Patent Application
20240049965
This application is based on and claims priority under 35 USC 119 from Japanese Patent Application No. 2022-128151 filed on Aug. 10, 2022, the entire content of which is incorporated herein by reference.
The present disclosure relates to a system that supports neural monitoring in a perioperative period. The present disclosure also relates to a processing apparatus included in the system and a computer program executable by a processor mounted on the processing apparatus.
JP-T-2017-503620 discloses a system that supports neural monitoring in a perioperative period of a surgery. A waveform corresponding to a change over time in a motor evoked potential of a subject based on stimulation is acquired. An index indicating any one of a plurality of colors is displayed on a display device, based on an amplitude change rate of the waveform with respect to an amplitude of a reference waveform.
It is required to enhance a support performance of neural monitoring in a perioperative period.
Aspects of certain non-limiting embodiments of the present disclosure address the features discussed above and/or other features not described above. However, aspects of the non-limiting embodiments are not required to address the above features, and aspects of the non-limiting embodiments of the present disclosure may not address features described above.
According to an aspect of the present disclosure, there is provided a neural monitoring system including:
A processing apparatus including:
A non-transitory computer-readable storage medium storing a computer program executable by one or more processors mounted on a processing apparatus,
Exemplary embodiment(s) of the present invention will be described in detail based on the following figures, wherein:
An Embodiment will be described in detail below with reference to the accompanying drawings.
In the present example, a change over time in a transcranial motor evoked potential (MEP) is monitored through electrical stimulation to the subject 20.
Therefore, the neural monitoring system 10 can include a stimulation device 11. The stimulation device 11 is configured to generate a stimulation signal ST corresponding to the electrical stimulation applied through an electrode 21 attached to the subject 20. Although a single electrode 21 is illustrated in
The MEP of the subject 20 obtained as a response to the electrical stimulation is detected through an electromyogram electrode 22 attached to the subject 20. That is, the electromyogram electrode 22 is configured to output a detection signal DT corresponding to the MEP. The detection signal DT may be an analog signal or a digital signal. Although a single electromyogram electrode 22 is illustrated in
The neural monitoring system 10 can include a processing apparatus 12. The processing apparatus 12 can include an input interface 121. The input interface 121 is implemented as a hardware interface that is configured to receive the detection signal DT. In a case where the detection signal DT is an analog signal, the input interface 121 can include an appropriate conversion circuit including an A/D converter.
The processing apparatus 12 can include a processor 122. The processor 122 can include one or more processors. The processor 122 is configured to acquire a waveform WF corresponding to the change over time in the MEP of the subject 20 with respect to the electrical stimulation, based on the detection signal DT received by the input interface 121.
In addition, the processor 122 is configured to acquire an amplitude value A defined as a difference between a maximum value and a minimum value of the MEP in the waveform WF. The amplitude value A is an example of an amplitude value of a waveform acquired based on a predetermined rule.
The processing apparatus 12 can include a storage 123. The storage 123 is a storage device that can be implemented by a semiconductor memory, a hard disk device, a magnetic tape device, or the like. The storage 123 is configured to store data corresponding to a reference waveform RF, which is baseline waveform. The reference waveform RF corresponds to a change over time in the MEP of the subject 20 detected under a predetermined condition before the surgery or the like. A reference amplitude value A0 is defined for the reference waveform RF. That is, the reference amplitude value A0 is defined as a difference between a maximum value and a minimum value of the MEP in the reference waveform RF.
The processor 122 is configured to acquire an amplitude change rate P that is a ratio of the amplitude value A to the reference amplitude value A0, based on the amplitude value A acquired as described above and based on the reference amplitude value A0 stored in the storage 123. In the present example, the amplitude change rate P is given by the following equation.
P=(A/A0)×100[%]
The neural monitoring system 10 can include a display device 13. The display device 13 has a configuration configured to visually provide information to a user. Examples of the configuration include a display, an indicator, and the like. The processing apparatus 12 and the display device 13 may be a part of the same device or may be devices independent of each other.
