Ignite Creation Date:
2024-05-06 @ 11:42 AM
Last Modification Date:
2024-10-26 @ 12:49 PM
Study NCT ID:
NCT03587935
Status:
COMPLETED
Last Update Posted:
2019-04-16
First Post:
2018-07-03
Brief Title:
A Clinical Validation Study of a Computerized Movement Analysis of the Colonoscope
Sponsor:
Rigshospitalet Denmark
Organization:
Rigshospitalet Denmark
Study Overview
Official Title:
A Clinical Validation Study of Two Computerized Systems Called the 3D-Colonoscopy Progression Score and 3D-Colonoscopy Retraction Score
Status:
COMPLETED
Status Verified Date:
2019-04
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Colonoscopy is the considered gold standard for diagnosing diseases in the colon A colonoscopy is normally divided into the insertion from anus to cecum the technical difficult part and a retraction or diagnostic part No objective measure exists to evaluate the performance of a colonoscopy Based on a movement analysis of the colonoscope we wish to seek evidence for an automated and objective system able to differentiate between endoscopists with various experience in a clinical setting The movement analysis is based on informations from the colonoscope Electromagnetic coils are built in along the length of colonoscopes They generate a pulsed magnetic field that is picked up a receiver coil The data-points for each coil are inserted into an algorithm for the movement analyzing This analysis is done as a change between the tip of the scope and the next tracked magnetic coil The result is a relative movement of the colonoscope in relation to the previous position
The study is conducted a three different University Hospitals in Denmark Twenty physicians with experience in colonoscopy are voluntary included Patients appointed to a screening colonoscopy are included and a minimum of five consecutive colonoscopies are recorded for each physician We predict the system to be automated and objective tool correlated with the physicians technical level of expertise in clinical colonoscopy
The study is conducted a three different University Hospitals in Denmark Twenty physicians with experience in colonoscopy are voluntary included Patients appointed to a screening colonoscopy are included and a minimum of five consecutive colonoscopies are recorded for each physician We predict the system to be automated and objective tool correlated with the physicians technical level of expertise in clinical colonoscopy
Detailed Description:
Objectives
1 Gather validity evidence for the 3D-Colonoscopy Progression score 3D-CoPS and 3D-Colonoscopy Retraction Score 3D-CoRS in a clinical setting
2 Investigate the relationship between 3D-CoPS3D-CoRS and a retrospective calculated Adenoma Detection Rate ADR of endoscopists with various experience
Background
Colonoscopy is the gold standard for diagnosing adenomas and colorectal cancer High Adenoma Detection Rate ADR is essential to reduce the risk of subsequent colorectal cancer To maximize the detection of adenomas during a colonoscopy the endoscopist need to see as much mucosa as possible To increase the mucosa visualized quality indicators such as bowel preparatin cecal intubation rate and an average time of at least 6 minutes spent during withdrawal should be used as supportive measures to minimize missed lesions and thereby decreasing interval cancer Bowel preparation cecal intubation and time spent during withdrawal are prerequisite measures for optimal visualization of the mucosa in the colorectum but are not a quality measure for actual detected pathology Time as a quality assurance for detection of adenomas means nothing if the physician isnt careful during withdrawal and look behind folds and change position to get a clear view of the mucosa surface The ADR has been introduced as a surrogate measure of adequate visualization of the mucosa but a recommend and a minimum number of 500 colonoscopies are needed to calculate a statistic reliable ADR Although ADR is one of the most widely used and accepted quality indicators great variance in number of performed procedures and ADR among physicians exits which makes ADR difficult to use in practice Currently there is no quality parameter evaluating the individual procedure and to our knowledge no objective tools exits to help increase diagnostic accuracy during a colonoscopy Objective easy implementable and automatic measures are needed to ensure a high detection of adenomas and subsequently prevent missed lesions and interval cancers
In collaboration with the Technical University of Denmark we have developed a score of progression and retraction during a colonoscopy called 3D-Colonoscopy Progression Score 3D-CoPS and 3D-Colonoscopy Retraction Score 3D-CoRS We predict the systems to be automated and objective tool correlated with the endoscopists technical level of expertise in clinical colonoscopy
Method and materials
Retrospective study part
