A Russian national computing and communication system designed to assist non-specialized physicians in the diagnosis and treatment of craniocerebral injury is described

Gurchin, A. F.

Kremleva, R. V.

Luchko, G. D.

Moiseyeva, N. I.

Morozov, A. V.

Nikitina, L. I.

Rodionov, K. K.

Shmatov, E. M.

English

NASA Technical Reports Server

  
 
 
N O T I C E 
 
THIS DOCUMENT HAS BEEN REPRODUCED FROM 
MICROFICHE. ALTHOUGH IT IS RECOGNIZED THAT 
CERTAIN PORTIONS ARE ILLEGIBLE, IT IS BEING RELEASED 
IN THE INTEREST OF MAKING AVAILABLE AS MUCH 
INFORMATION AS POSSIBLE 
https://ntrs.nasa.gov/search.jsp?R=19800014484 2020-03-21T18:13:03+00:00Z
a
NASA TECHNICAL MEMORANDUM
	
NASA TM-76097
AUTOMATED SYSTEM FOR DIAGNOSING
GRANIOCEREBRAL INJURY
N. I. Moiseyeva, G. D. Luchko, R. V. Kremleva, A. V. Murozov,
L. I. Niki*_ina, K. K. Rodionov, A. F. Gurchin, E. M. Shmatov
Translation of "Avtomatizirovannaya sistema diagnostiki cherepnomozgovoy
travmy", Sovetskaya meditsina, No. 10 (October) 1979, pp 94-98
(NASA-TM-76097) AUTOMATED SYSTEM FOR
DIAGNOSING CEANIOCEREBRAL INJURY (National
Aeronautics and Space Adsinistration) 10 p
HC A02/MF A01	 CSCL 06B
B60-22972
Unclas
G5/52 46891
NATIONAL AERONAUTICS AND SPACE ADMINISTRATION
WASHINGTON, D. C. 20546
	 MARCH 1980
1♦ ",
4
$TANDARD TITLE PAGE
' NAS^^ MN^6097	 7=9
omoo AssesNM Na 3. Recipl«N's C.1slq N..
4. Title sod s r►NHs s.	 R..to Dole
M	 CH 1980
Automated System for Diagnosing
s. Performing orgenisetien CedeCraniocerebral Injury
7.	 Atrther(s) E. Performing orysnitstlsn Repsrt He.
N. I. Moiseyeva, G. D. Luchko, R. V. Kremleva,
10.	 work Unit No.A. V. Morozov, L. 1. Nikitina, K. K. Rodionov,
A. F. Gurchin, E. M. Shmatov
I1.	 Centrest er Grent Ne.
NASw•f.	 Performing Orgenisstien Norse and Address
12. Type of Report end Psrisd CoveredSCITRAN
Box 5456
;Anta HArhara_ CA	 Q11 AR Translation
12. S
	
