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Purpose: The main objective is to test the measurements made by an automated eye?tracking system in the presence of strabismus and to compare the data with manual measurements of deviation. Methods: A prospective observational cross?sectional masked double?blinded study was conducted in a tertiary eye care center with 39 participants included in our study, aged 3–41 years. Initial screening of all participants was performed by an ophthalmologist. Ocular deviations were evaluated and compared between manual measurements and an automated eye?tracking system. The device is based on eye?tracking technology. The participants had either a congenital or acquired type of manifest or latent strabismus. Children less than 3 years of age, visual acuity <6/36, and abnormal configuration of the anterior segment were excluded from the study. Results: The prism alternate cover test (PACT) manual measurements and the automated alternate cover test for measuring horizontal deviation, the manual measurement, and the automated eye track system showed a highly positive correlation (r = 0.932, P < 0.001). The Bland Altman plot analysis shows good agreement between the two measurements, with the mean difference between the two measurements being 1.55 PD, and the 95% limit of agreement was ± 10 PD. Conclusion: The results obtained with an automated eye?tracking system correlate well with manual strabismus measurements with PACT in terms of diagnosis, precision, and accuracy, with an added benefit of lesser time consumption in performing the test in cooperative/motivated patients. Considering these aspects, patients above the age of 3 years could be assessed with the equipment.
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Background: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. Objective: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013–2014. Methods: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. Results: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. Conclusion: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.
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This paper realized an electromagnetic tracking system based on electrically-controlled rotating magnetic field. A tracking system using the digital signal processor (DSP) as the control processing device was developed, including a controllable constant current source module, a magnetic field source module, a three-axis magnetic sensor and ADC interface circuit. The experimental results verified that each time the system could be stable positioning, average error of position was 0.282 cm, the average error of orientation was 0.696o, the positioning time was 1.572 s. Through calibration and further improvement of the hardware circuit, the performance of the system is expected to further improve.
Subject(s)
Calibration , Electromagnetic Phenomena , Equipment Design , Magnetic FieldsABSTRACT
Objective To determine whether the quality insurance verification of Cyberknife Synchrony meet the clinical requirements of 3D tumor motion. Methods CT images were collected with modified Sunchrony phantom, and then a Synchrony E2E treatment plan was developed.A ball-cube with EBT film was loaded on the bed,and then placed in different movement directions to implement phantom verification plan.E2E film analysis software was used for film analysis to obtain the tracking error. Results The treatment accuracy of Synchrony in one-dimensional, two-dimensional and three-dimensional directions were 0.91, 1.03 and 0.90 mm respectively. Conclusion The present quality assurance validation method of Synchrony meets the demand of clinical three-dimensional tumor motion.
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Objective To develop a digital management system in the pulmonary function test room to realize pulmonary function data sharing between the outpatient department,ward,medical examination facility and community hospital.Methods The system was developed with Microsoft Visual Studio 2010 and enterprise-version SQL Server database,and the integration of pulmonary function test devices and HIS was achieved by linking up the spirometer,bluetooth height & weight digital measuring equipment,barcode scanner,back tracking system and the switch to HIS.Results The system contributed to enhancing the flow and efficiency of clinical service.Conclusion The system standardizes the flow and quality control of pulmonary function test,implements patient data sharing between the outpatient department and ward and facilitates scientific research data acquisition,and thus is worthy promoting clinically.
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Objective To develop a digital management system in the pulmonary function test room to realize pulmonary function data sharing between the outpatient department,ward,medical examination facility and community hospital.Methods The system was developed with Microsoft Visual Studio 2010 and enterprise-version SQL Server database,and the integration of pulmonary function test devices and HIS was achieved by linking up the spirometer,bluetooth height & weight digital measuring equipment,barcode scanner,back tracking system and the switch to HIS.Results The system contributed to enhancing the flow and efficiency of clinical service.Conclusion The system standardizes the flow and quality control of pulmonary function test,implements patient data sharing between the outpatient department and ward and facilitates scientific research data acquisition,and thus is worthy promoting clinically.