The processing apparatus 12 can include an output interface 124. The processor 122 is configured to cause the output interface 124 to output a display control signal DC, based on the amplitude value A and the amplitude change rate P acquired as described above. The display control signal DC is configured to cause the display device 13 to display an index indicating any one of a plurality of colors. The display control signal DC may be a digital signal or an analog signal, according to a specification of the display device 13. The output interface 124 is implemented as a hardware interface. In a case where the display control signal DC is an analog signal, the output interface 124 can include an appropriate conversion circuit including a D/A converter.
The first waveform display region WD1 is configured to display a first channel waveform corresponding to a change over time, in the MEP of the subject 20, related to a first channel associated with one of the plurality of electromyogram electrodes 22. In
The second waveform display region WD2 is configured to display a second channel waveform corresponding to a change over time, in the MEP of the subject 20, related to a second channel associated with another one of the plurality of electromyogram electrodes 22. In
The third waveform display region WD3 is configured to display a third channel waveform corresponding to a change over time, in the MEP of the subject 20, related to a third channel associated with still another one of the plurality of electromyogram electrodes 22. In
The display device 13 can further include a first index display region ID1, a second index display region ID2, and a third index display region ID3.
The first index display region ID1 is configured to display a first index IX1. The first index IX1 indicates a color determined based on comparison between the first channel waveform and the reference waveform RF. The first index display region ID1 is disposed adjacent to the first waveform display region WD1. In other words, the first index display region ID1 is disposed such that the user can recognize association between the first index IX1 and the first channel waveform.
The second index display region ID2 is configured to display a second index IX2. The second index IX2 indicates a color determined based on comparison between the second channel waveform and the reference waveform RF. The second index display region ID2 is disposed adjacent to the second waveform display region WD2. In other words, the second index display region ID2 is disposed such that the user can recognize association between the second index IX2 and the second channel waveform.
The third index display region ID3 is configured to display a third index IX3. The third index IX3 indicates a color determined based on comparison between the third channel waveform and the reference waveform RF. The third index display region ID3 is disposed adjacent to the third waveform display region WD3. In other words, the third index display region ID3 is disposed such that the user can recognize association between the third index IX3 and the third channel waveform.
That is, the processing apparatus 12 is configured to cause the output interface 124 to output the display control signal DC configured to cause the display device 13 to display the first index IX1, the second index IX2, and the third index IX3 together with the first channel waveform, the second channel waveform, and the third channel waveform. The number of channels (that is, the number of indexes) of the waveform displayed on the display device 13 may be appropriately determined according to the specification of the display device 13.
In the present example, each of the first index IX1, the second index IX2, and the third index IX3 indicates one of eight colors, according to a predetermined correlation for combinations of the amplitude value A and the amplitude change rate P.
For color numbers 1 to 7 in the example illustrated in
In a case where the processor 122 determines that the amplitude value A of the waveform WF can be specified (YES in STEP 1), the processor 122 acquires the amplitude value A of the waveform WF based on a predetermined rule (STEP 2).
Subsequently, the processor 122 determines whether the display color of the index can be determined based on the amplitude value A acquired in STEP 2 (STEP 3). In the correlation illustrated in
In a case where the display color of the index is determined (YES in STEP 3), the processor 122 is configured to cause the output interface 124 to output the display control signal DC configured to cause the display device 13 to display the index indicating the color (STEP 4).
