Imperial College London

ProfessorFernandoBello

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Surgical Computing and Simulation Science
 
 
 
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Contact

 

+44 (0)20 3315 8231f.bello Website

 
 
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Location

 

G3.50Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Publication Type
Year
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218 results found

Berkovic A, Laganier C, Chappell D, Nanayakkara T, Kormushev P, Bello F, Rojas Net al., 2022, A multi-modal haptic armband for finger-level sensory feedback from a prosthetic hand, EuroHaptics

Conference paper

Chappell D, Yang Z, Son HW, Bello F, Kormushev P, Rojas Net al., 2022, Towards instant calibration in myoelectric prosthetic hands: a highly data-efficient controller based on the Wasserstein distance, International Conference on Rehabilitation Robotics (ICORR), Publisher: IEEE

Prosthetic hand control research typically focuses on developing increasingly complex controllers to achieve diminishing returns in pattern recognition of muscle activity signals, making models less suitable for user calibration. Some works have investigated transfer learning to alleviate this, but such approaches increase model size dramatically—thus reducing their suitability for implementation on real prostheses. In this work, we propose a novel, non-parametric controller that uses the Wasserstein distance to compare the distribution of incoming signals to those of a set of reference distributions,with the intended action classified as the closest distribution. This controller requires only a single capture of data per reference distribution, making calibration almost instantaneous. Preliminary experiments building a reference library show that, in theory, users are able to produce up to 9 distinguishable muscle activity patterns. However, in practice, variation whenrepeating actions reduces this. Controller accuracy results show that 10 non-disabled and 1 disabled participant were able to use the controller with a maximum of two recalibrations to perform 6 actions at an average accuracy of 89.9% and 86.7% respectively. Practical experiments show that the controller allows users to complete all tasks of the Jebsen-Taylor HandFunction Test, although the task of picking and placing small common objects required on average more time than the protocol’s maximum time.

Conference paper

Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios Cet al., 2022, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 36, Pages: 5907-5920, ISSN: 0930-2794

Background3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research.MethodsA scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated.ResultsA total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found.ConclusionThe use

Journal article

Chappell D, Son HW, Clark AB, Yang Z, Bello F, Kormushev P, Rojas Net al., 2022, Virtual reality pre-prosthetic hand training with physics simulation and robotic force interaction, IEEE Robotics and Automation Letters, Vol: 7, Pages: 1-1, ISSN: 2377-3766

Virtual reality (VR) rehabilitation systems have been proposed to enable prosthetic hand users to perform training before receiving their prosthesis. Improving pre-prosthetic training to be more representative and better prepare the patient for prosthesis use is a crucial step forwards in rehabilitation. However, existing VR platforms lack realism and accuracy in terms of the virtual hand and the forces produced when interacting with the environment. To address these shortcomings, this work presents a VR training platform based on accurate simulation of an anthropomorphic prosthetic hand, utilising an external robot arm to render realistic forces that the user would feel at the attachment point of their prosthesis. Experimental results with non-disabled participants show that training with this platform leads to a significant improvement in Box and Block scores compared to training in VR alone and a control group with no prior training. Results performing pick-and-place tasks with a wider range of objects demonstrates that training in VR alone negatively impacts performance, whereas the proposed platform has no significant impact on performance. User perception results highlight that the platform is much closer to using a physical prosthesis in terms of physical demand and effort, however frustration is significantly higher during training.

Journal article

Lo SL, Cher PH, Bello F, 2022, Reflection as an Agile Course Evaluation Tool, Artificial Intelligence in Education. Posters and Late Breaking Results, Workshops and Tutorials, Industry and Innovation Tracks, Practitioners’ and Doctoral Consortium, Publisher: Springer International Publishing, Pages: 293-297, ISBN: 9783031116469

Book chapter

Cher PH, Lee JWY, Bello F, 2022, Machine Learning Techniques to Evaluate Lesson Objectives, Lecture Notes in Computer Science, Publisher: Springer International Publishing, Pages: 193-205, ISBN: 9783031116438

