ON REASONING WITH IMAGES:

THE USE OF IMAGES IN CLINICAL RESEARCH

Thomas BittnerLouis Goldberg

University at Buffalo

CLINICAL RESEARCH IN TEMPOROMANDIBULAR DISORDERS

TMD is a pain and disability disorder

current studies have significantly increased the size of the domain of analysis to capture all relevant variables

the temporomandibular joint (TMJ) is a crucial variable: it drives diagnosis and treatment

controversies abound concerning the relationship of joint characteristics as represented in images to patient symptoms and treatment choices

problem: how to represent TMJ image characteristics in a computer-based system that is interoperable with other data collected in the study

EXAMPLES OF MEASURABLE VARIABLES

pain levels

functional capacity

gross mobility of the jaw

mobility of the TMJ

pressure-pain threshold of the TMJ

biopsychosocial factors contributing to TMD

CLINICAL RESEARCH IN TEMPOROMANDIBULAR DISORDERS

TMD is a pain and disability disorder

current have studies increased the size of the domain of analysis to capture all relevant variables

the temporomandibular joint (TMJ) is a crucial variable: it drives diagnosis and treatment

controversies abound concerning the relationship of joint characteristics, as represented in images, to patient symptoms and treatment choices

problem: how to represent TMJ image characteristics in a computer-based system that is interoperable with other data collected in the study

The problems with pre-coordination, such as the pre-coordination of certain relationships of entities in the TMJ with clinical syndromes.

AN EXAMPLE OF PRE-COORDINATION

zone of articulation: relation of the posterior band of the articular disc in relation to the head of the condyle in the closed position. The posterior band should be between 11:30 and 12 o’clock. If it is anterior to that position it demonstrates the pathology; anterior disc displacement

Consequences

How to resolve conflicts that arise out of pre-coordination in the face of deeply held beliefs.

Research is necessary to determine if such pre-coordinations are valid.

TMJ DYNAMICS: NORMAL

Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

TMJ DYNAMICS: NORMAL & ABNORMAL

Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

RECAPTURE OF THE DISC

Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 20019

GOAL

represent the relationships among the condyle, the articular disc and the temporal bone in an automatic system

the practical point of view

the ontology must be immediately useful to a specific research enterprise

OVERVIEW

1. Identify the major parts of the TMJ

2. Establish the connectedness and adjacency relations among the various parts

3. Establish the qualitative order relations using landmarks as frames of reference

4. Establish relative size relations

Major parts of the TMJ

the TMJ is a real, three dimensional structure

choose the coarsest level of granularity sufficient to distinguish the major proper parts of the TMJ

gross anatomical granularity in this case

Major parts of the TMJ

material partsrigid partsnon-rigid parts

cavities

ANTERIOR

material parts

TMDs: An Evidence Based-Approach to Diagnosis and Treatment. (2006) Eds: D. M. Laskin, C. S. Greene, W. L. Hylander. Quintessence Books, Chicago.

Rigid material parts

parts that do notchange shape(bones)

fixed

movable

Non-rigid material parts

parts that do change shape

but the topology does not change: the connected partsremain connected

ANTERIOR

Cavities

filled with liquid: synovial fluid in the case of the TMJ

we have identified three kinds of entities (parts) in the TMJ

material rigidmaterial non-rigid cavities

Connectedness and adjacency relations among the parts of the

joint

Connectedness Relations

ANTERIOR

connectedness

connectednessgraph

closed and opened positions

jaw closed

jaw openedTMDs: An Evidence Based-Approach to Diagnosis and

Treatment. (2006) Eds: D. M. Laskin, C. S. Greene, W. L. Hylander. Quintessence Books, Chicago.

Connectedness remains invariant in the opened and closed positions

ANTERIOR

connectedness

Connectednessgraph

Every TMJ can be represented by this connectedness graph

Connectednessgraph

adjacency relations

No connectednessOnly (temporary) adjacency

Connectednessadjacencygraph

Adjacency relations

adjacency

•At all times the disc (red) is adjacent to the fossa (yellow)•At all times the disc (red) is adjacent to the condyle (pink)

Adjacency relations

But at different times the discmay be adjacent to different partsof the fossa / condyle

Adjacency disc-fossa

Time 1

Adjacency disc-fossa

Time 2

Adjacency disc-fossa

Time 3

Adjacency disc-condyle

Time 1

Adjacency disc-condyle

Time 2

Adjacency disc-condyle

Time 3

Ordering relations

Refining adjacencyrelation betweendisc and fossa

Refining adjacencyrelation between disc and condyle

Specifying relativelocation of condyle andfossa

Shape landmarks of the fossa

Rigid does notChange shape(bones)

