Remote palpation system

Abstract

The doctor can adjust the pressure while applying it to the affected area of ​​the patient, and can also measure the delicate tactile sensation of that area. [Solution] The physician-side control unit 80 is configured to transmit to the patient-side control unit 40 the position information of the physician's fingers acquired by the physician-side position information acquisition unit 51 and the pressing force detected by the pressing force detection unit 70A when the physician presses the human body model 60. The patient-side control unit 40 is configured to operate the palpation manipulator 20 based on the finger position information and pressing force to press the affected area of ​​the patient with the pressing unit. The patient-side control unit 40 is attached to the pressing unit and is configured to transmit to the physician-side control unit 80 tactile information detected by the tactile sensation detection unit 30 when it comes into contact with the affected area. The physician-side control unit 80 is configured to operate the tactile sensation presentation unit 70 based on the tactile sensation information to present the tactile information to the fingers.

Description

[Technical Field]

[0001] The present invention relates to a remote palpation system. [Background Art]

[0002] With the development of remote technology, development of systems that allow doctors to perform medical examination of patients remotely has been progressing. On the other hand, particularly in medical practice in orthopedic surgery, palpation is often performed in addition to visual inspection and inquiry. Palpation is an essential action for making an accurate diagnosis. For this reason, there is a demand for a system that allows a doctor to palpate a patient remotely.

[0003] Patent Document 1 describes a tactile sensing system used in such a remote palpation system. [Prior Art Literature] [Patent Literature]

[0004] [Patent Document 1] Japanese Unexamined Patent Publication No. 2005-192577 [Summary of the Invention] [Problem to be Solved by the Invention]

[0005] In conventional remote palpation systems, including the tactile sensing system described in Patent Document 1, it is difficult to physically and accurately acquire tactile information of a patient's affected area, and to accurately present the tactile information to a doctor's fingers. For this reason, there is a problem that it is difficult for a doctor to press the affected area of the patient while adjusting the pressing force, or to sense the delicate tactile feel of the patient's affected area. [Means for Solving the Problem]

[0006] Various aspects of a remote palpation system for solving the above problem are described. [Aspect 1] A system comprising a patient-side terminal device and a physician-side terminal device configured to be connectable to each other via a network, enabling a physician to perform a physical examination of a patient remotely, The aforementioned patient-side terminal device is A palpation manipulator having a pressing part configured to press on the affected area of ​​the patient, A tactile detection unit is attached to the pressing portion and detects tactile information when it comes into contact with the affected area, A patient-side position information acquisition unit that acquires positional information of the part of the patient's body that includes the affected area, A patient-side camera that captures at least the patient's face, It comprises a patient-side control unit and, The physician's terminal device is, A human body model that mimics the shape and feel of the part of the patient's body that includes the affected area, A tactile presentation unit configured to be wearable on the fingers of the physician, which presents the tactile information detected by the tactile detection unit to the fingers as vibrations, A physician-side position information acquisition unit that acquires the position information of the fingers, A pressing force detection unit for detecting the pressing force applied by the physician to the anatomical model, Based on the location information of the area including the affected area acquired by the patient-side location information acquisition unit and the location information of the fingers acquired by the physician-side location information acquisition unit, the physician-side display unit composites and displays the area including the affected area and the fingers, and also displays the face captured by the patient-side camera, It comprises a physician-side control unit and, The physician-side control unit is configured to transmit the finger position information acquired by the physician-side position information acquisition unit and the pressure detected by the pressure detection unit to the patient-side control unit, and the patient-side control unit is configured to operate the palpation manipulator based on the finger position information and the pressure to press the affected area with the pressure unit, The patient-side control unit is configured to transmit the tactile information detected by the tactile detection unit to the physician-side control unit, and the physician-side control unit is configured to operate the tactile presentation unit based on the tactile information to present the tactile information to the fingers. Remote palpation system.

[0007] [Aspect 2] The tactile feedback unit includes a vibration actuator having a dielectric elastomer that vibrates when a voltage is applied. The vibration actuator also functions as the pressing force detection unit. The remote palpation system described in Embodiment 1.

[0008] [Aspect 3] The aforementioned tactile detection unit is A pressure sensor having a first detection surface and detecting a load applied to the first detection surface, An intermediate member disposed on the first detection surface of the pressure sensor, The system includes a multi-axis force sensor disposed on the surface of the intermediate member, having a second detection surface with a smaller area than the first detection surface, and detecting an external force applied to the second detection surface, The pressure sensor detects the pressure applied to the first detection surface via the multi-axis force sensor and the intermediate member. The system is configured to estimate the tactile information that has come into contact with the tactile detection unit based on the detection results of the pressure sensor and the multi-axis force sensor. A remote palpation system according to Embodiment 1 or Embodiment 2.

[0009] [Aspect 4] The patient-side control unit is configured to perform feedback control of the palpation manipulator's operation so that the pressure detected by the pressure sensor becomes the pressing force detected by the pressing force detection unit. The remote palpation system described in Embodiment 3.

[0010] [Aspect 5] The patient-side control unit is configured to operate the palpation manipulator such that the pressing unit is separated from the affected area when the pressure detected by the pressure-sensitive sensor is equal to or higher than a predetermined value, The remote palpation system according to aspect 3 or aspect 4.

[0011] [Aspect 6] The patient-side position information acquisition unit comprises an optical motion capture system, The remote palpation system according to any one of aspects 1 to 5.

[0012] [Aspect 7] The doctor-side position information acquisition unit comprises an optical motion capture system, The remote palpation system according to any one of aspects 1 to 6.

