Development of a Simulator Capable of Generating Age-Specific Pulse Pressure Waveforms for Medical Palpation Training

Round 1

Reviewer 1 Report

Title: Development of a simulator capable of generating age-specific pulse pressure waveforms for medical palpation training

The work is very interesting, it addresses a field that is increasingly frequented: the use of Virtual Reality technologies in medicine.

I would have some considerations on your work, presented in what follows.

State of the art

The number of works studied seems very small. In this field, many simulators based on haptic forces have been created, from vibrating sensors mounted in clothing or chairs, till medical training simulators for the introduction of stents through veins in cardiovascular surgery.

Somehow, a broader presentation should be made, then structured, with an emphasis on the simulation and measurement of the pulse.

Equipment

Making a simulator for training doctors to read the pulse is a very good idea. It can be used in schools with a medical profile without problems.

Were there other models, constructive solutions that were made and which were later modified and improved? Or is the proposed solution the first realized and is it optimal?

The proposed equipment is very complex, it contains many parts in motion of rotation and translation, sensors, motors as well as the automation / software part. More elements, more sources of defects and errors.

In addition, the quality of operation is limited by the direct contact between the cam and the folower, as well as by the very precise control of the rotation speed of the motor that drives the cam.

The use and development of this system are limited by the existence of a rigid 3D cam, with no possibilities to expand the range.

However, the results obtained, measured and compared, seem to be very good. The idea is that this equipment can be used by doctors, without an engineer being present for adjustments and troubleshooting.

Test

In the title you talk about a simulator for medicine.

If a complete simulator and users study is not made, then we can no longer talk about medical applications. We are talking about a variable pressure generator. If the term medical palpation training is used ... There is no attempt to use it for palpation or testing with human / medical users

What tubes and what skin can be used to copy human tissues of various ages? If these materials will change the tactile / haptic perception? Very good pressure values ​​are obtained in vain if there are no materials that have properties comparable to those of human tissues, respecting the human structure (skin, bones, muscles, blood vessels).

Consequently, without User study tests, it is not possible to discuss medicine!!!

 Others

Fig.1.c –– the graph must be made in polar coordinates, not Cartesian, as you talked about above.

The size of the folower that follows the cam – is it circular? What radius does it have? Smaller than the radius of the cam?

Author Response

First and foremost, the authors would like to thank the reviewers for the time and expertise they have invested in these reviews. The authors have addressed the reviewers’ comments in the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Radial artery pulse palpation is an interesting diagnosis method in western medicine, and creating such as simulator for training is, as the authors mentioned, useful and important. The paper itself is well-written and easy to read and understand. However, there are some issues prevent me recommending the current version of paper to publish.  

The first one is the novelty and contribution. The authors mentioned in the paper that the previous pneumatic simulation systems are mainly “discrete” cam system. The proposed system is a “universal” cam system. However, based on the description of system design, the proposed system is more like a system that used a similar cam mechanism with four discrete cams connecting with each other. From this viewing point, the novelty and contribution of the paper is relatively weak.   

The second one is the description of design methods for the system. It is not very clear, at least to me, for the part of design and fabrication of the cam system. For example, how the cam profiles for the four age groups were determined based on the pulse pressure graphs in Figure 1. It is also interesting to know how the authors considered cutting four holes to reduce the overall weight (the shapes and sizes)? Further, why not design a cam system with multiple independent cams for different age groups? It seems more convenient to add more cams for extra age groups. This chapter needs more clarifications for these points.   

The third concern is results presentation. Authors used L2 errors and AI values to evaluate the pulse pressure generated from the cam system. However, the description and reasons for using such analysis methods are not clarified well. Some simple introduction and reasoning are required. For example, why L2 and AI error are considered less in the current case. The result parts should be presented more logical and clearer (e.g., the paragraph in page 9). I highly suggest the authors to improve this.

And at last, I would like to know the authors’ discussion about the advantages and disadvantages of current cam system compared to the previous systems. If there are any disadvantage of current system design in your opinion? What are the existing issues you have noticed? What are the practical usability and applications for the system? What are your future research topics based on the system? A proper discussion is needed.

Author Response

First and foremost, the authors would like to thank the reviewers for the time and expertise they have invested in these reviews. The authors have addressed the reviewers’ comments in the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I still have some doubts.
Fig.1.c does not have polar coordinates - it should contain an angle and a radius.
The problem of the complexity of the equipment is not yet justified. What measures have you taken to be sure that one of the multiple components or connections between them does not fail. How did you do the calibration?
In the Conclusions chapter, you should argue, with comparative data from other works in the bibliography, why this equipment is better than others.

Author Response

First and foremost, the authors would like to thank the reviewers. The authors have addressed the reviewers’ second comments as attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Basically, the authors’ response has addressed my previous comments and the paper has been improved.  But revisions (lines 311-319 for section 2) have not been made in the manuscript. Currently, the main concern is that there is no clear discussion for the advantages and disadvantages of the proposed system added in the manuscript, by comparing with previous systems (like the systems mentioned in the references). For example, besides that the system is a “universal” cam system, if the system is better than other systems from the view of measure data? What the reasons?  A deep discussion paragraph could be added. At least, some highlights about these should be mentioned in the conclusion part so that the contribution of the paper could be clearer.

Author Response

First and foremost, the authors would like to thank the reviewers. The authors have addressed the reviewers’ second comments as attachment.

Author Response File: Author Response.docx