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Digital Twin Technology: New Frontiers for Personalized Healthcare

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A special issue of Electronics (ISSN 2079-9292). This special issue belongs to the section "Bioelectronics".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 39492

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Special Issue Editors

Prof. Dr. Luigi Landini

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1. Department of Information Engineering, University of Pisa, Largo Lucio Lazzarino, 156122 Pisa, Italy
2. Fondazione Toscana Gabriele Monasterio, CNR - Regione Toscana, via Trieste 41, 56126 Pisa, Italy
Interests: biomedical signal processing; algorithms for fast image acquisition and reconstruction; ultrasound; photoacoustic imaging

Dr. Vincenzo Positano

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Fondazione Toscana “G. Monasterio”, 56124 Pisa, Italy
Interests: medical image processing and analysis
Special Issues, Collections and Topics in MDPI journals

Dr. Maria Filomena Santarelli

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Guest Editor

CNR Institute of Clinical Physiology, 56124 Pisa, Italy
Interests: medical image acquisition and reconstruction
Special Issues, Collections and Topics in MDPI journals

Dr. Simona Celi

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Guest Editor

Gabriele Monasterio Foundation, Pisa, Italy
Interests: vascular diseases; aneurysm; finite element method; computational fluid dynamics; biomechanics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The “digital twin” is the dynamic digital representation of the patient’s anatomy and physiology through computational models such as finite element analysis (FEM) and computational fluid dynamics (CFD), which are continuously updated from imaging sensors, wearable devices, and laboratory and clinical data. Information obtained from multiple sources can be used to create “digital twin” of organs or individuals that reflect the anatomical, physiological, functional, and biochemical behavior of the real system. In addition, digital twin used in combination with virtual reality (VR) and augmented reality (AR) and machine learning (ML) technologies will help doctors in therapeutic path personalization and in minimally invasive intervention procedures.

Although the first “digital twin” projects are already being tested with interesting results, much remains to be done in the development of new technologies and applications.

The aim of this Special Issue of Electronics is to gather cutting-edge research in the field of “digital twin” for future applications. We invite researchers to contribute original and unique articles, as well as sophisticated review articles in the field of medical imaging (ultrasound, optical, photoacoustic, X-ray, nuclear, magnetic resonance, etc.) and image processing, computational fluid dynamics, and artificial intelligence.

Topics of interest include, but are not limited to the following areas:

New sensors and detector technologies;
Wearable devices;
Algorithms for fast image acquisition and reconstruction;
Multimodal medical image analysis and fusion;
Signal and imaging integration;
3D virtual models;
3D printing;
Augmented reality and virtual reality;
Finite element analysis;
Computational fluid dynamics;
Modelling and analysis;
Machine learning

Prof. Dr. Luigi Landini
Prof. Dr. Vincenzo Positano
Prof. Dr. Maria Filomena Santarelli
Prof. Dr. Simona Celi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Electronics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

digital twin
personalized medicine
image analysis
3D models
3D printing
biomedical signal processing
medical image reconstruction
finite element analysis
computational fluid dynamics
machine learning

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Published Papers (12 papers)

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Editorial

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3 pages, 181 KiB

Open AccessEditorial

Digital Twin Technology: New Frontiers for Personalized Healthcare

by Luigi Landini, Vincenzo Positano, Maria Filomena Santarelli and Simona Celi

Electronics 2023, 12(8), 1921; https://doi.org/10.3390/electronics12081921 - 19 Apr 2023

Viewed by 1108

Abstract

Rapidly evolving health digital technologies are changing modern healthcare in unprecedented ways [...] Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

Research

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13 pages, 1586 KiB

Open AccessArticle

A Real-Time, Open-Source, IoT-like, Wearable Monitoring Platform

by Andrea Baldini, Roberto Garofalo, Enzo Pasquale Scilingo and Alberto Greco

Electronics 2023, 12(6), 1498; https://doi.org/10.3390/electronics12061498 - 22 Mar 2023