[0013] [Aspect 8] The palpation manipulator is: an annular portion provided slidably relative to an elongated mounting table along the longitudinal direction of said mounting table on which the patient's forearm can be placed, and configured such that the patient's forearm can be inserted therethrough; and a movable portion rotatably supported relative to said annular portion along the circumferential direction of said annular portion; said pressing portion comprises: a fixed portion fixed to said movable portion; and a pressing portion main body movably supported in the inner-outer direction of said annular portion by said fixed portion, The remote palpation system according to any one of aspects 1 to 7. Effects of the Invention

[0014] According to the present invention, a doctor can press the affected area of a patient while adjusting the pressing force, and can measure delicate tactile sensations of the affected area. Brief Description of the Drawings

[0015] [Figure 1] FIG. 1 is a block diagram of a remote palpation system according to one embodiment. [Figure 2]Figure 2 is a side view of a palpation manipulator of a remote palpation system according to one embodiment. [Figure 3] Figure 3 is a cross-sectional view taken along line 3-3 in Figure 2. [Figure 4] Figure 4 is a perspective view of the tactile detection unit of a remote palpation system according to one embodiment. [Figure 5] Figure 5 is a cross-sectional view taken along line 5-5 in Figure 4. [Figure 6] Figure 6 is an explanatory diagram of tactile motion. [Figure 7] Figure 7 is an explanatory diagram showing a patient using a remote palpation system according to one embodiment. [Figure 8] Figure 8 is an explanatory diagram showing a physician using a remote palpation system according to one embodiment. [Figure 9] Figure 9 is an explanatory diagram of a human body model of a remote palpation system according to one embodiment, with the skin sheet removed. [Figure 10] Figure 10 is an explanatory diagram of the tactile feedback section of a remote palpation system according to one embodiment. [Figure 11] Figure 11 is an explanatory diagram of the field of view obtained by the physician-side display unit of a remote palpation system according to one embodiment. [Modes for carrying out the invention]

[0016] A remote palpation system according to one embodiment will be described below with reference to Figures 1 to 11. As shown in Figure 1, the remote palpation system comprises a patient-side terminal device 10 and a physician-side terminal device 50 configured to be connectable to each other via a network 90, and is a system in which physician D remotely performs a palpation on patient P.

[0017] The remote palpation system of this embodiment is a system for palpating pain and joint abnormalities in the forearm and wrist of patient P. Network 90 is, for example, the internet.

[0018] <Patient-side terminal device> As shown in Figure 1, the patient-side terminal device 10 is positioned on the patient P side and includes a patient-side position information acquisition unit 11, a patient-side camera 12, a patient-side microphone 13, a patient-side speaker 14, a patient-side display unit 15, a patient-side temperature sensor 16, a palpation manipulator 20, a tactile sensation detection unit 30, and a patient-side control unit 40.

[0019] (Palpation manipulator) As shown in Figures 2 and 3, the palpation manipulator 20 comprises a base 21, a sliding mechanism 22, an annular portion 23, a movable portion 24, and a pressing portion 25.

[0020] The base 21 is positioned below a long, rectangular platform 29 on which the patient P's forearm can be placed. A sliding mechanism 22 is positioned on the base 21 so as to extend along the longitudinal direction of the platform 29. The sliding mechanism 22 is, for example, a ball screw mechanism.

[0021] Two annular sections 23 are provided on the mounting base 29, spaced apart from each other in the longitudinal direction. The two annular sections 23 are connected to a sliding mechanism 22 and are configured to slide along the longitudinal direction of the mounting base 29. The two annular sections 23 are configured to allow the forearm of patient P to pass through them.

[0022] The sliding mechanism 22 is driven by the rotation of a first motor (not shown), causing the two annular portions 23 to slide along the longitudinal direction of the mounting base 29. Between the two annular portions 23, a movable portion 24 is rotatably supported along the circumferential direction of the annular portion 23.

[0023] The movable part 24 has two inner annular members 24A, each rotatably supported by one and the other of the two annular parts 23, and a plurality of connecting members 24B that connect the inner annular members 24A to each other. The plurality of connecting members 24B are provided spaced apart from each other in the circumferential direction of the inner annular members 24A.

[0024] A gear is formed on the outer circumferential surface of the inner annular member 24A. A drive gear, which is rotationally driven by the rotation of a second motor (not shown), is meshed with this gear. The movable part 24 is configured to rotate when the inner annular member 24A is rotated by the rotation of a second motor (not shown).

[0025] The pressing portion 25 comprises a fixed portion 25A, a shaft portion 25B, and a pressing portion body 25C. The fixing part 25A is fixed to the connecting member 24B. The shaft portion 25B is fixed to the fixed portion 25A and is supported so as to be movable in the inward and outward directions of the annular portion 23. The fixed portion 25A is provided with a drive mechanism (not shown in the figure) that drives the shaft portion 25B to move in the inward and outward directions of the annular portion 23.

[0026] The pressing part body 25C is fixed to the tip of the shaft part 25B. The drive mechanism is driven by a third motor (not shown) through rotation, causing the pressing body 25C to move inward and outward along with the shaft 25B, thereby enabling it to press against the affected area PA of the patient P.

[0027] As shown in Figure 4, a tactile detection unit 30 is attached to the surface of the pressing unit body 25C to detect tactile information when it comes into contact with the affected area PA. The first motor, the second motor, and the third motor are all electrically connected to the patient-side control unit 40, which will be described later.

[0028] (Tactile detection unit) As shown in Figures 4 and 5, the tactile sensing unit 30 is shaped to mimic the pads of human fingers. In Figure 5, for ease of understanding, although only the multi-axis force sensor 341 is originally shown, the multi-axis force sensors 342 and 344 are also shown on the same cross-section.