Book chapter

Przedlacka A, Pellino G, Fletcher J, Bello F, Tekkis PP, Kontovounisios Cet al., 2021, Current and future role of three-dimensional modelling technology in rectal cancer surgery: a systematic review, World Journal of Gastrointestinal Surgery, Vol: 13, Pages: 1754-1769, ISSN: 1948-9366

BACKGROUND: Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise. AIM: To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery. METHODS: Medline/PubMed, Embase and Scopus databases were searched using the keywords "rectal surgery", "colorectal surgery", "three-dimensional", "3D", "modelling", "3D printing", "surgical planning", "surgical navigation", "surgical education", "patient education" to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist. RESULTS: Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of mod

Journal article

Kim M, Bello F, 2021, Multi-shape free-form deformation framework for efficient data transmission in AR-based medical training simulators, Applied Sciences, Vol: 11, Pages: 1-13, ISSN: 2076-3417

Augmented reality medical training simulators can provide a realistic and immersive experience by overlapping the virtual scene on to the real world. Latency in augmented reality (AR) medical training simulators is an important issue as it can lead to motion sickness for users. This paper proposes a framework that can achieve real-time rendering of the 3D scene aligned to the real world using a head-mounted display (HMD). Model deformation in the 3D scene is categorised into local deformation derived from user interaction and global deformation determined by the simulation scenario. Target shapes are predefined by a simulation scenario, and control points are placed to embed the predefined shapes. Free-form deformation (FFD) is applied to multiple shapes to efficiently transfer the simulated model to the HMD. Global deformation is computed by blending a mapping matrix of each FFD with an assigned weighting value. The local and global deformation are then transferred through the control points updated from a deformed surface mesh and its corresponding weighting value. The proposed framework is verified in terms of latency caused by data transmission and the accuracy of a transmitted surface mesh in a vaginal examination (VE) training simulation. The average latency is reduced to 7 ms, less than the latency causing motion sickness in virtual reality simulations. The maximum relative error is less than 3%. Our framework allows seamless rendering of a virtual scene to the real world with substantially reduced latency and without the need for an external tracking system.

Journal article

Kontovounisios C, 2021, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol, BMJ Open, Vol: 11, Pages: 1-4, ISSN: 2044-6055

IntroductionThree-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional (2D) medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research. Methods and AnalysisThe protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1/6/2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789). Two independent reviewers will screen titles, abstracts and perform full text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis performed. Ethics and Dissemination Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences.Registration detailsThe scoping review protocol has been registered on the Open Science Framework (osf.io/ta789)

Journal article

Neville JJ, Chacon CS, Haghighi-Osgouei R, Houghton N, Bello F, Clarke SAet al., 2021, Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair, Pediatric Surgery International, Vol: 38, Pages: 133-141, ISSN: 0179-0358

BackgroundThe role of simulation training in paediatric surgery is expanding as more simulation devices are designed and validated. We aimed to conduct a training needs assessment of UK paediatric surgical trainees to prioritise procedures for simulation, and to validate a novel 3D-printed simulation model for oesophageal atresia and tracheo-oesophageal fistula (OA-TOF) repair.MethodsA questionnaire was sent to UK trainee paediatric surgeons surveying the availability and utility of simulation. The operation ranked as most useful to simulate was OA-TOF repair. 3D-printing techniques were used to build an OA-TOF model. Content, face and construct validity was assessed by 40 paediatric surgeons of varying experience.ResultsThirty-four paediatric surgeons completed the survey; 79% had access to surgical simulation at least monthly, and 47% had access to paediatric-specific resources. Perceived utility of simulation was 4.1/5. Validation of open OA-TOF repair was conducted by 40 surgeons. Participants rated the model as useful 4.9/5. Anatomical realism was scored 4.2/5 and surgical realism 3.9/5. The model was able to discriminate between experienced and inexperienced surgeons.ConclusionUK paediatric surgeons voted OA-TOF repair as the most useful procedure to simulate. In response we have developed and validated an affordable 3D-printed simulation model for open OA-TOF repair.

