neuro-fuzzy glaucoma diagnosis and prediction system dr. mihaela ulieru, faculty of engineering, the...
TRANSCRIPT
![Page 1: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/1.jpg)
Neuro-Fuzzy Glaucoma Diagnosis and Prediction System
Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary
Dr. Nicolae Varachiu, Cynthia Karanicolas, Mihail Nistor, Faculty of Engineering, The University of Calgary
Investigator
Research team
Dr. Andrew Crichton, Faculty of Medicine, The University of CalgaryCo-Investigator
![Page 2: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/2.jpg)
Mihaela Ulieru, Faculty of Engineering, The University of CalgaryGerhardt Pogrzeba, President and CEO, TRANSFERTECH GmbH, Braunschweig, Germany
Authors
Presented papers based in this project
IASTED International Conference, Banff, July 2002Integrated Soft Computing Methodology for Diagnosis and Prediction with Application to Glaucoma Risk Evaluation.
Title
Nicolae Varachiu, Cynthia Karanicolas, Mihaela Ulieru, Faculty of Engineering, The University of Calgary
Authors
First IEEE International Conference in Cognitive InfromtaticsICCI’02, Calgary, August 2002. Computational Intelligence for Medical Knowledge Acquisition with Application to Glaucoma.
Title
![Page 3: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/3.jpg)
Introduction
Diagnosis: to determine if a patient suffers of a specific disease; if so, to provide a specific treatment
The main challenge for glaucoma specialists is the evaluation of the risk for its occurrence and the prediction of disease progression to establish a suitable follow up and treatment accordingly
Glaucoma: a progressive eye disease that if left untreated, can lead to blindness
![Page 4: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/4.jpg)
Most cases in glaucoma diagnosis are quite evident, but at least 5% of them will be ambiguous
In response to this need we have developed an integrated diagnosis and prediction methodology that uses several soft computing techniques
For these special cases the assessment of an “expert machine” can be essential in determining the right time for a follow up check as well as in-between treatment
![Page 5: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/5.jpg)
Visual field Loss
Elevated Intraocular Pressure
Cupping of the Optic nerve head
G l a u c o m a
5
![Page 6: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/6.jpg)
Loss of visual field
Clear image of a road.Note runner with white shirt on the left.
Glaucoma Visual Field LossLEFT EYEArc shaped loss of sensitivity startingfrom the normal blind spot(near where the runner is)into the inside (nasal) field of vision
Glaucoma - severe visualfield loss. Only a small central islandof vision remains. The centre ofthe vision is cut through horizontally as well
6
![Page 7: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/7.jpg)
Intraocular Pressure
The inner eye pressure (also called intraocular pressure or IOP) rises because the correct amount of fluid can’t drain out of the eye
7
![Page 8: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/8.jpg)
Optic disc nerve damage
8
![Page 9: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/9.jpg)
Glaucoma can also occur as a result of:
An eye injury
Inflammation
Tumor
Advanced cases of cataract
Advanced cases of diabetes
Also by certain drugs (such as steroids)
9
![Page 10: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/10.jpg)
Treatments
Medications
Laser surgery
Filtering surgery
10
![Page 11: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/11.jpg)
Fu
-zz
i-fi
er
Knowledge representation
Knowledge repository
Fuzzy logicInferenceSystem
(Processing model)
Inputs Outputs
De- fu-
zzi-
fier
11
![Page 12: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/12.jpg)
Linguistic variables
<x, T(x), U, G, M>
x = the Intraocular Pressure (IOP)
T(IOP) = {Low, Normal, High}
U = [0, 45] (measured in mm of Hg)
Low might be interpreted as “a pressure above 0 mm Hg and around 11mm Hg”; Normal as “a pressure around 16.5 mm Hg” and High as “a pressure around 21 mm Hg and bellow 45 mm Hg”.
12
![Page 13: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/13.jpg)
Membership Function
1
Low Normal High
0 0 12 16.5 22 45 mm Hg
Fuzzy sets (linguistic terms: Low, Normal, High) to characterize the linguistic variable Intraocular Pressure - IOP
13
![Page 14: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/14.jpg)
Iterative process that involves domain expert(s), knowledge engineers and the computer
Knowledge Acquisition
14
![Page 15: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/15.jpg)
developing an understanding of the application domain
Knowledge acquisition steps
determination of knowledge representation
selection, preparation and transformation of data and prior knowledge
knowledge extraction (machine learning)
model evaluation and refinement
15
![Page 16: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/16.jpg)
Design of the knowledge engine for disease assessment
The diagnosis of Glaucoma comprises the analysis of a myriad of risk factors, each of them related to the diagnosis with different degrees.
The rule base is being developed following an incremental development process
Existing data, Requirements,goals
Top-level specifications
Incremental development plan
Iteration 1:First set of rules
Visits to dr.’s officeOphthalmologist
feedback
Iteration 2:Second set of
rules
Visits to dr.’s officeOphthalmologist’s
feedback
Neuro – fuzzy System
Complete set of fuzzy rules
Iteration n
![Page 17: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/17.jpg)
Gather and select relevant information to create or modify the set of rules
Create, add or modify linguistic variables and/or fuzzy rules
Ophthalmologist’s feedback
Rule set evaluation and refinement
Main steps of the process
17
![Page 18: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/18.jpg)
In the first increment a minimal group of Fuzzy IF-THEN rules has been created. This ‘basic’ set of rules is the foundation for selecting relevant learning data for improving the prediction engine.
