Design of a Remote Monitoring System Based on Optical Sensors to Prevent Medical Accidents during Fluid Treatment

Round 1

Reviewer 1 Report

The authors have proposed an IV infusion monitoring system using   optical sensors. The system The proposed system can notify on the residual IV fluid, current infusion rate, and expected end time. Below are some of my concerns that would hopefully help the authors to improve the work.

1. Language needs to be improved in order to get rid of typo and grammar errors.
2. Reference list need to include studies from 2021 as well.
3. How the material of the IV chamber will effect the detection?
4. The current measurements are done with saline solution. What effect a changed solution type will bring on the system performance.
5. What is the significance of horizontal and vertical motion in the IV systems as they are being operated in static conditions?
6. The system's performance is characterised as having 88% accuracy. Why 12% is being lost and what would be the effect of this loss in practical medical systems?
7. A comparative study with competing solutions is needed to establish the working of the system. 

Author Response

Response to the reviewer #1’s comment

Title : Design of remote monitoring system based on optical sensor to prevent medical accidents during fluid treatments

 

First of all, the authors express their deep gratitude to the reviewer’s valuable comments, which were precise and comprehensible. Furthermore, the authors responded to each comment according to the reviewer’s crucial suggestions. All of the responses are as follows.

Comments and Suggestions for Authors

Comment #1 Language needs to be improved in order to get rid of typo and grammar errors.

Response #1 We appreciate your verdicts of our grammar to deliver our findings clearly. In the revised paper, the errors that we found are deleted and changes are colored in blue.

 

Comment #2 Reference list need to include studies from 2021 as well.

Response #2

Authors fully agree to include recent studies. Recent studies such as ‘Arabelli, R., Rajababu, D., Anuradha, P., & Bernatin, T. (2021), Reference number [7] and Smart intravenous infusion monitoring and controlling system using Internet of Things. Materials Today: Proceedings’ and ‘Safitri, M., Da Fonseca, H., & Loniza, E. (2021). Short Text Message Based Infusion Fluid Level Monitoring System. Journal of Robotics and Control (JRC), 2(2), 60-64. Reference number [10]’ are included. Former is using loadcell to measure weight of fluids and the latter is sending text messages to mobile phone about fluid’s level.

 

Comment #3 How the material of the IV chamber will effect the detection?

Response #3

It’s a good point to think about whether the material of the IV chamber would affect the detection or not. According to ISO standards, IV set (infusion set for medical use) have its own standard about material. The standard recommends PVC (polyvinyl chloride) for medical use, which is used in this study. To inform about a point in question, we added about this in Line 174 to 176 which is colored in blue.

 

Comment #4 The current measurements are done with saline solution. What effect a changed solution type will bring on the system performance.

Response #4

This is similar question with comment #3, which is reasonable point to think about. This study used transparent saline solution to experiment. Another experiment is done with lipid emulsion which is opaque. There were any differences on the system’s performance considering study’s main concept. The study’s main concept is to detect any drops falling between photosensors.

 

Comment #5 What is the significance of horizontal and vertical motion in the IV systems as they are being operated in static conditions?

Response #5

Authors appreciate reviewer’s comprehensive consider about motions. Static condition means infusion is undergoing without any motions which could be condition of patients lying in bed. Horizontal and vertical motion is literally motions of horizontally and vertically. When patients are under rehabilitation stage, which is known as post-operative, they should walk around ward to recover. In this situation, motions such as horizontally and vertically are occurred. Therefore, authors assumed situation of motions in this study to prove its usefulness. Moreover, to clarify, we added much more description about what the motion exactly means and where it comes from in Line 201 to 205 which is colored in blue and results are in Fig 6.

 

Comment #6 The system's performance is characterized as having 88% accuracy. Why 12% is being lost and what would be the effect of this loss in practical medical systems?

Response #6

As reviewer’s comment, it is very important to figure out the reason why 12% is being lost which authors fully agree with. We figured those loss because of external interferences. External interferences could be overcome by designing closed chamber room to block any external interferences. None the less, medical staffs, that we had meetings with, told us that design should be opened to look directly. As follows, authors designed opened design which was inevitable.

 

Comment #7 A comparative study with competing solutions is needed to establish the working of the system.

