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博碩士論文 etd-0411116-205333 詳細資訊
Title page for etd-0411116-205333
論文名稱
Title
一個基於權重的方法去分類尿流速曲線圖
A Weight-based Approach to the Classification of Uroflowmetry Curves
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
97
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2016-06-03
繳交日期
Date of Submission
2016-06-04
關鍵字
Keywords
尿流速圖型、尿流速曲線、流速指數、分類、權重計分
Uroflowmetry Curves, Classification, Uroflow Pattern, Flow Index, Weighted Grade
統計
Statistics
本論文已被瀏覽 5682 次,被下載 33
The thesis/dissertation has been browsed 5682 times, has been downloaded 33 times.
中文摘要
尿流速測定是一個在排尿時所測量的尿液流量及體積,也是一個常用且對人體無侵入性的泌尿診斷症狀的測量工具。然而尿路動力學是一個包含了許多項目的檢測,對於評估排尿功能是非常有價值的。其中尿流速測定比起其他檢測項目而言是一個好檢查及簡單操作的檢測,其測量的結果可以用來幫助評估膀胱及尿道的功能是否正常。而且尿流速測定在人體開始正常排尿時可以評估是否有阻塞物在裡面。排尿量、尿流速曲線和最高的尿流速是判讀尿流速測定結果時最常提到的參數。在尿流速測定裡面,我們可以很容易地知道排尿量及最高的尿流速的數據,但是尿流速測定裡只會顯示尿流速曲線,卻無法知道尿流速曲線是屬於哪一種類型,所以醫師必須要依照他們的經驗去進行圖型的分類。然而在判讀分類的結果中,醫師之間的一致性是非常差的。而為了避免在分類尿流速圖型時有錯誤,醫師必須要調整尿流速曲線的水平軸和垂直軸的長度比例。此外,當人們開始排放尿液到結束時,所形成的曲線不會是完美的鐘形,這種結果是因為不同的尿流速類型考慮的條件可能會有重疊的情況。為了要增強和醫師之間判讀尿流速曲線的一致性,我們詳細的調查判讀尿流速測定結果時會使用的參數及了解各個尿流速圖型的種類。因此,我們提出了一個基於權重的方法去分類尿流速圖,這是整合了醫師對於判讀尿流速圖型的經驗以及不同的條件給予不同的權重。然而將每一個類型的分數計算出來,分數最高的就是我們判讀的結果。當中我們直接用了座標及幾個重要的參數去運算,以至於我們不需要調整水平軸和垂直軸的比例就可以做判讀。除此之外,我們的方法不只在判斷是否為中斷型時可以將小曲線的面積精準的算出,還可以正確地知道流速的上升角度、掉落角度及掉落次數,這相較於醫師在判讀時更有效率及更可靠。所以,我們的方法在尿流速測定的分類結果有效地增強和醫師們觀察的一致性。從我們的實驗結果去做統計分析,比較我們方法的結果與一或二位醫師觀察的結果,在分類正常與異常的圖型時有很好的一致性。此外,在分類個別的圖型時亦有很好的一致性。雖然在分類平台型和阻塞型的一致性是差的,但其原因是醫師也很困難去定義這二種圖型的不同。因此,我們認為我們的尿流速曲線圖的分類決策規則在電腦輔助教學上面是有助於泌尿科學生的學習。
Abstract
Uroflowmetry, which measures the flow and volume of urine during urination, is a common, noninvasive urinary test to diagnose symptoms. The uroflowmetry results can help with assessment of bladder urethra function. The voided volume, the flow curve, and the maximum flow rate are the most frequently mentioned as relevant for interpretation. We can easily get the data of voided volume and maximum flow rate from uroflowmetry, but the flow curve only shows on the uroflowmetry. The result does not show what pattern it belongs to. The physicians need to classify the flow curve by their experiences. However, the results of the flow curve are usually poor agreement among the physicians. To avoid errors in classification of flow curves, before the physician interprets the flow curve, the scales of the horizontal and vertical axes for the output of the flow curve must be adjusted. Moreover, the flow curve may not be the perfect bell-shaped pattern, when the people released the urine from their body, which results in the situation that decided conditions of different patterns may be overlap. In order to increase the degree of the agreement of the results of uroflowmetry curves with the physician’s observation, we survey the parameters in interpreting uroflowmetry, and the uroflow pattern. Therefore, we propose a weight-based approach to the classification of flow curves, which integrates the physician’s interpretation experiences and different weights for different conditions, and the compared pattern with the highest score is the resulting pattern. Besides, we use the coordinates of both axes and several needed parameters to compute the result directly, so that the scale of horizontal and vertical axes are not needed to be adjusted. Moreover, our method not only accurately calculates the area of small curves which will affect the interrupted-shaped pattern, but also correctly computes the rising angle, the drop angle, and the number of drops which are more reliable and effective than the physician’s interpretation. Hence, the results of uroflowmetry efficiently enhance the degree of the agreement among the physicians’ observation by our approach. From our performance study by statistic analysis of comparing the results of our approach with one/two physician’s observation, we show that for the agreement of normal/abnormal types, it is good. Moreover, for the agreement of the specific patterns, it is also good. Although for the agreement of the plateau-shaped and the obstructive-shaped patterns are not good, we find the reason which includes it is also difficult for the physician to define the differences between these two patterns. Therefore, we suggest that our decision rules for pattern classification could be useful in CAI for students with a major in urology.
