Canine Palpation Trainer with Embedded Sensors

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1 Canine Palpation Trainer with Embedded Sensors First Semester Report Spring Semester 2014 By Bradley Evans Yiyu Feng Prepared to partially fulfill the requirements for ECE401 Department of Electrical and Computer Engineering Colorado State University Fort Collins, Colorado Project advisor(s): Dr. Jayasumana, Josh Carnes, Jim Kozisek, Dean Hendrickson Approved by: James Kozisek Reviewed by: Dr. Jayasumana, James Kozisek 1

2 ABSTRACT Training Veterinarians to palpate dogs is a not an easy task. To learn how to perform a palpation, students use a silicone dog model. The silicone dog model closely replicates the physical anatomy of a live dog. However, there is no feedback on the effectiveness of palpation. Without feedback from the model, the students have no idea if they are palpating in the correct location or with the correct pressure. To extend knowledge of the problem, interviews with CSU veterinary students were conducted. Many of the students expressed concern that, even in their senior year, they had trouble identifying some organs during palpation. Along with student interviews, the dean of the vet school, Dean Hendrickson, gave the professor perspective. The professors have difficulty determining if the palpation was performed correctly with the current model. Another method to extend the knowledge on the subject came from researching existing palpation models. Currently, palpation models exist for human pregnancy. Unfortunately, since those models have no electronic feedback, there wasn t too much to learn from them. The canine palpation trainer is still in its early stages. However, initial testing of sensor-embedded-organs has demonstrated the proof of concept of an instrumented liver. It is clear that this method of teaching palpation will be effective. Currently, only the liver has embedded sensors, but in future prototypes, more organs will have embedded sensors. Also, each organ will have an RJ45 connector or some other standard interface which will simplify the process for veterinary students who are tasked with replacing an organ. Furthermore, a graphical user interface (GUI) will be added as a means of showing the professor and students where the palpation is occurring and with how much pressure. 2

3 TABLE OF CONTENTS Title 1 Abstract 2 Table of Contents 3 List of Figures and Tables 4 I. Introduction 5 II. Review of previous work 7 III. Design and Concerns 7 A. Design Specs 7 B. Design Methods 7 C. Market Potential 12 D. Ethical Issue 12 IV. Conclusion and Future Work 12 Reference 14 Appendices 15 Appendix A 15 Appendix B 15 Appendix C 15 Acknowledgments 16 3

4 LIST OF TABLES AND FIGURES Figure 1 Proper Palpation Technique 5 Figure 2 Canine Chassis Used For Surgery and Palpation Practice 6 Figure 3 CapSense Illustration Showing a Change in Distance 8 Figure 4 CapSense Illustration Showing a Location 9 Figure 5 Force-Sensitive Resistor 9 Figure 6 Resistance vs Force 10 Figure 7 Voltage Divider Circuit 10 Figure 8 Resistor Determines the Sensitivity 11 Figure 9 Connect Liver Model to PSoC 11 Table 1 Force Values From Veterinary Schools 7 4

5 Chapter I - INTRODUCTION Palpation is an important medical procedure which allows both doctors and veterinarians to quickly assess the health of major organs [1]. By using their hands on a patient, health care professionals can gather data that visual inspection alone cannot provide. With palpation, doctors can learn the skin s temperature, the skin s moisture, the health of organs, and internal swelling. The project began with a focus on canine palpation. To correctly perform a palpation procedure on a dog, one must use three fingers on each hand. A figure of the proper procedure can be seen below: Figure 1: Proper Palpation Technique (original photo) By feeling upward on the belly of a standing dog, veterinarians can check each organ in the abdominal cavity for deformations or tumors. During the palpation, the veterinarian will feel six major organs: the liver, spleen, kidneys, stomach, bladder, and intestines. Each organ has a unique shape and location allowing a vet student to improve palpation procedures over time. Unfortunately, training a large number of students on how to perform a palpation procedure can be difficult. A few years ago, palpation would be taught on a live animal; an entire vet class would palpate the dog s abdominal cavity. Over time, the dog would become less cooperative and could eventually lead to the dog biting. Furthermore, by the time the entire class had practiced palpating, the dog s stomach would be tender, if not bruised. To solve this issue, the vet school created a silicone model. The goal of a silicone palpation model is to remove the need for a live dog in palpation training. Figure 2 below is the silicone model: 5