nsering A en y Nerve end Addross
^Ationa^ 
it
	 and Space Adoinistration
Waseington. D.C.
	 20546 r14.^ettss+ltt2 Assttsy Code
13.	 Nets$
Translation of "Avtomatizirovannaya sistema diagnostiki r_herepnomozgovoy
travmy", Sovetskaya meditsina, No. 10 (October) 1979, pp 94-98
1^. Abtnst'
The article describes a Russian, national computing and communica-
tion system designed to assist non-specialized physicans in the
diabnosis and treatment of craniocerebral injury.
17. Key Herds (seleeled by AMI1tM(p) le. Dlstri►rrNen statement
This copyrighted Soviet work is repro-
duced and sold by NTIS under license
from VAAP, the Soviet copyright agency,
No further copying is permitted with-
out permission from VAAP.
it. sorority Cleself. 41 this MWO l^ Clessil. (of 1Ma Pogo) 210 Na. d Payee 2L Pdcs	 f
Unclassified nUnclassified 10
ZI^± L Scienfific and Teoi;;: 1_cr3.1 F.	 .n'±. i	 ].- ty
£
'71it
UDC 615.471:617.51-001.036.11-07
AUTOMATED SYMM FOR DIAGNOSING CRANIOCEREBRAL INJURY
By
N. I. Moiseyeva, G. D. Luchko, R. V. Kremleva, A. V.
Morozov, L. I. Nikitina, K. K. Rodionov, A. F. Gurchin,
E. M. Shmatov*
In the "Main Directions for Development of the USSR National Economy fcr 79x'6- X94**
1980" further development and improvemen •c in the effective use of automated control
systems (ACS) and computers are provided for by successive unification of them into
a national system for collection and processing of information for computing,
planning, controlling and creating computer centers of collective use.
In recent ,years the USSR Ministry of Public Health has been intensively develo-
ping automated systems for the collection and processing of information, 23 ACS
have been made, and 22 information computer centers have been put into operation
(V. M. Timonin).
In develop.ng the principles of construction for a model of the public health
system for the municipal population V. P. Kaznacheyev et al. in the ACS "Gorod"
the function of the first of them, the ACS "Gorzdravh" includes an increase in the
effectiveness of health protection for the population due to automation of the
activity for control of public health and coordination of all organizations of the
city that implement health protection; the function of the second, the ACS "Zdorov'ye,"
includes an increase in the effectiveness of medical and sanitary servicing of the
population. The latter can be attained, on the one hand, with the help of creation
Scientific Res-arch Institute of Experimental Medicine of the USSR Academy
of Medical Scien:?es, Academician I. P. Pavlov First Leningrad Medical Institute,
Municipal hospitals No 10, 17, 20, 26, Leningrad.
**
Numbers in margin indicate pagination in original foreign text.
1
tR
R
of automated systems of mass preventive examinations and systems of prediction,I
and on the other hand--with the help of automated diagnostic systems that guarantee
machine diagnostics of a certain circle of diseases. Thus in the.A. V. Vishnevskiy
Institute of Surgery a remote control diagnostic system has been set up for diag-
nosis of acute surgical diseases of the heart and organs of the gastrointestinal
tract (M. L. Bykhovskiy et al.). The first phase of the automated system for
analysis of medt,cal data is operating in the Oncological Scientific Center, the
information-retrieval system of medical radiology and radiation therapy in the
Institute of Medical Radiology, the information-diagnostic system for surgical
treatment of acquired valvular diseases in the A. N. Bakulev Institute of Cardio-
vascular Surgery, the information-computer system on psychiatry in the V. P. Ser-
bskiy Institute of Forensic Psychiatry, etc.
Craniocerebral injury is one of the diseases for which machine diagnostics
is very desirable.
Diagnostics in th-. se
 cases is izrgent since the general state of the patient
is extremely serious, and the symptoms that can be studied are insufficient for
a confident conclusion. In addition, often the patients are not sent to specialized
treatment institutions, where consultation of the neurosurgeon and neuropathologist
are provided, but to any treatment institution located near the site of accident.
According to the data of I. S. Babchin, despite the growth in neurosurgical treat- /95
ment network 70-80% of the patients with craniocerebral injury enter nonspecialized