Cited by 6 | Viewed by 2981

Abstract

The spread of informatics and electronic systems capable of the real-time monitoring of multiple psychophysiological signals has continuously grown in the last few years. In this study, we propose a novel open-source wearable monitoring platform (WMP) to synchronously acquire and process multiple physiological signals in a real-time fashion. Specifically, we developed an IoT-like modular and fully open-source platform composed of two main blocks that on the one hand connect multiple devices (the sensor fusion unit) and on the other hand process and store the sensors’ data through the internet (the remote storing and processing unit). To test the proposed platform and its computational performance, 15 subjects underwent an experimental protocol, in which they were exposed to rest and stressful sessions implementing the Stroop Color and Word Test (SCWT). Statistical analysis was performed to verify whether the WMP could monitor the expected variations in the subjects’ psychophysiological state induced by the SCWT. The WMP showed very good computational performance for data streaming, remote storing, and real-time processing. Moreover, the experimental results showed that the platform was reliable when capturing physiological changes coherently with the emotional salience of the SCWT. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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17 pages, 1260 KiB

Open AccessArticle

Introduction of a Novel Image-Based and Non-Invasive Method for the Estimation of Local Elastic Properties of Great Vessels

by Benigno Marco Fanni, Alessandra Pizzuto, Giuseppe Santoro and Simona Celi

Electronics 2022, 11(13), 2055; https://doi.org/10.3390/electronics11132055 - 30 Jun 2022

Cited by 10 | Viewed by 1624

Abstract

Background: In the context of a growing demand for the use of in silico models to meet clinical requests, image-based methods play a crucial role. In this study, we present a parametric equation able to estimate the elasticity of vessel walls, non-invasively and indirectly, from information uniquely retrievable from imaging. Methods: A custom equation was iteratively refined and tuned from the simulations of a wide range of different vessel models, leading to the definition of an indirect method able to estimate the elastic modulus E of a vessel wall. To test the effectiveness of the predictive capability to infer the E value, two models with increasing complexity were used: a U-shaped vessel and a patient-specific aorta. Results: The original formulation was demonstrated to deviate from the ground truth, with a difference of 89.6%. However, the adoption of our proposed equation was found to significantly increase the reliability of the estimated E value for a vessel wall, with a mean percentage error of 9.3% with respect to the reference values. Conclusion: This study provides a strong basis for the definition of a method able to estimate local mechanical information of vessels from data easily retrievable from imaging, thus potentially increasing the reliability of in silico cardiovascular models. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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17 pages, 25376 KiB

Open AccessArticle

The Hemodynamic Effect of Modified Blalock–Taussig Shunt Morphologies: A Computational Analysis Based on Reduced Order Modeling

by Eirini Kardampiki, Emanuele Vignali, Dorela Haxhiademi, Duccio Federici, Edoardo Ferrante, Stefano Porziani, Andrea Chiappa, Corrado Groth, Margherita Cioffi, Marco Evangelos Biancolini, Emiliano Costa and Simona Celi

Electronics 2022, 11(13), 1930; https://doi.org/10.3390/electronics11131930 - 21 Jun 2022

Cited by 12 | Viewed by 3631

Abstract

The Modified Blalock Taussig Shunt (MBTS) is one of the most common palliative operations in case of cyanotic heart diseases. Thus far, the decision on the position, size, and geometry of the implant relies on clinicians’ experience. In this paper, a Medical Digital Twin pipeline based on reduced order modeling is presented for fast and interactive evaluation of the hemodynamic parameters of MBTS. An infant case affected by complete pulmonary atresia was selected for this study. A three-dimensional digital model of the infant’s MBTS morphology was generated. A wide spectrum of MBTS geometries was explored by introducing twelve Radial Basis Function mesh modifiers. The combination of these modifiers allowed for analysis of various MBTS shapes. The final results proved the potential of the proposed approach for the investigation of significant hemodynamic features such as velocity, pressure, and wall shear stress as a function of the shunt’s morphology in real-time. In particular, it was demonstrated that the modifications of the MBTS morphology had a profound effect on the hemodynamic indices. The adoption of reduced models turned out to be a promising path to follow for MBTS numerical evaluation, with the potential to support patient-specific preoperative planning. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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9 pages, 5445 KiB

