journal: Current Directions in Biomedical Engineering

Open Access Published since September 15, 2015

Current Directions in Biomedical Engineering

Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering

ISSN: 2364-5504

Editor-in-chief: Jens Haueisen

Editorial Board: Peter Augat, Thorsten M. Buzug, Olaf Dössel, Stefan Jockenhoevel, Petra Knaup-Gregori, Marc Kraft, Thomas Lenarz, Steffen Leonhardt, Hagen Malberg, Thomas Penzel, Gernot Plank, Klaus M. Radermacher, Erik Schkommodau, Thomas Stieglitz, Gerald A. Urban

About this journal

Objective
Current Directions in Biomedical Engineering (CDBME) is an open access journal publishing proceeding papers, often from the annual BMTE, CURAC, and TAR conferences, but also others. It is closely related to the journal Biomedical Engineering - Biomedizinische Technik (BME-BMT) that is well established and has published articles of high quality for more than 50 years. CDBME is as BME-BMT a forum for the exchange of knowledge in the fields of biomedical engineering, medical information technology and biotechnology/bioengineering for medicine and addresses engineers, natural scientists, and clinicians working in research, industry, or clinical practice.

Topics

Diagnostic Imaging
Biosignal Processing, Biomechanics, Image Processing, Modelling and Simulation
Information and Communication in Medicine, Telemedicine and e-Health
Surgery, Minimum Invasive Interventions, Endoscopy and Image Guided Therapy
Diagnostic and Therapeutic Instrumentation, Clinical Engineering
Micro- and Nanosystems in Medicine, Active Implants, Biosensors
Neuroengineering, Neural Systems, Rehabilitation and Prosthetics
Biomaterials, Cellular and Tissue Engineering, Artificial Organs
Biomedical Engineering for Audiology, Ophthalmology, Emergency and Dental Medicine

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Conference Proceedings Papers

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Volume 9 Issue 1

September 2023

Despite growing academic interest for dermal inking in contemporary society, the reason why skin tattoos remain visible for life has predominantly been studied from a biological perspective. In preliminary physics studies of ink it has been presumed that the hydrophobicity of its main constituent prevents further dilution of pigment dispersion and therefore may be a contributing factor to aforementioned lifelongevity. According to these early studies, ultrasound might change the hydrophobicity of microparticles. The purpose of this study was to confirm or refute the presence of hydrophobic components in carbon black tattoo ink and to relate sonication to such presence. Cuvettes with n-octanol, distilled water, and a droplet of unsonicated or sonicated carbon black ink were shaken, allowed to settle and subsequently photographed. The sonicated ink had been subjected to ultrasound during 5 min at a centre frequency of 1 MHz, a pulse-repetition frequency of 1 kHz, and a 10% duty cycle. The greyscale values in both parts of the cuvettes were averaged. The resulting ratio of light intensities was an indicator for the ink hydrophobicity. The intensity partition coefficient of carbon black ink was measured to be greater than 103 before sonication and less than 10 3 after sonication. Carbon black tattoo ink was found to be very hydrophobic. However, sonication was found to make the dispersion less hydrophobic. Influencing the hydrophobicity of tattoo ink might change the permanence of a skin tattoo.

Microbubbles with a negligible shell are of utmost importance in the study of harmonic ultrasound contrast agents. The purpose of this study was to collect and quantify experimental pulsation footage of gas microbubbles released from tablet matrix under sonication. Radii were measured as a function of time of 50 microbubbles that had been released from tablet matrix and were subjected to 3-cycle pulses of 1-MHz ultrasound with a 0.3-MPa peak-negative pressure. The size distribution was measured, as well as pre- and postsonication radii. The experimental footage showed proof of asymmetric buckling, but also of excursion-only behaviour. The former phenomenon has been attributed to a surplus of material accumulated on the microbubble-liquid interfaces, whilst the latter phenomenon has been associated with the presence of incompressible material inside the microbubbles. The postsonication resting radii of 41 microbubbles had become less compared to the corresponding pre-sonication radii. The opposite effect was observed with eight microbubbles in the same size range. This feasibility study confirmed that the gas microbubbles released from tablet matrix may pulsate asymmetrically. Thus, they might be suitable tracers for harmonic imaging.