institutions where the physicians are faced with a complicated task; its solution
without the immediate and qualified consultation is extremely difficult. The
interests of the practicing physicians in this respect can be guaranteed by the
centers of express.diagnostics where the physicians (regardless of their specialty
and qualification) can turn by telephone at any time of the day.
The first system of such type was set up in 1968 in Prague (P. Nadvornik et al),
whereupon the physicans who turned to the computer center received immediately two
answers: which of the seven forms of traumatic injury is the most probable ill the
victim, and which of 15 methods of conservative or surgical treatment is the most
efficient. Already in a year physicians not only from Prague but also entire east
'Thus, starting in 1971 the information-computer system forrediction of
influenza epidemics as been functioning (with center in Leningrad that is auto-
matically linked to 100 cities in the USSR (Yu. G. Ivannikov et al.).
t
2
F, E
a
L^
r
i.
^	 t
Czechoslovakia could turn to the center (Navdvornik at al.).
In Leningrad in the Scientific Research Institute of Experimental Medicine of
the USSR Academy of Medical Sciences the system of rapid diagnosis for cranio-
cerebral injury that gives an answer on the nature and on the localization of the
injury was finished in 1973 and it is currently operating. Both the medical and
the algorithmic parts of the system are continually being modified and supplemented.
The system is a set that has the following interrelated links.
1. Active algorithms and programs (on punched cards and magnetic tape), their
description (according to the requirements of the State Fund of Algorithms and
Programs), and instructions for the operator on their use.
The currently active algorithm of diagnostics that is realized in the form of
a program in the "Fortran-IV" language for the digital computer "Minsk-32" (A. n.
Matveyev at al., 1978a and b) consists of two parts. The first part is a multidimen-
sional scaling of discrete signs according to the data of each class, all of whose
objects are represented by their signs in the multidimensional space of the ordinal
scales. At this stage for each class of objects with regard for the peculiarities
of the distribution of its sampling the space of the ordinal scales of signs is
transformed into the space of metric scales in which the Boolean rules of the pro-
bability theory acquire a simple algebraic form (I. Pfantsagl'). Evaluation of
the ordinal statistics corresponding to the boundaries of the zones for the scale
of equal ratios is made from the formulas:
kS
KB (1)
KS
KBC2)::-,
KS
KB k3)
where a=2.618; KS--number of objects in which the given sign is measured.
The selection of a as the basis for the Fibonacci series guarantees the best
statistical properties of the evaluations of the ordinal statistics and the minimum
search time for the scale of equal ratios in the work of the algorithm. Then the
position code is computed for each object in each class as a measure of its typical-
ness:
3
PK(K)=PK(K) + lo(D(SR(K)-11 K=1,N,
I
Y
where PK(0)=0; SR(K)--value of scale of equal ratios for sign (K); D--number of
decimal digit's in number of signs. All the objects of one class are ordered in
	 j96
accordance with the amount of the position code.
The ordinal scales of typicalness of the objects are scaled and corrected. At
the final stage the scales of equal ratios of typicalness of the objects in the
class of data are opened on the ANP (.alpranumeric printer) and they are recorded
on magnetic tape.
2. Second part--diagnostics and analysis of the information content of the
signs in the multidimensional data.
For each class of objects (j) the measure of nontypicalness (M) of the sign
(xi j) of the object ( i) is evaluated with ;the help of the following Boolean rule:
((v.), t;E0—rr) ► .
where N--number of objects; p--scale of egt,'.1 ratios "pathology"; -N--scale of equal
ratios "hormal"; NK--number of classes.
For each case the table is opened making it possible to deduce the answer and
reveal which signs were not typical for the given class, which can also be very
useful for the physician making the decision.
3. The developed rules of selection, systematization, coding and punching the
medical information (in the form of method manuals and instructions) to the physicians