[0029] The tactile detection unit 30 comprises a base 31, a pressure sensor 32, an intermediate member 33, a multi-axis force sensor 34, and a covering 35. The base portion 31 has a planar support surface 31A.

[0030] The pressure sensor 32 is a sheet-shaped sensor fixed to the support surface 31A of the base 31. The pressure sensor 32 has one main surface fixed to the support surface 31A and a first detection surface 32A, which is the other main surface located on the opposite side. An intermediate member 33 is fixed to the first detection surface 32A of the pressure sensor 32.

[0031] The pressure sensor 32 detects the load applied to the first detection surface 32A through the intermediate member 33. As the pressure sensor 32, a known pressure sensor using a piezoelectric element or the like can be used. A preferred form of the pressure sensor 32 is an elastomer capacitive pressure sensor utilizing a dielectric elastomer.

[0032] Examples of the dielectric elastomers mentioned above include crosslinked polyrotaxanes, silicone elastomers, acrylic elastomers, and urethane elastomers. An elastomer-based capacitive pressure sensor is a sheet-like multilayer structure in which a sheet-like dielectric layer made of a dielectric elastomer and multiple positive and negative electrode layers, which serve as electrode layers, are stacked on both sides in the thickness direction of the dielectric layer.

[0033] Although not shown in the diagram, the pressure sensor 32 is connected to wiring for power supply and wiring for signal transmission. The power supply wiring is for supplying power to the pressure sensor 32 from a predetermined power source. The signal transmission wiring is for transmitting the signal output from the pressure sensor 32 to the patient-side control unit 40.

[0034] The intermediate member 33 is a block-shaped member having a flat back surface 33A and a curved front surface 33B located on the opposite side. The back surface 33A of the intermediate member 33 is a flat surface fixed opposite to the first detection surface 32A of the pressure sensor 32. The front surface 33B of the intermediate member 33 is formed in a convex curved shape that mimics the pad of a finger.

[0035] The multi-axis force sensor 34 is positioned on the surface 33B of the intermediate member 33. The multi-axis force sensor 34 has a second detection surface 34A and detects external forces applied to the first detection surface 32A. The area of ​​the second detection surface 34A of the multi-axis force sensor 34 is smaller than the first detection surface 32A of the pressure sensor 32.

[0036] The multi-axis force sensor 34 is a 6-axis force sensor that detects pressure in each coordinate axis direction of a 3D Cartesian coordinate system including coordinates orthogonal to the second detection surface 34A, and moments around each coordinate axis of the 3D Cartesian coordinate system. Alternatively, the multi-axis force sensor 34 may be a 3-axis force sensor that detects pressure in each coordinate axis direction of a 3D Cartesian coordinate system including coordinates orthogonal to the second detection surface 34A. The multi-axis force sensor 34 is, for example, a MEMS (Micro Electro Mechanical Systems) sensor constructed using MEMS technology.

[0037] Multiple multi-axis force sensors 34 are arranged on the surface 33B of the intermediate member 33. Each of the multi-axis force sensors 34 is fixed to the intermediate member 33 such that its second detection surface 34A is substantially parallel to the portion of the surface 33B of the intermediate member 33 on which the multi-axis force sensor 34 is located.

[0038] As shown in Figures 4 and 5, six multi-axis force sensors 341 to 346 are arranged on the surface 33B of the intermediate member 33 as a multi-axis force sensor 34. The multi-axis force sensors 341 to 346 are arranged such that the angle of the second detection surface 34A relative to the first detection surface 32A of the pressure sensor 32 is different for each of them.

[0039] The number and arrangement of the multi-axis force sensors 34 are not particularly limited. For example, the number of multi-axis force sensors 34 may be 1 to 5, or 7 or more. Furthermore, the system may have only one of the following: a multi-axis force sensor 34 in which the second detection surface 34A is parallel to the first detection surface 32A of the pressure sensor 32, or a multi-axis force sensor 34 in which the second detection surface 34A is inclined with respect to the first detection surface 32A of the pressure sensor 32.

[0040] Furthermore, it is preferable that the multi-axis force sensor 34 includes two or more multi-axis force sensors 34 in which the angle of the second detection surface 34A relative to the first detection surface 32A of the pressure sensor 32 is different. In this case, it is more preferable that the multi-axis force sensor 34 in which the second detection surface 34A is parallel to the first detection surface 32A of the pressure sensor 32 is included. It is even more preferable that the multi-axis force sensor 34 in which the second detection surface 34A is inclined relative to the first detection surface 32A of the pressure sensor 32 includes two or more multi-axis force sensors 34 in which one or both of the inclination angle and inclination direction are different.

[0041] The covering 35 is a film-like member that covers the entire surface 33B of the intermediate member 33 with the multi-axis force sensor 34 sandwiched in between. The covering 35 is formed of an elastic material that is softer than the intermediate member 33. Examples of materials for forming the covering 35 include silicone and urethane. It is preferable that the covering 35 has elasticity similar to that of a human fingertip.

[0042] The back surface 35A of the covering 35 is in contact with each of the second detection surfaces 34A of the multi-axis force sensors 34. In the example shown in Figure 5, the back surface 35A of the covering 35 has a partially recessed shape where the multi-axis force sensors 34 are located, and the portion between the multi-axis force sensors 34 on the surface 33B of the intermediate member 33 is filled by the covering 35. The surface 35B of the covering 35 is shaped to follow the surface 33B of the intermediate member 33, that is, it is formed in a convex curved shape that mimics the pad of a finger.

