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Towards a structure of the Knowledge Domain for Augmented Surgery with an ontological approach MD. Banihachemi Jean-Jacques Urgences, Service de Chirurgie.

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Presentation on theme: "Towards a structure of the Knowledge Domain for Augmented Surgery with an ontological approach MD. Banihachemi Jean-Jacques Urgences, Service de Chirurgie."— Presentation transcript:

1 Towards a structure of the Knowledge Domain for Augmented Surgery with an ontological approach MD. Banihachemi Jean-Jacques Urgences, Service de Chirurgie Orthopédique et de traumatologie du Sport Hôpital Sud – C.H.U. de Grenoble Avenue de Kimberley B.P. 338 38434 Echirolles Cedex Buffalo Nov.24.2008

2 SUMMARY Presentation Work Conclusion



5 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 )

6 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

7 –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.

8 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

9 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

10 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)

11 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

12 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.

13 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 …

14 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

15 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

16 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

17 Texts from the Bibliography Case Report Form terms concepts terms concepts Expert Knowledge Organization of concepts by Builder team Ontological Framework

18 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

19 MEDICAL DEVICE PATIENT EVALUATION MEDICO-ECONOMIC EVALUATION SCIENTIFIC EVALUATION Age, weight, height, gender, BMI Antecedents Quality of life Patient expectations RESEARCH PATIENT TRAINING COURSE Device dangerous not dangerous Quality score Cumberland (CAIT) Functional score Number 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 CE Mark Prototype/ non prototype Supplier Purchase price Observation notebook Operating procedure Class 1 2A 2B 3 reanimation – necessity precaution Software Evolution PublicationsProspective 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 Ergonomics interface furtive Brain Storming

20 Pathology = surgical indication Genu varum arthrosique Surgical treatment Ostéotomie de valgisation Surgical treatment indications A° > 15° => ostéotomie tibiale d’ouverture interne fixée -Cale phosphate TriCa - Plaque T A° ostéotomie tibiale (ouverture interne) ostéotomie fémorale (ouverture externe) DMS 1 - Surgeon Per-opératoire, à M3 182° < Axe mécanique post op < 186° Facilité d’évaluation etc… 2 - Patient Score fonctionnel Douleur Autre… 3 – In terms of Public Health - évaluation médico-économique - f (patients, matériels, etc.…) 4 – Society dimension Others … EMS 182° < Axe mécanique < 186° Facilité d’évaluation : ergonomie, etc... Formation 1 - Surgeon 2 - Patient Score fonctionnel 3 - In terms of Public Health 4 – Society dimension Mechanical Axis Définition 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 technology Dispositif médical Surgeon Conceptual fragment

21 Navigation Quality Objective Definition CAMI System Background Practical Anatomy Robot-assisted surgery Diminution de l’anisométrie Positionnement 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: 1 er 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

22 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

23 Pathology Anatomic Zone Intervention Patient Checkup concerns recommended for Case 1,1 0,* PlaceTeam 1,1 1,* Medical Device 0,* Used for Uses EMS TOP LAYER 1,1

24 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)

25 Conceptual diagram of an Information system Place of interventionMedical Device Pathology id startDate Symptoms handicaps Intervention date funcCheckupBefore funcCheckupAfter noDaysHospBefore noDaysHospAfter EMS DMS Patient Checkup (Post-operative) pain Functional Score Substitution Criteria …. Patient num lastName firstName birthDate address Anatomic Zone FMA Observation Start Date Patient Checkup (Quantified, Preoperative) pain Functional Score Substitution Criteria …. Team Members SurgeonNURSE LocTeam SURGEONNURSE ? 0,1 1,* 0,1 1 0,* 1,1 1* 1,1 0,* 1,1 1,* myPat myIlls myCode 1,1 0,1 1,1 0,* 1,* 0,* 1,1 ??? ADELI UNIT COST 1,1 UNIT COST Physical therapist follow-up Unit Cost Phys. Ther. nurse Thesaurus

26 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

27 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

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