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( Background ) Over the years, there has been increasing interest in adopting a quality approach in radiology, leading to the strategic pursuit of specific and key performance indicators (KPIs). These indicators in radiology can have significant impacts ranging from radiation protection to integration into digital healthcare. ( Purpose ) This study aimed to conduct a narrative review on the integration of key performance indicators (KPIs) in radiology with specific key questions. ( Methods ) This review utilized a standardized checklist for narrative reviews, including the ANDJ Narrative Checklist, to ensure thoroughness and consistency. Searches were performed on PubMed, Scopus, and Google Scholar using a combination of keywords related to radiology and KPIs, with Boolean logic to refine results. From an initial yield of 211 studies, 127 were excluded due to a lack of focus on KPIs. The remaining 84 studies were assessed for clarity, design, and methodology, with 26 ultimately selected for detailed review. The evaluation process involved multiple assessors to minimize bias and ensure a rigorous analysis. ( Results and Discussion ) This overview highlights the following: KPIs are crucial for advancing radiology by supporting the evolution of imaging technologies (e.g., CT, MRI) and integrating emerging technologies like AI and AR/VR. They ensure high standards in diagnostic accuracy, image quality, and operational efficiency, enhancing diagnostic capabilities and streamlining workflows. KPIs are vital for radiological safety, measuring adherence to protocols that minimize radiation exposure and protect patients. The effective integration of KPIs into healthcare systems requires systematic development, validation, and standardization, supported by national and international initiatives. Addressing challenges like CAD-CAM technology and home-based radiology is essential. Developing specialized KPIs for new technologies will be key to continuous improvement in patient care and radiological practices. ( Conclusions ) In conclusion, KPIs are essential for advancing radiology, while future research should focus on improving data access and developing specialized KPIs to address emerging challenges. Future research should focus on expanding documentation sources, improving web search methods, and establishing direct connections with scientific associations.

This study delves into the transformative potential of integrating augmented reality (AR) within imaging technologies, shedding light on this evolving landscape. Through a comprehensive narrative review, this research uncovers a wealth of literature exploring the intersection between AR and medical imaging, highlighting its growing prominence in healthcare. AR's integration offers a host of potential opportunities to enhance surgical precision, bolster patient engagement, and customize medical interventions. Moreover, when combined with technologies like virtual reality (VR), artificial intelligence (AI), and robotics, AR opens up new avenues for innovation in clinical practice, education, and training. However, amidst these promising prospects lie numerous unanswered questions and areas ripe for exploration. This study emphasizes the need for rigorous research to elucidate the clinical efficacy of AR-integrated interventions, optimize surgical workflows, and address technological challenges. As the healthcare landscape continues to evolve, sustained research efforts are crucial to fully realizing AR's transformative impact in medical imaging. Systematic reviews on AR in healthcare also overlook regulatory and developmental factors, particularly in regard to medical devices. These include compliance with standards, safety regulations, risk management, clinical validation, and developmental processes. Addressing these aspects will provide a comprehensive understanding of the challenges and opportunities in integrating AR into clinical settings, informing stakeholders about crucial regulatory and developmental considerations for successful implementation. Moreover, navigating the regulatory approval process requires substantial financial resources and expertise, presenting barriers to entry for smaller innovators. Collaboration across disciplines and concerted efforts to overcome barriers will be essential in navigating this frontier and harnessing the potential of AR to revolutionize healthcare delivery., Competing Interests: The authors declare no conflict of interest.

This study investigates, through a narrative review, the transformative impact of deep learning (DL) in the field of radiotherapy, particularly in light of the accelerated developments prompted by the COVID-19 pandemic. The proposed approach was based on an umbrella review following a standard narrative checklist and a qualification process. The selection process identified 19 systematic review studies. Through an analysis of current research, the study highlights the revolutionary potential of DL algorithms in optimizing treatment planning, image analysis, and patient outcome prediction in radiotherapy. It underscores the necessity of further exploration into specific research areas to unlock the full capabilities of DL technology. Moreover, the study emphasizes the intricate interplay between digital radiology and radiotherapy, revealing how advancements in one field can significantly influence the other. This interdependence is crucial for addressing complex challenges and advancing the integration of cutting-edge technologies into clinical practice. Collaborative efforts among researchers, clinicians, and regulatory bodies are deemed essential to effectively navigate the evolving landscape of DL in radiotherapy. By fostering interdisciplinary collaborations and conducting thorough investigations, stakeholders can fully leverage the transformative power of DL to enhance patient care and refine therapeutic strategies. Ultimately, this promises to usher in a new era of personalized and optimized radiotherapy treatment for improved patient outcomes.