In a case where the display color of the index is not able to be determined based on only the amplitude value A (NO in STEP 3), the processor 122 acquires the amplitude change rate P, of the waveform WF, with respect to the reference waveform RF (STEP 5). Any one of the color numbers 1 to 5 is selected based on an acquired value of the amplitude change rate P and the correlation illustrated in
In the example illustrated in
In a case where the processor 122 determines that the amplitude value A of the waveform WF is not able to be specified (NO in STEP 1), the processor 122 is configured to cause the output interface 124 to output the display control signal DC configured to cause the display device 13 to display an index indicating the color of the color number 8 illustrated in
According to the configuration described above, the amplitude value A of the waveform WF is introduced as an evaluation item of the MEP in addition to the amplitude change rate P of the waveform WF with respect to the reference waveform RF. Therefore, a more subdivided evaluation related to a decrease in an exercise function of the subject 20 can be provided. For example, in the correlation illustrated in
As described with reference to
According to such a configuration, an increase in a calculation load and a processing time by the processor 122 of the processing apparatus 12 can be prevented, in a situation where an influence of the amplitude value A on the evaluation of the decrease of the exercise function of the subject 20 is relatively high. Accordingly, the support performance of the evaluation related to the decrease in the exercise function can be enhanced.
As illustrated in
In a case where the reference amplitude value A0 of the reference waveform RF is small to some extent, the amplitude value A of the waveform WF also tends to be small. Therefore, it is necessary to pay attention to the evaluation result based on the amplitude value A. The change in the shape of the index as described above can be easily visually recognized by the user, and thus the user can be warned of the evaluation result. Therefore, the support performance of the exercise function monitoring can be further enhanced.
As illustrated in
The user interface 14 may be implemented by a switch or the like that can be mechanically operated, or may be implemented by a GUI that can be operated through an input device such as a mouse or a keyboard or through a touch panel operation. Alternatively, the instruction may be input through a voice or a gesture of the user.
The user interface 14 is configured to output an instruction signal IS corresponding to the received instruction. The instruction signal IS may be an analog signal or a digital signal, according to a specification of the user interface 14. The instruction signal IS received by the input interface 121 of the processing apparatus 12. In a case where the instruction signal IS is an analog signal, the input interface 121 can include an appropriate conversion circuit including an A/D converter.
The processor 122 is configured to change the shape of the index to be displayed in a case where the instruction signal IS corresponding to the instruction of changing the display color of the index is received by the input interface 121. Specifically, the processor 122 is configured to cause the output interface 124 to output the display control signal DC that changes the shape of the index to have a shape in which an upper right corner of the rectangle shape is cut out. In the example illustrated in
In a case where the display color of the index is changed afterward by a certain user, another user who views the waveform WF and the index indicating a changed color may feel a sense of discomfort. Therefore, it is preferable that a fact that the display color of the index is changed by a certain user is known to another user. The change in the shape of the index as described above may be easily visually recognized by another user, and therefore another user can be prompted to recognize that the display color of the index is changed. Therefore, the support performance of the exercise function monitoring can be further enhanced.
In addition to or instead of the configuration described above, the user interface 14 may be configured to receive an instruction of changing the threshold related to the reference amplitude value A0 from the user and configured to output the instruction signal IS corresponding to the instruction.
The processor 122 may be configured to change the shape of the index to be displayed in a case where the instruction signal IS corresponding to the instruction of changing the threshold related to the reference amplitude value A0 is received by the input interface 121. Specifically, the processor 122 is configured to cause the output interface 124 to output the display control signal DC that changes the shape of the index such that the lower right corner of the rectangle shape is cut out. In the example illustrated in
The change in the threshold related to the reference amplitude value A0 may affect a result of whether the shape of the index is changed. Therefore, it is preferable that a fact that the threshold is changed is known to the user. The change in the shape of the index as described above can also be easily visually recognized by the user, and therefore the user can be prompted to recognize that the threshold is changed. Therefore, the support performance of the exercise function monitoring can be further enhanced.
