Download - Towards a structure of the Knowledge Domain for Augmented Surgery with an ontological approach
Towards a structure of the Knowledge Domain for
Augmented Surgery with an ontological approach
MD. Banihachemi Jean-JacquesUrgences, Service de Chirurgie Orthopédique et de traumatologie du SportHôpital Sud – C.H.U. de GrenobleAvenue de KimberleyB.P. 33838434 Echirolles [email protected]
Buffalo Nov.24.2008
SUMMARY
• Presentation
• Work
• Conclusion
LES ALPES
HOPITAL SUD
• Hôpital Universitaire de Grenoble / France
• UJF, a university open to the world and society
• TIMC-IMAG Laboratory : (Techniques for biomedical engineering and complexity management – informatics, mathematics and applications – Grenoble )
Why This Subject
• Emergency Doctor : Cross view of all the medical specialties
• New specialty : – SYmu : Systéme multimedia des urgences:
(WO/2005/059802) SYSTEM AND METHOD FOR PROCESSING INFORMATION RELATING TO MEDICAL HOSPITAL CONSULTATIONS
– Master : Robot-Based Tele-Echography II - A Comparative Study
The aim of this clinical trial is to evaluate the concordance of diagnosis of injuries in thoracoabdominal trauma using two different echographic methods. The first method is a robot-based tele-echography performed by radiologists in a remote location. The second is bedside echography performed by emergency physicians according to the FAST (Focussed Assessment by Sonography of Trauma) examination.
• GMCAO - (J. Troccaz): Biomechanical modelling, image processing, data fusion and robotics for computer-assisted medical interventions.
• ThEMAS - (J.L. Bosson) : Epidemiology and clinical research methodology
• OSIRIS- (M. Simonet): Ontologies, Knowledge and Data: from Modelling to Representation and Exploitation. Application to Intelligent Information Systems in the Health domain
• CAMI Computer Assisted Medical Interventions
• The ultimate objective of the Computer-Aided Medical Interventions (CAMI) research group is clinical: the purpose is to assist the physician or surgeon in the successful execution of diagnostic or therapeutic gestures by minimizing invasiveness whilst improving accuracy
THE PROBLEM
• Augmented Surgery – Around for more than 25 years– Examples
• Orthopilot (B-Braun-Aesculap)
• CT-Free Vector Vision ( BrainLAB)
• Stryker Knee Trac
• Navitrack (Zimmer)
• FluoroKnee System (Smith et Nephew et Medtronic)
Evaluation of quality of existing & new devices Major Challenge
• What is Quality?– General Medical Field : World Health Organization : W.H.O.
• garantir à chaque patient l’assortiment d’actes diagnostiques et thérapeutiques lui assurant le meilleur résultat en termes de santé, conformément à l’état de la science médicale, au meilleur coût pour le meilleur résultat, au moindre risque iatrogénique, pour sa plus grande satisfaction en termes de procédures et de contacts humains à l’intérieur du système de soins
– Pharmacology : AFSSAPS (French National Authority for Health)• Expected Medical Service (EMS)• Delivered Medical Service (DMS)
– Augmented Surgery• EMS: what is EMS in this context?• DMS: what is DMS in this context?• Other notions
Quality in Augmented Surgery
• EMS : To be defined
• DMS : To be defined
EMS and DMS rely on various notions: – Inventory of notions related to Quality– Structuring
Final Objective : Build an Information System for the actual Evaluation of EMS and DMS.