The lockdown was imposed in Italy on 9 March 2020 due to the COVID-19 outbreak. Restrictions severely limiting individual freedom were indispensable to protect the population and reduce virus diffusion. Italian people had never before experienced similar restrictions that undoubtedly tested psychological health. After 1 week, we developed an electronic survey to collect demographic data and information on the presence of pets and the type of interaction with them and to administer a self-assessment anxiety test. A total of 3905 subjects, pet owners and non pet owners, filled in the electronic survey; 652 (16.7%, mean age 21.6) of them were young subjects, adolescents, and university students. The study first showed the feasibility and success of the technological solution used, capable of providing, at a distance, structured information on the participants and quantitative data on the psychological condition. Second , it reported that 23.1% of the youths showed anxiety above an attention level during the lockdown, in line with other studies. Third , it indicated, based on the outcome of the self-assessment test, that the pet presence could have a positive effect in mitigating the psychological impact and encourage to continue and deepen these investigations. Fourth , it reported positive feedback from the participants on the procedure, found useful during the pandemic and for the post-pandemic future. The study highlights the importance of investing in these solutions based on mobile technology and useful both for mental health and to deepen the investigation of the impact of the pet presence on the human psychology.

We are writing to you as the corresponding authors of the interesting systematic review study "Pathway of Trends and Technologies in Fall Detection: A Systematic Review" [...].

Cybersecurity is becoming an increasingly important aspect to investigate for the adoption and use of care robots, in term of both patients' safety, and the availability, integrity and privacy of their data. This study focuses on opinions about cybersecurity relevance and related skills for physiotherapists involved in rehabilitation and assistance thanks to the aid of robotics. The goal was to investigate the awareness among insiders about some facets of cybersecurity concerning human-robot interactions. We designed an electronic questionnaire and submitted it to a relevant sample of physiotherapists. The questionnaire allowed us to collect data related to: (i) use of robots and its relationship with cybersecurity in the context of physiotherapy; (ii) training in cybersecurity and robotics for the insiders; (iii) insiders' self-assessment on cybersecurity and robotics in some usage scenarios, and (iv) their experiences of cyber-attacks in this area and proposals for improvement. Besides contributing some specific statistics, the study highlights the importance of both acculturation processes in this field and monitoring initiatives based on surveys. The study exposes direct suggestions for continuation of these types of investigations in the context of scientific societies operating in the rehabilitation and assistance robotics. The study also shows the need to stimulate similar initiatives in other sectors of medical robotics (robotic surgery, care and socially assistive robots, rehabilitation systems, training for health and care workers) involving insiders.

Care robots represent an opportunity for the health domain . The use of these devices has important implications. They can be used in surgical operating rooms in important and delicate clinical interventions, in motion, in training-and-simulation, and cognitive and rehabilitation processes. They are involved in continuous processes of evolution in technology and clinical practice. Therefore, the introduction into routine clinical practice is difficult because this needs the stability and the standardization of processes. The agreement tools , in this case, are of primary importance for the clinical acceptance and introduction. The opinion focuses on the Consensus Conference tool and: (a) highlights its potential in the field; (b) explores the state of use; (c) detects the peculiarities and problems (d) expresses ideas on how improve its diffusion.

Motivation : We are witnessing two phenomena. The first is that the physiotherapist is increasingly becoming a figure that must interact with Digital Health. On the other hand, social robots through research are improving more and more in the aspects of social interaction thanks also to artificial intelligence and becoming useful in rehabilitation processes. It begins to become strategic to investigate the intersections between these two phenomena. Objective : Therefore, we set ourselves the goal of investigating the consensus and opinion of physiotherapists around the introduction of social robots in clinical practice both in rehabilitation and assistance. Procedure : An electronic survey has been developed focused on social robot-based rehabilitation and assistance and has been submitted to subjects focused on physiotherapy sciences to investigate their opinion and their level of consent regarding the use of the social robot in rehabilitation and assistance. Two samples of subjects were recruited: the first group (156 participating subjects, 79 males, 77 females, mean age 24.3 years) was in the training phase, and the second (167 participating subjects, 86 males, 81 females, mean age 42.4 years) group was involved in the work processes. An electronic feedback form was also submitted to investigate the acceptance of the proposed methodology. Results : The survey showed a consistency of the results between the two samples from which interesting considerations emerge. Contrary to stereotypes that report how AI-based devices put jobs at risk, physiotherapists are not afraid of these devices. The subjects involved in the study believe the following: (a) social robots can be reliable co-workers but will remain a complementary device; (b) their role will be of the utmost importance as an operational manager in their use and in performance monitoring; (c) these devices will allow an increase in working capacity and facilitate integration. All those involved in the study believe that the proposed electronic survey has proved to be a useful and effective tool that can be useful as a periodic monitoring tool and useful for scientific societies. Conclusions : The evolution of social robots represents an unstoppable process as does the increase in the aging of the population. Stakeholders must not look with suspicion toward these devices, which can represent an important resource, but rather invest in monitoring and consensus training initiatives.

