The "2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum" was held in Zhuhai, Guangdong Province from May 10 to 12, sponsored by the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and undertaken by Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine and Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. This conference invited a number of experts from all over the country to conduct in-depth discussions on new concepts, new technologies and new products in the field of vertigo medicine, bringing a feast of academic gluttony with various forms and rich contents. At this conference, Professor Chen Ganggang from the First Hospital of Shanxi Medical University gave a wonderful keynote report on "BPPV Artificial Intelligence Diagnosis".
The author of this article is the report team of the Yimaitong Vertigo Conference
Yimaitong collated the report, please do not reprint without authorization.
The development of AI applications in the field of vertigo
From a global perspective, artificial intelligence (AI)-assisted vertigo diagnosis and treatment has mainly experienced the following development processes: from the first vertigo medical auxiliary decision-making system "VERTIGO" published in Italy in 1990, to the "ONE" expert system released in Finland in 1999, the "EMBalance" expert decision-making system released in Europe in 2010, followed by the release of "DUCG" intelligent clinical auxiliary diagnosis platform in China in 2014, and the release of "MEDX" expert system in Germany in 2018. In 2022, Professor Li Huawei's team in Shanghai launched the "Fudan Vertigo AI" workstation, which has done a very good job. It is foreseeable that AI will give new life to the medical field.
Problems faced by BPPV intelligent diagnosis and treatment
Benign paroxysmal positional vertigo (BPPV, also known as otolithiasis) is a peripheral vestibular disorder induced by changes in the direction of gravity in the direction of the head, characterized by recurrent transient vertigo and characteristic nystagmus, which is often self-limited and prone to recurrence. The lifetime prevalence of otolithiasis is 2.4%, accounting for 15% to 30% of all patients with vestibular vertigo.
➤ The first difficulty in the intelligent diagnosis and treatment of BPPV is the completion of body position and nystagmus recognition:
1. Automation of inspection techniques: the technical difficulty lies in the automatic rotation of various directions and angles in the spatial coordinate system; The way to achieve this is a fully automatic BPPV reset instrument.
2. The technical difficulties of nystagmus recognition include the recognition of horizontal, vertical and torsional nystagmus, as well as the analysis of spatial and temporal characteristics of nystagmus, and the simultaneous dimensionality reduction analysis. This is achieved through a nystagmus viewfinder.
3. High-definition acquisition and real-time accurate analysis of eye tracking images: the technical problem is the analysis of high-definition high-frame rate cameras and image data; The way to achieve this is the development of efficient analysis algorithms in nystagmus viewers.
4. Realize the matching of eye tracking information and body position information: the technical problem is the analysis of body position dimension (2D to 3D); The way to achieve this is to add gyroscope plus body position video verification and develop body position recognition model.
Fully automated canalith examination and reduction
· HC-BPPV的位置试验：Roll-test
Methods: Take the supine position, turn the head to one side 90° to observe until the initial position is restored 30s after the vertigo or nystagmus disappears, and then turn to the other side 90° to observe, and the head can be directly turned to the opposite side 180° to observe when repeated induction. The analysis of the roll-test includes ground direction + less than 1 minute, ground direction + greater than 1 minute, back to ground + less than 1 minute, back to ground + more than 1 minute, ground reset and then turn back to ground, one side to ground + one side to the ground.
· Positional test of HC-BPPV: nystagmus morphology (horizontal nystagmus)
The judgment of the affected side includes the ground: the strong side of the nystagmus is the affected side; Back: The weak side of nystagmus is the affected side
· HC-BPPV治疗：Barbecue法
The Barbecue method was first proposed by Professor Lempert in 1996. The method is that the patient lies on the affected side, supine and healthy side-prone, sits up on the affected side, rolls continuously at 90°, waits for the nystagmus vertigo disappears for 30 seconds in each position, and then turns to the next position, and finally sits up and bows his head to rest. For patients with horizontal geotropic nystagmus external semicircular canal BPPV, the effective rate of two BBQ reductions on the first day of consultation was 69.1%. The overall cumulative effective rate of long-term follow-up can reach 50%-100%.
· HC-BPPV治疗：Gufoni法
Lie on your side on the side with weak nystagmus and turn your head 45° to the side of the fast nystagmus. The advantage of the Gufoni method is that it does not have to memorize how the affected side is judged; It is more effective for chirolithiasis. For patients with horizontal nystagmus external semicircular canal BPPV, the effective rate of two reductions on the first day of treatment can reach 60%; For patients with horizontal dorsal nystagmus external semicircular canal BPPV, the effective rate of two reductions on the first day of treatment was 73.1%.
· PC-BPPV的位置试验：Dix-Hallpike Test
The patient is seated, and the examiner holds the head to turn to one side 45°, keeps the head still and quickly lies on the back, and the head is tilted back and hangs at an angle of 30° to the horizontal plane, and the vertigo and nystagmus are observed.
· PC-BPPV治疗：Epley法
The response rate is 85% to 98% after 1 to 3 Epley reductions. The Epley method is as effective as the Semont method and is superior to the Brandt-Darof home practice.
Figure 1. Epley Law
For the rare posterior canal chirolithiasis, the latest RCT study in 2021 showed that neither the Epley method nor the Brandt-Daroff home exercise could be effective after a single treatment, and the response rates were 48% and 36%, respectively, after repeated reduction or one week of practice, with no statistical difference.
· PC-BPPV治疗：Semont法
The patient sits with his head turned 45° to the unaffected side, quickly reversing from the sitting position to the affected side in a lateral decubitus position, holding for a period of time, then getting up to the sitting position, then lying on his side in the opposite direction, and finally resuming the sitting position.
A 2012 RCT found that the Semont method had a short-term response rate of 85% for posterior canal BPPV. A 2016 meta-analysis found that there was no significant difference in the treatment rate and recurrence rate between the Semont method and the Epley method in the treatment of posterior canal stones.
Comparing the advantages and disadvantages of manual reset and automatic reset instrument, Professor Chen Ganggang said that people are more flexible, but machines are more efficient and accurate.
Table 1. Advantages and disadvantages of manual reset versus automatic reset instrument
➤ The second difficulty faced by BPPV intelligent diagnosis and treatment is the optimization of machine learning algorithms and diagnosis matching of massive data
1. Machine deep learning and algorithm optimization of massive clinical data: the technical difficulties are to collect massive data, determine the characteristics of the data set, unify the collection standards, and calibrate and analyze the images after acquisition. The implementation includes the development of an automatic calibration and analysis system for collected data, and the development of an efficient and low-energy nystagmus information recognition algorithm.
2. Finally complete the diagnosis and match to ensure high accuracy: the technical difficulty lies in the interference of atypical positional nystagmus and eye movement; The implementation methods include optimizing the algorithm, combining manual screening and calibration, and adding the validation data set, optimizing the diagnostic matching and accuracy.
BPPV Artificial Intelligence Diagnosis
Professor Chen Ganggang said that although the AI machine is still in its infancy, its diagnostic accuracy rate can reach 90% from clinical research, which is already considerable.
Figure 2. BPPV artificial intelligence diagnosis of right posterior canal canalith patients, positive rate of 94%
Professor Chen Ganggang concluded that BPPV has taken the lead in entering the era of intelligent diagnosis and treatment, and if the clinical treatment process is to be more "intelligent" than that of machines, it is necessary to adopt a comprehensive treatment method of reduction combined with drugs, rehabilitation and education to help patients solve various difficulties in life. Finally, it is necessary to avoid generalized diagnosis and excessive "otolith diagnosis and treatment".
A special report on the 2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum
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