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Background Quantum noise intrinsically limits the quality of fluoroscopic images. The lower is the X-ray dose the higher is the noise. Fluoroscopy video processing can enhance image quality and allows further patient’s dose lowering. This study aims to assess the performances achieved by a Noise Variance Conditioned Average (NVCA) spatio-temporal filter for real-time denoising of fluoroscopic sequences. The filter is specifically designed for quantum noise suppression and edge preservation. It is an average filter that excludes neighborhood pixel values exceeding noise statistic limits, by means of a threshold which depends on the local noise standard deviation, to preserve the image spatial resolution. The performances were evaluated in terms of contrast-to-noise-ratio (CNR) increment, image blurring (full width of the half maximum of the line spread function) and computational time. The NVCA filter performances were compared to those achieved by simple moving average filters and the state-of-the-art video denoising block matching-4D (VBM4D) algorithm. The influence of the NVCA filter size and threshold on the final image quality was evaluated too. Results For NVCA filter mask size of 5 × 5 × 5 pixels (the third dimension represents the temporal extent of the filter) and a threshold level equal to 2 times the local noise standard deviation, the NVCA filter achieved a 10% increase of the CNR with respect to the unfiltered sequence, while the VBM4D achieved a 14% increase. In the case of NVCA, the edge blurring did not depend on the speed of the moving objects; on the other hand, the spatial resolution worsened of about 2.2 times by doubling the objects speed with VBM4D. The NVCA mask size and the local noise-threshold level are critical for final image quality. The computational time of the NVCA filter was found to be just few percentages of that required for the VBM4D filter. Conclusions The NVCA filter obtained a better image quality compared to simple moving average filters, and a lower but comparable quality when compared with the VBM4D filter. The NVCA filter showed to preserve edge sharpness, in particular in the case of moving objects (performing even better than VBM4D). The simplicity of the NVCA filter and its low computational burden make this filter suitable for real-time video processing and its hardware implementation is ready to be included in future fluoroscopy devices, offering further lowering of patient’s X-ray dose.

A compact isolated low-power 32-channel 16-bit data-logging system around an NXP ARM processor (LPC1768) and four of the linear technology octal analogue-to-digital converters (ADCs) LTC1857/58/59 is designed. The system requires only 250 mA when powered at 5 V to run at full power (including a capacitive 2.8 inch touch-screen display and 32 Gb SHDC SD memory card). The sample rate is configurable up to 1 k SPS per channel as well as voltage dynamic input up to ±10 V; additionally, 32 chip select lines (SPI protocol) individually addressable and controllable while sampling to configure user-designed programmable gain amplifiers (PGAs) are available. Collaboration is being sought to improve the software capabilities, particularly to enrich the very basic user interface and to add wireless connectivity. The code is available (under the GPL licence) at our repository, the gerber file to reproduce the PCB is available (on the As-Is basis) on request. The galvanic isolation between the power supply data connection and ADC channels makes the data-logger also compatible with the main powered PCs, hence it is suitable for the implementation of medical devices at least for the prototyping and initial testing stages.

In this paper we propose a new algorithm for real-time filtering of video sequences corrupted by Poisson noise. The algorithm provides effective denoising (in some cases overcoming the filtering performances of state-of-the-art techniques), is ideally suited for hardware implementation, and can be implemented on a small field-programmable gate array using limited hardware resources. The paper describes the proposed algorithm, using X-ray fluoroscopy as a case study. We use IIR filters for time filtering, which largely simplifies hardware cost with respect to previous FIR filter-based implementations. A conditional reset is implemented in the IIR filter, to minimize motion blur, with the help of an adaptive thresholding approach. Spatial filtering performs a conditional mean to further reduce noise and to remove isolated noisy pixels. IIR filter hardware implementation is optimized by using a novel technique, based on Steiglitz–McBride iterative method, to calculate fixed-point filter coefficients with minimal number of nonzero elements. Implementation results using the smallest StratixIV FPGA show that the system uses only, at most, the 22% of the resources of the device, while performing real-time filtering of 1024 × 1024@49fps video stream. For comparison, a previous FIR filter-based implementation, on the same FPGA, in the same conditions and constraints (1024 × 1024@49fps), requires the 80% of the logic resources of the FPGA.