The vaccination against the COVID-19, finally available, has the potential to represent an important defence against the pandemic. The identification of both obstacles and tools to combat them are, at this moment, of strategic importance. Previous experiences on vaccinations have shown solutions and paths to take, also based on the behavioural sciences. The objective of the opinion is to face how mobile technology can help us both to fight these problems and to optimize the vaccination process. The opinion has four polarities. The first polarity consists in having detected the problems hampering an effective vaccination process. These problems have been grouped into the following four: Electronic and Informatic divide , Escape , Exposure risk , and Equity . The second polarity consists in having verified how the mobile technology can be useful to face the identified problems. The third polarity highlights the usefulness and importance of using electronic surveys. These tools are based on mobile technology. They are useful problem sensors for the stakeholders. The fourth polarity faces how mobile technology and mHealth can be of aid to optimize the flow of the vaccination process, from the first call up to the certification. This polarity is supported by an example based on the Italian national App IO. The study highlights: (a) on one side, the potential of mobile technology; on the other side, the need for interventions to reduce the digital divide with the purpose to increase its use. (b) How the role of mobile technology can be complementary to other intervention methods.

Background: The evolution of the Telemedicine and e-Health is strictly related to the evolution of the mobile-technology. If today it is possible to successfully use a wide range of mHealth applications, playing an important role in Telemedicine and e-Health, health care has surely a gratitude debt with the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of risks and it is therefore necessary to tackle the various gaps and/or the role that Telemedicine and e-Health itself has in this field., Methods: Through an overview to literature, Web and App stores the study faced the implications for health from the excessive use of the smartphone and therefore the various gaps and/or the role that Telemedicine and e-Health itself has in this area both in the prevention and in the monitoring with particular regard to the three components: eHealth, mHealth and eLearning ., Results: The study found (I) as emerging risks: the text neck, the risk of addiction and the risk in the use of deceptive Apps in mHealth ; (II) as Telemedicine and e-Health useful approach: the design of Apps for the text neck prevention and the relevant acceptance and effectiveness assessment; the design and application of electronic surveys for tele-assessment of the addiction risk; the design and application of information and training path on the deceptive Apps in mHealth., Conclusions: The key role of Telemedicine and e-Health in the prevention and monitoring of the risks from smartphone abuse has been clearly identified and the young people has been identified as target population and the relevant need to design specific teaching packages in this field focused on them., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/mhealth-20-150). DG serves as an unpaid editorial board member of mHealth from May 2019 to April 2021. The other authors have no conflicts of interest to declare., (2021 mHealth. All rights reserved.)

Background: The evolution of mHealth is strictly related to the evolution of the mobile-technology and in particular of the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of emerging risks and in particular (I) the text neck, (II) the addiction, (III) the use of deceptive Apps in mHealth and today telemedicine and e-Health solutions to face this are strongly needed. What young people need is a package of solutions that allow them to tackle all three of these problems at the same time through dedicated tools and specific material on these topics. However up to now this is lacking. The purpose of the study was the design and application of a teaching package focused in this field and specific for young people, the target population for the emerging risks., Methods: A teaching package was developed in a school-work alternation program for the secondary schools at the Italian National Institute of Health, according the Italian Law. It was available on the basis of proposals offered publically. It provided a two weeks stage on the topics: the risks from smartphone abuse and Telemedicine and e-Health solutions., Results: A specific electronic survey in this field was available at the end of the stage. The survey was submitted to 500 young subjects (50% male; 50% females; mean age 15.9 y; std-dev 1.2 y) at school and/or in meeting initiatives. The outcome demonstrated: (I) that the knowledge on the postural risk (text neck) was very poor, while the desiderata of Apps for correcting the posture was very high; (II) the feasibility to obtain feedback on the risk of addiction through a cyber-psychology approach; (III) a worrying position in relation to non-medical Apps confused with the medical ones., Conclusions: The study demonstrated how the young people mBorn can familiarize with some aspects of telemedicine and e-Health and be at the same time a kind of spreader of a correct vision of the ratio between user and smartphone and the knowledge on both the mTech and the related problems., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/mhealth-20-129). DG serves as an unpaid editorial board member of mHealth from May 2019 to April 2021. The other authors have no conflicts of interest to declare., (2021 mHealth. All rights reserved.)

