The chief scientist reports... Clinical decision making (3). Questioning patients by computer: who will benefit?
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Reported is on satisfactory results obtained with a small-size computer consisting of punching and scanning device, as well as plain writing machine in the respiratory function laboratory. Developed in on- as well as off-line processing by an own technical staff, a diagnostic and teaching program was established for all respiratory function routine methods with the advantages of a large number of cases examined, elimination of sources of error, considerable supply of data and information, automatic documentation and filing, plain writing, interpretation and evaluation of findings. In continuation of such works also the blood gas analysis has been included. These values as the total of disturbances of the pathophysiological acid-base status are considered and interpreted. Clinical correction is forced in this man-machine dialogue by automatic stops of the whole machinery before going on. Subsequently and in addition are computer alveolar-arterial oxygen pressure gradient, venous shunt and oxygen saturation and expressed utilizing the capacity of the small-size computer. Further developments in the respiratory function diagnostic- and teaching program for small-size computers--not too expensive in the building block principle - are intended.
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A basic study was carried out to determine the parameters of a pattern recognition system for the automatic assessment of cytologic cell samples. Various cell features were extracted, whose combinations were evaluationed by an "ambiguity function". It was shown that the highest reliability can be obtained with a combination of the features of nuclear staining, nuclear area, area of cytoplasm, nuclear/cytoplasmic ratio, nuclear shape and chromatin pattern. However, recognition of the nuclear edge and chromatin patterns is complicated and makes automation difficult. Even if these two features are omitted, false positives do not exceed 20 per cent. Consequently screening of abnormal cells can be carried out by image recognition procedures by the use of a computer.
In images of Papanicolaou stained cells 64 gray levels have been differentiated by scanning densitomery. One of the two peaks in a differential histogram indicates the threshold of the cytoplasm, the other that of the nucleus. The two modes indicate where in the digitized image of good segmentation of the cell from its background and the nucleus from the cytoplasm can be accomplished.
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Because when fed to an on-line computer the ECG information carries a good deal of noise, of prime importance is devising a method for representation and filtration of the useful asignal. It is shown that in order to separate the ueful signal with a protracted direct ECG input from the patient to a computer the use of the proposed modified method of coherent accumulation is advisable. This modification envisages a step-wise solution of the following problems: current diagnosis of arrhythmic contractions exclusion of arrhythmic contractions from the accumulation procedure, automatic search of the normal duration of the RR intervals, equalization of the RRh intervals duration, statistical averaging of the obtained quantum values. The devised modification of the coherent accumulation method, while considerably increasing the noise-immunity of the algorhythm, enables it to effect a direct long-term automatic analysis of the ECG at intensive care units. The identification and measurement of the ECG waves and intervals are done through and automatic selection of the curve elements search zones, finding local maxima and also of the commencement and end of waves by using the method of the "moving window" with an adaptive evaluation of the first signal derivative intensity.
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