Journal article

Korzeniowski P, Chacon CS, Russell VR, Clarke SA, Bello Fet al., 2021, Virtual reality simulator for pediatric laparoscopic inguinal hernia repair, Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol: 31, Pages: 1322-1330, ISSN: 1092-6410

Purpose: Due to the small space environment, the learning curve of pediatric laparoscopic procedures is steep and requires excellent procedural skills. These are mainly gained through an apprenticeship on real patients. Computer-based virtual reality (VR) simulators offer a safe, cost-effective, and configurable training environment free from ethical and patient safety issues.Materials and Methods: We have developed a prototype VR simulator for core manual skills training for pediatric laparoscopic hernia repair. The simulator currently consists of a hernia suturing task on a virtual nonanatomic trainer at a real pediatric scale.Results: A simulation realism validation study was carried out by obtaining subjective feedback (face and content validity) through a questionnaire from 36 pediatric surgeons. The overall simulation realism was on average marked 3.08 on a 5-point Likert scale (1: “very unrealistic” and 5: “very realistic”). The participants were most satisfied with the visual realism (3.33) and most critical about the behavior of virtual tissue. The simulator showed good content validity; its usefulness as a training tool for hernia repair, suturing in general, and in learning fundamental laparoscopic skills was marked 3.61, 3.64, and 3.89, respectively.Conclusions: VR simulation of pediatric laparoscopic procedures can contribute to surgical training and improve the educational experience without putting our youngest patients at risk. This simulator is a first prototype, and the initial results indicate that it provides promising foundations for further development. More formal and larger studies such as construct validity and transfer of skills are envisaged as the prototype is developed further.

Journal article

Al Asmri MA, Ennis J, Stone RJ, Bello F, Haque MS, Parle Jet al., 2021, Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis, BMJ Simulation & Technology Enhanced Learning, Vol: 7, Pages: 414-421, ISSN: 2056-6697

Background Digital rectal examination (DRE) is a challenging examination to learn.Objective To synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selection EMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.Findings 863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.Conclusions TES training is associated with improved DRE skills and should be used more widely.

Journal article

Fawcett M, Coughlan C, McGeorge E, Imran A, Bello F, Kneebone R, Watson Met al., 2021, Qualitative evaluation of asthma services for young people: a sequential simulation study, BMJ Simulation && Technology Enhanced Learning, Vol: 7, Pages: 134-139, ISSN: 2056-6697

Background Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation.Method We designed a sequential simulation focusing on routine asthma management in young people aged 12–18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis.Results 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care.Conclusion Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.

Journal article

Racy M, Barrow A, Tomlinson J, Bello Fet al., 2021, Development and validation of a virtual reality haptic femoral nailing simulator, Journal of Surgical Education, Vol: 78, Pages: 1013-1023, ISSN: 0149-7944

OBJECTIVE: To create a virtual reality (VR) femoral nailing simulator combining haptics and image intensifier functionality and then carry out validation studies to assess its educational value. DESIGN: The simulator consisted of a 3D virtual environment, a haptic device and 3D printed drill handle and a VR headset. The environment was created using a video game development engine, interfaced with plugins to allow haptic feedback and image intensifier functionality. Two tasks were created within the simulator as part of an antegrade femoral intramedullary (IM) nail procedure: proximal guidewire entry and distal locking.For the validation study, participants performed the above tasks on the simulator. Metrics were collected including time taken, number of X-rays and tool distance travelled and used to assess construct validity. A questionnaire was then completed to assess authenticity and content validity. SETTING: Simulator development in centre for simulation and engagement science laboratory. Validation study in a teaching hospital environment. PARTICIPANTS: Orthopedic specialist trainees and consultants. RESULTS: Surgeon experience (number of IM nails performed/postgraduate year) correlated with significantly improved task performance. More experienced surgeons took less time, used fewer X-rays and had greater economy of movement than less experienced surgeons. Authenticity and content validity were well rated, with criticisms primarily due to hardware limitations. CONCLUSIONS: To our knowledge this is the first orthopedic simulator to combine immersive VR with haptics and full image intensifier functionality. By combining multiple aspects of surgical practice within a single device, we aimed to improve participant immersion and educational value. Our work so far has focused on technical skills, demonstrating good authenticity, content and construct validity, however our findings show promise in other applications such as nontechnical skill development and assess