The study focuses on emerging problems caused by the spread of medical apps. Firstly, it reviews the current role of cybersecurity and identifies the potential need to widen the boundaries of cybersecurity in relation to these apps. Secondly, it focuses on the pivotal device behind the development of mHealth: the smartphone, and highlights its role and current potential for hosting wearable medical technology. Thirdly, it addresses emerging issues regarding these apps, which are in a gray zone. This is done through an analysis of the important positions of scholars, and by means of a survey report on the increased use of various categories of apps during the COVID-19 pandemic, highlighting an accentuation of the problem. The study ends by explaining the reflections and proposals that emerged after performing the analysis.

Background: We are today assisting to an increasing interest to the animal assisted therapy (AAT). Among the goals of the AAT there is to improve a patient's psychological and physiological condition during the rehabilitation therapies. Several studies showed the health benefits (psychological and physiological) for the human subject thanks to the AAT. Today, according to the new central position of the pet, the approach must be revised in a more general and bidirectional approach embedding the assessment of the health benefits contemporary for the two actors, human and pet., Methods: Among the most commonly used types of AAT there is the canine assisted therapy (CAT). The study focused to the CAT and was dedicated to the design and validation of a wearable system for the assessment of physiological parameters during the walking of the two actors man and dog. A properly designed case-study involved a human (age 40; height 1.80 m; weight 80 kg) with three dogs with different sizes. It has been performed in a rectilinear walkway of 1 km of asphalt with 15 repetition with each one of the three different dogs at a speed typical for a walk., Results: The study showed a mean error ≤0.6% in the step counting. The study also showed: the feasibility to use parameters correlating the human and dog motion activity; a high acceptance of the methodology as assessed by 5 independent observers and an interesting perspectives for the future scenario of investigation of the medical scientific evidence of the approach based on the CAT., Conclusions: From a general point of view the work highlights the importance and the utility of the design and application of tool for the contemporary monitoring of the man and the dog during walking and other activities., Competing Interests: Conflicts of Interest: DG serves as an unpaid editorial board member of mHealth from May 2019 to Apr. 2021. The other authors have no conflicts of interest to declare., (2020 mHealth. All rights reserved.)

Background: We are today assisting to: an increasing interest to both the animal assisted therapy (AAT) and to the pet quality of life and health. The animal-assisted therapy is an alternative or complementary type of therapy that involves animals as a form of treatment. Among the goals of AAT there is to improve a patient's psychological and physiological condition during the rehabilitation therapies. The increasing interest into the pet quality of life and health is a direct consequence of the recognition to its contribute to the society., Methods: Through an analysis of the literature the study investigated this field in order to derivate new models based on mHealth. Several studies showed the health benefits (psychological and physiological) for the human subject thanks to the AAT. Today, according to the new central position of the pet, the approach must be revised in a more general and bidirectional approach embedding the assessment of the health benefits contemporary for the two actors, human and pet., Results: The study highlights that the most commonly used types of AAT is the canine-assisted therapy (CAT). Among the most used CAT applications in psychological and physiological rehabilitation there are: the (I) co-presence during the dynamic activity (in particular the walking) and the (II) co-presence in the Area of living (mainly the home). The study focused to the CAT, introduces a conceptual model for the contemporary parameters monitoring of the two actors during the two applications (I,II) and able to provide a quantification of the utility of the CAT. It is based on to two sub-systems. The first sub-systems is a wearable mobile solution with kinematic sensors for the human and the dog monitoring in (I) during walking. The second sub-system, allowing the monitoring in (II), is based on RFID technology., Conclusions: After an analysis of the literature a new model for the CAT, based on kinematic sensors and RFID technology has been proposed and will be introduced in this field., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 mHealth. All rights reserved.)

Respiratory rehabilitation is a therapeutic path based on performing regular physical exercise. It aims to modify the impact that the respiratory disease has on the patients' quality of life, reducing the severity of the symptoms, and improving their ability to adhere to the activities of daily life. After an initial assessment, they are prescribed (1) different forms and modes of physical exercise and (2) exercise of pulmonary musculature to improve individual performance and the consequences of the symptoms of the emotional sphere related to the pathological condition. At the moment, the devices for pulmonary exercitation/incentivization, even if gamified, give out qualitative information and are not provided with electronics and/or are not connected to the network. The objective of this opinion article is to introduce new models of rehabilitation in this field of Telemedicine and e-Health at a first stage of research. In particular, a new environment for home rehabilitation is proposed, which is based to gamified devices for pulmonary incentivization integrated to the e-Healthcare system integratable also with automatic systems for the 6-min walk tests proposed by the same authors. A first device has been designed and tested. The next steps will be dedicated to the widening of the environment with the design of other devices and to complete the integration with the healthcare system.