Open AccessArticle

A Decision-Support Informatics Platform for Minimally Invasive Aortic Valve Replacement

by Katia Capellini, Vincenzo Positano, Michele Murzi, Pier Andrea Farneti, Giovanni Concistrè, Luigi Landini and Simona Celi

Electronics 2022, 11(12), 1902; https://doi.org/10.3390/electronics11121902 - 17 Jun 2022

Cited by 2 | Viewed by 1735

Abstract

Minimally invasive aortic valve replacement is performed by mini-sternotomy (MS) or less invasive right anterior mini-thoracotomy (RT). The possibility of adopting RT is assessed by anatomical criteria derived from manual 2D image analysis. We developed a semi-automatic tool (RT-PLAN) to assess the criteria of RT, extract other parameters of surgical interest and generate a view of the anatomical region in a 3D space. Twenty-five 3D CT images from a dataset were retrospectively evaluated. The methodology starts with segmentation to reconstruct 3D surface models of the aorta and anterior rib cage. Secondly, the RT criteria and geometric information from these models are automatically and quantitatively evaluated. A comparison is made between the values of the parameters measured by the standard manual 2D procedure and our tool. The RT-PLAN procedure was feasible in all cases. Strong agreement was found between RT-PLAN and the standard manual 2D procedure. There was no difference between the RT-PLAN and the standard procedure when selecting patients for the RT technique. The tool developed is able to effectively perform the assessment of the RT criteria, with the addition of a realistic visualisation of the surgical field through virtual reality technology. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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19 pages, 4069 KiB

Open AccessFeature PaperArticle

Towards a Digital Twin of Coronary Stenting: A Suitable and Validated Image-Based Approach for Mimicking Patient-Specific Coronary Arteries

by Gianluca Poletti, Luca Antonini, Lorenzo Mandelli, Panagiota Tsompou, Georgia S. Karanasiou, Michail I. Papafaklis, Lampros K. Michalis, Dimitrios I. Fotiadis, Lorenza Petrini and Giancarlo Pennati

Electronics 2022, 11(3), 502; https://doi.org/10.3390/electronics11030502 - 8 Feb 2022

Cited by 12 | Viewed by 3354

Abstract

Considering the field of application involving stent deployment simulations, the exploitation of a digital twin of coronary stenting that can reliably mimic the patient-specific clinical reality could lead to improvements in individual treatments. A starting step to pursue this goal is the development of simple, but at the same time, robust and effective computational methods to obtain a good compromise between the accuracy of the description of physical phenomena and computational costs. Specifically, this work proposes an approach for the development of a patient-specific artery model to be used in stenting simulations. The finite element model was generated through a 3D reconstruction based on the clinical imaging (coronary Optical Coherence Tomography (OCT) and angiography) acquired on the pre-treatment patient. From a mechanical point of view, the coronary wall was described with a suitable phenomenological model, which is consistent with more complex constitutive approaches and accounts for the in vivo pressurization and axial pre-stretch. The effectiveness of this artery modeling method was tested by reproducing in silico the stenting procedures of two clinical cases and comparing the computational results with the in vivo lumen area of the stented vessel. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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17 pages, 2634 KiB

Open AccessArticle

CZT Detectors-Based SPECT Imaging: How Detector and Collimator Arrangement Can Determine the Overall Performance of the Tomograph

by Maria Filomena Santarelli, Anna Mori, Michelangelo Bertasi, Vincenzo Positano, Alessia Gimelli, Michele Scipioni, Paolo Marzullo and Luigi Landini

Electronics 2021, 10(18), 2230; https://doi.org/10.3390/electronics10182230 - 11 Sep 2021