Response #7

Authors sincerely express their gratitude to the reviewer’s suggestion to do comparative study with competing solutions. In figure 6, there are comparative studies result which are using single photosensor, loadcell and developed system. We restored competing solutions to compare with developed system. Moreover, we added more descriptions in page 8 in result section to inform how we’ve done a comparative experiment.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors have presented their findings of a topic that is of great relevance to the community, especially during a global pandemic. However, the research has not been conducted with enough scrutiny and rigor. The central objective of the research has been defined to be the use of a IoT (internet of things) based system for improved automation of IV dose delivery to patients. However, the experiments conducted do not provide enough data to support these claims. The presentation of the paper and the sequence of experiments carried out is also not coherent and very difficult for the reader to follow. For these and the specific reasons listed below, I strongly recommend the Editor to not publish this paper in the reputed journal of Applied Sciences without major revisions.

1. The introduction paragraphs are not clear and do not convey the objective of the story coherently. The authors list several shortcomings of existing IV therapies including photodiode-laser based IV delivery, ultrasound based, and load cell based IV delivery methods. However, the conclusion of that paragraph is that IV monitoring is necessary and IoT based system can automate the process and make it more effective. However, then the authors go on to point the shortcomings of the different approaches to use IoT to monitor IV infusion – RFID, Bluetooth, and WiFi. The conclusion provided for this paragraph is that the present research proposes a system better than all the methods above without providing any details of what exactly is different in the research and how it improves on the current system. The authors are suggested to add a summary of their findings here for the reader’s ease.
2. The ‘Design Method’ section claims that the proposed design improves resistance to external interferences and higher accuracy of monitoring. However, not enough comparison with existing systems is made to substantiate these claims. The authors are recommended to add more data showing the reduction in monitoring noise, time or other variables that are achieved when compared to the current IV monitoring systems.
3. The method of capturing the IV infusion rate by monitoring the drop rate of IV drops using the absorption of light is explained in extensive detail. This is an established method and the community is aware of the procedure. Hence, the details can be reduced and the discussion can highlight how the proposed design is better than the existing system.
4. The full form for the abbreviation MCU is not listed.
5. Page 5 lists Gtt as as the “remaining time” of IV infusion but the equation 8 shows that this value represents rate of infusion (infused volume/infused time). Similarly, residual volume of the fluid Vr is not defined as a volume but as a percentage fraction of residual volume/initial volume. Residual volume would be V_l – V_lf.
6. Page 8 – Static vs dynamic systems for IV infusion are not defined. Movement in horizontal and vertical directions are mentioned but what are these motions of?
7. “Developed” systems are not defined but called out in the discussion and as plots. The reader assumes “developed” systems are the proposed systems with photodiodes and laod cells but the author are recommended to explicitly state that.
8. There are several grammatical errors throughout the paper. Some are minor like "challenges" on Page 3 while others distort the meaning of the sentence like V_lf representing “infused volume of the fluid to the patient” on Page 5. The authors should consult a native English speaker to rephrase some of the paragraphs in the paper to better deliver the message.

 

Author Response

Response to the reviewer #2’s comment

Title : Design of remote monitoring system based on optical sensor to prevent medical accidents during fluid treatments

 

First of all, authors express their deep gratitude to the reviewer’s valuable comments, which were precise and comprehensible. Also, genuinely apologetic for causing deep concerns. In agreement with reviewer, we tried hard to enhance readability and coherence of the paper. Furthermore, authors responded each comment according to reviewer’s crucial suggestions. All of responses are as follows.

 

Comments and Suggestions for Authors

Comment #1 The introduction paragraphs are not clear and do not convey the objective of the story coherently. The authors list several shortcomings of existing IV therapies including photodiode-laser based IV delivery, ultrasound based, and load cell based IV delivery methods. However, the conclusion of that paragraph is that IV monitoring is necessary and IoT based system can automate the process and make it more effective. However, then the authors go on to point the shortcomings of the different approaches to use IoT to monitor IV infusion – RFID, Bluetooth, and Wi-Fi. The conclusion provided for this paragraph is that the present research proposes a system better than all the methods above without providing any details of what exactly is different in the research and how it improves on the current system. The authors are suggested to add a summary of their findings here for the reader’s ease.