The study is conducted at three different university hospitals Twenty endoscopists with a lifetime experience of no less than 50 screening colonoscopies are voluntarily enrolled To calculate the ADR for each endoscopist data of the last screenings colonoscopies is retrospectively collected minimum 50 colonoscopies per endoscopist
The following will be noted for each endoscopist
Number of total colonoscopies
Number of colonoscopies within the last year
Number of other endoscopies
Number of screenings colonoscopies
Intern junior resident senior resident consultant
Surgical or medical gastrointestinal background
Sex
Age
Time since graduation
Prospective part
A minimum of five consecutive screenings colonoscopies for each endoscopist are included Patients appointed to a screening colonoscopy are chosen due to a higher ADR approximately 50 and a more homogeneous group All procedures are performed with a standard Olympus colonoscope model in combination with the Magnetic Endoscopy Imaging system MEI Data collection starts at the intubation of the colonoscope in the anus and stops when the procedure is finished The data collection is fully automated without any interference from the investigators during the normal clinical setup
Approval is applied at the Danish Data Protection Agency the Danish Patient Safety Authority and the Regional Committee on Health Research Ethics
General mathematical formulation for 3D-CoPS and 3D-CoRS
Electromagnetic coils are built in along the length of the Olympus colonoscopes They generate a pulsed low-intensity magnetic field that is picked up a receiver coil The data-points for each coil are inserted into an algorithm for movement analyzing The two main measurements conducted in relation with the colonoscopy is the Colonoscopy Progression Score CoPS and Colonoscopy Retraction Score CoRS Both of these have a joint basis for the analysis in the form of a movement analysis This analysis is done as a vector product between the tip of the scope and the next tracked magnetic coil - where on the relative magnitude of the change in position is multiplied on This results in a relative movement that is scaled with how much the scope moves in relation to the previous position and how much this movement is deflected according to the direction the tip points in This movement analysis is used for distinction between the progression- and retraction phase which is essential such that the CoPS and CoRS measurements is performed at the right times
3D-CoPS To perform the CoPS measurement the above definition helps by defining the progression phase The general belief is that if the scope progresses smoothly the colonoscopist is experienced and vice versa Therefor tracking how much time the tip of the scope is stagnant is used to define the CoPS Specifically a two dimensional histogram is used spanned across the movement area of the colonoscopy Filling the histogram is simply performed by sampling the tip position at each time step and putting it into the respective bin If the scope is then stagnant at many stages throughout the procedure the bins values will be locally very high On the other hand if a smooth progression is present the bin values will be smoothly distributed across all the different bins This is the basis for the CoPS value Finally followed with a normalizing and scaling of the 2D histogram value for easing interpretation
3D-CoRS Analyzing the retraction phase must be done differently as the tip is supposed to be stagnant at different times through this phase Therefor the movement analysis as described above is used to measure how the instrument moves This movement is then high-passed filtered as experienced colonoscopist seems to have much more high frequency movements where-in the novices moves with much lower frequency more hesitant This overall movement is evaluated as a difference between the different positions by differentiation and a count of peaks and valleys is done with a fitting margin This final count is then high if an expert is performing the procedure as more high frequency movements will take place and low if a novice is performing the procedure
Patient related information
Number of polyps
The polyp size
Polyp type
Polyp histology
Polyp location
Validity
Evidence of validity is based on Messicks five major sources 10
Content
1 3D-CoPS and 3D-CoRS are being developed based on the evidence of an ongoing simulation-based validation study A Validation Study of a Computerized Movement Analysis of the Colonoscope in Simulated Colonoscopy and general good practice of how a colonoscope is withdrawn from cecum to anus
Response process
The process is standardized using an Olympus colonoscope and MEI system All participants will be instructed informed of the systems and the data-collection All data-collection regarding are presented in a uniform file-format The 3D-CoPS and 3D-CoRS are objective automated and unbiased tools
Internal structure
To ensure internal consistency of the 3D-CoPS and 3D-CoRS among the endoscopists a minimum of 5 consecutive colonoscopies are needed based on an article not yet published The score system is automated and unbiased why the internal structure in this regard is consistent