The aim of the study is to characterize the local muscles motion in individuals undergoing whole body mechanical stimulation. In this study we aim also to evaluate how subject positioning modifies vibration dumping, altering local mechanical stimulus. Vibrations were delivered to subjects by the use of a vibrating platform, while stimulation frequency was increased linearly from 15 to 60 Hz. Two different subject postures were here analysed. Platform and muscles motion were monitored using tiny MEMS accelerometers; a contra lateral analysis was also presented. Muscle motion analysis revealed typical displacement trajectories: motion components were found not to be purely sinusoidal neither in phase to each other. Results also revealed a mechanical resonant-like behaviour at some muscles, similar to a second-order system response. Resonance frequencies and dumping factors depended on subject and his positioning. Proper mechanical stimulation can maximize muscle spindle solicitation, which may produce a more effective muscle activation.

This study extends a previous research concerning intervertebral motion registration by means of 2D dynamic fluoroscopy to obtain a more comprehensive 3D description of vertebral kinematics. The problem of estimating the 3D rigid pose of a CT volume of a vertebra from its 2D X-ray fluoroscopy projection is addressed. 2D-3D registration is obtained maximising a measure of similarity between Digitally Reconstructed Radiographs (obtained from the CT volume) and real fluoroscopic projection. X-ray energy correction was performed. To assess the method a calibration model was realised a sheep dry vertebra was rigidly fixed to a frame of reference including metallic markers. Accurate measurement of 3D orientation was obtained via single-camera calibration of the markers and held as true 3D vertebra position; then, vertebra 3D pose was estimated and results compared. Error analysis revealed accuracy of the order of 0.1 degree for the rotation angles of about 1 mm for displacements parallel to the fluoroscopic plane, and of order of 10 mm for the orthogonal displacement.

Cardiotocography is the most diffused prenatal diagnostic technique in clinical routine. The simultaneous recording of foetal heart rate (FHR) and uterine contractions (UC) provides useful information about foetal well-being during pregnancy and labour. However, foetal electronic monitoring interpretation still lacks reproducibility and objectivity. New methods of interpretation and new parameters can further support physicians' decisions. Besides common time-domain analysis, study of the variability of FHR can potentially reveal autonomic nervous system activity of the foetus. In particular, it is clinically relevant to investigate foetal reactions to UC to diagnose foetal distress early. Uterine contraction being a strong stimulus for the foetus and its autonomic nervous system, it is worth exploring the FHR variability response. This study aims to analyse modifications of the power spectrum of FHR variability corresponding to UC. Cardiotocographic signal tracts corresponding to 127 UC relative to 30 healthy foetuses were analysed. Results mainly show a general, statistically significant (t test, p<0.01) power increase of the FHR variability in the LF 0.03-0.2 Hz and HF 0.2-1 in correspondence of the contraction with respect to a reference tract set before contraction onset. Time evolution of the power within these bands was computed by means of time-varying spectral estimation to concisely show the FHR response along a uterine contraction. A synchronised grand average of these responses was also computed to verify repeatability, using the contraction apex as time reference. Such modifications of the foetal HRV that follow a contraction can be a sign of ANS reaction and, therefore, additional, objective information about foetal reactivity during labour.

Intervertebral kinematics closely relates to the functionality of the spinal segments. Direct measurement of the intervertebral kinematics in vivo is very problematic. The use of a fluoroscopic device can provide continuous screening of the lumbar tract during patient spontaneous motion, with an acceptable, low X-ray dose. The kinematic analysis is intended to be limited to planar motion. Kinematic parameters are computed from vertebral landmarks on each frame of the image sequence. Landmarks are normally selected manually in spite of the fact that this is subjective, tedious to perform and regarded as one of the major contributors to errors in the computed kinematic parameters. The aim of this work is to present an innovative method for the automatic recognition of vertebral landmarks throughout a fluoroscopic image sequence to provide an objective and more precise quantification of intervertebral kinematics. The recognition procedure is based upon comparing vertebral features in two adjacent frames by means of a cross-correlation index, which is also robust despite the low signal-to-noise ratio of the lumbar fluoroscopic images. To provide a quantitative assessment of this method a calibration model was used which consisted of two lumbar vertebrae linked by a universal joint. The reliability and accuracy of the kinematic measurements have been investigated. The errors are of the order of a millimetre for the localisation of the intervertebral centre of rotation and tenths of a degree for the intervertebral angle. Error analysis suggests that this method improves the accuracy of the intervertebral kinematic calculations and has the potential to automate the selection of anatomical landmarks.

