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Early detection of ulceration in diabetic feet an intelligent telemedicine monitoring system

Projectomschrijving

Voetzoolcontrole op afstand
Veel patiënten met diabetes mellitus hebben vaat- en zenuwproblemen aan de voeten. Daardoor krijgt ongeveer 15% van de patiënten te maken met chronische wonden (ulcera). Indien niet adequaat behandeld, kunnen deze wonden infecteren. Dit kan uiteindelijk leiden tot amputatie van (een deel van) de voet of het onderbeen. Vroege herkenning en behandeling kan wonden en amputatie voorkomen. Probleem is echter dat patiënten vaak last hebben van stijve ledematen en verminderd zicht. Zelfonderzoek is daardoor moeilijk of onmogelijk. In dit project wordt gewerkt aan een intelligent ‘telegeneeskundig monitoring systeem’.

Doelstelling
Het vaststellen van de benodigde functionele architectuur voor een thuiscontrolesysteem voor diabetespatiënten met voetproblemen. Het systeem moet met behulp van een intelligente sensor voortekenen van chronische voetwonden opsporen (eelt, roodheid, blaren en scheuren). Het uiteindelijke doel van het project is te komen tot een adequaat en betaalbaar systeem dat kan worden geplaatst bij de patiënten thuis.

Verslagen


Samenvatting van de aanvraag

Many patients with diabetes mellitus suffer from vascular and neurological complications in the lower extremities. These include loss of protective sensation and reduced arterial blood flow in the feet. These conditions significantly increase the risk of developing foot ulcers (chronic wounds). Approximately 15% of all diabetes patients eventually develop a foot ulcer. If not adequately treated, these ulcers may lead to foot infection and eventually to amputation of (part of) the foot or the lower leg. Foot ulcers may be prevented by early recognition and subsequent treatment of pre-signs of ulcers, such as callus formation, redness, fissures, and blisters. For this purpose, frequent examination of the feet is needed, preferably on a daily basis. However, patients at high risk for developing foot ulcers often suffer from stiff limbs and reduced eye-sight as complication of the disease, so that self examination is difficult or not possible. Daily examination by health care professionals is costly and not feasible. In a previous project (Vincent50) a series of photographic foot-sole scanners were built and tested to overcome these problems. These scanners were deployed at the patients’ homes to take photographs of the sole of the patient’s feet on a daily basis. The photographs were then automatically transferred through the internet to a specialized foot clinic where they were examined by trained professionals. Although this project showed good agreement between the diagnosis of foot disease from a photograph and from live assessment, the scanners were limited in that only the foot sole could be imaged whereas many ulcers develop on the dorsum of the foot. Furthermore, important signs such as abundant callus and redness were considered difficult to diagnose from the photographs and diagnosis was not automated requiring significant time from health care professionals. In this proposal, we envision an intelligent telemedicine monitoring system that can be deployed at the patient’s home and that overcomes the limitations of the previous scanner. This system is capable of reliably detecting (pre-signs of) ulceration on an automated basis using intelligent sensor principles. Based on the detection of pre-signs, the risk of a beginning ulceration is assessed, and, if needed, the system signals the user and/or a remote specialist that treatment is warranted. Regular screening (daily or every other day) with this device may significantly contribute to the prevention of ulceration and amputation in diabetes and with that significantly improve patient autonomy and health related quality of life in these patients. By a selective distribution of the device to a high-risk category of patients, the device is expected to be cost-effective and significantly reduce healthcare cost. The design, development, and widespread implementation of the device cannot be realized within one NiG project. Therefore, we intend to achieve our goals in two steps: an applied research project (the current proposal), and an implementation project by means of a follow-up proposal (not belonging to the current proposal). The goal of the current proposal is to determine the needed functional architecture of the device, and to provide a proof of concept in the automated detection of early stages and pre-signs of ulceration. First, we will investigate which modalities (physical principles of image formation) add diagnostic value to just photographic imaging. The literature suggests that infrared imaging is informative for some types of pre-signs. Other candidates are hyperspectral imaging, photometric stereo imaging, and 3D surface imaging. Our proposal is to develop a scanner which combines the most promising modalities. Secondly, we will develop algorithms to process the acquired image data (from different sensors) and automatically detect pre-signs of ulceration to timely warn the patient and/or physician. Thirdly, the diagnostic quality of the various modality combinations, and the corresponding algorithms, will be investigated using clinical data. The successful development of an intelligent foot scanner for the patient’s home provides a technological telemedical advancement for extramural care for chronic medical problems that to date are mainly dealt with in an intramural setting. Our experience with previous projects is that such a device can be easily implemented in the home environment of the patient and is safe and easy to use providing good adherence. This greatly increases the autonomy of the patient who is already largely dependent on health care due to the complexity of the disease. Additionally, the successful development of this device will greatly increase work-employment in the region.

Onderwerpen

Kenmerken

Projectnummer:
300040001
Looptijd: 100%
Looptijd: 100 %
2010
2015
Onderdeel van programma:
Projectleider en penvoerder:
Dr. ir. F. Heijden
Verantwoordelijke organisatie:
Universiteit Twente