Response #1

Authors appreciate on reviewer’s kindness and suggestions about our introduction in paper which we fully agree with. Line 54 to 55 is deleted to be coherent. Line 58 to 60 is added to connect each paragraph smoothly. Line 77 to 82 is added clarify what is different between our method and previous methods. There is report that exercising helps to recover. Therefore, we considered that it is also important to monitor patient not only lying down in bed but also who is exercising. This is our different approach to monitor patient in any condition, anytime and anywhere. Thus, we wrote about those simply in last paragraph of introduction.

 

Comment #2 The ‘Design Method’ section claims that the proposed design improves resistance to external interferences and higher accuracy of monitoring. However, not enough comparison with existing systems is made to substantiate these claims. The authors are recommended to add more data showing the reduction in monitoring noise, time or other variables that are achieved when compared to the current IV monitoring systems.

Response #2

Thanks for reviewing our paper deeply. Comparison results with existing system are written in Line 202 to 227.

 

Comment #3 The method of capturing the IV infusion rate by monitoring the drop rate of IV drops using the absorption of light is explained in extensive detail. This is an established method and the community is aware of the procedure. Hence, the details can be reduced and the discussion can highlight how the proposed design is better than the existing system.

Response #3

Thanks for your concern of extensive detail. Unfortunately, any of prior studies showed how exactly photosensor works. Therefore, we focused on principle of working mechanism and excellency of using photosensor. Moreover, we added more descriptions to make up for our methods.

 

Comment #4 The full form for the abbreviation MCU is not listed.

Response #4

Authors appreciate reviewer’s precisianism. As micro controller unit, abbreviated in MCU, is used only once, we wrote down in full text. This change is colored blue in Line 94.

 

Comment #5 Page 5 lists Gtt as as the “remaining time” of IV infusion but the equation 8 shows that this value represents rate of infusion (infused volume/infused time). Similarly, residual volume of the fluid Vr is not defined as a volume but as a percentage fraction of residual volume/initial volume. Residual volume would be V_l – V_lf.

 

Response #5

Authors fully agree to reviewer’s opinion about equations. Equation 8 is showing about Gtt calculation, not remaining time of IV infusion. Also, Vr should be defined percentage of residual volume of the fluid, not residual volume of fluid. We are sorry for making confusions about those. Those changes are colored in blue at Line 151, Line 156.

 

Comment #6 Page 8 – Static vs dynamic systems for IV infusion are not defined. Movement in horizontal and vertical directions are mentioned but what are these motions of?

 

Response #6 Authors appreciate reviewer’s comprehensive consider about motions. Static condition means infusion is undergoing without any motions which could be condition of patients lying in bed. Horizontal and vertical motion is literally motions of horizontally and vertically. When patients are under rehabilitation stage, which is known as post-operative, they should walk around ward to recover. In this situation, motions such as horizontally and vertically are occurred. Therefore, authors assumed situation of motions divided into three cases newly described in Line 206 to 212 and results are in Fig 6 (b), (c), (d)

 

Comment #7 “Developed” systems are not defined but called out in the discussion and as plots. The reader assumes “developed” systems are the proposed systems with photodiodes and laod cells but the author are recommended to explicitly state that.

 

Response #7

As what we’ve done is not newly developing or introducing, we changed developed systems into proposed systems.

 

Comment #8 There are several grammatical errors throughout the paper. Some are minor like "challenges" on Page 3 while others distort the meaning of the sentence like V_lf  representing “infused volume of the fluid to the patient” on Page 5. The authors should consult a native English speaker to rephrase some of the paragraphs in the paper to better deliver the message.

 

Response #8

We appreciate your verdicts of our grammar to deliver our findings clearly. We’ve discussed with several errors we found with native speaker to deliver intended message. In the revised paper, the errors that we found are deleted (which are colored in red) and changes are colored in blue. Unfortunately, we could not find “challenges” on page 3.

Author Response File: Author Response.docx

Reviewer 3 Report

My main concern with this manuscript is that: a vest amount of existing studies have proposed the similar concept. This paper should review the class of these papers and clearly give the differences and major improvements of the proposed mechanism. For instance:

1. Meo Vincent Caya, Marvin U. Cosindad, Nicanor I. Marcelo, Jose Nicolas M. Santos, Jumelyn L. Torres, "Design and Implementation of an Intravenous Infusion Control and Monitoring System", Consumer Electronics - Asia (ICCE-Asia) 2019 IEEE International Conference on, pp. 68-72, 2019.