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Background: UNICEF along with the State Government of Bihar launched a computer tablet‑based Mother and Child Tracking System (MCTS) in 2014, to capture real‑time data online and to minimize the challenges faced with the conventional MCTS. Objective: The article reports the process of implementation of tablet‑based MCTS in Bihar. Methods: In‑depth interviews with medical officers, program managers, data managers, auxiliary nurse midwives (ANMs), and a monitoring and evaluation specialist were conducted in October 2015 to understand the process of implementation, challenges and possibility for sustainability, and scale‑up of the innovation. Results: MCTS innovation was introduced initially in one Primary Health Centre each in Gaya and Purnia districts. The device, supported with Android MCTS software and connected to a dummy server, was given to ANMs. ANMs were trained in its application. The innovation allows real‑time data entry, instant uploading, and generation of day‑to‑day work plans for easy tracking of beneficiaries for providing in‑time health‑care services. The nonlinking of the dummy server to the national MCTS portal has not lessened the burden of data entry operators, who continue to enter data into the national portal as before. Conclusion: The innovation has been successfully implemented to meet its objective of tracking the beneficiaries. The national database should be linked to the dummy server or visible impact. The model is sustainable if the challenges can be met. Mobile technology offers a tremendous opportunity to strengthen the capacity of frontline workers and clinicians and increase the quality, completeness, and timeliness of delivery of critical health services.
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Background: Effective monitoring and supervision of health care programs depend on complete, accurate, and timely flow of data. Mother and Child Tracking System (MCTS) is a centralized information technology (IT)-based application launched in 2009 for improving the delivery of maternal and child health care services through name-based tracking. There is minimal evidence in the literature evaluating the operational aspects of such a name-based tracking system even after 5 years of its implementation. Objective: The present study was thus conducted to understand the opportunities and challenges in the operationalization of MCTS strategy in a district in Haryana and to understand the stakeholder's perspectives. Materials and Methods: Performance of Routine Information System Management (PRISM) framework was used. This cross-sectional study was conducted in Shahzadpur block of Ambala district, Haryana, India involving in-depth interviews of health care providers and clients in 12 subcenters (SCs) and two primary health centers (PHCs). Results: Lack of appropriate training, overburdened data entry operator (DEO) and auxiliary nurse midwife (ANM), poor Internet connectivity, slow server speed, and frequent power failures were revealed as major limitations for the effective implementation of MCTS. Nearly 18% of the clients reported receiving short message service (SMS) and only 6% could understand the SMS. Conclusion: MCTS has led to accountability and improved supervision of health workers, apart from empowering the community.
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BACKGROUND: There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. METHODS: Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. RESULTS: There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). CONCLUSIONS: The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.
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Aged , Female , Humans , Male , Arm/physiology , Arthroplasty, Replacement, Shoulder/methods , Biomechanical Phenomena , Cohort Studies , Fiducial Markers , Imaging, Three-Dimensional/methods , Range of Motion, Articular/physiology , Scapula/physiology , Shoulder Joint/physiologyABSTRACT
PURPOSE: Nystagmus is not considered a good indication for laser refractive surgery. However, we report 2 cases with congenital nystagmus that underwent a safe procedure due to improvement of laser firing rate and eye tracker. CASE SUMMARY: Two myopic patients with congenital nystagmus underwent transepithelial photorefractive keratectomy with the Schwind Amaris laser platform using an eye tracker. The laser ablations were performed under topical anesthesia without any mechanical eyeball fixation. A 30-year-old man with a history of muscle surgery at 11 years of age had a conjugate, 4 Hz right beating jerk nystagmus. His preoperative refractive error was -8.50 D sph = -0.50 D cyl x 160degrees x 20/30) in the right eye, and -6.00 D sph = -0.75 D cyl x 30degrees x 20/25) in the left eye. A 19-year-old man had a conjugate, 3 Hz pendular nystagmus. His refractive error was -5.25 D sph = -2.50 cyl x 175degrees x 20/30) in the right eye, and -4.25 D sph = -2.50 D cyl x 180degrees x 20/30) in the left eye. Both patients underwent a well-centered laser ablation without any problems. Six months after surgery, uncorrected visual acuity was 20/25 or better, and refractive error was within +/-0.50 D in all 4 eyes. In addition, the 19-year-old man showed decreased nystagmus amplitude. CONCLUSIONS: In some patients with congenital nystagmus, laser refractive surgery may be safely and accurately performed under topical anesthesia using an active tracking system. The best uncorrected visual acuity may improve in certain patients postoperatively.
