An ontology-based tool for modeling and documenting events in neurosurgery

Abstract

Background: Intraoperative neurophysiological monitoring (IOM) plays a pivotal role in enhancing patient safety during neurosurgical procedures. This vital technique involves the continuous measurement of evoked potentials to provide early warnings and ensure the preservation of critical neural structures. One of the primary challenges has been the effective documentation of IOM events with semantically enriched characterizations. This study aimed to address this challenge by developing an ontology-based tool.

Methods: We structured the development of the IOM Documentation Ontology (IOMDO) and the associated tool into three distinct phases. The initial phase focused on the ontology's creation, drawing from the OBO (Open Biological and Biomedical Ontology) principles. The subsequent phase involved agile software development, a flexible approach to encapsulate the diverse requirements and swiftly produce a prototype. The last phase entailed practical evaluation within real-world documentation settings. This crucial stage enabled us to gather firsthand insights, assessing the tool's functionality and efficacy. The observations made during this phase formed the basis for essential adjustments to ensure the tool's productive utilization.

Results: The core entities of the ontology revolve around central aspects of IOM, including measurements characterized by timestamp, type, values, and location. Concepts and terms of several ontologies were integrated into IOMDO, e.g., the Foundation Model of Anatomy (FMA), the Human Phenotype Ontology (HPO) and the ontology for surgical process models (OntoSPM) related to general surgical terms. The software tool developed for extending the ontology and the associated knowledge base was built with JavaFX for the user-friendly frontend and Apache Jena for the robust backend. The tool's evaluation involved test users who unanimously found the interface accessible and usable, even for those without extensive technical expertise.

Conclusions: Through the establishment of a structured and standardized framework for characterizing IOM events, our ontology-based tool holds the potential to enhance the quality of documentation, benefiting patient care by improving the foundation for informed decision-making. Furthermore, researchers can leverage the semantically enriched data to identify trends, patterns, and areas for surgical practice enhancement. To optimize documentation through ontology-based approaches, it's crucial to address potential modeling issues that are associated with the Ontology of Adverse Events.

Keywords: Adverse events; Apache Jena; BFO; Knowledge base; Neurosurgery; Ontology.

Fig. 1

Schematic visualization of the pathway with MEPs. Transcranial electrical stimulation (yellow flash) of the motor cortex results in a response that is transmitted through the brain and spinal cord to cause muscle contraction. Here a brain tumor (brown) infiltrates the motor pathways. By using IOM techniques, as much tumor as possible can be removed with the goal of preserving motor function at the same time

Fig. 2

The relevant section regarding measurements related to continuants in IOMDO

Fig. 3

Results of the HermIT Reasoner in connection inconsistencies

Fig. 4

Graphical user interface for documenting events in the IOMDO software

Fig. 5

Saved RDF/XML of the documented events in the IOMDO software file as displayed in Protégé

Fig. 6

Core concepts of IOMDO and their application in entering records into the ontology via the GUI

Fig. 7

The two query types in the IOMDO tool GUI. Predefined ones at the top and SPARQL queries at the bottom. On the left side, the create query view (Abfrage erstellen) is selected. On the upper right side of the view, the user can execute a predefined query, which will be executed in the backend by clicking the button execute (Ausführen)

Fig. 8

A sequence diagram showing how the user interaction with the GUI is forwarded to the backend to store and query data in the ontology