[0043] As shown in Figure 6, the tactile detection unit 30 is used by bringing the affected area PA of the patient P into contact with the surface 35B of the covering body 35. Each of the multi-axis force sensors 34 independently detects the external force applied to the second detection surface 34A through the covering 35 when the affected area PA is brought into contact with the surface 35B of the covering 35. In other words, each of the multi-axis force sensors 34 locally detects the external force transmitted to a specific part on the surface 33B of the intermediate member 33. Each of the multi-axis force sensors 34 then outputs its detection result to the patient-side control unit 40.

[0044] The pressure sensor 32 detects the pressure applied to the first detection surface 32A through the covering 35, the multi-axis force sensor 34, and the intermediate member 33 when the affected area PA is brought into contact with the surface 35B of the covering 35. In other words, the pressure sensor 32 detects the total load transmitted to the intermediate member 33. The pressure sensor 32 then outputs the detection result to the patient-side control unit 40.

[0045] The patient-side control unit 40, described later, is configured to estimate tactile information of the affected area PA that has come into contact with the tactile detection unit 30, based on the detection results of the pressure sensor 32 and the multi-axis force sensor 34.

[0046] (Patient-side location information acquisition unit, patient-side camera, patient-side microphone, patient-side speaker, patient-side display unit) As shown in Figure 1, the patient-side position information acquisition unit 11 is configured to acquire position information of the patient P's body, including the affected area PA. The patient-side position information acquisition unit 11 includes, for example, an optical motion capture system.

[0047] The patient-side camera 12 is configured to capture at least the face of patient P. The patient-side microphone 13 is configured to pick up the voice of patient P. The patient-side speaker 14 is configured to broadcast the voice of Doctor D, which has been picked up by the doctor-side microphone 53, as described later.

[0048] As shown in Figure 7, the patient-side display unit 15 is configured to display the face of Doctor D, which is captured by the doctor-side camera 52, which will be described later. The patient-side display unit 15 is, for example, a transparent display. The patient-side display unit 15 may also display the face of Doctor D's avatar. The patient-side display unit 15 is positioned in front of the patient P.

[0049] The patient-side temperature sensor 16 is configured to detect the body temperature of patient P. (Patient-side control unit) The patient-side control unit 40 is electrically connected to the patient-side position information acquisition unit 11, the patient-side camera 12, the patient-side microphone 13, the patient-side speaker 14, the patient-side display unit 15, the patient-side temperature sensor 16, the palpation manipulator 20, and the tactile detection unit 30.

[0050] The patient-side control unit 40 is configured to transmit location information acquired by the patient-side location information acquisition unit 11, video information captured by the patient-side camera 12, audio information collected by the patient-side microphone 13, body temperature information detected by the patient-side temperature sensor 16, and tactile information detected by the tactile sensation detection unit 30 to the physician-side control unit 80 via the network 90.

[0051] The patient-side control unit 40 is configured to control the patient-side speaker 14. The patient-side control unit 40 is configured to control the operation of the palpation manipulator 20.

[0052] <Physician's terminal device> As shown in Figure 1, the physician-side terminal device 50 is located on the physician D side and includes a physician-side position information acquisition unit 51, a physician-side camera 52, a physician-side microphone 53, a physician-side speaker 54, a physician-side display unit 55, a human body model 60, a tactile presentation unit 70, and a physician-side control unit 80.

[0053] (human body model 60) As shown in Figures 8 and 9, the anatomical model 60 mimics the shape and feel of the forearm and wrist joint, which are the parts of patient P's body that include the affected area PA.

[0054] Figure 9 shows the human body model 60 shown in Figure 8 with the skin sheet 61, which mimics skin, removed. As shown in Figure 9, the human body model 60 includes a skeletal section 62 that mimics the skeleton, a muscle section 63 that mimics muscles, a tendon section 64 that mimics tendons, and a vascular section 65 that mimics blood vessels, etc.

[0055] As shown in Figures 8 and 9, the human body model 60 is constructed by covering the skeletal part 62, muscle part 63, tendon part 64, and blood vessel part 65 with a skin sheet 61. Fluid channels are provided inside the muscle part 63, tendon part 64, and blood vessel part 65.

[0056] As shown in Figure 1, an adjustment device 66 is connected to the flow channels of the muscle section 63 and other parts of the anatomical model 60. Through the adjustment device 66, the pressure and temperature of the liquid supplied to the flow channels of the muscle section 63 and other parts are adjusted, thereby adjusting the general shape of the patient P's body, body temperature, and the reaction force acting on the body's muscles.

[0057] (Tactile sensation presentation section) As shown in Figure 10, the tactile presentation unit 70 is configured to be attachable to the finger DF of physician D, and presents tactile information detected by the tactile detection unit 30 to the finger DF as vibration.

[0058] The tactile feedback unit 70 of this embodiment includes a vibration actuator 72 having a dielectric elastomer that vibrates when a voltage is applied. The tactile feedback unit 70 includes a band-shaped base 71 that can be wrapped around and attached to the fingers DF of physician D. The base 71 is made of, for example, a flexible and stretchable soft material. Examples of the soft material constituting the base 71 include silicone, elastomers such as urethane, and stretch fabrics.

[0059] A vibration actuator 72 is positioned on the inner surface of the base portion 71. The vibration actuator 72 is a sheet-shaped dielectric elastomer actuator (DEA). Although not shown in the figures, a holding portion is provided on the inner or outer surface of the base portion 71 for holding the base portion 71 while it is wrapped around a finger. The holding portion is not particularly limited, and a known configuration used for holding band-shaped members such as hook-and-loop fasteners can be used.

[0060] DEA is a multilayer structure consisting of multiple stacked sheets of dielectric elastomer, and positive and negative electrode layers positioned on both sides of the dielectric layer in the thickness direction. An insulating layer is stacked on the outermost layer of DEA. When a DC voltage is applied between the positive and negative electrodes in DEA, the dielectric layer deforms in a way that compresses in the thickness direction and expands in the direction of the DEA surface, which is along the surface of the dielectric layer, depending on the magnitude of the applied voltage. DEA allows physician D to perceive vibrations and other sensations based on the expansion and contraction of DEA as tactile sensations.