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Adult , Humans , Young Adult , Anesthesia , Fires , Laser Therapy , Nystagmus, Congenital , Nystagmus, Pathologic , Photorefractive Keratectomy , Refractive Errors , Refractive Surgical Procedures , Visual AcuityABSTRACT
Objective:For clinical interventional procedures in surgery,blind spot, as well as minimally invasive surgery more precise surgical navigation requirements, this paper explores the use of a new generation of Aurora electromagnetic tracking technology assisted surgical navigation through free combination with a variety of surgical instruments, surgical further addressed various problems encountered. Methods:Aurora electromagnetic tracking system used with metal-containing material that matches the medical surgical environment, the use of electromagnetic tracking system comes with control software, the use of which is equipped with the SDK (secondary development package), I use a set of VC programming language suitable for clinical surgical navigation, real-time display system, and in our hospital different medical surgical navigation application performance test and comparative experiments measured the accuracy of the tracking system, the statistics of various surgical instruments corresponding to different surgical applications. Results:By author in Jingzhou City, First People's Hospital conducted a series of clinical application, verify the advantages of the system, allows doctors during surgery even more powerful, fully reflects the Aurora electromagnetic tracking system, superior performance, as well as in the medical surgical navigation important far-reaching significance. Conclusion:By using a variety of surgical instruments and medical surgical navigation in different experiments, we found that Aurora electromagnetic tracking system surgery centimeter-level positioning accuracy can be changed from the millimeter level, navigation accuracy average of less than 2 mm, and is available for user secondary development package, free easy programming operation, combined with surgical instruments and flexible, easy to implement intelligent navigation surgery. For clinical work provides an updated, more broad application space, enhancing the overall surgical navigation accuracy and controllability.
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Objective In order to meet the needs of more precise surgical navigation during interventional procedures and minimally invasive surgery, Aurora electromagnetic tracking technology-assisted surgical navigation with free combination of various surgical instruments was tested, trying to further solve problems encountered in surgery. Methods Aurora electromagnetic tracking system was used to match the medical surgical environment with metal-containing material. The built-in control software in this electromagnetic tracking system, which was equipped with the software development kit, was used to write a set of VC programming language suitable for real-time display of clinical surgical navigation system, and relative performance tests and comparative experiments were conducted for different medical surgical navigation application in the hospital to measure the precision degree of the tracking system, as well as the statistics of various surgical instruments corresponding to the application in different surgeries. Results 160 patients in interventional surgery with coronary angiography were randomly selected, 80 patients treated by digital subtraction angiography(DSA) with electromagnetic tracking systems as the experimental group, and 80 patients by DSA only as the control group. It was found out that with obviously less operating time, the amount of contrast agent was significantly reduced in the experimental group, and the degree of controllability for interventional surgical procedure was increased from 95% success rate to 99%. Conclusions The comparative experiments proved that Aurora electromagnetic tracking technology could significantly improve the accuracy in surgery, with the mean value of navigation less than 2 mm. In terms of interventional procedures and minimally invasive surgery, this electromagnetic tracking technology can greatly relieve patients' suffering and reduce medical risks to make medical care safer, and enhance the surgical technology level in hospital.
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Objective To design and apply the quality tracking system for central sterile supply department,complete the quality tracking of sterile medical products,rental surgical devices and high level disinfected products,conform the second-class storage management and human resource management.Methods By using the modern technology of WiFi wireless network,mobile PDA technology and two dimensional barcode,through establishing the team,collecting the data,installing the hardware,debugging the system,training and education,the development and application of the system was completed.Results The system has been operated for two years nearly in central sterile supply depamnent and other departments in hospital,it showed great practicability and convenience,covered all the daily work in central sterile supply department,achieved the information management in mobile digital way.Conclusions The application of digital mobile quality management system accelerates the central sterile supply department in standard way and realizes scientific in strategic decision and management.