Relationship to other variables
We assume the sample data reflects a population that follows a probability distribution based on a fixed set of parameters The correlation between experience logarithmic and scores will be investigated using Pearsons r Scores from 3D-CoPS and 3D-CoRS will be correlated with patient and endoscopist variables The endoscopist is not blinded during data-collection which might affect the performance Even thou data collection is fully automated the technic during withdrawal of the colonoscope from caecum to anus could change and increase mucosa visualized and therefore polyp detection increased awareness of the endoscopist
Consequences
Contrasting groups method will be used to set a passfail standard based on the scores imitating aminimum performance during intubation a minimum ADR and false positive and false negative will be investigated
Ethics
The study contains no biomedical involvement Participants and patients will not suffer from any physical or psychological discomfort All endoscopists will be provided with oral and written information and sign a letter of informed consent before entering the study The collected data are anonymized
1 Gather validity evidence for the 3D-Colonoscopy Progression score 3D-CoPS and 3D-Colonoscopy Retraction Score 3D-CoRS in a clinical setting
2 Investigate the relationship between 3D-CoPS3D-CoRS and a retrospective calculated Adenoma Detection Rate ADR of endoscopists with various experience
Background
Colonoscopy is the gold standard for diagnosing adenomas and colorectal cancer High Adenoma Detection Rate ADR is essential to reduce the risk of subsequent colorectal cancer To maximize the detection of adenomas during a colonoscopy the endoscopist need to see as much mucosa as possible To increase the mucosa visualized quality indicators such as bowel preparatin cecal intubation rate and an average time of at least 6 minutes spent during withdrawal should be used as supportive measures to minimize missed lesions and thereby decreasing interval cancer Bowel preparation cecal intubation and time spent during withdrawal are prerequisite measures for optimal visualization of the mucosa in the colorectum but are not a quality measure for actual detected pathology Time as a quality assurance for detection of adenomas means nothing if the physician isnt careful during withdrawal and look behind folds and change position to get a clear view of the mucosa surface The ADR has been introduced as a surrogate measure of adequate visualization of the mucosa but a recommend and a minimum number of 500 colonoscopies are needed to calculate a statistic reliable ADR Although ADR is one of the most widely used and accepted quality indicators great variance in number of performed procedures and ADR among physicians exits which makes ADR difficult to use in practice Currently there is no quality parameter evaluating the individual procedure and to our knowledge no objective tools exits to help increase diagnostic accuracy during a colonoscopy Objective easy implementable and automatic measures are needed to ensure a high detection of adenomas and subsequently prevent missed lesions and interval cancers
In collaboration with the Technical University of Denmark we have developed a score of progression and retraction during a colonoscopy called 3D-Colonoscopy Progression Score 3D-CoPS and 3D-Colonoscopy Retraction Score 3D-CoRS We predict the systems to be automated and objective tool correlated with the endoscopists technical level of expertise in clinical colonoscopy
Method and materials
Retrospective study part
The study is conducted at three different university hospitals Twenty endoscopists with a lifetime experience of no less than 50 screening colonoscopies are voluntarily enrolled To calculate the ADR for each endoscopist data of the last screenings colonoscopies is retrospectively collected minimum 50 colonoscopies per endoscopist
The following will be noted for each endoscopist
Number of total colonoscopies
Number of colonoscopies within the last year
Number of other endoscopies
Number of screenings colonoscopies
Intern junior resident senior resident consultant
Surgical or medical gastrointestinal background
Sex
Age
Time since graduation
Prospective part
A minimum of five consecutive screenings colonoscopies for each endoscopist are included Patients appointed to a screening colonoscopy are chosen due to a higher ADR approximately 50 and a more homogeneous group All procedures are performed with a standard Olympus colonoscope model in combination with the Magnetic Endoscopy Imaging system MEI Data collection starts at the intubation of the colonoscope in the anus and stops when the procedure is finished The data collection is fully automated without any interference from the investigators during the normal clinical setup
Approval is applied at the Danish Data Protection Agency the Danish Patient Safety Authority and the Regional Committee on Health Research Ethics