目次 Table of Contents
THESIS VALIDATION LETTER . . . . . . . . . . . . . . . . . . . . . . i
ACKNOELWDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
ABSTRACT (CHINESE) . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
ABSTRACT (ENGLISH) . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
1. Introduction ................................. 1
1.1 UrinarySystem.............................. 2
1.2 UrodynamicTests............................. 3
1.3 Uroflowmetry ............................... 6
1.4 InterpretationofUroflowmetry ..................... 7
1.5 RelatedWork ............................... 10
1.6 Motivation................................. 11
1.7 OrganizationoftheThesis........................ 13
2. Survey..................................... 14
3.
2.1 ParametersinReadingUroflowmetry .................. 14
2.2 UroflowPattern.............................. 17
2.2.1 NormalUroflowPattern ..................... 18
2.2.2 AbnormalUroflowPattern.................... 19
2.3 Poor Inter-observer Agreement on Interpretation of Uroflowmetry Curves ofKindergartenChildren......................... 25
A Weight-based Approach to the Classification of Flow Curves . 27
3.1 ScalesofHorizontalandVerticalAxes ................. 27
3.2 ConditionsofInterpretedPatterns ................... 30
3.3 TheGradingPolicyforPatterns..................... 40
3.3.1 OverlappingConditions ..................... 41
3.3.2 GradesforDifferentConditions ................. 46
3.3.3 The Priority of Interpretation of Uroflowmetry Curves . . . . 54
4. Performance ................................. 57
4.1 PerformanceModel............................ 57
4.1.1 StudyDesign ........................... 59
4.1.2 StatisticalAnalysis ........................ 59
4.2 ExperimentsResults ........................... 60
5. Conclusion .................................. 75
5.1 Summary ................................. 75
5.2 FutureWork................................ 76
BIBLIOGRAPHY................................ 77
A. Cohen’sKappaExample ......................... 81
參考文獻 References
[1] Urodynamics Testing. National Institute of Diabetes and Digestive and Kidney Diseases, 2014.
[2] P. Abrams, J. G. Blaivas, S. L. Stanton, and J. T. Andersen, “Standardisation of Terminology of Lower Urinary Tract Function,” Neurourology and Urodynamics, Vol. 7, No. 5, pp. 403–427, 1988.
[3] P. Abrams, L. Cardozo, M. Fall, D. Griffiths, P. Rosier, U. Ulmsten, P. V. Kerre- broeck, A. Victor, and A. Wein, “The Standardisation of Terminology in Lower Urinary Tract Function: Report From the Standardisation Sub-committee of the International Continence Society,” Urology, Vol. 61, No. 1, pp. 37–49, 2003.
[4] P. Abrams, R. Feneley, and M. Torrens, Urodynamics. Springer, 2006.
[5] P. Abrams and M. Torrens, “Urine Flow Studies,” Urol Clin North Am, Vol. 6,
No. 1, pp. 71–79, Feb 1979.
[6] P. H. Abrams, R. C. Feneley, and M. Torrens, Urodynamic Investigations. Springer, 1983.
[7] D. Altman, Practical Statistics for Medical Research. Chapman & Hall/CRC Texts in Statistical Science, Taylor & Francis, 1990.
[8] P. F. Austin, S. B. Bauer, W. Bower, J. Chase, I. Franco, P. Hoebeke, S. Rittig, J. V. Walle, A. von Gontard, and A. Wright, “The Standardization of Termi- nology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardisation Committee of the International Children’s Con- tinence Society,” The Journal of Urology, Vol. 191, No. 6, pp. 1863–1865, 2014.
[9] S. J. Chang, I. N. Chiang, C. H. Hsieh, C. D. Lin, and S. D. Yang, “Age-and Gender-specific Nomograms for Single and Dual Post-void Residual Urine in Healthy Children,” Neurourology and Urodynamics, Vol. 32, No. 7, pp. 1014– 1018, 2013.
77
[10] S. J. Chang, C. H. Hsieh, and S. D. Yang, “Constipation is Associated with Incomplete Bladder Emptying in Healthy Children,” Neurourology and Urody- namics, Vol. 31, No. 1, pp. 105–108, 2012.
[11] S. J. Chang and S. D. Yang, “Inter-observer and Intra-observer Agreement on Interpretation of Uroflowmetry Curves of Kindergarten Children,” Journal of Pediatric Urology, Vol. 4, No. 6, pp. 422–427, 2008.
[12] S. J. Chang and S. D. Yang, “Variability, Related Factors and Normal Reference Value of Post-void Residual Urine in Healthy Kindergarteners,” The Journal of Urology, Vol. 182, No. 4, pp. 1933–1938, 2009.
