved accuracy in estimating spatial firing characteristics and head direction tuning of neurons. This improved temporal accuracy is crucial for accurately aligning videos from multiple cameras in large spaces and characterizing spatially modulated cells in a large environment. NEW & NOTEWORTHY Studies of neural correlates of space are limited to biologically unrealistically small spaces by neural recording and position tracking hardware. We developed a camera system capable of tracking animals in large spaces at a high temporal accuracy. Together with the new wireless recording systems, this system facilitates the study of neural correlates of space at biologically relevant scale. This increased temporal accuracy of tracking also improves the estimates of spatiotemporal correlates of neural activity.

Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections.

OBJECTIVE: In recent decades endoscopic techniques have been increasingly used in neurosurgery as they may offer a valuable close-up view of the working area through a minimally invasive surgical corridor. Herein, we present an inexpensive and efficient endoscopic surgical model using a borescope, which was used for a "modified pure endoscopic approach" to the pineal region. METHODS: A borescope video camera was connected to a 16-inch personal computer monitor. A standard midline suboccipital craniotomy was performed on 2 cadaveric heads in the Concorde position. Then, a "borescopic" supracerebellar infratentorial approach was executed, thus reaching the pineal region, which was exposed through an extensive arachnoid dissection. RESULTS: Using the previously described model, we were able to provide excellent exposure of the main neurovascular structures of the pineal region, as shown by the intraoperative videos. In 1 specimen we identified an incidental pineal cyst that was meticulously dissected and removed. CONCLUSIONS: Our proposed "borescopic" surgical model may represent an inexpensive and efficient alternative to conventional endoscopic techniques and could be used for training purposes, as well as even for clinical procedures, after a proper validation, particularly in economically challenging environments.

Motor Assessment in Huntington's Disease Mice.

Motor deficits are a characteristic consequence of striatal damage, whether induced by experimental lesions, or in genetic models of Huntington's disease involving polyglutamine expansion in the huntingtin protein. With the growing power of genetic models and genetic tools for analysis, mice are increasingly the animal model of choice, and objective quantitative measures of motor performance are in demand for experimental analysis of disease pathophysiology, progression, and treatment. We present methodological protocols for six of the most common tests of motor function-ranging from spontaneous activity, locomotor coordination, balance, and skilled limb use-that are simple, effective, efficient, and widely used for motor assessment in Huntington's disease research in experimental mice.

Neurophysiological Assessment of Huntington's Disease Model Mice.

Electrophysiological and cell imaging techniques are powerful tools for understanding alterations in neuronal activity in Huntington's disease (HD), a fatal neurological disorder caused by an expansion of CAG repeats in the HTT gene. Changes in neuronal activity often precede the behavioral manifestations of HD, therefore, understanding the electrophysiology of HD is critical for identifying potential prodromal markers and therapeutic targets. This chapter outlines the basic methodology behind four major electrophysiological and imaging techniques used in HD mouse models: patch clamp recordings, optogenetics, in vivo electrophysiology, and Ca2+ imaging, as well as some of the advancements in HD research using each of these techniques.

"Do-It-Yourself" reliable pH-stat device by using open-source software, inexpensive hardware and available laboratory equipment.

In this paper, we present the construction of a reliable and inexpensive pH stat device, by using open-source "OpenPhControl" software, inexpensive hardware (a peristaltic and a syringe pump, Arduino, a step motor…), readily available laboratory devices: a pH meter, a computer, a webcam, and some 3D printed parts. We provide a methodology for the design, development and test results of each part of the device, as well as of the entire system. In addition to dosing reagents by means of a low-cost peristaltic pump, we also present carefully controlled dosing of reagents by an open-source syringe pump. The upgrading of the basic open-source syringe pump is given in terms of pump control and application of a larger syringe. In addition to the basic functions of pH stat, i.e. pH value measurement and maintenance, an improvement allowing the device to be used for potentiometric titration has been made as well. We have demonstrated the device's utility when applied for cellulose fibers oxidation with 2,2,6,6-tetramethylpiperidine-1-oxyl radical, i.e. for TEMPO-mediated oxidation. In support of this, we present the results obtained for the oxidation kinetics, the consumption of added reagent and experimental repeatability. Considering that the open-source scientific tools are available to everyone, and that researchers can construct and adjust the device according to their needs, as well as, that the total cost of the open-source pH stat device, excluding the existing laboratory equipment (pH meter, computer and glossary) was less than 150 EUR, we believe that, at a small fraction of the cost of available commercial offers, our open-source pH stat can significantly improve experimental work where the use of pH stat is necessary.