When designing a complete system of daily-telerehabilitation it should be borne in mind that properly designed methodologies should be furnished for patients to execute specific motion tasks and for care givers to assess the relevant parameters. Whether in hospital or at home, the system should feature two basic elements: (a) instrumented and walking aids or supports, (b) equipment for the assessment of parameters. Being gait the focus, the idea was to design, construct and validate - as an alternative to the complex and expensive instruments currently used - a simple, portable kit that may be easily interfaced/integrated with the most common mechanical tools used in motion rehabilitation (instrumented walkways, aids, supports), with feedback to both patient for self-monitoring and trainer/therapist (present or remote) for clinical reporting. The proposed system consists of: one step-counter, three couples of photo-emitter detectors, one central unit for collecting and processing the telemetrically transmitted data; a software interface on a dedicated PC and a network adapter. The system has been successfully validated in a clinical application on two groups of 16 subjects at the 1st and 2nd level of the Tinetti test. The degree of acceptance by subjects and care-givers was high. The system was also successfully compared with an Inertial Measurement Unit, a de facto standard. The portable kit can be used with different rehabilitation tools and different ground rugosity. The advantages are: (a) very low costs when compared with optoelectronic solutions and other portable solutions; (b) very high accuracy, also for subjects with imbalance problems; (c) good compatibility with any rehabilitative tool., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: When designing a complete process of daily telerehabilitation, it should be borne in mind that patients should be furnished with properly designed methodologies for executing specific motion tasks and the assessment of the relevant parameters. In general, such a process should comprehend three basic elements in both the hospital and the home: (a) instrumented walkways, (b) walking aids or supports, and (c) equipment for the assessment of parameters. The objective, with gait being the focus, of this study was thus to design a simple, portable kit-as an alternative to the complex and expensive instruments currently used-to be easily interfaced or integrated with the instrumented walkways and aids/supports both for self-monitoring while patients are exercising with their own aids and for clinical reporting., Materials and Methods: The proposed system is a portable kit that furnishes useful parameters with feedback to both the patient and the trainer/therapist. Capable of being integrated with the most common mechanical tools used in motion rehabilitation (handrail, scales, walkways, etc.), it constantly monitors and quantitatively assesses progress in rehabilitation care. It is composed of one step counter, photo-emitter detectors, one central unit for collecting and processing the telemetrically transmitted data, and a software interface., Results and Discussion: The system has been successfully validated on 16 subjects at the second level of the Tinetti test in a clinical application for both home and the hospital. The portable kit can be used with different rehabilitation tools and on varying ground rugosity. Advantages include (a) very low cost, when compared with optoelectronic solutions or other portable devices, (b) very high accuracy, also for subjects with imbalance problems, compared with other commercial solutions, and (c) integration (compatibility) with any rehabilitative tool.

Today the risk factors related to the use of Video Display Terminals (VDT) are assessed by investigating the actual activities at the VDT through subjective questionnaires and/or quantitative measurements. Questionnaire outcomes are quite imprecise and seldom objective. Quantitative measurements (EMG recordings, electrogoniometers, motion analysis systems) mostly prevent subjects from moving freely while working at the VDT. The paper presents an automatic tool for the monitoring of activity at VDTs, using a quantitative, objective approach. The suitability of the proposed tool was fully tested in the laboratory, both in terms of functionalities, accuracy of the tool, and acceptance by the subjects involved. The outcomes show that the tool allows for a detailed analysis of VDT activities and may be used to improve VDT-related risk analysis with high accuracy and good acceptance by workers., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Input from the foot plays an essential part in perceiving support surfaces and determining kinematic events in human walking. To simulate adequate tactile pressure inputs under body weight support (BWS) conditions that represent an effective form of locomotion training, we here developed a new method of phasic mechanical foot stimulation using light-weight pneumatic insoles placed inside the shoes (under the heel and metatarsus). To test the system, we asked healthy participants to walk on a treadmill with different levels of BWS. The pressure under the stimulated areas of the feet and subjective sensations were higher at high levels of BWS and when applied to the ball and toes rather than heels. Foot stimulation did not disturb significantly the normal motor pattern, and in all participants we evoked a reliable step-synchronized triggering of stimuli for each leg separately. This approach has been performed in a general framework looking for "afferent templates" of human locomotion that could be used for functional sensory stimulation. The proposed technique can be used to imitate or partially restore surrogate contact forces under body weight support conditions., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The paper approaches a new technological scenario relevant for the introduction of the digital cytology (D-CYT) in the health service. A detailed analysis of the state of the art on the status of the introduction of D-CYT in the hospital and more in general in the dispersed territory has been conducted. The analysis was conducted in a form of review and was arranged into two parts: the first part focused on the technological tools needed to carry out a successful service (client server architectures, e-learning, quality assurance issues); the second part focused on issues oriented to help the introduction and evaluation of the technology (specific training in D-CYT, health technology assessment in-routine application, data format standards and picture archiving computerized systems (PACS) implementation, image quality assessment, strategies of navigation, 3D-virtual-reality potentialities). The work enlightens future scenarios of actions relevant for the introduction of the technology.