In addition to or instead of the configuration described above, the user interface 14 may be configured to receive, from the user, the instruction of changing each of the thresholds related to the amplitude value A, the amplitude change rate P, and the display color of the index illustrated in
In this case, the processor 122 is configured to change the shape of the index to be displayed in a case where the instruction signal IS corresponding to the instruction of changing the threshold related to the display color of the index and at least one of the amplitude value A and the amplitude change rate P is received by the input interface 121. Specifically, the processor 122 is configured to cause the output interface 124 to output the display control signal DC that changes the shape of the index such that the lower right corner of the rectangle shape is cut out. In the example illustrated in
The change in the threshold related to the display color of the index and at least one of the amplitude value A and the amplitude change rate P may affect the evaluation result related to the exercise function of the subject 20. Therefore, it is preferable that a fact that the threshold is changed is known to the user. The change in the shape of the index as described above can also be easily visually recognized by the user, and therefore the user can be prompted to recognize that the threshold is changed. Therefore, the support performance of the exercise function monitoring can be further enhanced.
A change mode of the index shape based on the instruction of changing the threshold related to the display color of the index and at least one of the amplitude value A and the amplitude change rate P may be different from a change mode of the index shape based on the instruction of changing the threshold related to the reference amplitude value A0 of the reference waveform RF. For example, in a case where the instruction signal IS corresponding to the instruction of changing the threshold related to the amplitude change rate P is received by the input interface 121, the processor 122 may cause the output interface 124 to output the display control signal DC that changes the shape of the index such that the lower left corner of the rectangle shape is cut out.
Any method may be adopted for changing the shape of the index displayed on the display device 13. As described above, not only a change of removing a part of a graphic in an initial state but also a change of adding another graphic to the graphic in the initial state may be made. Alternatively, the rectangle shape may be changed to a graphic having a different name, such as a circle, a triangle, or a starry shape.
The graph display region GR is configured to display, in a so-called trend form, a change over time of the amplitude change rate P acquired based on the waveform WF. A left-right direction in the graph display region GR corresponds to passage of time. Specifically, as it goes to a right direction, it corresponds to the more recent past. An up-down direction in the graph display region GR corresponds to a value of the amplitude change rate P. Specifically, an up direction corresponds to a larger value. A center line CL represents P=100%.
Every time the amplitude change rate P is acquired, plotting is performed at a position corresponding to an acquisition time point in the left-right direction of the graph display region GR. The newer amplitude change rate P is plotted to a right of the older amplitude change rate P. A graph is formed by connecting plots adjacent to each other in the left-right direction by a connection line. In a case where a current time point reaches a right end of the graph display region GR, the entire graph moves leftward and the plotting is continued.
The first current value display region CV1 is configured to display a numerical value of the amplitude change rate P corresponding to the latest plot. The second current value display region CV2 is configured to display a numerical value of the amplitude value A at a time point when the latest amplitude change rate P is acquired. The value history display region VH is configured to display, above each plot in the graph display region GR, a numerical value of the amplitude change rate P corresponding to the plot.
The index display region ID is configured to display, as the index, a scale SC including a plurality of colors based on the correlation illustrated in
The graph display region GR according to the present example is configured to display, in a so-called water-fall form, the change over time of the amplitude change rate P acquired based on the waveform WF. The up-down direction in the graph display region GR corresponds to the passage of time. Specifically, as it goes to the up direction, it corresponds to the more recent past. The left-right direction in the graph display region GR corresponds to the value of the amplitude change rate P. Specifically, the right direction corresponds to a larger value. A center line CL represents P=100%.
Every time the amplitude change rate P is acquired, the plotting is performed at an upper end of the graph display region GR. The newer amplitude change rate P is plotted above the older amplitude change rate P. A graph is formed by connecting plots adjacent to each other in the up-down direction by a connection line. While the entire graph moves downward, the plotting is continued.
The value history display region VH is configured to display a numerical value of the amplitude change rate P corresponding to the plot on the right side of each plot in the graph display region GR.