Introduction: 3D surface scan-based diagnosis of craniosynostosis is a promising radiation-free alternative to traditional diagnosis using computed tomography. The cranial index (CI) and the cranial vault asymmetry index (CVAI) are well-established clinical parameters that are widely used. However, they also have the benefit of being easily adaptable for automatic diagnosis without the need of extensive preprocessing. Methods: We propose a multi-height-based classification approach that uses CI and CVAI in different height layers and compare it to the initial approach using only one layer. We use ten-fold cross-validation and test seven different classifiers. The dataset of 504 patients consists of three types of craniosynostosis and a control group consisting of healthy and non-synostotic subjects. Results: The multi-height-based approach improved classification for all classifiers. The k-nearest neighbors classifier scored best with a mean accuracy of 89% and a mean F1-score of 0.75. Conclusion: Taking height into account is beneficial for the classification. Based on accepted and widely used clinical parameters, this might be a step towards an easy-to-understand and transparent classification approach for both physicians and patients.

Open Access September 20, 2023

Reflection of the Medical Device Regulation

A Review of Socioeconomic Impacts

Karolina Sojka, Keywan Sohrabi, Volker Gross, Michael Scholtes

Page range: 202-205

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Abstract

The MDR states the objectives of the law in the preface. There you will find, among other things, a consideration of small and medium-sized enterprises as well as high health protection and an innovative effect. Therefore, the question arises to what extent these goals have been achieved so far or can be achieved in the foreseeable future. To this end, a systematic literature review was conducted to present the perspectives of various stakeholders in the healthcare sector. Critical situations certainly arise for certain manufacturers, Notified Bodies and certain patient groups. The adopted extension of the transitional periods could be helpful but will not solve all problems.

To cope with the increasing demands in care due to the aging society and the simultaneous lack of professional caregivers， a technical assistance system can help to monitor elderly people in their own homes and to support professional caregivers and caring relatives. The technical assistance system consists of a smart sensor with an omnidirectional camera on the ceiling of each room and additionally, other smart home sensors in an apartment for elderly persons. Based on smart sensor data, the positions, poses, and activities of the patient are detected with the help of machine learning (ML) techniques. In this work a temporal behaviour model of the patient is developed to recognize activities of daily living (ADL) such as "eating", "sleeping" or "emergency". For this, the actions (e.g., walking, sitting) and the location in the current room of the patient, as well as the data of other sensors in the apartment are used. This input data is fed into a trained decision tree of depth 14, which ultimately determines the patient’s activity. The accuracy for detecting activities of daily living with the decision tree is 96.47%, where the activities can be detected in real-time.

The radial strength of balloon expandable stents represents a key property for a successful recanalization of sclerotic blood vessels. This study focuses on the most commonly used method for investigation of radial strength and radial stiffness via segmented head test setup. A custom made user software was used for evaluation of the radial force curves considering requirements of international standards such as ASTM F3067. Contributing factors during measurement such as friction and test setup deformation as well as the single cycle and multi cycle approach were addressed and discussed.

This study attempts to detect and differentiate Multi Drug Resistant (MDR) - Tuberculosis (TB) and Drug Sensitive (DS)-TB Chest Radiographs (CXR) using local texture descriptors and Ensemble Learning method. Studies report that CXR images contain likelihood information of the drug resistance which can be utilized computationally. Initially, CXR images are subjected to lung fields segmentation using Reaction Diffusion Level Set method. Further, Local Directional Texture Pattern (LDTP) features are extracted from the segmented lungs to characterize the localized textural variations. Extreme Gradient Boosting (XGBoost) classifier is employed to differentiate DS-TB and MDR-TB images. The obtained results demonstrate the ability of extracted LDTP features to characterize nonspecific textural inhomogeneities in images by operating on its principal directions. XGBoost algorithm provides maximum accuracy of 93% and true positive rate of 94.6% in detecting MDR-TB. As the proposed study differentiates the MDR-TB condition using CXR images, its computerized diagnostics could be used in the early screening and followup of TB ridden patients for public health infection control in any setting.