Telemedicine represents a valid aid in rehabilitation process. A remote therapist in a telerehabilitation program could monitor daily motion activity and assign motion-rehabilitation tools on the basis of the fall risk. However, one problem is detection of the fall risk itself. Web-based video-camera images alone do not help the remote assessment of the fall risk using the most commonly used qualitative tests based on visual observation. A novel wearable system to assess fall risk in telerehabilitation has been proposed based on an Inertial Measurement Unit and a medical protocol. It provides a score in four levels (1: no fall risk; 4: major fall risk). The telemedicine tool is integrated to the Global System for Mobile communication (GSM) net. Each component of the wearable system has been designed and integrated. Each component in the system has been tested individually and in a closed loop. One subject was monitored in a telemedicine link. The test showed a high degree of acceptance. The tool will be furnished to subjects along with a homecare device for daily routine monitoring of motion activity and could eventually be integrated with other systems designed to monitor other physiological parameters along with different aids and monitoring tools.

Thermal imaging of the skin has been used for several decades for monitoring of temperature distribution of human skin for the detection of thermal abnormalities indicating pathologies (malignancies, inflammation, infection, and vascular, dermatological, and rheumatic disorders). Literature has shown that to detect and monitor the thermal abnormalities related to pathologic conditions, there is a need to extend acquisition over 8, 12, 16, or 24 hours. A wearable device is strongly needed in contact thermography to reach the objective of long-term monitoring of contact thermography, especially in telemedicine applications. A wearable system has been designed and constructed that allows the continuous thermographic monitoring of a skin region at the point of affixation. Measurement allowed by this system is direct and not hampered by the influence of the environment--as with IR thermography--nor by the geometry of skin surface (curvatures, roughness) thanks to the flexible adaptation of the sensing head to the surface. The validation of the system embedded in a pilot preliminary telemedicine application was successful. The next step will be the wide focusing and adaptation to telemedicine clinical applications to assess the response to the chemotherapy and tune the therapy at home of the breast cancer or the response to the inflammation care.

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA. In the present study, a solution offering a structured HTA of T-E products was designed. The methodology assured also the definition of standardized quality levels for the application. The first level represents the minimum level of acceptance; the other levels are accessory levels useful for a more accurate assessment of the product. The methodology showed to be useful to rationalize the process of standardization and has received a high degree of acceptance by the subjects involved in the study.

This paper investigates the trunk postural modifications induced by a wearable device which assesses the trunk sway and provides biofeedback information through sonification of trunk kinematics. The device is based on an inertial wearable sensing unit including three mono-axial accelerometers and three rate gyroscopes embedded and mounted orthogonally. The biofeedback device was tested on nine healthy subjects during quiet stance in different conditions of sensory limitation eyes closed on solid surface, eyes open on foam cushion surface, eyes closed on foam cushion surface. Five trials were performed for each condition; the order of the trials was randomized. The results reported in this paper show how subjects reduced their rotational kinetic energy by using the biofeedback information and how this reduction was related to the limitation of sensory information.

In the management of stroke, after the first critical care period at the hospital, it is important for the subjects to plan a neural and motion rehabilitation program at home. Telerehabilitation could represent a valid aid for subjects involved in a rehabilitation process at home. Motion and neural rehabilitation are strictly correlated. Prompt motion rehabilitation is essential to ensure good recovery performance from the stroke defect. Remote therapy, which involves a telerehabilitation program, should monitor daily motion activity. An optimal telerehabilitation program should be capable of monitoring patient activity starting from a high disability of imbalance, when there is the need for properly designed aids or prosthesis. The program should continue when the patient improves his or her condition, and progressively changes or abandons aids or prosthesis. New home care for remote activity monitoring has been proposed. It includes a sensorized-codivilla-spring and a gastrocnemius expansion measurement unit to allow activity monitoring in terms of step-counting for the continuity of care at home. This home care has been integrated in a telerehabilitation process. Preliminary clinical trials have shown the effectiveness and the high degree of client satisfaction (patient and therapist). The next phase will be the integration with other units to allow the monitoring of other physiological parameters (blood pressure, heart rate, blood glucose) useful to investigate in stroke telerehabilitation.