6 Figure 2: Canine Chassis Used For Surgery and Palpation Practice [2] The silicone canine model allows palpations to be performed many times by any number of students. The model exactly replicates the organ structure of a real dog and maintains a realistic feeling. However, with this model, there is no feedback. To study more about the current problems, we spent substantial time at the veterinary school at CSU. We had tutoring sessions from vet students on proper palpation techniques. The problem became evident when students were unsure if they were feeling the correct organ. At the end of the palpation class, the professors hold a final exam. During this exam, the professor asks the student to feel each organ separately. After talking with the vet students, it seemed that many simply memorize a script of what to say and where to feel on the model without ever learning palpation. This means that when veterinarian students practice palpating, they have no idea if they are feeling the correct organ. Furthermore, when teachers assess a student s ability, they have no way of knowing if the correct organ was palpated and no way of knowing if the correct pressure was used. Canine palpation trainer aims to create a canine model with accurate feedback. Embedding force sensitive resistors in the internal organs of the silicone model allows active feedback. The feedback can show both students and teachers location and pressure of palpation. The pressure and location is calculated using a PSoC microcontroller and then sent to a computer. In the future, the transmission between the PSoC and the computer will be done with a bluetooth module. On the computer, an application will be running which shows a graphical representation of a dog. The computer dog model will highlight where the palpation is occurring and will change color based upon the pressure. Green indicates that the palpation pressure is correct while red indicates that the palpation is too hard. 6

7 Chapter II - Review of Previous Work Canine palpation trainer is the first training model of its type. Currently, there are no electronic feedback models for training palpation. As such, the technology needed to be invented. However, the silicone canine model does exist for palpation training without feedback. The model exactly replicates the organs and feeling of a real dog. It is currently created and distributed by a company called SurgiReal. There are also palpation models available for humans which, again, lack electronic feedback. A company called health edco creates and distributes a pregnancy palpation model [3]. Chapter III - Design and Concerns A. Design Specs In the initial design steps, clear design parameters were set by the veterinary school. Each parameter was explained and documented to ensure clarity throughout the entire project. Quantifying pressure accurately is important for the training process. To quantify the pressure values, the veterinary school provided force values. A simple conversion will give pressure values. Pressure = Force Area The collected pressure values from the veterinary school can be seen from Table 1: Palpation (Times) Force (kg) Average Force Data (kg) 1.51 Table 1: Force Values From Veterinary Schools Table 1 indicates that the highest force value is 1.71 kg, the lowest force value is 1.34 kg, and the average force is 1.51 kg. Since palpation procedures are performed by three fingers each hand, the force needed to be divided by the area of six fingers. The area of six fingers area is about 3*7 cm 2 to 5*11 cm 2. The pressure estimate ranges from N/m 2 to N/m 2. B. Design Methods One of the main challenges of the project is to embed sensors inside the model. To find the best sensors for the model, a benefit analysis on the sensor types was performed along with an evaluation of the different organs. There are six organs in the model: liver, stomach, bladder, intestines, kidney, and spleen. Among those organs, the liver, kidneys and spleen are the ones that relatively hard. None of those organs compress much during a palpation. On the other hand, the bladder, intestines, and stomach are the organs with air or liquid filled inside. 7

8 The project was too large to tackle all at once, so smaller goals were set. The design method of rapid prototyping was employed which allowed for each small goal to be quickly accomplished. At first, only 3 organs were dealt with: the liver, kidneys and spleen. For those organs, the pressure can be sensed by force sensors directly due to the material feature of the organs. This left the stomach, the liver, and the intestines for next semester. Each of those organs is soft and air tight, a barometric pressure sensor could be embedded inside to sense the change in ambient pressure. It is unlikely that a force sensitive pressure sensor would work on such soft organs. During the initial testing for sensors, many ideas were thrown around. Since the idea of embedding sensors into a silicone palpation model was new, every idea was original and unproven. In the beginning, the idea of capacitive sense touching was tested. The basic idea behind using CapSense is that the capacitance of a wire changes when a finger is brought near it. As such, wires were embedded into the silicone skin slab in a pattern that created an x,y coordinate system. Then, when a finger presses on a certain spot, the two wires will get closer. By measuring the capacitance change, we can obtain the location as well as the pressure. The relationship between the capacitance (C) and the distance (d) can be seen below: C = ɛrɛ0(a/d) If a finger presses on the skin slab, it will cause the wire in the x direction to get closer to the wire in the y direction. As the wires approach close to each other, the distance between the wires decreases causing the capacitance (C) to increase. Figure 3 illustrates the concept of this system. Figure 3: CapSense Illustration Showing a Change in Distance In addition to getting pressure values, CapSense would allow the model to determine an exact location of palpation. CapSense works by continuously measuring the capacitance of the wires. When 2 wires are triggered simultaneously, a location is given: 8