Cited by 8 | Viewed by 6195

Abstract

A technical comparison is described between two SPECT systems, one dedicated to cardiovascular studies and one general-purpose, to evaluate the advantages and disadvantages of their use in an organ-specific clinical setting. The comparison was made between a dedicated cardiac SPECT (Alcyone, Discovery NM 530c, GE Healthcare) scanner and a general-purpose one (Discovery NM/CT 670 CZT, GE Healthcare). The two scanners differ in terms of hardware, mainly in the arrangement of the detectors and collimators, which are the main components of SPECT. A standard NEMA phantom was used to characterize the energy resolution, spatial resolution, and sensitivity for the two systems. Then, using a custom-made cardiac phantom, more specific indices were computed to evaluate the quality of cardiac images, such as signal-to-background noise ratio (SBNR), tissue-background contrast-to-noise ratio (TBCNR), and uniformity. Finally, the same indices were computed for clinical images acquired with the two systems from 11 subjects. Alcyone showed superior performance for dedicated cardiac imaging; however, its excellent qualities are aimed only at the study of the heart and only at patients with a low body-mass index, unlike Discovery NM/CT 670 CZT, which can be used for every anatomic district area and for every type of patient. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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17 pages, 556 KiB

Open AccessArticle

Generative Adversarial Networks for Anonymized Healthcare of Lung Cancer Patients

by Luis Gonzalez-Abril, Cecilio Angulo, Juan-Antonio Ortega and José-Luis Lopez-Guerra

Electronics 2021, 10(18), 2220; https://doi.org/10.3390/electronics10182220 - 10 Sep 2021

Cited by 20 | Viewed by 3641

Abstract

The digital twin in health care is the dynamic digital representation of the patient’s anatomy and physiology through computational models which are continuously updated from clinical data. Furthermore, used in combination with machine learning technologies, it should help doctors in therapeutic path and in minimally invasive intervention procedures. Confidentiality of medical records is a very delicate issue, therefore some anonymization process is mandatory in order to maintain patients privacy. Moreover, data availability is very limited in some health domains like lung cancer treatment. Hence, generation of synthetic data conformed to real data would solve this issue. In this paper, the use of generative adversarial networks (GAN) for the generation of synthetic data of lung cancer patients is introduced as a tool to solve this problem in the form of anonymized synthetic patients. Generated synthetic patients are validated using both statistical methods, as well as by oncologists using the indirect mortality rate obtained for patients in different stages. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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11 pages, 4354 KiB

Open AccessFeature PaperArticle

Investigating the Feasibility of Virtual Reality (VR) for Teaching Cardiac Morphology

by Endrit Pajaziti, Silvia Schievano, Emilie Sauvage, Andrew Cook and Claudio Capelli

Electronics 2021, 10(16), 1889; https://doi.org/10.3390/electronics10161889 - 6 Aug 2021

Cited by 7 | Viewed by 2831

Abstract

Congenital heart disease (CHD) is the most common defect at birth. Effective training for clinical professionals is essential in order to provide a high standard of care for patients. Visual aids for teaching complex CHD have remained mostly unchanged in recent years, with traditional methods such as diagrams and specimens still essential for delivering educational content. Diagrams and other 2D visualisations for teaching are in most cases artistic illustrations with no direct relation to true, 3D medical data. Specimens are rare, difficult for students to access and are limited to specific institutions. Digital, patient-specific models could potentially address these problems within educational programmes. Virtual Reality (VR) can facilitate the access to digital models and enhance the educational experience. In this study, we recorded and analysed the sentiment of clinical professionals towards VR when learning about CHD. A VR application (VheaRts) containing a set of patient-specific models was developed in-house. The application was incorporated into a specialised cardiac morphology course to assess the feasibility of integrating such a tool, and to measure levels of acceptance. Attendees were clinical professionals from a diverse range of specialities. VR allowed users to interact with six different patient-derived models immersed within a 3D space. Feedback was recorded for 58 participants. The general response towards the use of VR was overwhelmingly positive, with 88% of attendees rating 4 or 5 for ‘helpfulness of VR in learning CHD’ (5-points Likert scale). Additionally, 70% of participants with no prior VR experience rated 4 or 5 for ‘intuitiveness and ease of use’. Our study indicates that VR has a high level of acceptance amongst clinical trainees when used as an effective aid for learning congenital heart disease. Additionally, we noted three specific use-cases where VR offered novel teaching experiences not possible with conventional methods. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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14 pages, 2876 KiB