by the computer center and to the technician-punch card operators 2 ; coded list of
symptoms.3
4. Medical information collected in the form of a copy from the histories of
sickness of the patients with a certain diagnosis and outcome of the disease, coded,
punched, is recorded on magnetic tape ("medical storage of the machine," "general
2The principles of systematization are described in detail in the monographs of
N. I. Moiseyeva (1967, 1972); ordered lists of the neurological symptomatology are
also given there.
3The coding list of symptoms is given in the monograph of N. I. Moiseyeva and
G. D. Zuchko.
4
ri
^t
set"). In order to make access to the system available to any practicing physician
information is fed in a random form common for each medical person, without a
specialized information chart. The translation of the data into a language
accessible to the machine is made by the physicians in the computer center according
to the instructions and coded list of symp.;oms (see point 2). Instructions are-
given to the physicians, technician-punched card operators and technician-operators
for usage of this information.
5. Instructions on the order i ;ez6plion of information on each incoming
patient for the purposes of diagnostics, sequence of the actions in the establish-
ment of 1, diagnosis; instructions on the order of response to the hospital from
which the information came; instructions on the order of registering and storing
the incoming and initial documents.
The order of making a current diagnosis: 1) treatment institutions of Lenin-
grad are informed of the possibility of obtaining diagnostic advice in the case
of a request by telephone; 2) reception of data by telephone is carried out by the
attendant from 09.30 to 17.30 daily on work days. The reception of data was initially
implemented by the colleagues of the computer center. Since 1977 the data have been
received by physicians working in state hospital No 17, rarely in the computer
center. In certain hospitals of the city that have constant communication the
attendant colleagues call on designated days and ask whether any new patients have
been admitted; 3) the obtained information is recorded by the physician, recorded
in a special log and coded according to the code list, containing 128 paired signs;
4) information in the form of a digital code is transmitted to the attendant opera-
tor of the computer center; 5) the attendant operator punches the data on punched
cards, calls from the working magnetic tapes the diagnostic program and the data of
-,he general set, introduces data on the patient who has been admitted for diagnos-
tics, and implements the diagnostic procedure; 6) the diagnostic answer  of the
machine is reported to the physician who has received and coded the data(personally
or by telephone). The diagnostic blank is filed into a package of answers; 7) the
physician sends the diagnostic answer to the hospital from which the information
The answer is a report on the most likely diagnosis for the given patient:
severe concussion of the brain; contusion of the brain; epidural hematoma; subdural
hematoma; combination of cerebral contusion with epidural hematoma and subarachnoid
hemorrhage; combination of contusion and subdural hematoma; combination of contusion,
subdural hematoma and subarachnoid hemorrhage; intracerebral hematoma; subarachnoid
hemorrhage (with light degree of cerebral contusion); massive mixed injury; dis-
ruption in cerebral circulation of nontraumatic etiology.
/97
5
^y1
H
a
'w
0
H
w
O
U
H
f^
C7
A
rl
z
a
O
J
O
O
a
0
U
mUJ
O
hd_,D
^i
A
i
I
O
L°	 ^	 00
cd O rd off
O O
p	NO	 •r^"i
O
I
V
Cpl
U\1
asUl
U1
^
m r^1
Ul
0^0
4.1 +3
O rl
— -	 }
H m4-1 O	 O	 (^!
 H
.L
0,9
 cod
. 4-1
(D • H w
A
N	 o
mo20 1c\V	 °r-+°	 o
,H o o
—O -H
+' 4-1
7a cd O
eG
O
H CSI	 c^
N O	 \
CH •,1 s~	 0) Crl r-I	 C1	 U1
CH 4-1
^.
Pla
to
cd N H U H
m m 0) 00	 L`o cat	 ao
0
N00 --.tU cd
o U)
m m	 ' OD
rl
•cd r 1 •r1 9 m
O OS". mP H
rl	 p O	 U
•Cd
•f-I 
cad .2 H-P
u
•^ 
•C
rp H •	 U ^
4-')UO •ri H O
•.1 	 to
	 O •rl>~ H
0 4-1 .ri .° rdH rd -	 •rj (dd
hp
m 0 0k	
rd
o
rd O s~ co F^ N •rl •ri U rd U
O O a) •r I U •r 1 0 •H
EQ
 O HUUx 3d, 0En4-34-1P
O
\1O
04	 r-i
C--I	 N
OD
i
c*1U\
C
H
H
O
H	 H
O
efl	 ^
•r^	 O►r
CH 	 rd
r.
0
+a
rd	
19
rd	 Cd
Efl
mU
O •	 •r1
H m
UI
i^ 
U 
O
OD
O -P
	