[0061] With the tactile sensor 70 attached to the fingertip DF of physician D's hand, when the voltage applied to the DEA is increased, the DEA extends in the circumferential direction of the fingertip. Subsequently, when the voltage applied to the DEA is decreased, the DEA contracts back to its original state. By repeatedly increasing and decreasing the voltage applied to the DEA (for example, by applying the voltage in a pulsed manner), the DEA repeatedly expands and contracts, vibrating in the circumferential direction of the fingertip.

[0062] The vibration of the DEA is transmitted to the fingers DF of physician D, and physician D recognizes the vibration as a tactile sensation. As a result, the tactile sensation (pseudo-force sensation) is presented to physician D from the tactile sensation presentation unit 70. By changing the magnitude of the voltage applied to the DEA and the timing of switching the applied voltage, the vibration pattern of the DEA can be changed, allowing physician D to recognize various tactile sensations. The tactile sensation presentation unit 70 is equipped with a drive unit (not shown) that applies voltage from a power source such as a battery (not shown) between a pair of electrodes composed of the positive electrode and negative electrode of the vibration actuator 72.

[0063] The dielectric elastomer constituting the dielectric layer is not particularly limited, and any dielectric elastomer used in known DEAs can be used. Examples of such dielectric elastomers include crosslinked polyrotaxanes, silicone elastomers, acrylic elastomers, and urethane elastomers. One of these dielectric elastomers may be used, or multiple types may be used in combination.

[0064] Examples of materials constituting the positive and negative electrodes include conductive elastomers, carbon nanotubes, Ketjenblack®, and metal vapor-deposited films. Examples of the conductive elastomers include conductive elastomers containing insulating polymers and conductive fillers.

[0065] Examples of the insulating polymers mentioned above include crosslinked polyrotaxanes, silicone elastomers, acrylic elastomers, and urethane elastomers. One of these insulating polymers may be used, or multiple types may be used in combination. Examples of the conductive fillers mentioned above include carbon nanotubes, Ketjenblack (registered trademark), carbon black, and metal particles such as copper and silver. One of these conductive fillers may be used, or multiple types may be used in combination.

[0066] The insulating elastomer constituting the insulating layer is not particularly limited, and known insulating elastomers used in the insulating portion of known DEA can be used. Examples of such insulating elastomers include crosslinked polyrotaxane, silicone elastomer, acrylic elastomer, and urethane elastomer. One of these insulating elastomers may be used, or multiple types may be used in combination.

[0067] Although not shown in the diagram, the vibration actuator 72 is connected to wiring for power supply and wiring for signal transmission. The power supply wiring is for supplying power to the vibration actuator 72 from a predetermined power source. The signal transmission wiring is for transmitting the signal output from the vibration actuator 72 to the physician-side control unit 80.

[0068] (Pressing force detection unit 70A) As shown in Figure 10, the pressing force detection unit 70A detects the pressing force applied by the doctor D to the anatomical model 60. In this embodiment, the vibration actuator 72 of the tactile presentation unit 70 also functions as the pressing force detection unit 70A.

[0069] In other words, the vibration actuator 72 constitutes a capacitive pressure sensor. A capacitive pressure sensor is a pressure sensor that detects the operating force pressing on it and outputs a signal based on its own capacitance. The capacitance of the vibration actuator 72 is a parameter that is inversely proportional to the distance between the electrodes of the vibration actuator 72 and proportional to the area of ​​the electrodes (opposing area). Therefore, the greater the force that compresses the dielectric layer against the vibration actuator 72, the smaller the thickness of the dielectric layer becomes, and the greater the capacitance of the vibration actuator 72.

[0070] (Physician's location information acquisition unit, physician's camera, physician's microphone, physician's speaker, physician's display unit) As shown in Figure 1, the physician-side position information acquisition unit 51 is configured to acquire position information of physician D's fingers DF. The physician-side position information acquisition unit 51 includes, for example, an optical motion capture system.

[0071] The doctor's camera 52 is configured to capture the face of doctor D. The doctor's microphone 53 is configured to pick up the voice of doctor D. The doctor's speaker 54 is configured to broadcast the voice of patient P, which has been picked up by the patient's microphone 13 mentioned above.

[0072] As shown in Figure 11, the physician's display unit 55 displays the forearm, wrist, and fingers DF, which are the parts including the affected area PA, based on the location information of the affected area PA acquired by the patient's location information acquisition unit 11 and the location information of the fingers DF acquired by the physician's location information acquisition unit 51. The physician's display unit 55 also displays the face captured by the patient's camera 12. The physician's display unit 55 is preferably a head-mounted display.

[0073] (Physician-side control unit) The physician-side control unit 80 is electrically connected to the physician-side position information acquisition unit 51, physician-side camera 52, physician-side microphone 53, physician-side speaker 54, physician-side display unit 55, human body model 60, and tactile presentation unit 70 (pressure detection unit 70A).

[0074] The physician-side control unit 80 is configured to transmit location information acquired by the physician-side location information acquisition unit 51, video information captured by the physician-side camera 52, audio information collected by the physician-side microphone 53, and pressure information detected by the pressure detection unit 70A to the patient-side control unit 40 via the network 90.

[0075] The physician-side control unit 80 is configured to control the physician-side speaker 54. The physician's control unit 80 is configured to control the adjustment device 66 of the anatomical model 60. The physician-side control unit 80 is configured to control the operation of the tactile feedback unit 70.