Open AccessArticle

Numerical Simulations of Light Scattering in Soft Anisotropic Fibrous Structures and Validation of a Novel Optical Setup from Fibrous Media Characterization

by Francesco di Bartolo, Emanuele Vignali, Emanuele Gasparotti, Antonio Malacarne, Luigi Landini and Simona Celi

Electronics 2021, 10(5), 579; https://doi.org/10.3390/electronics10050579 - 2 Mar 2021

Cited by 2 | Viewed by 2231

Abstract

The insight of biological microstructures is at the basis of understanding the mechanical features and the potential pathologies of tissues, like the blood vessels. Different techniques are available for this purpose, like the Small Angle Light Scattering (SALS) approach. The SALS method has the advantage of being fast and non-destructive, however investigation of its physical principles is still required. Within this work, a numerical study for SALS irradiation of soft biological fibrous tissues was carried out through in-silico simulations based on a Monte Carlo approach to evaluate the effect of the thickness of the specimen. Additionally, the numerical results were validated with an optical setup based on SALS technique for the characterization of fibrous samples with dedicated tests on four 3D-printed specimens with different fibers architectures. The simulations revealed two main regions of interest according to the thickness (thk) of the analyzed media: a Fraunhofer region (thk < 0.6 mm) and a Multiple Scattering region (thk > 1 mm). Semi-quantitative information about the tissue anisotropy was successfully gathered by analyzing the scattered light spot. Moreover, the numerical results revealed a remarkable coherence with the experimental data, both in terms of mean orientation and dispersion of fibers. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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16 pages, 12094 KiB

Open AccessEditor’s ChoiceArticle

Development and Realization of an Experimental Bench Test for Synchronized Small Angle Light Scattering and Biaxial Traction Analysis of Tissues

by Emanuele Vignali, Emanuele Gasparotti, Luigi Landini and Simona Celi

Electronics 2021, 10(4), 386; https://doi.org/10.3390/electronics10040386 - 4 Feb 2021

Cited by 8 | Viewed by 2531

Abstract

Insights into the mechanical and microstructural status of biological soft tissues are fundamental in analyzing diseases. Biaxial traction is the gold standard approach for mechanical characterization. The state of the art methods for microstructural assessment have different advantages and drawbacks. Small angle light scattering (SALS) represents a valuable low energy technique for soft tissue assessment. The objective of the current work was to develop a bench test integrating mechanical and microstructural characterization capabilities for tissue specimens. The setup’s principle is based on the integration of biaxial traction and SALS analysis. A dedicated control application was developed with the objective of managing the test procedure. The different components of the setup are described and discussed, both in terms of hardware and software. The realization of the system and the corresponding performances are then presented. Full article

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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Review

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30 pages, 4634 KiB

Open AccessReview

The Core of Medical Imaging: State of the Art and Perspectives on the Detectors

by Maria Filomena Santarelli, Giulio Giovannetti, Valentina Hartwig, Simona Celi, Vincenzo Positano and Luigi Landini

Electronics 2021, 10(14), 1642; https://doi.org/10.3390/electronics10141642 - 10 Jul 2021

Cited by 9 | Viewed by 4914

Abstract

In this review, the roles of detectors in various medical imaging techniques were described. Ultrasound, optical (near-infrared spectroscopy and optical coherence tomography) and thermal imaging, magnetic resonance imaging, computed tomography, single-photon emission tomography, positron emission tomography were the imaging modalities considered. For each [...] Read more.

(This article belongs to the Special Issue Digital Twin Technology: New Frontiers for Personalized Healthcare)

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