Conceptual Structuring of the Domain
• Ontological approach– Identify Concepts & Relations
related to Quality in Augmented Surgery• Name • Define• Structure
– Conceptual structuring ~ Conceptual Schema, Terminology, Ontology
• Objective: Information System for Quality Evaluation– Conceptual Schema: support to database design– Terminology: standard vocabulary of the domain– Ontology: ultimately …
The TEAM / ACTORS
• Builders team• an emergency doctor with expertise in medical new
technologies Jean-Jacques Banihachemi, MD
• an engineer-doctor with expertise in Augmented Surgery Alexandre Moreau-Gaudry, MD-PhD, head of the
CIC-IT
• a researcher with expertise in the ontological domain Michel Simonet, PhD
• a researcher with expertise in Information System design Ana Simonet, PhD
• Role• Identify and structure concepts • Represent the conceptual structure
THE TEAM / ACTORS
• Users team• Several internationally-published orthopedic surgeons
– SARAGAGLIA. D., MD-PHD– MERLOZ. P., MD-PHD– PLAWESKI. S, MD– ……
• French Public Health doctors who are experts in the domain of Augmented Surgery
– CINQUIN. P., MD-PHD– BOSSON. J-L., MD-PHD– ……
• Role• Validate Concepts and their structuring
MATERIAL
• Expert knowledge
• Bibliographical Texts• valgus osteotomies• anterior cruciate ligament surgery• total knee replacement
• Case report Form• “Medico-economical Evaluation of Surgical
navigation in treating insufficiencies of anterior cruciate ligament surgery of the knee”
• National multi-centric study
Texts from the BibliographyCase Report Form
terms
concepts
terms
terms
concepts
concepts
Expert Knowledge
Organization of concepts by Builder team
Ontological Framework
METHODOLOGY
• Identify Concepts– Acquisition from experts
• Brain storming terms• Grouping equivalent terms concepts
– Extraction from texts• Manual extraction ( Excel file)• Selection and grouping of terms
• Identify Relations– «Structuring» sessions
Fragments of a conceptual structure
MEDICAL DEVICE
PATIENT
EVALUATION
MEDICO-ECONOMIC EVALUATION
SCIENTIFIC EVALUATION
Age, weight, height, gender, BMI
Antecedents
Quality of life
Patient expectations
RESEARCHPATIENT TRAINING
COURSE
Device
dangerous
not dangerousQuality score
Cumberland (CAIT)
Functional scoreNumber of lost working days
Number of days in the hospital
Number of re-hospitalizations
Endoscope robot
Navigation station
(ACL)
Criteria
- individuals / society (political)
- scientific / medico / economic
- cost–benefit ratio
EXPERIENCE
OPERATING PRACTITIONER
Surgeon, neuro-surgeon / orthopedic-surgeon
Radiologist
Emergency Doctor
Gastroenterologist
NON OPERATING PERSONNEL
Anesthetist
Paramedic
TRAINING
for surgeons
Anatomical zones FMA
IS-A IS-A
CE Mark
Prototype/ non prototype Supplier
Purchase price
Observation notebook
Operating procedure
Class
1
2A
2B
3 reanimation – necessity precaution
Software
Evolution
Publications
Prospective trial
Retrospective trial
Functional index
Methodology
Number of user sites
Number of operators
Number of patients operated on
Number of lawsuits
Countries where it is used
GDP
Big Mac Index
indicators
SOCIOLOGY
COMMUNITYDISSEMINATION
METHODOLOGIE D’EVALUATION
Ergonomicsinterface
furtive
Brain Storming
Pathology = surgical indicationGenu varum arthrosique
Surgical treatmentOstéotomie de valgisation
Surgical treatment indicationsA° > 15° => ostéotomie tibiale d’ouverture interne fixée
-Cale phosphate TriCa- Plaque T
A° < 15° => ostéotomie tibiale (ouverture interne) ostéotomie fémorale (ouverture externe)
DMS1 - SurgeonPer-opératoire, à M3182° < Axe mécanique post op < 186°Facilité d’évaluation etc…
2 - PatientScore fonctionnelDouleurAutre… 3 – In terms of Public Health- évaluation médico-économique- f (patients, matériels, etc.…)
4 – Society dimension
Others …
EMS182° < Axe mécanique < 186°Facilité d’évaluation : ergonomie, etc...Formation1 - Surgeon
2 - PatientScore fonctionnel 3 - In terms of Public Health
4 – Society dimension
Mechanical AxisDéfinition axe mécanique-Qu’est-ce que c’est? Définition modalité d’évaluation- Comment?
