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ON REASONING WITH IMAGES: THE USE OF IMAGES IN CLINICAL RESEARCH

ON REASONING WITH IMAGES: THE USE OF IMAGES IN CLINICAL RESEARCH. Thomas Bittner Louis Goldberg University at Buffalo. CLINICAL RESEARCH IN TEMPOROMANDIBULAR DISORDERS. TMD is a pain and disability disorder

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ON REASONING WITH IMAGES: THE USE OF IMAGES IN CLINICAL RESEARCH

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  1. ON REASONING WITH IMAGES:THE USE OF IMAGES IN CLINICAL RESEARCH • Thomas BittnerLouis Goldberg • University at Buffalo

  2. 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

  3. EXAMPLES OF MEASURABLE VARIABLESpain levelsfunctional capacitygross mobility of the jawmobility of the TMJpressure-pain threshold of the TMJbiopsychosocial factors contributing to TMD

  4. 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

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

  6. 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

  7. 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.

  8. TMJ DYNAMICS: NORMAL Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

  9. TMJ DYNAMICS: NORMAL & ABNORMAL Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

  10. RECAPTURE OF THE DISC Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 20019

  11. GOAL • represent the relationships among the condyle, the articular disc and the temporal bone in an automatic system

  12. the practical point of view • the ontology must be immediately useful to a specific research enterprise

  13. OVERVIEW • Identify the major parts of the TMJ • Establish the connectedness and adjacency relations among the various parts • Establish the qualitative order relations using landmarks as frames of reference • Establish relative size relations

  14. 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

  15. Major parts of the TMJ • material parts • rigid parts non-rigid parts • cavities

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

  17. fixed movable Rigid material parts parts that do not change shape (bones)

  18. Non-rigid material parts parts that do change shape but the topology does not change: the connected parts remain connected

  19. Cavities filled with liquid: synovial fluid in the case of the TMJ ANTERIOR

  20. we have identified three kinds of entities (parts) in the TMJ material rigid cavities material non-rigid

  21. Connectedness and adjacency relations among the parts of the joint

  22. connectedness connectedness graph Connectedness Relations ANTERIOR

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

  24. connectedness Connectedness graph Connectedness remains invariant in the opened and closed positions ANTERIOR

  25. Connectedness graph Every TMJ can be represented by this connectedness graph

  26. No connectedness Only (temporary) adjacency Adjacency relations adjacency relations Connectedness adjacency graph

  27. Adjacency relations But at different times the disc may be adjacent to different parts of the fossa / condyle 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)

  28. Adjacency disc-fossa Time 1

  29. Adjacency disc-fossa Time 2

  30. Adjacency disc-fossa Time 3

  31. Adjacency disc-condyle Time 1

  32. Adjacency disc-condyle Time 2

  33. Adjacency disc-condyle Time 3

  34. Refining adjacency relation between disc and condyle Refining adjacency relation between disc and fossa Specifying relative location of condyle and fossa Ordering relations

  35. Convex curvature changes to concave Shape landmarks of the fossa Rigid does not Change shape (bones)

  36. Convex curvature changes to concave Fiat boundaries Rigid does not change shape (bones)

  37. Local maxima/ minima Shape landmarks of the fossa Rigid does not change shape (bones)

  38. Shape landmarks of the fossa Rigid does not change shape (bones) articular (glenoid)fossa articular eminence

  39. Fiat boundaries Rigid does not change shape (bones)

  40. Fiat boundaries Rigid does not change shape (bones) 6 major fiat parts

  41. Frames of reference F C E Rigid does not change shape (bones) B D A Circle is adjacent-to A

  42. Frames of reference F C E Rigid does not change shape (bones) B D A Circle is adjacent-to B

  43. Frames of reference F C E Rigid does not change shape (bones) B D A Disc is adjacent-to C and D

  44. Refining adjacency relation between disc and condyle Refining adjacency relation between disc and fossa Specifying relative location of condyle and fossa Ordering relations

  45. Posterior head of condyle anterior head of condyle Shape landmarks of the condyleas frame of reference Disc is adjacent to the posteriorhead of the condyle

  46. Posterior head of condyle anterior head of condyle Shape landmarks of the condyleas frame of reference Disc is adjacent to the posteriorandanteriorhead of the condyle

  47. Posterior head of condyle anterior head of condyle Shape landmarks of the condyleas frame of reference Disc is adjacent to the anteriorhead of the condyle

  48. Refining adjacency relation between disc and condyle Refining adjacency relation between disc and fossa Specifying relative location of condyle and fossa Ordering relations

  49. Extension of The middle axis Middle axis of the condyle Shape landmarks of the condyle

  50. Frames of reference F C E Rigid does not change shape (bones) B D A The extension of the axis of the condyle intersects the fossa in region C

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