Journal article

Kebria PM, Nahavandi D, Jalali SMJ, Khosravi A, Nahavandi S, Bello F, Mc Ginn Cet al., 2020, Robust collaboration of a haptically-enabled double-slave teleoperation system under random communication delays, IEEE International Conference on Systems, Man, and Cybernetics (SMC), Publisher: IEEE, Pages: 2919-2924, ISSN: 1062-922X

Communication delays are known to create stability and performance issues in multilateral teleoperation systems. Multilateral teleoperation configurations usually include more than two communication channels, which can become problematic for robot control when limitations in network bandwidth results in delays and uncertainties in data transmission routes. This study develops a sliding surface based on the synchronization errors characterized between each sides of the considered multilateral teleoperation system. Here, two slave robots receive commands from the master system to cooperatively execute the desired teleoperation task in the remote, shared workspace. Lyapunov stability analysis approach guarantees the performance of the proposed controller. Moreover, the effectiveness of the controller is experimentally evaluated through a real-world Internet-based double-slave teleoperation system.

Conference paper

Granados A, Cox S, Low-Beer N, Higham J, Kneebone R, Bello Fet al., 2020, Taking the pressure off the patient - understanding digital rectal examinations on a real subject, IEEE Transactions on Biomedical Engineering, Vol: 67, Pages: 2798-2805, ISSN: 0018-9294

Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. OBJECTIVE: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. METHODS: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. RESULTS: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). CONCLUSIONS: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. SIGNIFICANCE: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance.

Journal article

Kebria PM, Khosravi A, Nahavandi S, Wu D, Bello Fet al., 2020, Adaptive type-2 fuzzy neural-network control for teleoperation systems with delay and uncertainties, IEEE Transactions on Fuzzy Systems, Vol: 28, Pages: 2543-2554, ISSN: 1063-6706

Interacting with human operators, remote environment, and communication networks, teleoperation systems are considerably suffering from complexities and uncertainties. Managing these is of paramount importance for safe and smooth performance of teleoperation systems. Among the countless solutions developed by researchers, type-2 fuzzy (T2F) algorithms have shown an outstanding performance in modeling complex systems and tackling uncertainties. Moreover, artificial neural networks (NNs) are well known for their adaptive learning potentials. This article proposes an adaptive interval type-2 fuzzy neural-network control scheme for teleoperation systems with time-varying delays and uncertainties. The T2F models are developed based on the experimental data collected from a teleoperation setup over a local computer network. However, the resulted controller is evaluated on an intercontinental communication network through the Internet between Australia and Scotland. Moreover, the slave robot and the remote workspace are completely different and unforeseen. Stability and performance of the proposed control is analyzed by Lyapunov-Krasovskii method. Comprehensive comparative studies demonstrate that the proposed controller outperforms traditional techniques in experimental evaluations.

Journal article

Przedlacka A, Cox S, Tekkis P, Bello F, Kontovounisios Cet al., 2020, Rectal 3D MRI modelling for benign and malignant disease, British Journal of Surgery, Vol: 107, Pages: e561-e562, ISSN: 0007-1323

Journal article

Kebria PM, Nahavandi D, Khosravi A, Nahavandi S, Bello Fet al., 2020, Adaptive Neural Network-based Perception and Awareness of Teleoperation Systems in Human-Machine Interactions

This paper addresses the problem of perception and awareness of teleoperation systems in the presence of human collaboratives/objects in the workspace. Although the term teleoperation generally refers to operations being executed remotely, in many applications, like telemedicine, there exist human beings in the remote workspace. Hence, it is critically important that the teleoperator system to operate safely enough in the presence of human kinds in the workspace. In this paper, we propose a perception and awareness scheme for a teleoperation system that prevents the teleoperator from imposing extreme and unwanted forces/movements. To achieve this goal, we train a neural network to estimate and predict the motion and force commands from the human operator. Furthermore, we develop an adaptive algorithm for fine-Tuning network parameters for robustness purposes. Theoretically proven, stability and performance of the proposed scheme is comparatively evaluated in comprehensive simulations.