Clinical trial methodology - Rétrospectif- Comparaison,- Significativité- méthodologie etc.
Pathological Evaluation- Axe mécanique préopératoire
Pre-operative Planning- simuler sur la radiographie l’ouverture souhaitée pour obtenir bon axe mécanique
Quality- Définition des critères- évaluation des différents critères- résultats obtenus-
New technologyDispositif médical
Surgeon
Conceptual fragment
Navigation
Quality
Objective
DefinitionCAMI
System
BackgroundPractical
Anatomy
Robot-assisted surgery
Diminution de l’anisométriePositionnement optimale des tunnels osseux
•Temps consommé (temps additionnel)
•Perception
•Raisonnement
•Action
•Détermination objective de la laxité et son importance
•Positionnement le plus isométrique du transplant
•Rapprochement de la stabilité originale de l’articulation
•précision
definition
•Mécanique•Ultrasonique•Magnétique ou électromagnétique•optique infra rouge +++
•Grenoble TIMC
•Neuro chirurgie
•ORL
•Chirurgie du genou 1992: 1er Prototype
•Planifier
•réaliser
3 generations
•Robot Doc: prototype industriel
•Visée pédiculaire dans la chirurgie du rachis
•Logiciel applicatif : Navitrack, ototrak, orthopilot, surgetics, surgigate
•Positionnement
•Calibrage et évaluation
•Planification et navigation
•Bone morphing
LCA
Précis fiable
Physiopathologie
•Encombrement
•Cout
Clinique: Lachman + Pivot Shift
Radiographie: Telos
Conceptual Fragment
• Brain Storming• Extraction from Texts
Fragments of a conceptual schema “How to arrive to a conceptual Schema?”
Expert in Information System Design
Top Layer of Conceptual Schema
Pathology
Anatomic Zone
Intervention
Patient
Checkup
concerns
recommended forCase 1,1
0,*
Place Team1,11,*
1,*
1,* Medical Device0,*
Usedfor
Uses
EMS
TOP LAYER
1,1
RESULTS
• Three major concepts were identified and support our modelization – Medical Device – Intervention– Case
• EMS : Linked to the Medical Device • DMS :
– relates to experience with users– evaluated a posteriori, possibly over a long period– refers to several elementary ontology fragments (FMA, ontology of Medical Devices, …)
• Top layer of a conceptual schema (next slide)
Conceptual diagram of an Information systemPlace of intervention Medical Device
Pathology
idstartDateSymptomshandicaps
Intervention
datefuncCheckupBeforefuncCheckupAfternoDaysHospBeforenoDaysHospAfter
EMS
DMS
Patient Checkup(Post-operative)
painFunctional ScoreSubstitution Criteria….
Patientnum
lastNamefirstNamebirthDateaddress
Anatomic ZoneFMA
Observation Start Date
Patient Checkup (Quantified, Preoperative)
painFunctional ScoreSubstitution Criteria….
Team
Members
Surgeon NURSE
LocTeam
SURGEON NURSE?
0,1
1,* 1,*
0,1
1
0,*
0,*
0,*
1,1
1*
1,1
0,*
1,1
1,*
myPat
myIlls
myCode
1,1
1,1
1,1
0,11,1
1,1
0,*
1,*0,*
0,*1,1
???ADELIUNITCOST
1,1
UNITCOST
Physical therapist follow-up
Unit Cost
Phys.Ther.
nurse
Thesaurus
CONCLUSION
• The ontological structuration work : Formalize the notion of Expected Medical Service (EMS) and Delivered Medical Service (DMS)
• Key to quality for Augmented Surgery• Ontological framework : a priceless aid • Support for the design of an Information
System
Perspective
• Support – Teaching– Medical research (data)– Medical economics– Patient’s choice
• Standard for Quality in Augmented Surgery• Towards an Ontology of Quality?
– Out of reach of our group alone Ontological material