Authors: S.K. Shoukourian, A.K.Shukurian, A.A.Avagyan, A.M. Vasilyan

1. Designing a Virtual Operating Room for Operative Interventions under Some Pathologies of Middle Ear. A Case of the Database Authors: S.K. Shoukourian, A.K.Shukurian, A.A.Avagyan, A.M. Vasilyan ENT Department 2 Koryun str., 375025 Yerevan State Medical University Yerevan, Armenia Tel: (3741) 56 05 94 Fax: (3741) 52 96 05 E-mail: ashukuryan@yahoo.com

2. EXPECTED ACHIEVEMENTS • A thought simulation technology both for off-line and on-line modes of simulation; • Simulation execution of different models of a hearing system; • Easy changes of a model; • A simplicity for changing simulation algorithms ; • A smooth addition of a new models, simulation algorithms and modes; • No dependence of a hearing system specific configurations; • Easy usage of different interfaces to existing biomedical networks and telecommunication resources

3. OBJECTIVES OF THE PROPOSED RESEARCH • Creation of a models and applications for predication of operative interventions and hearing function changes (a virtual operating room) • Creation of a cheap and justified technology for simulation algorithms and operative interventions strategies in off-line and on-line modes and for different abstraction levels; • Creation of the theoretical methods and algorithms for the design justification of models (e.g., operative intervention); • Creation of an object-oriented technology base (algorithms, program utilities and interfaces) within the existing computer-integrated environments and telecommunication resources; • investigation of the advantages of the technology for concrete classes of middle ear pathologies; • evaluation of the correlation degree and nature between conductive and neurasensoral violations of hearing;

4. A system for the actuality evaluation for an OI model A model generation system for an OI process A control system for an OI process An operative field TECHNICAL DESCRIPTION A VIRTUAL OPERATING ROOM

5. Information flow Rules of evaluation A goal structure A goal strA system of results evaluationucture A history archive of models development An archive of models An agent of a model generation A goal structure ACTUALITY EVALUATION SUBSYSTEM A MODEL GENERATION SUBSYSTEM

6. A process manager A surgeon A scheduler A dispatcher An agent for error correction An agent for process optimization An assistant An agent for process monitoring An agent for process diagnosis TECHNICAL DESCRIPTIONA CONTROL SYSTEM FOR AN OI PROCESS

7. Components of middle ear A set of devices A state of an operative field Adegree of a disease reasons A set of instruments A patient state Groups of a disease reasons AN OPERATIVE FIELD

8. A virtual operating room An interface for a virtual operating room Database A diagnostic equipment A real operating room AN INTERCONNECTION BETWEEN VIRTUAL AND REAL OPERATING ROOMS

9. Object 1 Object 2 Object 3 Object 4 A list of operation triggers Broker of objects A list of assumptions A clock TECHNICAL DESCRIPTIONA SIMPLIFIED VERSION OF INFORMATION EXCHANGE

10. AN INTERFERENCE WITH GLOBAL BIOMEDICAL NETWORKS • automatic transmission of different medical images and data (e.g., audiograms) and retransmission of analysis results; • using of possibilities of 3D visualization within a virtual operating room; • using of possibilities of HPC cites for experiments with complicated models;

11. Tympanic membrane Malleus Incus Stapes Inner ear Outer ear Stapes muscle Muscles of tympanic membrane Horizontal semicircular canal Tympanicccavity Eustacheantube Mucous membrane Mastoid processus TECHNICAL DESCRIPTIONA MODEL OF MIDDLE EAR IN A FORM OF INTERACTING OBJECTS

12. Tympanic membrane1. normal2. attic perforation3. edge perforation4. central perforationMalleus and incus1. normal2. affectionStapes1. normal2. affection of foot plate3. no affection of foot plate Mucous membrane1. normal2. hyperplasie3. polyp Muscles of tympanic membrane and stapes1. normal2. affection Eustachean tube and mastoid processus 1. normal2. affection Horizontal semicircular canal 1. normal 2. affection

13. A TECHNOLOGY BASEALGORITHMS AND MODELSAlgorithms of predicationModels of hearing organ and operative interventionsHARDWAREGlobal telecommunication networksSpecial hardwareSOFTWAREUser-friendly programming abstractionsSpecial software