General mathematical formulation for 3D-CoPS and 3D-CoRS
Electromagnetic coils are built in along the length of the Olympus colonoscopes They generate a pulsed low-intensity magnetic field that is picked up a receiver coil The data-points for each coil are inserted into an algorithm for movement analyzing The two main measurements conducted in relation with the colonoscopy is the Colonoscopy Progression Score CoPS and Colonoscopy Retraction Score CoRS Both of these have a joint basis for the analysis in the form of a movement analysis This analysis is done as a vector product between the tip of the scope and the next tracked magnetic coil - where on the relative magnitude of the change in position is multiplied on This results in a relative movement that is scaled with how much the scope moves in relation to the previous position and how much this movement is deflected according to the direction the tip points in This movement analysis is used for distinction between the progression- and retraction phase which is essential such that the CoPS and CoRS measurements is performed at the right times
3D-CoPS To perform the CoPS measurement the above definition helps by defining the progression phase The general belief is that if the scope progresses smoothly the colonoscopist is experienced and vice versa Therefor tracking how much time the tip of the scope is stagnant is used to define the CoPS Specifically a two dimensional histogram is used spanned across the movement area of the colonoscopy Filling the histogram is simply performed by sampling the tip position at each time step and putting it into the respective bin If the scope is then stagnant at many stages throughout the procedure the bins values will be locally very high On the other hand if a smooth progression is present the bin values will be smoothly distributed across all the different bins This is the basis for the CoPS value Finally followed with a normalizing and scaling of the 2D histogram value for easing interpretation
3D-CoRS Analyzing the retraction phase must be done differently as the tip is supposed to be stagnant at different times through this phase Therefor the movement analysis as described above is used to measure how the instrument moves This movement is then high-passed filtered as experienced colonoscopist seems to have much more high frequency movements where-in the novices moves with much lower frequency more hesitant This overall movement is evaluated as a difference between the different positions by differentiation and a count of peaks and valleys is done with a fitting margin This final count is then high if an expert is performing the procedure as more high frequency movements will take place and low if a novice is performing the procedure
Patient related information
Number of polyps
The polyp size
Polyp type
Polyp histology
Polyp location
Validity
Evidence of validity is based on Messicks five major sources 10
Content
1 3D-CoPS and 3D-CoRS are being developed based on the evidence of an ongoing simulation-based validation study A Validation Study of a Computerized Movement Analysis of the Colonoscope in Simulated Colonoscopy and general good practice of how a colonoscope is withdrawn from cecum to anus
Response process
The process is standardized using an Olympus colonoscope and MEI system All participants will be instructed informed of the systems and the data-collection All data-collection regarding are presented in a uniform file-format The 3D-CoPS and 3D-CoRS are objective automated and unbiased tools
Internal structure
To ensure internal consistency of the 3D-CoPS and 3D-CoRS among the endoscopists a minimum of 5 consecutive colonoscopies are needed based on an article not yet published The score system is automated and unbiased why the internal structure in this regard is consistent
Relationship to other variables
We assume the sample data reflects a population that follows a probability distribution based on a fixed set of parameters The correlation between experience logarithmic and scores will be investigated using Pearsons r Scores from 3D-CoPS and 3D-CoRS will be correlated with patient and endoscopist variables The endoscopist is not blinded during data-collection which might affect the performance Even thou data collection is fully automated the technic during withdrawal of the colonoscope from caecum to anus could change and increase mucosa visualized and therefore polyp detection increased awareness of the endoscopist
Consequences
Contrasting groups method will be used to set a passfail standard based on the scores imitating aminimum performance during intubation a minimum ADR and false positive and false negative will be investigated
Ethics
The study contains no biomedical involvement Participants and patients will not suffer from any physical or psychological discomfort All endoscopists will be provided with oral and written information and sign a letter of informed consent before entering the study The collected data are anonymized
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None