Open Access September 20, 2023

Intra-operative test electrode and electrical auditory brainstem response after preoperative assessment in cochlear implant candidacy

Comparison of electrical auditory brainstem response results by using an auditory nerve test electrode and system intra-operatively after an pre-operatively objective promontory stimulation test to check integrity of the patient’s auditory pathway

Daniel Polterauer, Giacomo Mandruzzato, Maike Neuling, Marek Polak, Joachim Müller, John Martin Hempel

Page range: 725-728

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Abstract

Introduction: Over the last years, in doubt of cochlear implant (CI) candidacy, assessment of excitability of the auditory nerve is performed with pre-operative tests. These tests are the pre-operative (pre-op.) performed electrical auditory brainstem (EABR) and the late response (EALR) recorded with trans-tympanic promontory stimulation in local anesthesia. But in some cases after such preoperative tests there is still doubt about the excitability of the auditory pathway. The most reliable EABR is recorded with using stimulation via the CI. However, before CI implantation,, an intra-cochlear test electrode could be used in order to achieve similar EABR results. Methods: In doubtful cases of patients who underwent pre-op. EABR, we performed EABR by a test electrode, part of the auditory nerve test system. This measurement was used to confirm the pre-operative results just before CI implantation. Additionally, EABR using CI stimulation was performed intra-operatively right after the CI implantation to confirm EABR using the test stimulation electrode results. Results: Six subjects were included in this study. They were tested by pre-op. EABR (n=6), pre-op. EALR (n=5), intra-op. EABR using test electrode (n=6), intraop. EABR via CI (n=6), and post-op. EABR (n=2), and postop. EALR (n=2). In two cases, intra-operative EABR showed a positive, i.e. clearly measureable, response whereas there was a doubtful response in pre-op. EABR. Intra-op. EABRs (test electrode and CI stimulation) showed the same results in all cases. Waveforms of EABR using test electrode look similar to EABR using CI stimulation but with more defined peaks compare to the pre-op. EABR. In one case with all-over positive EABR, pre-op. EALR, and post-operative EALR were matching. Conclusion: Intra-op. EABR using test electrode was easy to record and it shows similar results to EABR using CI stimulation. Intra-op. EABR using test electrode may help in confirming the results of not clear preop. EABR with a minimal increase in recording time.

Open Access September 20, 2023

Re-evaluation of local anesthesia transtympanic electrical auditory brainstem response in cochlear implant candidacy

An objective promontory stimulation test using electrical auditory brainstem response to check patients’ integrity of the auditory pathway preoperatively

Daniel Polterauer, Giacomo Mandruzzato, Maike Neuling, Marek Polak, Joachim Müller, John Martin Hempel

Page range: 729-732

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Abstract

Introduction: The trans-tympanic electrically evoked auditory brainstem response measurement in local anesthesia (= LA-TT-EABR) has been shown as a useful tool in doubtful CI candidacy to objectively evaluate the excitability of the auditory pathway up to the brainstem. Previous studies in this matter were of relatively low subjects number. To update the knowledge of the reliability of LA-TTEABR, we re-evaluated the latest results from a bigger subjects dataset from our clinic and follow up regarding hearing sensation post-operatively. Methods: LA-TT-EABR was performed, as described in previous publications, with a trans-tympanic golf-club electrode in the round window niche for pre-operative stimulation in local anesthesia and with an evoked potential device for EABR recording. Hearing sensations were monitored in the implanted CI subjects. Results: 39 of 40 planned subjects were included in this study. In 22 subjects, a positive LA-TT-EABR was recorded. In 11 subjects, the response was insecure. In 6 subjects, no response was recorded. One subject was excluded because of pain during the paracentesis. Among them, 19 were implanted with a CI, and 18 had hearing sensations with a hearing prosthesis post-operative. The sensitivity and specificity of LA-TTEABR in estimating the excitability of the auditory nerve preoperatively are both 100%. Conclusion: LA-TT-EABR was shown as a reliable pre-operative test to objectively evaluate the auditory brainstem response. In addition to LA-TT-EABR, an analysis of the auditory cortex using LA-TT-EALR may provide correlation and confirmation of LA-TT-EABR results and additional information about cortical reorganization after long deafness.

Ahead of Print / Just Accepted

Ahead of Print / Just Accepted

Volume 9 (2023)

Issue 1 Proceedings of the 57th Annual Meeting of the German Society of Biomedical Engineering (26 – 28 September 2023, Duisburg)