2. Nicola Giaquinto, Marco Scarpetta, Mattia Alessandro Ragolia, Pietro Pappalardi, "Real-time drip infusion monitoring through a computer vision system", Medical Measurements and Applications (MeMeA) 2020 IEEE International Symposium on, pp. 1-5, 2020.

3. Ananya Madhav, N. M. Bhamini, H. N. Suma, "An IoT Based Intravenous Drip Rate Controlling and Monitoring Device", COMmunication Systems & NETworkS (COMSNETS) 2021 International Conference on, pp. 723-727, 2021.

4.Nicola Giaquinto, Marco Scarpetta, Maurizio Spadavecchia, Gregorio Andria, "Deep Learning-Based Computer Vision for Real-Time Intravenous Drip Infusion Monitoring", Sensors Journal IEEE, vol. 21, no. 13, pp. 14148-14154, 2021.

-- Besides the existing works in the literature, it would be better to compare related infusion monitoring products in the market (e.g., comparing to hospital products in terms of system cost, complexity, and effectiveness).

-- Based on Fig. 1, what is the system response time from the sensing system to the nursing station? what is the impacts of the obstacles on system performance?

-- What are the impacts of the sensing measurements on the system performance during moving and static conditions? What are system limitations?

Author Response

Response to the reviewer #3’s comment

Title : Design of remote monitoring system based on optical sensor to prevent medical accidents during fluid treatments

 

First of all, authors express their deep gratitude to the reviewer’s valuable comments, which were precise and comprehensible. Furthermore, authors responded each comment according to reviewer’s crucial suggestions. All of responses are as follows.

 

Comments and Suggestions for Authors

Comment #1 Besides the existing works in the literature, it would be better to compare related infusion monitoring products in the market (e.g., comparing to hospital products in terms of system cost, complexity, and effectiveness).

Response #1

Thank you for appropriate suggestion. It is true that there are many products in market in terms of monitoring infusion volume of fluid. Also, there were vast of studies before. Nonetheless, what this study include is about movements caused by patient’s motion such as walking around ward or going somewhere. Under those conditions, prior system’s accuracy was poor while our developed system showed significant accuracy. Experiments were done, which were shown in Figure 6, with restoring prior studies methods and comparing with developed system. In this system, about 90-100 USD is used which is affordable comparing 1800-4000 USD market’s infusion pump. Furthermore, developed system have simple structure even novice can fix or switch sensors in person. Overall, we consider developed system can be used abroad with its effectiveness.

 

Comment #2 Based on Fig. 1, what is the system response time from the sensing system to the nursing station? what is the impact of the obstacles on system performance?

Response #2

Authors appreciate reviewer’s comprehensive concern about system’s response time from the sensing system. As developed system is based on Wi-fi, there are some delays average of 220ms50ms. These are reasons of these delays. The one is, the microprocessor unit (MCU) we used, low level computing ability of which could cause lag of system. The other is network condition, which depends on network suppliers. As developed system showed better result than prior studies in moving conditions, the main obstacle of the system is connectivity. If patient with developed system steps out from Wi-fi coverage, MCU cannot send information’s about fluid infusion state. In future studies, 4G or 5G network could be applied to this system.

 

Comment #3 What are the impacts of the sensing measurements on the system performance during moving and static conditions? What are system limitations?

Response #3

Considering reviewer’s comment, the possible impacts of the sensing measurements on the system performance during moving and static conditions are leakage of fluid. In some reports, it is reported that IV fluid bag’s leakage is frequent. All of systems are using electronical units, electronical short is most concerned. In further studies, it could be worthy to make system as waterproof for prevent unprecedented accidents caused by electricity. As mentioned in response #2, system limitations are coverage of Wi-fi.

 

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors have put in the effort to make the paper more readable. I am satisfied with the changes and responses from the authors. The paper is recommended to be published in the Applied Sciences journal after minor grammatical revisions.

Reviewer 3 Report

The authors have satisfactorily addressed the main concerns.