Conference paper

Escobar-Castillejos D, Noguez J, Bello F, Neri L, Magana AJ, Benes Bet al., 2020, A review of training and guidance systems in medical surgery, Applied Sciences, Vol: 10, Pages: 1-35, ISSN: 2076-3417

In this paper, a map of the state of the art of recent medical simulators that provide evaluation and guidance for surgical procedures is performed. The systems are reviewed and compared from the viewpoint of the used technology, force feedback, learning evaluation, didactic and visual aid, guidance, data collection and storage, and type of solution (commercial or non-commercial). The works’ assessment was made to identify if—(1) current applications can provide assistance and track performance in training, and (2) virtual environments are more suitable for practicing than physical applications. Automatic analysis of the papers was performed to minimize subjective bias. It was found that some works limit themselves to recording the session data to evaluate them internally, while others assess it and provide immediate user feedback. However, it was found that few works are currently implementing guidance, aid during sessions, and assessment. Current trends suggest that the evaluation process’s automation could reduce the workload of experts and let them focus on improving the curriculum covered in medical education. Lastly, this paper also draws several conclusions, observations per area, and suggestions for future work.

Journal article

Haghighi Osgouei R, Soulsby D, Bello F, 2020, Rehabilitation Exergames: use of motion sensing and machine learning to quantify exercise performance in healthy volunteers, JMIR Rehabilitation and Assistive Technologies, Vol: 7, ISSN: 2369-2529

Background:Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well or not patients are performing the prescribed tasks. The absence of proper feedback might result in patients doing the exercises incorrectly, which could worsen their condition.Objective:We propose the use of two machine learning algorithms, namely Dynamic Time Warping (DTW) and Hidden Markov Model (HMM), to quantitively assess the patient’s performance with respects to a reference.Methods:Movement data were recorded using a Kinect depth sensor, capable of detecting 25 joints in the human skeleton model, and were compared to those of a reference. 16 participants were recruited to perform four different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand. Their performance was compared to that of a physiotherapist as a reference.Results:Both algorithms show a similar trend in assessing participants' performance. However, their sensitivity level was different. While DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details.Conclusions:The chosen algorithms demonstrated their capacity to objectively assess physical therapy performances. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whilst DTW could be used later on to focus on the detail.

Journal article

Muangpoon T, Haghighi Osgouei R, Escobar-Castillejos D, Kontovounisios C, Bello F, Muangpoon T, Haghighi Osgouei R, Escobar-Castillejos D, Kontovounisios C, Bello Fet al., 2020, Augmented reality system for digital rectal examination training and assessment: system validation, Journal of Medical Internet Research, Vol: 22, Pages: 1-13, ISSN: 1438-8871

Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients.Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers.Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system.Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group.Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal or

Journal article

Clark AE, Shaw CJ, Bello F, Chalouhi GE, Lees CCet al., 2020, Quantitating skill acquisition with optical ultrasound simulation, Australasian Journal of Ultrasound in Medicine, Vol: 23, Pages: 183-193, ISSN: 1836-6864

ObjectiveTo investigate and compare the effect of simulator training on quantitative scores for ultrasound‐related skills for trainees with novice level ultrasound experience and expert ultrasound operators.MethodsThree novice (comprising of 11, 32, 23 participants) and one expert (10 participants) subgroups undertook an ultrasound simulation training session. Pre‐ and post‐training test scores were collected for each subgroup. Outcome measures were as follows: mean accuracy score for obtaining the correct anatomical plane, percentage of correctly acquired target planes, mean number of movements, time to achieve image, distance travelled by probe and accumulated angling of the probe.ResultsThe novices showed improvement in image acquisition after completion of the simulation training session with an improvement in the rate of correctly acquired target planes from 28–57% to 39–83%. This was not replicated in the experts. The novice’s individual ratios based on pre‐ vs. post‐training metrics improved between 1.7‐ and 4.3‐fold for number of movements, 1.9‐ and 6.7‐fold for distance, 2.0‐ and 5.2‐fold for time taken and 1.8‐ and 7.3‐fold for accumulated angling. Among the experts, there was no relationship between pre‐training simulator metrics and years of ultrasound experience.ConclusionsThe individual simulation metrics suggest the sessions were delivered at an appropriate level for basic training as novice trainees were able to show demonstrable improvements in both efficiency and accuracy on the simulator. Experts did not improve after the simulation modules, and the novice scores post‐training were similar to those of experts, suggesting the exercises were valid in testing ultrasound skills at novice but not expert level.

