Fail-safe System for Diagnosis Quality Control in Cancer Screening Canscreen

Transcription

1 Fail-safe System for Diagnosis Quality Control in Cancer Screening Contract number 125 / 2006 financed by Romanian Government, through CEEX Romanian National Research & Development Programme, VIASAN Research domain: Health Duration: september 2006 september 2008

2 Consortium CO - "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca project manager: prof. dr. Andrei Achimaş-Cădariuş P1 - "I. Chiricuţă" Oncology Institute, Cluj-Napoca project responsable: dr. physician Florian Nicula P2 - SC IPA SA Cluj Subsidiary project responsable: senior researcher eng. Ioan Stoian P3 - "Babeş Bolyai" University, Cluj-Napoca project responsable : prof. dr. Liana Lupşa P4 - Al. Trestioreanu Oncology Institute, Bucureşti project responsable: physician Milena Duma 2

3 Project Objectives Main objective - to find an appropriate cervical and breast cancer screening strategy for Romania and thus, the reduction of incidence and mortality by cancer with the improvement of quality of life for the patients. has the following scientifically and technological objectives: building up of a complex fail safe system which will ensure the diagnosis and treatment quality at European Standards design of a database which will include the tested women and also registers with high risk women design of algorithms for individualized diagnosis and a protocol for subsequent therapeutics indications improving the smears interpretation analysis and selection of smears with cytological abnormalities insuring the quality of the system by random selection of a percent of samples of interpreted smears and transmitting them to an expert cytologist distance transmission of mammography and ensuring their quality control designing the cost-effectiveness study which allows to choose the screening strategy with the lowest ratio of cost-effectiveness using the Markov model 3

4 Project Phases Phase 1: Study of the actual situation in cancer pathology and of it's monitoring in Romania Phase 2: Definition of support methodology; Phase 3: Designing the informatic system Phase 4: Implementation and verification of the informatic system Phase 5: Evaluation of preliminary results and results dissemination

5 System Functions system functions: access of people monitoring administrative personnel defining physician dictionaries assigned to following medical facilities: family medicine, sampling centers, cytological laboratory, image processing centers, etc mailing screening invitations for a number of persons which respect some mandatory criteria and generates needed documents for economical research of invitation process establishing an individual schedule of sampling for persons that make a reservation depending on availability/unavailability yof the interpretation centers gathering, in electronic screening format, of data for each registered patient, her cross thru sampling center, laboratories, the result of investigation and the recommendation of the specialist physician recording prevailed images on the file server and on screening program s database images quality improvement and improper image files automatic elimination viewing of round s historical, episodes and invitations for a participant to screening program automatic persons involve in screening programs planning according to the screening test result screening persons monitoring in caseofhpvandcolposcopy py testing to keep the possibility of their reintegration in screening programs developing specific annual statistic reports according to database s post processing data export to other related software applications 5

6 Medical Screening Protocols Based on the medical protocols specific for the screening of cervical and breast cancer defined by the methodology the technical specifications for the database and for collecting and analyzing images was established. Medical protocols define the system technical specifications: establishing external source of medical data to import establishing medical data necessary to the system analysis of the quantification possibilities and coding for medical data designing the hardware configuration necessary for the informatics system establishing data flow from informatics point of view establishing requirements for the cost-effectiveness study and algorithms 6

7 Screening Programs Data Collection Necessary steps in data collection process: taking the smears processing the smears and images smears/images interpretation data storing 7

8 System Architecture Hardware architecture n-tier architecture with the levels: presentation level logical management level logical data access level database level Hardware architecture is composed by: client workstations WEB server database and application server files server 8

9 System Architecture System s software architecture contains the modules: interface design module accomplishes the user access to the level of the medical centers involved in the screening program for the cervical and breast cancer (MPI) medical data quantification and representation module (MRCD) medical images acquisition module (cytological and mammographic images) (MAI) medical data generation and exploitation module offers the possibility of retrieving data according to certain criteria defined by the screening protocol. Another module function is the pacients tratament management which involves special investigations.(mgebd) images filtering module intends to optimize the interpreting procedures for the cytological smears and mammographies, by elaborating recognition algorithms for extracting the quantifiable features (MFI) quality module randomly selects a percentage of the analyzed images, which h are afterwards re-read and transferred to a cytology expert (MAC) economical analysis module decides the screening strategy in accordance with the costefficiency ratio, by using Markov models applied to existing data in the database (MAE) 9

10 System Architecture Software modules interaction: 10

11 System Database database consists of the following data collections: clinical information store - high-order relational database - encoded medical data involved in the screening program in accordance with the guidelines for screening protocols images repository - low-order relational database - only the image address is memorised in the database, not the entire image database is designed and implemented in Erwin and Microsoft SQL Server high-order relational database low-order relational database 11

12 System Database Global relational entities model 12

13 Application Program Implemented in Microsoft Visual Studio 2005 Manages the system database and implements the system functions 13