A primary or secondary compulsive epileptic crisis (EC) causes a sudden loss of consciousness. During the acute phase, the subject is completely unable to interact with the environment. Electroencepholographic (EEG) signals show a significant frequency spectrum centered at 6.5 Hz during an EC. Telemonitoring of EEG signals could be useful to remotely communicate the occurrence of an EC. The purpose of this work was to design and construct a system based on a frequency algorithm to detect an EC. In addition, the system must remotely communicate the occurrence of the EC and its geographical coordinates through the national global system for mobile communications (GSM) network. A wearable system for the detection of the EC and the communication has been proposed. The EEG signals are multiplexed, amplified, and low pass filtered at 20 Hz by means of the conditioning unit. As soon as an EC event is detected by a signal-processing unit based on the microP DSPic33fj12gp (Microchip Technolgoy, Inc., Chadler, AZ), a trigger is sent to a communication unit based on two separate GPS/GSM FT596K9 (Siemens, Berlin, Germany) units. The communication unit then sends an SMS message with an alarm and the coordinates of the subject. The final weight of the complete system developed using surface-montage-technology was equal to 3,760 mN, with a volume equal to 282 cm(3). Each component of the wearable system was designed separately and integrated. The system was tested in each component part and simulated in a closed loop. In particular, the system as a whole was simulated using 20 EEG rough traces (10 positive and 10 negative) in describing an EC. In both cases, the system did not show failures.

During stroke rehabilitation at home, the most used equipment is the Codivilla spring for both bilateral and one-side stroke damage. A novel Codivilla spring prosthesis has been electronically sensorized in order to allow new functionalities pertinent to telerehabilitation, such as the step counting and biofeedback mapping of gait-phases. The principal elements of the electronics are a couple of force-sensing resistors affixed in the plantar area of the prosthesis, and a wearable unit with a microprocessor-based on Microchip technology (Microchip Technology, Inc., Chandler, AZ) for data processing and a telemetric system based on Aurel technology (Aurel, Modigliana, Italy) for data tansfer. While ambulating, the foot-sensing resistors detect the pressure of the foot-tip and heel. The microprocessor provides step-counting on the basis of an algorithm. The microprocessor also drives two vibrotactile actuators (one at the foot-tip and the other at the heel). These actuators are fixed at the level of the belt directly in contact with the skin and give biofeedback mapping of the gait-phases to the patient wearing the prosthesis, who can then walk without looking at his or her feet. The sensorized prosthesis was tested on six subjects undergoing stroke rehabilitation at level 2 of the Tinetti test. These subjects performed five repetitions of 100 steps with three different instructions (fast, slow, and normal). The mean error was lower than 0.6%. A test conducted by means of Cosmed devices (Cosmed USA, Chicago, IL) also showed that the biofeedback function provided by means of the actuators diminished the energy expenditure by 0.7% in mean value. The next phase will be the optimization of the equipment for long-term medical application in a patient's home.

Step counting is an important index of motion activity and it is currently used in the management of obesity, in applications for the prevention of cardiovascular problems, in diabetes care, and in motion rehabilitation. Commercial pedometers are not appropriate for telemonitoring subjects with motion disability such as Parkinson's disease. The aim of this paper was to test the integration of a Gastrocnemius Expansion Measurement Unit (GEMU) for step counting in a telemedicine application involving subjects with Parkinson's Disease. The test of GEMU in a new model of care was performed on 6 subjects with Parkinson's disease at Level 3 of the Tinetti test of unbalance. They were asked to record binary information about the correct assumption of dopaminergic therapy. Results showed greater than 97% success of monitoring. A statistical analysis also shows (p < 0.05) the feasibility of correlating the decrement of mobility in terms of the step counting with an incorrect assumption of dopaminergic therapy. Furthermore, the methodology showed a high degree of acceptance, and the users gave suggestions for future improvements, especially related to the interface between GEMU and home care itself.

We have investigated the use of an Artificial Neural Network (ANN) for the assessment of fall-risk (FR) in patients with different neural pathologies. The assessment integrates a clinical tool based on a wearable device (WD) with accelerometers (ACCs) and rate gyroscopes (GYROs) properly suited to identify trunk kinematic parameters that can be measured during a posturography test with different constraints. Our ANN--a Multi Layer Perceptron Neural Network with four layers and 272 neurones--shows to be able to classify patients in three well-known fall-risk levels. The training of the neural network was carried on three groups of 30 subjects with different Fall-Risk Tinetti scores. The validation of our neural network was carried out on three groups of 100 subjects with different Fall-Risk Tinetti scores and this validation demonstrated that the neural network had high specificity (> or =0.88); sensitivity (> or =0.87); area under Receiver-Operator Characteristic Curves (>0.854).