Journal article

Marechal L, Balland P, Lindenroth L, Petrou F, Kontovounisios C, Bello Fet al., 2020, Toward a common framework and database of materials for soft robotics, Soft Robotics, Vol: 8, Pages: 1-14, ISSN: 2169-5172

To advance the field of soft robotics, a unified database of material constitutive models and experimental characterizations is of paramount importance. This will facilitate the use of finite element analysis to simulate their behavior and optimize the design of soft-bodied robots. Samples from seventeen elastomers, namely Body Double™ SILK, Dragon Skin™ 10 MEDIUM, Dragon Skin 20, Dragon Skin 30, Dragon Skin FX-Pro, Dragon Skin FX-Pro + Slacker, Ecoflex™ 00–10, Ecoflex 00–30, Ecoflex 00–50, Rebound™ 25, Mold Star™ 16 FAST, Mold Star 20T, SORTA-Clear™ 40, RTV615, PlatSil® Gel-10, Psycho Paint®, and SOLOPLAST 150318, were subjected to uniaxial tensile tests according to the ASTM D412 standard. Sample preparation and tensile test parameters are described in detail. The tensile test data are used to derive parameters for hyperelastic material models using nonlinear least-squares methods, which are provided to the reader. This article presents the mechanical characterization and the resulting material properties for a wide set of commercially available hyperelastic materials, many of which are recognized and commonly applied in the field of soft robotics, together with some that have never been characterized. The experimental raw data and the algorithms used to determine material parameters are shared on the Soft Robotics Materials Database GitHub repository to enable accessibility, as well as future contributions from the soft robotics community. The presented database is aimed at aiding soft roboticists in designing and modeling soft robots while providing a starting point for future material characterizations related to soft robotics research.

Journal article

Cox W, Cavenagh P, Bello F, 2020, What are the benefits and risks of sharing patients’ diagnostic radiological images with them? A cross-sectional study of the perceptions of patients and clinicians in the UK, BMJ Open, Vol: 10, ISSN: 2044-6055

Objectives The objective for this work was to assess clinical experts’ and patients’ opinions on the benefits and risks of sharing patients’ diagnostic radiological images with them.Setting This study was conducted outside of the primary and secondary care settings. Clinical experts were recruited at a UK national imaging and oncology conference, and patients were recruited via social media.Participants 121 clinical experts and 282 patients completed the study. A further 73 patient and 10 clinical expert responses were discounted due to item non-response. Individuals were required to be a minimum of 18 years of age at the time of participation.Primary and secondary outcome measures This study was exploratory in nature. As such, the outcomes to be measured for demonstration of the successful completion of this study were generated organically through the process of the investigation itself. These were: (1) the delineation of the benefits available from, and the risks posed by, widening access to diagnostic radiological images; (2) establishment of the level and nature of demand for access to diagnostic radiological images; and (3) the identification of stakeholder requirements for accessing available benefit from diagnostic radiological images.Results 403 usable questionnaires were returned consisting of responses from clinical experts (n=121) and patients (n=282). Both groups acknowledge the potential benefits of this practice. Examples included facilitating communication, promoting patient engagement and supporting patients in accepting health information shared with them. However, both groups also recognised risks associated with image sharing, such as the potential for patients to be upset or confused by their images.Conclusions There is a demand from patients for access to their diagnostic radiological images alongside acknowledgement from clinical experts that there may be benefits available from this. However, due to the acknowledged risks, t

