As simulation is playing an increasingly important role in medicine, providing the individual patient with a customised diagnosis and treatment is envisaged as part of future precision medicine. Such customisation will become possible through the emergence of digital twin (DT) technology. The objective of this article is to review the progress of prominent research on DT technology in medicine and discuss the potential applications and future opportunities as well as several challenges remaining in digital healthcare. A review of the literature was conducted using PubMed, Web of Science, Google Scholar, Scopus and related bibliographic resources, in which the following terms and their derivatives were considered during the search: DT, medicine and digital health virtual healthcare. Finally, analyses of the literature yielded 465 pertinent articles, of which we selected 22 for detailed review. We summarised the application examples of DT in medicine and analysed the applications in many fields of medicine. It revealed encouraging results that DT is being increasing applied in medicine. Results from this literature review indicated that DT healthcare, as a key fusion approach of future medicine, will bring the advantages of precision diagnose and personalised treatment into reality.

Digital twin in healthcare: Recent updates and challenges

The use of digital twins (DTs) has proliferated across various fields and industries, with a recent surge in the healthcare sector. The concept of digital twin for health (DT4H) holds great promise to revolutionize the entire healthcare system, including management and delivery, disease treatment and prevention, and health well-being maintenance, ultimately improving human life. The rapid growth of big data and continuous advancement in data science (DS) and artificial intelligence (AI) have the potential to significantly expedite DT research and development by providing scientific expertise, essential data, and robust cybertechnology infrastructure. Although various DT initiatives have been underway in the industry, government, and military, DT4H is still in its early stages. This paper presents an overview of the current applications of DTs in healthcare, examines consortium research centers and their limitations, and surveys the current landscape of emerging research and development opportunities in healthcare. We envision the emergence of a collaborative global effort among stakeholders to enhance healthcare and improve the quality of life for millions of individuals worldwide through pioneering research and development in the realm of DT technology. 

Digital twins for health: a scoping review

Artificial intelligence (AI) is a broad term referring to the application of computational algorithms that can analyze large data sets to classify, predict, or gain useful conclusions. Under the umbrella of AI is machine learning (ML). ML is the process of building or learning statistical models using previously observed real world data to predict outcomes, or categorize observations based on 'training' provided by humans. These predictions are then applied to future data, all the while folding in the new data into its perpetually improving and calibrated statistical model. The future of AI and ML in healthcare research is exciting and expansive. AI and ML are becoming cornerstones in the medical and healthcare-research domains and are integral in our continued processing and capitalization of robust patient EMR data. Considerations for the use and application of ML in healthcare settings include assessing the quality of data inputs and decision-making that serve as the foundations of the ML model, ensuring the end-product is interpretable, transparent, and ethical concerns are considered throughout the development process. The current and future applications of ML include improving the quality and quantity of data collected from EMRs to improve registry data, utilizing these robust datasets to improve and standardized research protocols and outcomes, clinical decision-making applications, natural language processing and improving the fundamentals of value-based care, to name only a few. 

Machine learning and artificial intelligence in research and healthcare✰,✰✰.

The last decade saw the emergence of highly autonomous, flexible, re-configurable Cyber-Physical Systems. Research in this domain has been enhanced by the use of high-fidelity simulations, including Digital Twins, which are virtual representations connected to real assets. Digital Twins have been used for process supervision, prediction, or interaction with physical assets. Interaction with Digital Twins is enhanced by Virtual Reality and Augmented Reality, and Industry 5.0-focused research is evolving with the involvement of the human aspect in Digital Twins. This paper aims to review recent research on Human-Centric Digital Twins (HCDTs) and their enabling technologies. A systematic literature review is performed using the VOSviewer keyword mapping technique. Current technologies such as motion sensors, biological sensors, computational intelligence, simulation, and visualization tools are studied for the development of HCDTs in promising application areas. Domain-specific frameworks and guidelines are formed for different HCDT applications that highlight the workflow and desired outcomes, such as the training of AI models, the optimization of ergonomics, the security policy, task allocation, etc. A guideline and comparative analysis for the effective development of HCDTs are created based on the criteria of Machine Learning requirements, sensors, interfaces, and Human Digital Twin inputs.

/pdf/human-centric-digital-twins-in-industry-a-comprehensive-3muueh45.pdf

Human-Centric Digital Twins in Industry: A Comprehensive Review of Enabling Technologies and Implementation Strategies

The use of digital twins to represent a product or process digitally is trending in many engineering disciplines. This term has also been recently introduced in the medical field. In arthroscopic surgery education, the paradigm shift from apprenticeship to simulation training has driven the need for better simulators, and the current focus is on improving simulators with respect to computational efficiency and system accuracy. However, expanding surgical simulations towards digital twins has not yet been explored. This paper introduces the digital twin concept for arthroscopic surgery, and explores its potential in light of the existing scientific literature. Thus, a systematic review was conducted to summarize and analyze the literature with respect to fast and robust design of an arthroscopic digital twin using patient-specific information, and methods for interactive surgical soft tissue simulation. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol with three reliable scientific search engines: IEEE Xplore, ScienceDirect and PubMed. Eighty papers were included in the review, and the extracted data included modeling methods, tissue types, constitutive behavior, computational efficiency or accuracy, hardware configuration, haptic device description, software tools, and system architectures. Considering the review, a novel macro-level conceptual arthroscopic digital twin system is presented, and the applicability of the review findings for the identified subsystems are discussed. The proposed system integrates patient-specific images, diagnostic data, intraoperative sensor data, and surgical practice as inputs, and conceptually enables surgical skills training, preoperative planning, and a database of virtual surgeries. 

/pdf/toward-a-digital-twin-for-arthroscopic-knee-surgery-a-c0pbk1sg.pdf

Toward a Digital Twin for Arthroscopic Knee Surgery: A Systematic Review

Axial alignment of the talar implant in total ankle arthroplasty remains a major issue, since the real axis of motion of each patient is impossible to determine with usual techniques. Further knowledge regarding individual axis of motion of the ankle is therefore needed. Therefore, digital twins, artificial intelligence, and machine learning technology were used to identify a real personalized motion axis of the tibiotalar joint. Three-dimensional (3D) models of distal extremities were generated using computed tomography data of normal patients. Digital twins were used to reproduce the mobility of the ankles, and the real ankle of the patients was matched to the digital twin with machine learning technology. The results showed that a personalized axis can be obtained for each patient. When the origin of the axis is the centre of mass of the talus, this axis can be represented in a geodesic system. The mean value of the axis is a line passing in first approximation through the centre of the sphere (with a variation of 3 mm from the centre of the mass of the talus) and through a point with the coordinates 91.6° west and 7.4° north (range 84° to 98° west; − 2° to 12° north). This study improves the understanding of the axis of the ankle, as well as its relationship to the possibility to use the geodesic system for robotic in ankle arthroplasty. The consideration of a personalized axis of the ankle might be helpful for better understanding of ankle surgery and particularly total ankle arthroplasty.

Digital twins, artificial intelligence, and machine learning technology to identify a real personalized motion axis of the tibiotalar joint for robotics in total ankle arthroplasty

Subtalar axis determined by combining digital twins and artificial intelligence: influence of the orientation of this axis for hindfoot compensation of varus and valgus knees

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Digital twins, artificial intelligence, and machine learning technology to identify a real personalized motion axis of the tibiotalar joint for robotics in total ankle arthroplasty

Subtalar axis determined by combining digital twins and artificial intelligence: influence of the orientation of this axis for hindfoot compensation of varus and valgus knees