[0076] The patient-side control unit 40 is configured to operate the palpation manipulator 20 based on the position information and pressing force of the physician D's fingers DF transmitted from the physician-side control unit 80, thereby pressing the affected area PA with the pressing unit 25.

[0077] The physician-side control unit 80 is configured to operate the tactile presentation unit 70 based on tactile information transmitted from the patient-side control unit 40 to present tactile information to the physician D's fingers DF. It is preferable that the patient-side control unit 40 is configured to provide feedback control of the operation of the palpation manipulator 20 so that the pressure detected by the pressure sensor 32 becomes the pressing force detected by the pressing force detection unit 70A.

[0078] Preferably, the patient-side control unit 40 is configured to operate the palpation manipulator 20 so that the pressing part 25 moves away from the affected area PA when the pressure detected by the pressure sensor 32 exceeds a predetermined value.

[0079] <Operation of this embodiment> As shown in Figure 11, the physician's display unit 55 displays a composite image of the patient P's body, including the affected area PA, and the physician D's fingers DF, along with the patient P's face. The physician D visually observes the patient P's face, the affected area PA, and his own fingers DF displayed on the physician's display unit 55, and touches the human body model 60 with his fingers DF, which are fitted with a tactile feedback unit 70 (see Figure 8). The physician's position information acquisition unit 51 then acquires the position information of the physician D's fingers DF, and the pressure detection unit 70A detects the pressure applied by the physician D to the human body model 60. The physician's control unit 80 then transmits the position information and pressure to the patient's control unit 40. Based on the position information and pressure to the physician D's fingers DF, the patient's control unit 40 operates the palpation manipulator 20, causing the patient P's affected area PA to be pressed by the pressure unit 25. In this way, the force applied by physician D to the anatomical model 60 is reproduced by the palpation manipulator 20 as the force applied to the affected area PA of patient P.

[0080] Meanwhile, the touch detection unit 30 attached to the pressing unit 25 detects tactile information of the affected area PA. The patient-side control unit 40 then transmits the tactile information to the physician-side control unit 80. The physician-side control unit 80 then operates the tactile presentation unit 70 based on the tactile information, presenting the tactile information to physician D's fingers DF. In this way, the tactile information of the affected area PA of patient P detected by the touch detection unit 30 is reproduced by the tactile presentation unit 70 vibrating physician D's fingers DF.

[0081] Here, Doctor D can identify a relevant case from among those he has examined in the past, based on the tactile information of the affected area PA of patient P. More specifically, Doctor D can identify a relevant case based on the combination of how the affected area PA is touched and the patient P's reactions, such as how much pain they experience.

[0082] In particular, the remote palpation system of this embodiment is equipped with a human body model 60 and a tactile sensation presentation unit 70 separately. Therefore, the human body model 60 presents force sensations that require relatively large output, such as the general shape of the patient P's body, body temperature, and reaction forces acting on the body's muscles, while the tactile sensation presentation unit 70 presents subtle tactile sensations that are difficult to represent with the human body model 60.

[0083] Furthermore, since Doctor D only needs to attach the tactile sensor 70 to his fingers DF when performing remote palpation, Doctor D's body is not easily restricted by the remote palpation system. Therefore, Doctor D can perform palpation with the same movements and actions as in a normal medical examination.

[0084] <Effects of this embodiment> (1) The remote palpation system comprises a patient-side terminal device 10 and a physician-side terminal device 50 configured to be connectable to each other via a network 90. ​​The patient-side terminal device 10 comprises a palpation manipulator 20, a tactile detection unit 30, a patient-side position information acquisition unit 11, a patient-side camera 12, and a patient-side control unit 40. The physician-side terminal device 50 comprises a human body model 60, a tactile presentation unit 70, a physician-side position information acquisition unit 51, a pressure detection unit 70A, a physician-side display unit 55, and a physician-side control unit 80. The physician-side control unit 80 is configured to transmit the position information of the finger DF acquired by the physician-side position information acquisition unit 51 and the pressure detected by the pressure detection unit 70A to the patient-side control unit 40, and the patient-side control unit 40 is configured to operate the palpation manipulator 20 based on the position information of the finger DF and the pressure to press the affected area PA with the pressing unit 25. The patient-side control unit 40 is configured to transmit tactile information detected by the tactile detection unit 30 to the physician-side control unit 80, and the physician-side control unit 80 is configured to operate the tactile presentation unit 70 based on the tactile information to present the tactile information to the physician D's fingers DF.

[0085] With this configuration, the above embodiment works as described above, allowing physician D to press into the affected area PA of patient P while adjusting the pressure, and to measure the delicate tactile sensation of the affected area PA.

[0086] (2) The tactile feedback unit 70 includes a vibration actuator 72 having a dielectric elastomer that vibrates when a voltage is applied. The vibration actuator 72 also functions as a pressing force detection unit 70A.

[0087] With this configuration, the vibration actuator 72 having a dielectric elastomer also functions as a pressure detection unit 70A. Therefore, compared to a configuration in which the tactile presentation unit 70 and the pressure detection unit 70A are provided separately, the configuration of the tactile presentation unit 70 and the pressure detection unit 70A can be made simpler and lighter.

[0088] (3) The tactile detection unit 30 comprises a pressure sensor 32, an intermediate member 33, and a multi-axis force sensor 34. The pressure sensor 32 detects the pressure applied to the first detection surface 32A via the multi-axis force sensor 34 and the intermediate member 33. The unit is configured to estimate tactile information of the affected area PA that is in contact with the tactile detection unit 30 based on the detection results of the pressure sensor 32 and the multi-axis force sensor 34.