H	 r-1
19 0
.rq	 m
cd m
•g 2
r-i m
	
?
	
U?	 •rf
	
-H	 4p
	
U)	 H
	
U)	 O
•U) O
	
H
rd -P
 
-N
•rj d r-i
4-1 O	 .o
C c^
H Cd
Ell
m r—OI	 O Od	 1~
U ^ r-1
	
%1O 4-1	 U
^9
	
cd	 U
O H
U
Crl cd
H O
* -N z
6
came, and makes a notation in the log with indication of the diagnosis and the
time of issuing of the answer; 8) at the and of 2 -3 days (in certain cases a week)
after establishment of the machine diagnosis the physician who made the coding
calls the hospital for clarification of the final diagnosis that is entered into
the log; 9) notations in the histories of the disease on the obtained machine 	 /98
diagnosis are made by the physicians of the hospital.
The time spent for one case of diagnostics is made un of the time necessary
for transmission of data from the hospital on telephone and its recording, which
is from 5 to 20 min. (depending on the number of symptoms); the time of coding--
from 18 to 12 min. (also depending on the number , of symptoms fow d in the patient);
time of punching--3-6
 min; time of calculating on the machine-- 5-8 min; time for
evaluating the response of the machine and transmission of this answer on the tele-
phone. On the whole the diagnostic response is given in 30 -60 min.
Diagnostics of craniocerebral injury was made with the help of the described
system in natients under treatment in stato hospitals No. 10, 17, 20 and 26 of
Leningrad, as well as in the traumatology departments of the First Leningrad Medical
Institute and the Leningrad Sanitary-Hygienic Institute. In individual cases
answers were given to other hospitals of the city and to the Sestroretskiy hospital.
Here the physicians of different hospitals received 252 diagnostic answers. In
25 cases information was transmitted on the patients who did not receive cranio-
cerebral injury or this injury promoted the detection of the concomitant disease
(tumor of the brain, tuberculous meningitis, etc.). In order to evaluate the
results of the activity of the diagnostic system the table presents a comparison
df the medical and machine diagnostics of the craniocerebral injury in 201 patients
whose final diagnosis is known from the results of surgery (108 cases, of them in
29 additional results were obtained from pathological-anatomical study), from data
of autopsy (28), or after fairly lengthy clinical observation (65).
As is apparent from the table, the machine diagnosis is somewhat more accurate
than the physicians'. One should stress that the diagnosis was made on the machine
from data of the first examination in the very beginning of the disease, i.e.,
precisely when the diagnosis is especially complicated.
Usage of the machine does not require from the physician any special knowledge.
The use of the automated systems of diagnostics is accessible for any treatment
institution.
7
F- s
References
Babchin, I. S. Vestn. khir., No. 6 (1975), P. 3--7.
Bykhouskiy M. L.; Lerner, M. A.; and Petrunin, V. V. Vestn, ANN SSSR, No. 5
( 1973, p • 12-16.
Ivannikov, Yu. G.; Shipulin, Ye. S.; and Sychev, V. S. in Epidemilo_giya i profilak-
tikarg ip v sotsialistichegh1Yb atrana-sh ["Epidemiology and Prevention of
Influenza in Socialist Countries"], Leningrad, 1975, p. 123-128.
Kaznacheyev, V. P.; Bessonenko, V. V.; Volkov, G. I., et al., Sov. zdravookhr.
No. 2 (1977), p . 13-18.
Moiseyeva, N. I. Problemy mashinnc o diagnoza v nevrologii L" problems of Machine
Diagnosis in Neurology" , Leningrad, 1967.
Moisa eva, N. I. Meditsi.nsk_ye aspekty vychislitel'noy dia nostiki_ v nevrologii
"Medical Aspects of Computer Diagnostics in Neurology" J, Leningrad, 1972.
Moiseyeva, N. I.; and Luchko, G. D. Dpyt ratio t konsul'tativno-dia_gnosti ..IQgo
punkta vychislitel'noy dincstikiostroy chere^	 trno-mozgovoy avmy L"Experi-
mental Word of Consultative-Diagnostic Point of Computer Diagnostics of Acute
Craniocerebral Injury"], Leningrad, 1977•
Nadvornik. P.; Stranskiy, P.; Kebort, Ya., et al,, 4ksper. khir., No. 4 (1968), n.
19-24.
Nfantsagl', I. Teoriya iz merenv "Theory of Measurements"], Moscow, 1976.
Timonin, V. M. Sov. zdravookhr., No. 12 (1976), P. 3-6.
Nadvornik, P.; Stransky, P.; and Husak, T. Zbl. Neurochir., No. 30 (1969), p ► 29-
32•
A
c/ DP ^A I eq 7-.- 3,0 V c.*' Y l / *
N
114
-e	 S1 VA
	
1 y ^5
s


Automated system for diagnosing craniocerebral injury

Automated system for diagnosing craniocerebral injury

Abstract

Similar works

Full text

Available Versions

NASA Technical Reports Server