14. EXAMPLES OF PROBLEMS TO BE EXAMINED3D VISUALIZATION AND PROCESSING DURING INVESTIGATION OF A TEMPORAL BONEDETERMINATION AND LOCALIZATION OF OTOSCLEROSIS HEARTHSSIMULATION AND DETERMINATION OF ACOUSTIC PARAMETERS FOR DIFFERENT TRANSPLANTATION MATERIALSINVESTIGATION OF DIFFERENT POSSIBLE COMPLICATION OWING TO PECULIARITIES OF A PATIENT

15. Anesthesia Ear channel Ossicular chain Tympanic membrane Mucosa surgery Many to One Many to Many One to many (“Multiple to Single”) ("Multiple to Multiple") ("Single to Multiple") Operative Therapy Intervention Otosurgeon Diagnosis Patient Anamnesis Pharmaceutical Therapy Clinical Examinations Roentgen Anatomical evaluation Biochemical Audiometry results Vestibular status Anesthesia STRUCTURE OF THE INFORMATION FIELD

16. Functional Specification System Design Component Implementation A METHOD OF DESIGNSTEPS OF A DESIGN PROCESS

17. Allocation Partitioning Refinement Memories Variables to memories Address assignment Variables Processors Behaviors to processors Interfacing Behavior Connections Channels Protocols Channels SYSTEM DESIGN TASKS • Allocation defines system components for the given functional specification; • Partitioning assigns functional object to allocated components; • Refinementupgrades the original specification to reflect the impact of a given allocation and partition.

18. INITIAL REQUIREMENTS TO THE DATABASE SYSTEM 1. An opportunity of distributed data processing; 2. Tables, which are describing parameters of a patient examination or technique of an operative intervention, contain too many descriptive attributes; 3. Information can be obtained in a graphical form (for example, roentgenograms); 4. Direct receipt of information from a diagnostic medical equipment is possible; 5. An opportunity of real time processing; 6. Usage of data both from local and global computer-integrated environments; 7. A differentiation of access, based on a centralized password authorization of a user as well as on a concept of user groups with the group rights (medical, laboratory, administrative personnel, patients) and a concept of groups for information field resources (personal data, laboratory results, diagnoses, operative interventions). 8. Data integrity limitations implied by the relations "single to multiple", "multiple to multiple" and "inherence" between objects. 9. Declarative data integrity limitations, imposed by descriptive attributes.

19. CLINICAL ASPECTS OF A VIRTUAL OPERATING ROOM FOR PREDICTION OF OPERATIVE INTERVANTIONS UNDER SOME PATHOLOGIES OF MIDDLE EAR • A retrospective review of satiating meanings for the word "virtual" in the area of computer sciences clearly demonstrates its development from a virtual storage, then a virtual machine to a virtual reality, i.e. an adequate 3D framework and an environment for a user generated by a computer. It allows without any effort to include and to merge a user within the mentioned environment. The virtual reality hides reading, writing and arithmetic and replaces it by direct, non-symbolic environmental experience. The problems of a virtual reality turned to be specially important for novel complicated and higher-precision technologies. At the same time these technologies very rapidly become obsolete and the main problem here is a great contradiction between the time of determining optimal modes and possibilities of such a technology and the time of a new technology creation. • This is the reason why investigations in the area of virtual high-precision technologies are considered as the most global and important problems within many national and international perspective scientific programs. All the existing achievements in modern information technologies and computer-integrated environments including global networks, communication resources, multimedia, etc. are serving to achieve solutions for these problems.

20. On the other hand, an intensive development of a surgical medical instrument set and tools (microscopes, lasers, computer monitoring, etc.), a tendency of decreasing essentially a time interval between a new and a typical operative intervention and a tendency of increasing essentially a complexity of operative interventions and a number of surgical patients allow to ascertain as the determining for the present and the nearest future a creation of high-precision, complicated, computer-integrated and, at the same time, rapidly becoming obsolete technologies of operative interventions. • The described situation is very typical for otosurgery which could be characterized, on one hand, by a complexity of a miniature hearing organ, a usage of a very high-precision instrument set, essential contradictions among scientific references on operative interventions and, on the other hand, a relatively compact and simple operative environment. • All the mentioned characteristics make otosurgery evidently suitable for experiments on its immersion into a computer-integrated environment. • The planned system will make simulation and prediction of operative interventions transparent and empower the participant with natural interaction. The technical challenge is to create mediation languages and tools which enforce rigorous mathematical computation while supporting intuitive behavior. • The system will be based on new possibilities of computer-integrated environments and will be presented in a form of a virtual operating room.