[13] S. J. Chang, S. D. Yang, and I. N. Chiang, “Large Voided Volume Suggestive of Abnormal Uroflow Pattern and Elevated Post-void Residual Urine,” Neurourol- ogy and urodynamics, Vol. 30, No. 1, pp. 58–61, 2011.
[14] Y. C. Chuang, P. Tyagi, C. C. Huang, M. B. Chancellor, and N. Yoshimura, “Mechanisms and Urodynamic Effects of a Potent and Selective EP4 Receptor Antagonist, MF191, on Cyclophosphamide and Prostaglandin E2-induced Blad- der Overactivity in Rats,” BJU international, Vol. 110, No. 10, pp. 1558–1564, 2012.
[15] G. Drach, T. Layton, and W. Binard, “Male Peak Urinary Flow Rate: Rela- tionships to Volume Voided and Age.,” The Journal of Urology, Vol. 122, No. 2, pp. 210–214, 1979.
[16] I. Franco, S. D. Yang, S. J. Chang, B. Nussenblatt, and J. A. Franco, “A Quanti- tative Approach to The Interpretation of Uroflowmetry in Children,” Neurourol- ogy and Urodynamics, 2015.
[17] M. Gacci, G. Del Popolo, W. Artibani, A. Tubaro, D. Palli, G. Vittori, A. Lapini, S. Serni, and M. Carini, “Visual Assessment of Uroflowmetry Curves: Description and Interpretation by Urodynamists,” World Journal of Urology, Vol. 25, No. 3, pp. 333–337, 2007.
[18] T. R. Jarvis, L. Chan, and V. Tse, “Practical Uroflowmetry,” BJU International, Vol. 110, pp. 28–29, 2012.
[19] K. Jensen, J. Jørgensen, and P. Mogensen, “Reproducibility of Uroflowmetry Variables in Elderly Males,” Urological Research, Vol. 13, No. 5, pp. 237–239, 1985.
[20] C. E. Kelly, “Evaluation of voiding dysfunction and measurement of bladder volume,” Reviews in Urology, Vol. 6, No. Suppl 1, pp. S32–S37, 2004.
78
[21] H. C. Kuo, “Videourodynamic Results in Stress Urinary Incontinence Patients After Pelvic Floor Muscle Training,” Journal of the Formosan Medical Associa- tion, Vol. 102, No. 1, pp. 23–29, 2003.
[22] Mark Mitchell, “Engauge Digitizer Version 4.1,” 2002.
[23] T. Nev ́eus, A. von Gontard, P. Hoebeke, K. Hj ̈alm ̊as, S. Bauer, W. Bower, T. M. Jørgensen, S. Rittig, J. V. Walle, and C.-K. Yeung, “The Standardization of Ter- minology of Lower Urinary Tract Function in Children and Adolescents: Report from the Standardisation Committee of the International Children’s Continence Society,” The Journal of Urology, Vol. 1, No. 176, pp. 314–324, 2006.
[24] M. Torrens and P. Abrams, “Cystometry,” Urol Clin North Am, Vol. 6, No. 1, pp. 79–85, Feb 1979.
[25] C. Van de Beek, H. Stoevelaar, J. McDonnell, H. Nijs, A. Casparie, and R. Janknegt, “Interpretation of Uroflowmetry Curves by Urologists,” The Jour- nal of urology, Vol. 157, No. 1, pp. 164–168, 1997.
[26] Wikipedia, “Cohen’s kappa — Wikipedia, The Free Encyclopedia,” 2016. [On- line; accessed 29-April-2016].
[27] P. J. Yang, J. Pham, J. Choo, and D. L. Hu, “Duration of Urination Does Not Change with Body Size,” Proceedings of the National Academy of Sciences, Vol. 111, No. 33, pp. 11932–11937, 2014.
[28] S. D. Yang and S. J. Chang, “The Effects of Bladder Over Distention on Voiding Function in Kindergarteners,” The Journal of Urology, Vol. 180, No. 5, pp. 2177– 2182, 2008.
[29] S. D. Yang and S. J. Chang, “Uroflowmetry in Children can be Simply Classified as Normal or Abnormal Pattern,” Urological Science, Vol. 21, No. 3, pp. 142–144, 2010.
[30] S. D. Yang, I. N. Chiang, and S. J. Chang, “Interpretation of Uroflowmetry and Post-Void Residual Urine in Children: Fundamental Approach to Pediatric Non-neurogenic Voiding Dysfunction,” Incontinence & Pelvic Floor Dysfunction, Vol. 6, No. 1, pp. 9–12, 2012.
[31] S. D. Yang, I. N. Chiang, C. H. Hsieh, and S. J. Chang, “The Tzu Chi Nomograms for Maximum Urinary Flow Rate (Qmax) in Children: Comparison with Miskolc Nomogram,” BJU International, Vol. 113, No. 3, pp. 492–497, 2014.
79
[32] S. D. Yang, C. C. Wang, and Y. T. Chen, “Home Uroflowmetry for the Evaluation of Boys with Urinary Incontinence,” The Journal of Urology, Vol. 169, No. 4, pp. 1505–1507, 2003.
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