Fall prevention lacks easy, quantitative and wearable methods for the classification of fall-risk (FR). Efforts must be thus devoted to the choice of an ad hoc classifier both to reduce the size of the sample used to train the classifier and to improve performances. A new methodology that uses a neural network (NN) and a wearable device are hereby proposed for this purpose. The NN uses kinematic parameters assessed by a wearable device with accelerometers and rate gyroscopes during a posturography protocol. The training of the NN was based on the Mahalanobis distance and was carried out on two groups of 30 elderly subjects with varying fall-risk Tinetti scores. The validation was done on two groups of 100 subjects with different fall-risk Tinetti scores and showed that, both in terms of specificity and sensitivity, the NN performed better than other classifiers (naive Bayes, Bayes net, multilayer perceptron, support vector machines, statistical classifiers). In particular, (i) the proposed NN methodology improved the specificity and sensitivity by a mean of 3% when compared to the statistical classifier based on the Mahalanobis distance (SCMD) described in Giansanti (2006 Physiol. Meas. 27 1081-90); (ii) the assessed specificity was 97%, the assessed sensitivity was 98% and the area under receiver operator characteristics was 0.965.

Step counting is an important index of motion in telemonitoring. We have developed a wearable system based on a device with a force-sensing resistor. This is affixed at the calf gastrocnemius level to monitor the muscular expansion related to the gait. The gastrocnemius expansion measurement unit (GEMU) was tested on three subjects at Level 2 of the Tinetti test of unbalance, who performed five repetitions of 100 steps at two different speeds (normal and slow). The mean error was less than 0.5%. The GEMU also performed better than an accelerometer unit, which is normally considered to be the best solution for this disability. The system can be integrated into a routine home-care application based on a GSM home-care unit.

Remote therapy, involved in a tele-rehabilitation program, should monitor daily motion activity. Furthermore, patients should have all possible means to improve rehabilitation care at their disposal, such as suitable prostheses and biofeedback tools. During stroke rehabilitation at home, the most used equipment is the AFO prosthesis, which is also called codivilla-spring, as it is used in cases of both bilateral and mono-lateral damage. A new codivilla-spring prosthesis with sensors for telemonitoring / telerehabilitation has been designed and constructed. It provides step counting. It is based on a couple of force sensing resistors affixed in the plantar area of the prosthesis, and a wearable unit with a micro-processor microP PIC 16F877 (Microchip, USA). The data exchange is assured by the Aurel-XTR-434H telemetric system. While ambulating, FSRs detect the pressure of the foot-tip and heel. The PIC on the basis of an algorithm furnishes the step-counting. The proposed sensorized-codivilla-spring (SECOSP) was tested as a step-counter on three subjects after stroke-rehabilitation with mono-lateral damage at Level 2 of the Tinetti test of unbalance. These subjects performed 100 steps with two different instructions (fast, slow). The mean error was lower than 0.6 %. The next phase will be the optimization of SECOSP for long term medical application in a patient's home.

We have designed and constructed force measurement equipment to assess hand-finger function in pressing tasks. The equipment was used for monitoring the follow-up of five hand-transplanted subjects. Interactive software was integrated into the instrument to monitor the functionality of the hand and fingers during exercises in realtime. The interactive software included biofeedback to provide realtime quantitative responses for the patient and the therapist. Acceptance of the system was investigated with patients and therapists: the system was found to be user-friendly and effective; it was practical both for patients and therapists. The system could be used in a telerehabilitation centre or in a patient's home.

We have designed and constructed a wearable device for skin-contact thermography [Giansanti D, Maccioni G. Development and testing of a wearable integrated thermometer sensor for skin-contact thermography. Med Eng Phys 2007;29(5):556-65] that uses 16 integrated silicon sensors with a thermal resolution of 0.03 degrees C and a spatial resolution of 1.6 x 10(-5)m(2). In order to perform a dynamic bench test, a thermographic phantom was designed and constructed that permits the imposition of 16 independent thermal waveforms to the device. The phantom was based on 16 small black bodies units designed with a 10(-4) m thin layer of black conductive gum. An infrared system was used in closed loop to correct in real time the error between the theoretical and the actual temperature imposed. The methodology proved to be adequate for bench testing the device. The difference between the imposed and the theoretical waveforms was never greater than 0.85 x 10(-2) degrees C in mean value, as measured with the infrared (IR) system.

Hand rehabilitation requires continuous and frequent monitoring of the functionality in order to assess therapy and/or refine it. In order to contain costs for the rehabilitation program, a telehomecare rehabilitation system is suitable. The purpose of this paper was to describe the setup and configuration of a homecare device for telemonitoring/telerehabilitation of patients who underwent hand transplant. The telehomecare device allows the assessment of dynamics and kinematics of hand function by integrating dedicated software in two components. The first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy). The second was a set of instruments for the measurement of digit force using an Instrumented Keyboard and an Instrumented Mouse-Like device. The software integrating the devices is composed of two modular components. The first is to drive the devices; the second is for the data-analysis and display. The methodology was validated at the Istituto Superiore di Sanit (the Italian National Institute of Health) in the framework of an Italian National Project, funded by the Ministry of Health.