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Carboxymethylcellulose Sodium , Displacement, Psychological , Forehead , Head , Neurosurgery , Orthognathic Surgery , Splints , Track and FieldABSTRACT
PURPOSE: To evaluate the effect of the scanning laser ophthalmoscope (SLO) guided re-test mode on short- and long-term measurement variability of peripapillary retinal nerve fiber layer (RNFL) thickness obtained by spectral domain-SLO optical coherence tomography (SD-SLO/OCT). METHODS: Seventy five healthy eyes were scanned 3 times per day (intra-session variability) by both the SLO guided re-test mode and the independent mode of SD-SLO/OCT. Subjects were scanned 3 times by both modes at visits within a 2-week interval (inter-session variability). For testing longitudinal variability, 3 separate exams were performed over 6 months by both modes. The coefficient of variation (CV), reproducibility coefficient (RC) and intraclass correlation coefficient of RNFL thickness were compared between the two modes. RESULTS: The intra-session RC and CV ranged from 5.4 to 12.9 microns and 1.76% to 5.72% when measured by independent mode and 5.4 to 12.5 microns and 1.75% to 5.58% by re-test mode, respectively. The inter-session RC and CV ranged from 5.8 to 13.3 microns and 1.89% to 5.78% by independent mode and 5.8 to 12.7 microns and 1.90% to 5.54% by re-test mode, respectively. Intra-session and inter-session variability measurements were not significantly different between the two modes. The longitudinal RC and CV ranged from 8.5 to 19.2 microns and 2.79% to 7.08% by independent mode and 7.5 to 14.4 microns and 2.33% to 6.22% by re-test mode, respectively. Longitudinal measurement variability was significantly lower when measured by the re-test mode compared to the independent mode (average, p = 0.011). CONCLUSIONS: The SLO guided re-test mode for RNFL thickness measurement in SD-SLO/OCT employing a tracking system improved long-term reproducibility by reducing variability induced by inconsistent scan circle placement.
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Adult , Female , Humans , Male , Algorithms , Anatomy, Cross-Sectional , Nerve Fibers , Ophthalmoscopes , Reference Values , Reproducibility of Results , Retinal Ganglion Cells/cytology , Tomography, Optical Coherence/methodsABSTRACT
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Humans , Esthetics , Eye , Head , Mandibular Nerve , Maxilla , Neck , Orthognathic Surgery , OsteotomyABSTRACT
PURPOSE: The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. MATERIALS AND METHODS: We devised a patient-specific stent for patient-to-image registration and navigation. Threedimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. RESULTS: The accuracy over 8 anatomical landmarks showed an overall mean of 0.56+/-0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. CONCLUSION: The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.
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Mandrillus , Molar, Third , Organothiophosphorus Compounds , Stents , Surgery, Computer-Assisted , Surgery, Oral , Track and FieldABSTRACT
In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System (SynchronyTM, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were 11.5+/-3.09 mm for desynchronization and 0.14+/-0.08 mm for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was 0.18+/-0.06 mm. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was 17.39+/-0.14 mm for inactivity and 1.37+/-0.11 mm for activity. The mean difference of absolute dose was 0.68+/-0.38% in static target and 1.31+/-0.81% in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.
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Four-Dimensional Computed Tomography , Prescriptions , Radiosurgery , Track and FieldABSTRACT
PURPOSE: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. MATERIALS AND METHODS: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system (Synchrony(TM)). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. RESULTS: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and 13.9+/-5.5 mm, respectively from the superior to the inferior direction, 3.9 mm and 1.9+/-0.9 mm, respectively from left to right, and 8.3 mm and 4.9+/-1.9 mm, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be 3.3degrees and 2.6+/-1.3degrees, respectively for X (Left-Right) axis rotation, 4.8degrees and 2.3+/-1.0degrees, respectively for Y (Cranio-Caudal) axis rotation, 3.9degrees and 2.8+/-1.1degrees, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment's accuracy was 1.1+/-0.7 mm. CONCLUSION: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.
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PURPOSE: The purpose of this study was to develop a system for the measurement and simulation of the TMJ movement and to analyze the mandibular movement quantitatively. MATERIALS AND METHODS: We devised patient-specific splints and a registration body for the TMJ movement tracking. The mandibular movements of the 12 subjects with facial deformity and 3 controls were obtained by using an optical tracking system and the patient-specific splints. The mandibular part was manually segmented from the CT volume data of a patient. Three-dimensional surface models of the maxilla and the mandible were constructed using the segmented data. The continuous movement of the mandible with respect to the maxilla could be simulated by applying the recorded positions sequentially. Trajectories of the selected reference points were calculated during simulation and analyzed. RESULTS: The selected points were the most superior point of bilateral condyle, lower incisor point, and pogonion. There were significant differences (P<0.05) between control group and pre-surgical group in the maximum displacement of left superior condyle, lower incisor, and pogonion in vertical direction. Differences in the maximum lengths of the right and the left condyle were 0.59+/-0.30 mm in pre-surgical group and 2.69+/-2.63 mm in control group, which showed a significant difference (P<0.005). The maximum of differences between lengths of the right and the left calculated during one cycle also showed a significant difference between two groups (P<0.05). CONCLUSION: Significant differences in mandibular movements between the groups implies that facial deformity have an effect on the movement asymmetry of the mandible.