Journal article

Haghighi Osgouei R, Marechal L, Kontovounisios C, Bello Fet al., 2020, Soft pneumatic actuator for rendering anal sphincter tone, IEEE Transactions on Haptics, Vol: 13, Pages: 183-190, ISSN: 1939-1412

Sphincter tone examination, as part of digital rectal examination (DRE), can provide essential information to support the early detection of colorectal cancer. Mastering DRE skills for junior doctors is always challenging due to the lack of real training cases. In this article, we developed a soft pneumatic active actuator,made of a compound of silicone rubber materials, to mimic human sphincter muscles and simulate various anal sphincter tones for the purpose of training. Different pumping actuation (syringe and bellows) and driving mechanisms (linear, stepper, and servo motor) were implemented and compared for their effect on the rendered tones. A further comparison was made with a previous prototype based on a cable-driven mechanism. Both quantitative and qualitative assessments were conducted to evaluate the performance of each mechanism. A differential pressure sensor was used to measure applied pressure on a catheter balloon placed inside the sphincter, comparing the readings with anorectal manometry data obtained from real patients. Qualitative feedback was gathered through a user study with ten colorectal expert practitioners. Four questions were asked targeting reaction/response time, pressure level, pressure quality, and similarity to a real case. The results show the capacity and limitation of each mechanism, with the one based on a servo motor and a bellows being the most favourably rated.

Journal article

Najdovski Z, Deshpande S, Wei L, Salaken SM, Mohajer N, Nahavandi S, Bello Fet al., 2020, Investigating the Effectiveness of a Cable-driven Pinch-Grasp Haptic Interface, 14th Annual IEEE International Systems Conference (SysCon), Publisher: IEEE, ISSN: 1944-7620

Conference paper

Haghighi Osgouei R, Soulsby D, Bello F, 2019, Rehabilitation exergames: use of motion sensing and machine learning to quantify exercise performance in healthy volunteers, Publisher: JMIR Publications

Background:Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well or not patients are performing the prescribed tasks. The absence of proper feedback might result in patients doing the exercises incorrectly, which could worsen their condition.Objective:We propose the use of two machine learning algorithms, namely Dynamic Time Warping (DTW) and Hidden Markov Model (HMM), to quantitively assess the patient’s performance with respects to a reference.Methods:Movement data were recorded using a Kinect depth sensor, capable of detecting 25 joints in the human skeleton model, and were compared to those of a reference. 16 participants were recruited to perform four different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand. Their performance was compared to that of a physiotherapist as a reference.Results:Both algorithms show a similar trend in assessing participants' performance. However, their sensitivity level was different. While DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details.Conclusions:The chosen algorithms demonstrated their capacity to objectively assess physical therapy performances. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whilst DTW could be used later on to focus on the detail.

Working paper

Kelay TK, Ako E, Cook C, Yasin M, Gold M, Chan KL, Bello F, Kneebone R, Malik Iet al., 2019, Physician-patient interactions & communication with conscious patients during simulated cath-lab procedures: An exploratory study, BMJ Simulation & Technology Enhanced Learning, Vol: 5, ISSN: 2056-6697

Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the pr

Journal article

Kebria PM, Khosravi A, Nahavandi S, Bello F, Krishnan Set al., 2019, Robust adaptive synchronisation of a single-master multi-slave teleoperation system over delayed communication, IEEE International Conference on Industrial Technology (IEEE ICIT), Publisher: IEEE, Pages: 193-198, ISSN: 2643-2978

Considering communication delays in networked multi-robot teleoperation systems, this paper proposes a new control strategy for synchronisation and stability purposes. A single-master and multi-slave (SMMS) networked robotic teleoperation system is considered. Based on a sliding surface combined with a smooth filtering and estimation methodology, a robust adaptive control is developed to guarantee the synchronisation and stability of the system in the presence of network-induced time-varying delays. Extensive simulation studies demonstrate the effectiveness of the developed control scheme.

Conference paper

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