[0089] In this configuration, the tactile detection unit 30 includes two types of sensors, a pressure sensor 32 and a multi-axis force sensor 34, which are positioned with the intermediate member 33 in between. The multi-axis force sensor 34 is positioned relatively close to the surface 33B of the intermediate member 33, that is, the surface (covering 35) of the tactile detection unit 30, which is the part that the affected area PA comes into contact with, when the affected area PA is brought into contact with the tactile detection unit 30 (hereinafter referred to as the tactile action). The multi-axis force sensor 34 then detects a localized external force applied to a part of the surface 33B of the intermediate member 33, that is, at the location where the multi-axis force sensor 34 is installed.

[0090] The pressure sensor 32 is positioned on the back surface of the intermediate member 33, that is, relatively far from the surface of the tactile detection unit 30, which is the part that the affected area PA comes into contact with, during touch operation. The pressure sensor 32 detects the load applied from the intermediate member 33 to the pressure sensor 32, that is, the total load applied to the entire intermediate member 33.

[0091] Thus, the tactile detection unit 30 can acquire two types of information during a touch operation: the local external force applied to the surface 33B of the intermediate member 33, and the total load applied to the entire intermediate member 33. By estimating tactile information by combining these two types of information, the accuracy of the estimation is improved compared to estimating tactile information based solely on the detection results of the multi-axis force sensor 34.

[0092] Furthermore, it is preferable that the arrangement of the pressure sensor 32 and the multi-axis force sensor 34 in the tactile detection unit 30 mimics the arrangement of skin receptors that control human tactile sensation. (4) The patient-side control unit 40 is configured to provide feedback control of the operation of the palpation manipulator 20 so that the pressure detected by the pressure sensor 32 becomes the pressing force detected by the pressing force detection unit 70A.

[0093] The shape of the anatomical model 60 does not necessarily match the shape of patient P's body. Therefore, if the movement of the palpation manipulator 20 is made to perfectly follow the movement of physician D's fingers DF, there is a risk that physician D may not be able to apply pressure to the affected area PA of patient P as intended.

[0094] In this regard, with the above configuration, feedback control of the operation of the palpation manipulator 20 is performed so that the pressure detected by the pressure sensor 32 becomes the pressing force detected by the pressing force detection unit 70A. This makes it possible to suppress the occurrence of the above-mentioned problems.

[0095] (5) The patient-side control unit 40 is configured to operate the palpation manipulator 20 so that the pressing part 25 moves away from the affected area PA when the pressure detected by the pressure sensor 32 exceeds a predetermined value.

[0096] In the above remote palpation system, the patient P's body is not restrained during palpation. Therefore, because the patient P's movements are not suppressed, there is a risk that the patient P may perform unexpected movements, potentially resulting in excessive load being applied to the patient P or the palpation manipulator 20.

[0097] In this regard, with the above configuration, if the pressure detected by the pressure sensor 32 exceeds a predetermined value, the palpation manipulator 20 is operated so that the pressing part 25 moves away from the affected area PA. This prevents excessive load from being applied to the patient P or the palpation manipulator 20.

[0098] (6) The patient position information acquisition unit 11 is configured to acquire position information of the patient P's body, including the affected area PA, using an optical motion capture system. With this configuration, the patient P's body is not restrained by the patient position information acquisition unit 11. Therefore, patient P can undergo a physical examination in the same manner as during a normal medical consultation.

[0099] (7) The physician-side position information acquisition unit 51 is configured to acquire position information of physician D's fingers using an optical motion capture system. With this configuration, the physician D's body is not restrained by the physician-side position information acquisition unit 51. Therefore, physician D can perform palpation with the same actions and movements as in a normal medical examination.

[0100] (8) The palpation manipulator 20 comprises an annular portion 23 that is slidably mounted along the longitudinal direction of a long mounting base 29 on which the patient P's forearm can be placed and through which the patient P's forearm can be inserted, and a movable portion 24 that is rotatably supported relative to the annular portion 23 along the circumferential direction of the annular portion 23. It comprises a fixed portion 25A fixed to the movable portion 24 and a pressing portion body 25C that is supported by the fixed portion 25A so as to be movable in the inward and outward directions of the annular portion 23.

[0101] With this configuration, during remote palpation, patient P inserts their forearm into the annular portion 23 and places it on the mounting base 29. The patient-side control unit 40 adjusts the pressing position of the pressing portion 25 by sliding the annular portion 23 or rotating the movable portion 24 of the palpation manipulator 20 based on the position information of physician D's fingers DF. In addition, the pressing portion body 25C moves radially relative to the fixed portion 25A fixed to the movable portion 24, thereby pressing the affected area PA. In this way, the affected area PA of patient P corresponding to the part of the anatomical model 60 touched by physician D is pressed by the pressing portion 25. Therefore, the palpation manipulator 20 can be easily realized.

[0102] <Example of changes> This embodiment can be implemented with the following modifications. This embodiment and the following modifications can be combined with each other to the extent that they do not contradict each other technically.

[0103] The physician's display unit 55 is not limited to a wearable display unit attached to the physician D, such as a head-mounted display, but may also be a non-wearable display unit. The palpation manipulator 20 is not limited to those exemplified in the above embodiment, and may be a multi-jointed robotic arm.

[0104] • The physician's position information acquisition unit is not limited to an optical motion capture system; a magnetic 3D position measurement system can also be used. The patient position information acquisition unit is not limited to an optical motion capture system; a magnetic 3D position measurement system can also be used.

[0105] The tactile detection unit 30 is not limited to having both a pressure sensor 32 and a multi-axis force sensor 34, but may also have only a multi-axis force sensor 34. In the above embodiment, a configuration was illustrated in which the vibration actuator 72 of the tactile presentation unit 70 also functions as a pressure detection unit 70A. However, the pressure detection unit 70A may be implemented as a separate configuration from the tactile presentation unit 70. In this case, for example, the pressure detection unit 70A may be built into the human body model 60.