According to the screen display illustrated in
In the graph display region GR, a graph indicating a change over time in the amplitude value A may be displayed. The center line CL may represent, for example, A=10 μV. In this case, the first current value display region CV1 is configured to display the numerical value of the amplitude value A corresponding to the latest plot. The second current value display region CV2 is configured to display the numerical value of the amplitude change rate P at the time point when the latest amplitude value A is acquired. The value history display region VH is configured to display the numerical value of the amplitude value A corresponding to each plot in the graph display region GR.
The processor 122 of the processing apparatus 12 having various functions described above may be implemented by a general-purpose microprocessor that operates in cooperation with a general-purpose memory. Examples of the general-purpose microprocessor include a CPU, an MPU, and a GPU. Examples of the general-purpose memory include a ROM and a RAM. In this case, the ROM may store a computer program for implementing the function. The ROM is an example of a non-transitory computer-readable medium that stores a computer program. The general-purpose microprocessor designates at least a part of the programs stored in the ROM, loads the programs in the RAM, and executes the above-described processing in cooperation with the RAM. The computer program may be pre-installed in the general-purpose memory, or may be downloaded from an external server via a communication network and then installed in the general-purpose memory. In this case, the external server is an example of a non-transitory computer-readable medium that stores the computer program.
The processor 122 may be implemented by a dedicated integrated circuit such as a microcontroller, an ASIC, or an FPGA that are includes a storage element in which a computer program for implementing the function is pre-installed. In this case, the storage element is an example of a non-transitory computer-readable medium in which a computer program is stored.
The processor 122 may be implemented by a combination of a general-purpose microprocessor and a dedicated integrated circuit.
The configurations described above are merely examples for facilitating understanding of the present disclosure. The configurations may be appropriately changed or combined with another configuration without departing from the gist of the present disclosure.
The amplitude value A acquired for the waveform WF does not need to be the difference between the maximum value and the minimum value of the MEP. In a case where two points that can serve as references in the waveform WF are specified based on a predetermined rule, a difference in the MEP between the two points can be acquired as the amplitude value A. Examples of such two points include the maximal value and the minimal value, the maximum value or the minimum value and a base line potential, and a maximal value or a minimal value and the base line potential.
The display device 13 may be an independent device having a display function, or may be provided as a part of another device. For example, as illustrated in
A target of the neural monitoring is not limited to the MEP. A somatosensory evoked potential (SEP), a visual evoked potential (VEP), an auditory brainstem response (ABR), and the like can also be targets of the monitoring. In a case where the SEP is the target, the stimulation device 11 applies the electrical stimulation to the subject 20, and a sensory function of the subject 20 is evaluated. In a case where the VEP is the target, the stimulation device 11 applies optical stimulation to a retina of the subject 20, and a visual neural function of the subject 20 is evaluated. In a case where the ABR is the target, the stimulation device 11 applies sound stimulation to the subject 20, and an auditory neural function of the subject 20 is evaluated.
The configurations to be listed below also constitute a part of the present disclosure.
(1): A neural monitoring system including:
(2): The neural monitoring system according to (1),
(3): The neural monitoring system according to (1),
(4): The neural monitoring system according to any one of (1) to (3),
(5): The neural monitoring system according to any one of (1) to (4),
(6): The neural monitoring system according to (5),
(7): The neural monitoring system according to any one of (1) to (6),
(8): The neural monitoring system according to any one of (1) to (7),
(9): The neural monitoring system according to any one of (1) to (8),
(10): A processing apparatus including:
(11): A non-transitory computer-readable storage medium storing a computer program executable by one or more processors mounted on a processing apparatus,
The foregoing description of the exemplary embodiments of the present invention has been provided for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obviously, many modifications and variations will be apparent to practitioners skilled in the art. The embodiments were chosen and described in order to best explain the principles of the invention and its practical applications, thereby enabling others skilled in the art to understand the invention for various embodiments and with the various modifications as are suited to the particular use contemplated. It is intended that the scope of the invention be defined by the following claims and their equivalents.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2022-128151 | Aug 2022 | JP | national |