The study reported here explored the design and realization of a low-cost, electromyographically controlled hand prosthesis for amputees living in developing countries. The developed prosthesis is composed of a light aluminum structure with opposing fingers connected to a DC motor that imparts only the movement of grasp. Problems associated with surface electromyographic signal acquisition and processing, motor control, and evaluation of grasp force were addressed, with the goal of minimizing cost and ensuring easy assembly. Simple analog front ends amplify and condition the electromyographic signals registered from two antagonist muscles by surface electrodes. Analog signals are sampled at 1 kHz and processed by a microcontroller that drives the motor with a supply voltage proportional to the muscular contraction, performing the opening and closing of the opposing fingers. Reliable measurements of the level of muscle contractions were obtained by specific digital processing: real-time operators implementing the root mean square value, mean absolute value, standard deviation, and mean absolute differential value were compared in terms of efficiency to estimate the EMG envelope, computational load, and time delay. The mean absolute value operator was adopted at a time window of 64 milliseconds. A suitable calibration procedure was proposed to overcome problems associated with the wide variation of electromyograph amplitude and background noise depending on the specific patient's muscles selected. A pulse-width modulated signal drives the DC motor, allowing closing and opening of the prosthesis. The relationship between the motor-driver signal and the actual hand-grasp force developed by the prosthesis was measured using a hand-held grip dynamometer. The resulting force was proportional to current for moderate values of current and then saturated. The motor torque, and, in turn, the force elicited, can be measured by sensing the current absorbed by the motor. Therefore, the grasp force can be opportunely limited or controlled. The cost of the only electronic and mechanical components of the electromyographically controlled hand was about US$50; other costs, such as the cost of labor to assemble the prosthesis and the production of adapters for patients, were not estimated.

Reliable detection of pacemaker pulses is getting more and more important in electrocardiography (ECG) diagnosis. Many studies recommend ECG amplifiers with higher bandwidth to prevent errors. In the past, few pilot studies showed that analysis of pacemaker pulses waveform can enhance diagnosis (eg, lead failure and fractured wire), but they were carried out with inadequate instrumentations for clinical practice. Typically, pacemaker pulses last hundreds of microseconds, edges of pulses elapse in few microseconds, and amplitude may exhibit large variations from few millivolts to volts. Pulse waveforms change often and depend on pacemaker type and programming. A simple, biopotential amplifier made of a few off-the-shelf components is proposed. The circuit fulfills specifications for biopotential amplifiers and offers a large bandwidth (~1 MHz). Therefore, it is able to accurately record time course of pacemaker pulses and allows highly accurate pulse detection and timing. Signals can be easily displayed and acquired by means of a standard, battery-powered oscilloscope. Pacemaker pulse vectorcardiography can be obtained by using two or more, wideband channels. Some exemplificative waveforms recorded during patient's periodic medical examination are reported. The proposed circuit offers simultaneous conventional ECG signal as an additional output.

Feedback plays an important role when learning to use a brain computer interface (BCI), particularly in the case of synchronous feedback that relies on the interaction subject. In this preliminary study, we investigate the role of combined auditory-visual feedback during synchronous μ rhythm-based BCI sessions to help the subject to remain focused on the selected imaginary task. This new combined feedback, now integrated within the general purpose BCI2000 software, has been tested on eight untrained and three trained subjects during a monodimensional left-right control task. In order to reduce the setup burden and maximize subject comfort, an electroencephalographic device suitable for dry electrodes that required no skin preparation was used. Quality and index of improvement was evaluated based on a personal self-assessment questionnaire from each subject and quantitative data based on subject performance. Results for this preliminary study show that the combined feedback was well tolerated by the subjects and improved performance in 75% of the naïve subjects compared with visual feedback alone.