9 Figure 4: CapSense Illustration Showing a Location (original illustration) As Figure 4 demonstrates, one press spot will trigger two wires. Figure 5 below is the force-sensitive resistor that we used in our prototype. Figure 5: Force-Sensitive Resistor [4] The resistance of this force-sensitive resistor will decreases as the force applied on it increases. According to the datasheet [5], Figure 6 shows the relationship between resistance and force is show below. 9

10 Figure 6: Resistance Vs Force [5] Therefore, when the force is extremely low the resistance of the sensor is over 100kΩ while the resistance drops with the increases of the force. The force will trigger the variation of the resistance. Therefore, by measuring the resistance the variation of the force can be obtained and can give feedback about whether the sensor has been pressed. The task becomes measuring the change of resistance. In this case, we use a simple voltage divider circuit. The basic idea is given in Figure 7. Figure 7: Voltage Divider Circuit (original drawing) There are two reasons for utilizing the voltage divider. Firstly, by putting the sensor with the resistor in series, we could have a changeable sensitivity about the sensor. Figure 8 below demonstrates the sensitivity of the sensor with different R1 values. 10

11 Figure 8: Resistor Determines the Sensitivity[5] The sensitivity of the sensor is displayed by the slope of the curves. When the value of series resistor is 10kΩ, the high slope indicates higher pressure sensitivity. Secondly, it is straightforward and easy to measure the voltage between the two resistors and then convert the analog signal to digital signal by using an A/D converter. Based on this concept, sensors were embeded into the current canine liver model to test if the sensor will work with the silicone model. Then, we tested the model by connecting the sensor with resistor in series and put the components on PSoC, the result turned out to be once we press the sensing area the voltage between resistor and sensor are detected as Figure 9 indicates. Figure 9: Connect Liver Model to PSoC 11

12 C. Market Potential The market for palpation models is large with 30 veterinary schools in the United States. The feedback that the model provides makes it a valuable tool for veterinary schools. Veterinary school professors can more easily evaluate and teach their students with a model like this. Furthermore, there are no palpation models for humans. If the same model approach is applied to a human model, medical schools would be a large market for future model sales. Each force sensitive sensor costs around $4 when bought in bulk. The whole project requires around 40 sensors bringing the total sensor cost up to around $160. The microcontroller costs $4 and the wires and wire connectors are around $5 total. When all the electrical components are added, the total cost is around $170. The silicone model is created out of inexpensive materials. The estimated silicone and plastic costs of the canine model is $30 bringing up the total expenses to $200. After surveying the veterinary students, it was clear that a model like the canine palpation trainer was necessary. Veterinary schools need a model like it for their students and would be willing to pay for it. It wouldn t be unreasonable to change between 1 and 2 thousand dollars for each training model. D. Ethical Issues The Canine Palpation Trainer project is primarily an ethically neutral project. However, there are some ethical issues that needed to be addressed. Ethical behavior requires honesty, transparency, and respectful decisions. Our project will face these issues both during the project creation and when we have our final product. During the creation of the canine palpation project, there was a need to demonstrate ethical behavior during interaction with others. Texas Instruments, Dr. Jayasumana, Dr. Hendrickson, and Mrs. Notaros all play a role in keeping this project on track. During interactions with these different groups, it was important to be open and honest about the project. At times, it was difficult to balance honesty with discretion, especially when it came to filing the provisional patent. However, keeping all involved parties informed about proceedings was the best policy. It was clear that honesty is the best practice when it comes to group projects because it inspires trust. Another major ethical issue deals with how the veterinary students are trained. If the palpation calibrations are off, our model will be teaching veterinary students to palpate incorrectly. As a result, students could palpate too hard on a real dog and injure it or too softly and not obtain a diagnosis. Both of these scenarios are major considerations when it comes to creating a training model. The canine palpation project is unique because there is the opportunity to work with live animals during palpation demonstrations. As a result, the ethical treatment of animals must be observed. For instance, if the animal is restless and does not want to be palpated, we should be respectful and avoid making the animal uncomfortable. Chapter IV - Conclusions and Future Work This semester, the main progress was embedding force sensitive resistor in the canine liver organ. With one pressure sensor embedded, it showed proof of concept. Next semester, the canine palpation trainer project will add sensors to more organs. The end project will have between 40 and 60 sensors embedded inside the organs to give a complete pressure overview. Additionally, each organ will have an embedded RJ45 connector for ease of removal and replacement. At this point, all the sensors are force sensitive. Force sensitive resistors will not work when the stomach, bladder, and intestines are monitored for pressure changes. Because of this, barometric pressure 12