Convex curvaturechanges to concave

Fiat boundaries

Rigid does notchange shape(bones)

Convex curvaturechanges to concave

Rigid does notchange shape(bones)

Local maxima/minima

Shape landmarks of the fossa

Rigid does notchange shape(bones)

articular (glenoid)fossa

articular eminence

Shape landmarks of the fossa

Fiat boundaries

Rigid does notchange shape(bones)

Fiat boundaries

Rigid does notchange shape(bones)

6 major fiat parts

Frames of reference

Rigid does notchange shape(bones)

A

BC

DE

F

Circle is adjacent-to A

Frames of reference

Rigid does notchange shape(bones)

A

BC

DE

F

Circle is adjacent-to B

Frames of reference

Rigid does notchange shape(bones)

A

BC

DE

F

Disc is adjacent-to C and D

Ordering relations

Refining adjacencyrelation betweendisc and fossa

Refining adjacencyrelation between disc and condyle

Specifying relativelocation of condyle andfossa

Shape landmarks of the condyle

as frame of reference

anterior head of condyle

Disc is adjacent to the posterior head of the condyle

Posteriorhead of condyle

Shape landmarks of the condyle

as frame of reference

anterior head of condyle

Disc is adjacent to the

posterior and anterior head of the condyle

Posteriorhead of condyle

Shape landmarks of the condyle

as frame of reference

anterior head of condyle

Disc is adjacent to the anterior head of the condyle

Posteriorhead of condyle

Ordering relations

Refining adjacencyrelation betweendisc and fossa

Refining adjacencyrelation between disc and condyle

Specifying relativelocation of condyle andfossa

Middle axis ofthe condyle

Extension ofThe middle axis

Shape landmarks of the condyle

Frames of reference

Rigid does notchange shape(bones)

A

BC

DE

F

The extension of the axis of the condyleintersects the fossa in region C

Frames of reference

Rigid does notchange shape(bones)

A

BC

DE

F

The extension of the axis of the condyleintersects the fossa in region D

Bringing the various ordering relations together

Ordering relations

Refining adjacencyrelation betweendisc and fossa

Refining adjacencyrelation between disc and condyle

Specifying relativelocation of condyle andfossa

Ordering relations

A

B C D E F

A

B C D E F

bringing together multiple ordering structures:two frames of reference locates the position of the disc and condyle with respect to each other and to the fossa

•The extension of the axis of the condyle intersects the fossa in region DA

B CD E F

• The disc is adjacent-to fossa regions C and D

• The disc is adjacent to the posterior and anterior head of the condyle

we now have a three dimensional combinatorial space of possible

relationshipscontained in the domain of the TMJ

All combinatorial possible constellations

Disc adjacent to posterior head

All combinatorial possible constellations

Disc adjacent to anterior head

Disc adjacent to posterior head

All combinatorial possible constellations

A B C D E F

Disc is adjacent to fossa region

Disc adjacent to posterior head

All combinatorial possible constellations

A B C D E F

A

B

C

D

E

F

AxisOfCondyleintersects

Disc is adjacent to fossa region

Disc adjacent to posterior head

A B C D E F

A

B X X X

C

D

E

F

AxisOfCondyleintersects

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Disc is adjacent to fossa region

Disc adjacent to posterior & anterior head

A B C D E F

A

B X

C

D

E

F

AxisOfCondyleintersects

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Disc is adjacent to fossa region

Disc adjacent to anterior neck

A B C D E F

A

B X X

C

D

E

F

AxisOfCondyleintersects

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Disc is adjacent to fossa region

Disc adjacent to anterior head & neck

A B C D E F

A

B

C

D

E X X

F

AxisOfCondyleintersects

Disc is adjacent to fossa region

Disc adjacent to posterior & anterior head

Conclusions/Methodology

TMJ ontology

Mereology•How many parts•What kind of parts

Topology•Which parts are connected•Which parts are adjacent

TMJ ontology

Mereology•How many parts•What kind of parts

Topology•Which parts are connected•Which parts are adjacent

Qualitative order•How are things arranged with respect to each other•How does relative location change during movement

TMJ ontology

Qualitative order•How are things arranged with respect to each other•How does relative location change during movement

A|B|C|D|E|Fadjacent-to

intersects