Different risk factors and data is being used to add new rules in each successive increment.
Each increment will contain all previously developed rules plus some new ones determined to be relevant by the medical expert.
![Page 19: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/19.jpg)
Fuzzy linguistic variables
N° x T (x) U MMeasurement unit
1Visual field tests
Low damage Damage Severe damage
[0, 76]
A1LD = {0/1 15/1
30/0 76/0}A1D = {0/0 15/0
30/1 45/1 60/0 76/0}A1SD = {0/0 45/0
60/1 76/1}
Low points
2Visual acuity
NormalAbnormal
[20/15 20/400]
A2N = {20/15/1
20/20/1 20/50/0 20/400/0}A2A = {20/15/0
20/20/0 20/50/1 20/400/1}
Number
3 Myopia High [-10, 4]A3 = {-10/1 -4/1
0/0 4/0}No.
4Cup to disc
High ratio [0 1] A4 = {0/0 1/1} Number
19
![Page 20: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/20.jpg)
N° x T (x) U MMeasure
ment unit
5 IOPHighNormalLow
[0, 45]
A5H = {0/0 16.5/0
22/1 45/1} A5M = {11/0 16.5/1
22/0}A5L = {0/1 11/1
16.5/0 45/0}
MmHg
6
Diurnal Fluctuations of IOP
Low High
[0, 10]A6L = {0/1 5/0 10/0}
A6H = {0/0 3/1 10/1}MmHg
7 Age Old [0, 100]A7 = {0/0 40/0 80/1
100/1}Years old
8 RiskLowModerateHigh
Output
OL = {0/1 33/1 50/0
100/0}OM = {0/0 33/0
50/1 66/0 100/0}OH = {0/0 50/0 66/1
100/1}
Fuzzy linguistic variables
20
![Page 21: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/21.jpg)
Output interpretation
Low risk: follow-up within 6-12 months
Moderate risk: follow-up within next 2-6 months
High risk: follow-up within next few weeks
21
![Page 22: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/22.jpg)
If- Then Rules22
![Page 23: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/23.jpg)
Example
Visual field tests 45Visual acuity 20/150Myopia -9.75Cup to disc 0.8IOP 15Diurnal Fluctuations of IOP 0Age 80
FCM Result 51.765: next 3-4 monthsDoctor’s action Appt within 3-4 months
23
![Page 24: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/24.jpg)
The diagnostic methodology at a glance Ulieru and Pogrzeba
The methodology has been designed around the software suite developed by Transfertech GmbH Germany, by integrating several of their packages.
Aim: emulate the assessment done by the expert physician and collect relevant data for predicting the disease progression
Diagnosis Engine: embeds expert knowledge
Prediction Engine: developed in a three-step process
![Page 25: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/25.jpg)
Machine Parameters(Measured)
DiagnosisEngine
Disease Assessment
PredictionEngineTreatment
Follow-up Time
Doctor’sDecision
Doctor’sDecision
Prediction
Diagnosis
Prediction
Machine ParametersDisease
Assessment Treatment Time Prediction
Data Base
![Page 26: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/26.jpg)
An evolutionary learning strategy for tuning the prediction engine
This step assumes a database with sufficient patient information is already available
The design of the database was a challenging process
Input handwritten patient files.
Database contains: measured parameters, disease assessment, treatment and time interval decided by medical expert and the result of the prediction engine.
![Page 27: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/27.jpg)
PreviousDisease
AssessmentTreatment
MachineParameters
New DiseaseAssessment
Time
... ............
CAMCAMFuzzyProject
ExtentionForMarking
New Rule Base
Create
ExportedFile
Data File (once only exported from Database)
1. Only once creation of CAM project
PreviousDisease
AssessmentTreatment
MachineParameters
New DiseaseAssessment
Time
... ............
Mark
...
2. Set Marking using FCM
CAMFuzzyProject
Data read by DDE
Database
withExtention
forMarking
FCM
PreviousDisease
AssessmentTreatment
MachineParameters
New DiseaseAssessment
Time
... ............
Mark
...
3. Learning Stage
File reading
Database
EVO
OldFuzzyEngine
Filereading
Uptated Fuzzy Engine
![Page 28: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/28.jpg)
Web-centric extension of the system
Enable data from several clinics to contribute to the knowledge refinement process.
The prediction system and the central database will be placed on a central server
Database will be updated periodically
A copy of the diagnosis and prediction engines will function in each clinic and will be updated after the learning process is done on the central ‘master’ copy
Secure and reliable connection between local engines to the ‘master’ engine
![Page 29: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/29.jpg)
Currently, we are working in the development of a holachy, that would enable the access of the diagnosis and prediction system from clinics and by nomadic patients
![Page 30: Neuro-Fuzzy Glaucoma Diagnosis and Prediction System Dr. Mihaela Ulieru, Faculty of Engineering, The University of Calgary Dr. Nicolae Varachiu, Cynthia](https://reader030.vdocuments.mx/reader030/viewer/2022032707/56649e265503460f94b1547d/html5/thumbnails/30.jpg)
Conclusions
Computational intelligence can embed in a natural way the uncertainty surrounding the complex medical processes, and in our specific situation can increase the accuracy and consistency of diagnosing, risk evaluation and prognostic of glaucoma
Our goal is to make this system available on the international health care arena, therefore several standards have to be investigated and reconciled (e-health).
The computational intelligence methods increase the accuracy and consistency of diagnosing, risk evaluation and prognostic of glaucoma