13 sensors will be added inside each organ s hollow air pocket. The ambient pressure will be monitored with the barometric sensor. This portion of the project will be finished by the end of August. The project will also face some difficulties dealing with the sheer number of wires. With sensors being monitored, the wires can become a mess. We have chosen to use Ethernet cables to contain the mess inside the silicone dog model. However, once the Ethernet is wired over to the controller, the mess will become prevalent. To solve this issue, we will add external mux to mux between signals and lower the number of wires to the PSoC. Also, Cypress released a new prototyping board which can be soldered to. This board will greatly simplify the problem. This portion will be completed by mid- September. The microcontroller side will need organization. There will be 7 incoming Ethernet cables which require 7 RJ45 connectors. To organize the incoming cables, a 3D printed controller box will be added. On the outside, it will contain a power slot, a power button, and 7 RJ45 connectors. On the inside, it will have a PSoC 4, and wires connecting the RJ45 outputs to the PSoC or external mux. This portion will be completed by the end of September. The dog model will also employ a Bluetooth module to allow wireless communication between the model and the computer. This will simplify the model for the veterinarian students who will only need to turn the model on and open the software on the computer. This portion will be completed by mid- October. The last addition that the project requires is a graphical user interface (GUI). This computer model will take in pressure values from the microcontroller and show how much pressure is being applied and where it is being applied to. The pressure will be visually shown by using colors on a graphical representation of the dog. Green colors on the organ will indicate that the palpation is being performed with the correct pressure while red colors will indicate that the organ is being palpated with incorrect pressure. This portion of the project will be completed by the end of October. The project will be finished by the end of October allowing for testing time during November. There is a high probability that the project will be commercialized for sale in veterinary schools throughout the country. As such, we will need to start reliability testing. 13

14 REFERENCES [1] Palpation. Internet: n/, [05/01/2014]. [2] SurgiReal, Internet: [05/04/2014]. [3] Abdominal Palpation Model, Internet: [05/04/2014]. [4] Force Sensitive Resistance, Internet: [05/04/2014]. [5] Force Sensitive Resistance, Internet: [05/04/2014]. 14

15 APPENDICES Appendix A Abbreviations GUI PSoC CapSense Meaning graphical user interface Programmable System On - Chip Capacitive Sensing Appendix B The project is funded by Colorado State University Veterinary School and Colorado State University College of Engineering. So far, our team spent dollars in total. Firstly, we spend on buying a single Force-Sensitive Resistor for testing. After we proved the sensor is feasible, we brought 10 of them which cost dollars. Besides, in order to design a robust connect from sensors to PSoC, we purchased one Ethernet cable for dollars. Finally, we brought 2 RJ45 8-pin connectors and ten jumper wire which cost dollars. Also, we have to thank Texas Instruments for their generous donation. Appendix C 15

16 ACKNOWLEDGMENTS We'd like to thank Dr. Jayasumana, Josh Carnes and Jim Kozisek for their ongoing support and professional guides. Also, we'd like to thank Olivera Notaros for her continued support of senior design projects. Dean Hendrickson, the dean from veterinary school for the initial idea and for funding the project. A special thanks to Jessica Sullivan from veterinary school who took the time to demonstrate proper palpation techniques for us, and Grahm Hendrickson for helping us with those organ models. 16

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