###### Abstract  
With the emergence of the metaverse and other human-computer interaction technologies, promising applications such as medical palpation training are growing for training and education purposes. Thus, the overarching goal of this study is to develop a portable and simple pulse pressure simulator that can reproduce age-specific pulse pressure waveforms for medical palpation training. For training applications, the simulator is required to produce accurate radial pulse waveforms consistently and repeatedly. To this end, exploiting the cam-based pneumatic pulse generation mechanism, this study intends to develop a cylindrical (or 3D) cam whose continually varying surface contains a wide range of age-related pulse pressure profiles. To evaluate the performance of the simulator, the reproduced pulse waveforms were compared with approximate radial pulse pressure waveforms based on in vivo data in terms of the augmentation index (AI) and L\({}^{2}\) error. The results show that the errors were less than 10% for all ages, indicating that the proposed pulse simulator can reproduce the age-specific pulse waveforms equivalent to human radial pulse waveforms. The findings in this study suggest that the pulse simulator would be an excellent system for RAPP palpation training as it can reproduce a desired pulse accurately and consistently. medical palpation; haptics; pulse pressure waveform; 3D cam +
Footnote †: journal: Medical and Engineering Letters  
real procedures and operations. [PERSON] et al. reviewed medical simulators based on haptic devices for stitching, dental palpation procedures, endoscopy, laparoscopy, and orthopedics [3]. One of the important potential applications of MR technology includes medical palpation training. In a previous study, an augmented reality simulation method was applied for training femoral palpation [4; 5]. The method of giving haptic feedback is important for palpation training for diagnosing the condition of a virtual patient [6]. In practical robotic-based telesurgery, a technique has been developed that allows the surgeon to feel the fingertip contact deformation as a vibration for ensuring the stability of the teleoperator [7]. Although vibration feedback can be a convenient haptic sensory transmission method, pneumatic-actuated haptic feedback in VR/AR-based medical simulators can deliver a sensation similar to a real human pulse [8; 9; 10; 11]. The pneumatic-actuated haptic feedback method, which is actively controlled by a pneumatic pump, is a convenient method of delivering haptic cues but is not suitable for applications that require precise palpation feedback, such as radial artery pulse palpation (RAPP) training. RAPP holds significant potential for such an application. In particular, diagnosis of illness based on the palpation of the radial artery is important in traditional and modern medicine. RAPP on the wrist is the primary diagnosis method for Oriental medicine [12], and it is one of the pragmatic diagnosis methods for predicting the risks of cardiovascular diseases in Western medicine. This is mainly attributed to the benefits of RAPP, which provides hemodynamic features (such as arterial stiffness, blood pressure, and cardiac output), ease of access to the arteries, and comfortable measurement conditions [13; 14; 15]. In particular, by using RAPP, Oriental medical experts categorize the radial artery pulse waveforms into 28 classes to diagnose the causes of diseases [16]. To classify subtle changes in the pulse waveforms, they feel various temporal and spatial features such as pulse amplitude, width, length, depth, rate, and shape only using their fingertips. Therefore, taking a pulse is a dexterous manipulation skill; hence, repetitive training is necessary to be an expert. In addition to the medical implications, the quality of the RAPP serves as a diagnostic test in tactical combat casualty care (TCCC), as it can be used as an important surrogate marker of hemorrhagic shock. [PERSON] et al.