14 Cytological Images Interpretation Algorithms for cytological images interpretation : algorithms used in automatic cellular formation segmentation (found in cytological images) (Otsu method) automatic cellular formation segmentation found in cytological images using clustering algorithms (Moving kmeansclustering algorithm) post-processing segmented image using clustering algorithms (Modified Seed Based Region Growing algorithm) automatic cellular formation segmentation found in cytological images using clustering algorithms and segmentation algorithms based on global segmentation limit calculation 14

15 Mammographic Images Interpretation Algorithms for mammographic images interpretation: multi scale segmentation algorithms microcalcifies detection algorithms based on crossed entropy minimization microcalcifies detection algorithms based on bidimensional simultaneous apparition matrix microcalcifies detection algorithms based on conditional entropy maximization 15

16 Markov Model database is used to do an economic evaluation of healthcare interventions to ensure the quality of the screening programs. Medical decision analysis using Markov model: modeling the progression of a chronic disease (cervical and breast cancer) predict effect changes in cervical and breast cancer practice States of Markov models from which it is impossible the leaves are known as absorbing states (overfullfilment of including age in screening). All possible transitions between absorbing states in a Markov model are given by a transition matrix. Transaction matrix for a 15-state Markov model in cervical cancer screening program State W L H UC1 UC2 UC3 UC4 D1 D2 D3 D4 S DC D Possible transactions W, L, H, D, A W, L, H, D, A W, L, H, UC1, D, A UC1, C1, UC2, D, A UC2, C2, UC3, D, A UC3, C3, UC4, D, A UC4, C4, UC2, D, A D1, D2, S, DC, D, A D2, D3, S, DC, D, A D3, D4, S, DC, D, A D4, S, DC, D, A S, D, A Absorbing state Absorbing state 16 A Absorbing state

17 Quantifiable Results Direct quantifiable results: developing a model of a fail-safe system of diagnosis control in screening program developing a database of data and images that will contain information about identification of tested women, medical parameters, and also registers of women with high risk developing a study of economical analysis, a study of cost-effectiveness to decide the screening strategy impact on working people, specialization in informatics field of the medical personnel, about 10 persons Indirect quantifiable results : increasing the life expectancy of the patients, by elaborating individualized diagnosis algorithms and prognosis with consecutive therapeutic indications increasing the management capability of the project coordinator in leading interdisciplinary projects 17

18 Expected Beneficiaries Oncology units from the public health network The project can be extended, as a network at the level of rural localities, geographically isolated or in the consulting rooms of family doctors and in health centers. Thus it will increase efficiency of public health system and it will bring the Romanian health system on European coordinates. The project offers the following benefits: access of high risk feminine population for developing breast or ovarian cancer to be monitored according to European Community standards access of feminine population to organized screening for precocious identification of cervical cancer, using an optimal strategy developing of a complex system to control for the diagnosis quality in the cancer screening program developing a study of economical analysis a cost-effectiveness study to decide the screening strategy 18

19 Project Dissemination List of published research papers in national and international conferences proceedings and jounals: The Role of Cancer Registries in Suveillance and Cancer Care, Improvement of Data Quality in Institutional Cancer Registry by Data Linkage, Luciana Neamţiu, Daniela Coza, Florian Nicula, Ofelia Suteu, pp. 129, Poster, Octomber 2006, Amsterdam (Netherlands) XII-th International Conference on Applied Stochastic Models and Data Analysis (ASMDA), Stochastic Fractal Interpolation Function and its Applications to Fractal Analysis of Normal and Pathological Body Temperature Graphs by Children, Anna Soos, May June 2007, Chania, Creta (Grece) Meditech 2007, Data Management System for Cervical Cancer Screening CanScreen, Teodora Sanislav, Ioan Stoian, Dorina Căpăţînă, ţ Mihaela L. Drăgan, Luciana Neamţiu, ţ Florian Nicula, Ofelia Şuteu,, Liana Lupşa, September 2007, Cluj-Napoca (Romania) ENUMATH 2007, Multiple Dynamic Programming Applied in Cervical Screening, LucianaNeamţiu, Ioana Chiorean, Final Program and Abstracts, September 2007, Graz (Austria) ENUMATH 2007, Special Efficient Solutions for Multicriterial Transport Problems, LianaLupşa, Ioana Chiorean, Dorel I. Duca, Luciana Neamţiu, Final Program and Abstracts, t September 2007, Graz (Austria) IACR 29TH ANNUAL MEETING, The Role of Cancer Control Department in Our Comprehensive Cancer Center Oncological Institute Ion Chiricuţă, Daniela Coza, Florian Nicula, Ofelia Şuteu, Luciana Neamţiu, Ioana Rădulescu, Mihaela Sârbu, Lidia Lovasz, September 2007, Ljubljana (Slovenia) Seminar of Functional Equation, Approximation and Convexity, Lex-Min Assignment Problem, Luciana Neamţiu, Radu-Lucian Lupşa, Volume 5, Septembrie 2007, Cluj-Napoca (Romania) Tiberiu Popoviciu Seminar of Functional Equation, Approximation and Convexity, Posibilităţi deaplicare în medicină amăsurilor de neconvexitate, Liana Lupşa, September 2007, Cluj-Napoca (Romania) 19