[0106] The pressure detection unit 70A is not limited to a sensor that directly detects pressure. For example, an optical motion capture system may be used to detect the position information of physician D's fingers DF and the amount of indentation of the affected area PA of patient P, and the pressure may be estimated based on this position information and the amount of indentation. Alternatively, when physician D presses the affected area PA with his fingers DF, the color of his fingers DF may change, and his fingers DF may be photographed with a camera or the like, and the pressure may be estimated based on the change in the color of the fingernails of his fingers DF. [Explanation of Symbols]

[0107] 10...Patient-side terminal device 11...Patient side position information acquisition unit 12... Patient-side camera 13…Patient-side microphone 14…Patient-side speaker 15...Patient side display section 16…Patient-side temperature sensor 20... Palpation Manipulator 21...Base 22...Slide mechanism 23... Ring section 24...Movable part 24A...Inner annular member 24B…Connecting member 25...Pressing part 25A…Fixed part 25B…Shaft part 25C... Pressing part body 29… Mounting platform 30...Tactile detection unit 31...Base 32... Pressure-sensitive sensor 32A...First detection surface 33…Intermediate member 33A…Back side 33B…Surface 34…Multi-axis force sensor 34A...Second detection surface 35...Coating 40…Patient-side control unit 50…Physician's terminal device 51... Doctor's location information acquisition unit 52…Doctor's camera 53…Doctor's microphone 54… Doctor's speaker 55…Doctor's side display section 60…human body model 61…Skin sheet 62...Skeletal part 63…Muscles 64...Tendon part 65...Vascular area 66…Adjustment device 70...Tactile sensation presentation section 70A...Pressing force detection unit 71...Base 72…Vibration actuator 80…Physician-side control unit 90…Network D... Doctor DF…Finger P…Patient PA…affected area

Claims

1. A system comprising a patient-side terminal device and a physician-side terminal device configured to be connectable to each other via a network, enabling a physician to perform a physical examination of a patient remotely, The aforementioned patient-side terminal device is A palpation manipulator having a pressing part configured to press on the affected area of ​​the patient, A tactile detection unit is attached to the pressing portion and detects tactile information when it comes into contact with the affected area, A patient-side position information acquisition unit that acquires positional information of the part of the patient's body that includes the affected area, A patient-side camera that captures at least the patient's face, It comprises a patient-side control unit and, The physician's terminal device is, A human body model that mimics the shape and feel of the part of the patient's body that includes the affected area, A tactile presentation unit configured to be wearable on the fingers of the physician, which presents the tactile information detected by the tactile detection unit to the fingers as vibrations, A physician-side position information acquisition unit that acquires the position information of the fingers, A pressing force detection unit for detecting the pressing force applied by the physician to the anatomical model, Based on the location information of the area including the affected area acquired by the patient-side location information acquisition unit and the location information of the fingers acquired by the physician-side location information acquisition unit, the physician-side display unit composites and displays the area including the affected area and the fingers, and also displays the face captured by the patient-side camera, It comprises a physician-side control unit and, The physician-side control unit is configured to transmit the finger position information acquired by the physician-side position information acquisition unit and the pressure detected by the pressure detection unit to the patient-side control unit, and the patient-side control unit is configured to operate the palpation manipulator based on the finger position information and the pressure to press the affected area with the pressure unit, The patient-side control unit is configured to transmit the tactile information detected by the tactile detection unit to the physician-side control unit, and the physician-side control unit is configured to operate the tactile presentation unit based on the tactile information to present the tactile information to the fingers. Remote palpation system.

2. The tactile feedback unit includes a vibration actuator having a dielectric elastomer that vibrates when a voltage is applied. The vibration actuator also functions as the pressing force detection unit. The remote palpation system according to claim 1.

3. The aforementioned tactile detection unit is A pressure sensor having a first detection surface for detecting a load applied to the first detection surface, An intermediate member disposed on the first detection surface of the pressure sensor, The system includes a multi-axis force sensor disposed on the surface of the intermediate member, having a second detection surface with a smaller area than the first detection surface, and detecting an external force applied to the second detection surface, The pressure sensor detects the pressure applied to the first detection surface via the multi-axis force sensor and the intermediate member. The system is configured to estimate the tactile information that has come into contact with the tactile detection unit based on the detection results of the pressure sensor and the multi-axis force sensor. The remote palpation system according to claim 1 or claim 2.

4. The patient-side control unit is configured to perform feedback control of the palpation manipulator's operation so that the pressure detected by the pressure sensor becomes the pressing force detected by the pressing force detection unit. The remote palpation system according to claim 3.

5. The patient-side control unit is configured to operate the palpation manipulator so that the pressing part moves away from the affected area when the pressure detected by the pressure sensor exceeds a predetermined value. The remote palpation system according to claim 3.

6. The patient-side position information acquisition unit includes an optical motion capture system. The remote palpation system according to claim 1.

7. The physician-side position information acquisition unit includes an optical motion capture system. The remote palpation system according to claim 1.

8. The aforementioned palpation manipulator is An annular portion is provided that is slidably mounted along the longitudinal direction of a long, rectangular platform on which the patient's forearm can be placed, and through which the patient's forearm can be inserted, The annular portion comprises a movable portion that is rotatably supported by the annular portion along the circumferential direction of the annular portion, The pressing portion comprises a fixed portion fixed to the movable portion, and a pressing portion body supported by the fixed portion so as to be movable in the inward and outward directions of the annular portion. The remote palpation system according to claim 1.

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