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BackgroundEndotracheal tube (ETT) tip position is determined on chest X-ray (CXR) and should lie between the upper border of the first thoracic vertebra (T1) and the lower border of second thoracic vertebra (T2). Infant weight is commonly used to estimate how far the ETT should be inserted but frequently results in malpositioned ETT tips. Palpation of the ETT tip at the suprasternal notch has been recommended as an alternative.ObjectiveTo determine whether estimating ETT insertion depth using suprasternal palpation of the ETT tip rather than weight results in more correctly positioned ETT tips.DesignSingle-centre randomised controlled trial.SettingLevel III neonatal intensive care unit (NICU) at a university maternity hospital.PatientsNewborn infants without congenital anomalies intubated in the NICU.InterventionsParticipants were randomised to have ETT insertion depth estimated using palpation of the ETT tip at the suprasternal notch or weight [insertion depth (cm)=6 + wt (kg)].Main outcome measureCorrect ETT position, that is, between the upper border of T1 and lower border of T2 on CXR, determined by one consultant paediatric radiologist masked to group assignment.ResultsThere was no difference in the proportion of correctly placed ETT tips between the groups (suprasternal palpation 27/58 (47%) vs weight 23/60 (38%), p=0.456). Most incorrectly positioned ETTs were too low (56/68 (82%)).ConclusionEstimating ETT insertion depth using suprasternal palpation did not result in more correctly positioned ETTs.Trial registration number ISRCTN13570106.

Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation. This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique. A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group. Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully.

Medical palpation is a task that traditionally requires a skilled practitioner to assess and diagnose a patient through direct touch and manipulation of their body. In regions with a shortage of such professionals, robotic hands or sensorized gloves could potentially capture the necessary haptic information during palpation exams and relay it to medical doctors for diagnosis. From an engineering perspective, a comprehensive understanding of the relevant motions and forces is essential for designing haptic technologies capable of fully capturing this information. This study focuses on thyroid examination palpation, aiming to analyze the hand motions and forces applied to the patient’s skin during the procedure. We identified key palpation techniques through video recordings and interviews and measured the force characteristics during palpation performed by both non-medical participants and medical professionals. Our findings revealed five primary palpation hand motions and characterized the multi-dimensional interaction forces involved in these motions. These insights provide critical design guidelines for developing haptic sensing and display technologies optimized for remote thyroid nodule palpation and diagnosis.

BackgroundThe loss of tactile feedback in minimally invasive robotic surgery remains a major challenge to the expanding field. With visual cue compensation alone, tissue characterization via palpation proves to be immensely difficult. This work evaluates a bimodal vibrotactile system as a means of conveying applied forces to simulate haptic feedback in two sets of studies simulating an artificial palpation task using the da Vinci surgical robot.MethodsSubjects in the first study were tasked with localizing an embedded vessel in a soft tissue phantom using a single-sensor unit. In the second study, subjects localized tumor-like structures using a three-sensor array. In both sets of studies, subjects completed the task under three trial conditions: no feedback, normal force tactile feedback, and hybrid vibrotactile feedback. Recordings of correct localization, incorrect localization, and time-to-completion were used to evaluate performance outcomes.ResultsWith the addition of vibrotactile and pneumatic feedback, significant improvements in the percentage of correct localization attempts were detected (p = 0.0001 and p = 0.0459, respectively) during the first experiment with phantom vessels. Similarly, significant improvements in correct localization were found with the addition of vibrotactile (p = 2.57E−5) and pneumatic significance (p = 8.54E−5) were observed in the second experiment involving tumor phantoms.ConclusionsThis work demonstrates not only the superior benefits of a multi-modal feedback over traditional single-modality feedback, but also the effectiveness of vibration in providing haptic feedback to artificial palpation systems.

Purpose Optical elastography has been developed for intraoperative tumour margin assessment during breast-conserving surgery (BCS), based on the elevated stiffness of tumour. It aims to assist the surgeon in removing all cancerous tissue in a single operation, reducing re-excision surgeries and potentially lowering recurrence rate. In this study, we investigate the use of a new, cost‑effective method called stereoscopic optical palpation (SOP), a camera‑based optical elastography technique, for breast cancer detection. We tested its diagnostic feasibility on tissue samples from 48 patients. Experimental design SOP was performed on the margins of freshly excised breast tissue from 48 patients. For each specimen, pairs of photographs were taken, and within two minutes, detailed stress maps were generated to show areas of mechanical pressure on the tissue surface. To evaluate SOP’s accuracy, selected regions of interest were analysed and co‑registered with standard histopathology results. These regions were randomly divided into 10 groups, and an automatic classifier was trained and tested using 10‑fold cross‑validation. Results Histopathology showed that 11.3% of the analysed regions had cancer within 1 mm of the margin. Based on the stress maps acquired using SOP and the automatic classifier, the sensitivity of cancer detection near the margin is 82.1% and the specificity of identifying benign tissue is 83.6%. The mean stress threshold determined to identify positive margins is 10.1 kPa. Conclusion This diagnostic feasibility study shows that SOP can achieve accurate cancer assessment within 1 mm of the tissue boundary. Its simplicity and low cost make SOP a promising tool for real-time tumour margin assessment during BCS.

Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points. In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement. Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate. Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.

Background Reliable morphological assessment remains a clinical challenge in congenital clubfoot management, as current clinical scoring systems fail to capture the complex three-dimensional anatomy required for precise evaluation and treatment planning. Virtual palpation of anatomical landmarks offers a standardized, objective approach to define bony axes, but requires rigorous validation to become clinically applicable. Methods 3D models (dried clubfoot and normal foot) were reconstructed from segmented CT scan datasets using image segmentation. For reproducibility purpose, thirty-two anatomical landmarks covering major tarsal bones were independently identified by three operators on three separate occasions using an in-house software lhpFusionBox (Laboratory of Biomechanics and Bioengineering, Université libre de Bruxelles, Brussels, Belgium). Key measurements are proposed to quantify foot bone orientations including root mean square errors (RMS), Bland-Altman plots, and stability indices assessed reproducibility. A complementary analysis evaluated clinical applicability through bony axis measurement and three-dimensional deformity quantification. Results Intra-operator reproducibility achieved mean RMS of 1.07 mm (90.6% < 2 mm) and inter-operator reproducibility of 1.28 mm (84.03% < 2 mm)—both within clinically acceptable thresholds. Mean biases were negligible (− 0.5 to + 0.5 mm) with narrow limits of agreement (± 6–7 mm). Distal lateral and dorsal landmarks demonstrated superior stability (< 0.6 mm). The protocol successfully identified clinically significant angular deviations between clubfoot and normal foot axes, demonstrating its utility for objective morphometric assessment and treatment monitoring. Conclusion This standardized 3D landmark-based protocol achieves significative intra- and inter-observer reliability with proven geometric validity, meeting critical requirements for clinical adoption. It provides orthopedic clinicians with an objective, reproducible tool for clubfoot assessment, bridging the gap between subjective clinical evaluation and quantitative morphometric analysis. This advancement enables more precise treatment planning and standardized monitoring of deformity correction.

Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA). To compare UGFNA to PGFNA by cytopathologists at an academic medical center. A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared. Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%). This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.

This paper presents a novel Fiber Bragg Grating (FBG)-based palpation force sensor to explore tissue abnormalities during minimally invasive surgery. The proposed sensor design mainly consists of a miniature force-sensitive flexure, one tightly suspended optical fiber embedded with one FBG element and associated connectors and fixations. The flexure design has been prototyped through the configuration synthesis of Sarrus mechanism by using a rigid-body replacement method to achieve an excellent axial linear force–deformation relationship and a large measurement range. The mounted fiber has been configured at the flexure’s central line with its two ends glued, and its tight suspension configuration can achieve improved resolution and sensitivity and avoid the FBG chirping failure compared to the commonly used direct FBG-pasting methods. Finite element method (FEM)-based simulation has been performed to investigate both static and dynamic performance to aid in structural design. Simulation-enabled structural optimization design has also been implemented to further improve the proposed design and the sensor’s sensitivity has been increased. The optimized sensor design has been prototyped and calibrated to demonstrate an excellent linearity with a small linearity error of 0.97% and achieve a high resolution of 2.55 mN within a relatively large measurement range of 0–5 N. Dynamic force stimulation experiments, in vitro palpation implementation on a silicone phantom embedded with simulated tumors and ex vivo indentation experiments on a porcine liver have validated the effectiveness of the presented sensor design.

Although there are increasing reports on the usefulness of sonopalpation with ultrasound imaging, many previous studies have reported interventions without a control group. This single-blind, parallel-group randomised controlled trial aimed to determine whether educational instruction with sonopalpation for physical therapy students has a more superior effect on skill improvement than traditional instruction without ultrasonography. Twenty-nine physical therapy students participated in the study and were randomised using block randomisation into an ultrasound imaging group (n = 15) and a control group (n = 14). Subsequently, they underwent three training sessions focusing on the shoulder joint. Participants underwent a scoring assessment of their palpation skills at pre-intervention, post-intervention, and follow-up 3 months after training. The raters were blinded to the subjects’ group. The Friedman and Mann–Whitney U tests were used for data analysis. The intervention group showed a significant increase in scores at post-intervention and the 3-month follow-up; the effect sizes were large (0.849 and 0.849, respectively). A comparison of the scores at different time points after the intervention at the 3-month follow-up revealed no significant difference between the groups. Education using ultrasound imaging may be non-inferior to education without it; nevertheless, further studies are needed to demonstrate superiority.