ON REASONING WITH IMAGES: THE USE OF IMAGES IN CLINICAL RESEARCH Thomas Bittner Louis Goldberg University at Buffalo

CLINICAL RESEARCH IN TEMPOROMANDIBULAR DISORDERS TMD is a pain and disability disorder current studies have significantly increased the size of the domain of analysis to capture all relevant variables the temporomandibular joint (TMJ) is a crucial variable: it drives diagnosis and treatment controversies abound concerning the relationship of joint characteristics as represented in images to patient symptoms and treatment choices problem: how to represent TMJ image characteristics in a computer- based system that is interoperable with other data collected in the study

EXAMPLES OF MEASURABLE VARIABLES pain levels functional capacity gross mobility of the jaw mobility of the TMJ pressure-pain threshold of the TMJ biopsychosocial factors contributing to TMD

CLINICAL RESEARCH IN TEMPOROMANDIBULAR DISORDERS TMD is a pain and disability disorder current have studies increased the size of the domain of analysis to capture all relevant variables the temporomandibular joint (TMJ) is a crucial variable: it drives diagnosis and treatment controversies abound concerning the relationship of joint characteristics, as represented in images, to patient symptoms and treatment choices problem: how to represent TMJ image characteristics in a computer- based system that is interoperable with other data collected in the study

The problems with pre-coordination, such as the pre-coordination of certain relationships of entities in the TMJ with clinical syndromes.

AN EXAMPLE OF PRE- COORDINATION zone of articulation: relation of the posterior band of the articular disc in relation to the head of the condyle in the closed position. The posterior band should be between 11:30 and 12 o’clock. If it is anterior to that position it demonstrates the pathology; anterior disc displacement

Consequences How to resolve conflicts that arise out of pre-coordination in the face of deeply held beliefs. Research is necessary to determine if such pre-coordinations are valid.

TMJ DYNAMICS: NORMAL Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

TMJ DYNAMICS: NORMAL & ABNORMAL Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 2001

RECAPTURE OF THE DISC Annika Isberg,Temporomandibular joint Dysfunction:A Practitioner's Guide, ISIS Medical Media, 20019

GOAL represent the relationships among the condyle, the articular disc and the temporal bone in an automatic system

the practical point of view the ontology must be immediately useful to a specific research enterprise

OVERVIEW 1.Identify the major parts of the TMJ 2.Establish the connectedness and adjacency relations among the various parts 3.Establish the qualitative order relations using landmarks as frames of reference 4.Establish relative size relations

Major parts of the TMJ the TMJ is a real, three dimensional structure choose the coarsest level of granularity sufficient to distinguish the major proper parts of the TMJ gross anatomical granularity in this case

Major parts of the TMJ material parts rigid parts non-rigid parts cavities

ANTERIOR material parts TMDs: An Evidence Based-Approach to Diagnosis and Treatment. (2006) Eds: D. M. Laskin, C. S. Greene, W. L. Hylander. Quintessence Books, Chicago.

Rigid material parts parts that do not change shape (bones) fixed movable

Non-rigid material parts parts that do change shape but the topology does not change: the connected parts remain connected

ANTERIOR Cavities filled with liquid: synovial fluid in the case of the TMJ

we have identified three kinds of entities (parts) in the TMJ material rigid material non-rigid cavities

Connectedness and adjacency relations among the parts of the joint

Connectedness Relations ANTERIO R connectedness graph

closed and opened positions jaw closed jaw opened TMDs: An Evidence Based-Approach to Diagnosis and Treatment. (2006) Eds: D. M. Laskin, C. S. Greene, W. L. Hylander. Quintessence Books, Chicago.

Connectedness remains invariant in the opened and closed positions ANTERIO R connectedness Connectedness graph

Every TMJ can be represented by this connectedness graph Connectedness graph

adjacency relations No connectedness Only (temporary) adjacency Connectedness adjacency graph Adjacency relations

adjacency At all times the disc (red) is adjacent to the fossa (yellow) At all times the disc (red) is adjacent to the condyle (pink) Adjacency relations But at different times the disc may be adjacent to different parts of the fossa / condyle

Adjacency disc-fossa Time 1

Adjacency disc-fossa Time 2

Adjacency disc-fossa Time 3

Adjacency disc-condyle Time 1

Adjacency disc-condyle Time 2

Adjacency disc-condyle Time 3

Ordering relations Refining adjacency relation between disc and fossa Refining adjacency relation between disc and condyle Specifying relative location of condyle and fossa

Shape landmarks of the fossa Rigid does not Change shape (bones) Convex curvature changes to concave

Fiat boundaries Rigid does not change shape (bones) Convex curvature changes to concave

Rigid does not change shape (bones) Local maxima/ minima Shape landmarks of the fossa

Rigid does not change shape (bones) articular (glenoid)fossa articular eminence Shape landmarks of the fossa

Fiat boundaries Rigid does not change shape (bones)

Fiat boundaries Rigid does not change shape (bones) 6 major fiat parts

Frames of reference Rigid does not change shape (bones) A B C D E F Circle is adjacent-to A

Frames of reference Rigid does not change shape (bones) A B C D E F Circle is adjacent-to B

Frames of reference Rigid does not change shape (bones) A B C D E F Disc is adjacent-to C and D

Ordering relations Refining adjacency relation between disc and fossa Refining adjacency relation between disc and condyle Specifying relative location of condyle and fossa

Shape landmarks of the condyle as frame of reference anterior head of condyle Disc is adjacent to the posterior head of the condyle Posterior head of condyle

Shape landmarks of the condyle as frame of reference anterior head of condyle Disc is adjacent to the posterior and anterior head of the condyle Posterior head of condyle

Shape landmarks of the condyle as frame of reference anterior head of condyle Disc is adjacent to the anterior head of the condyle Posterior head of condyle

Ordering relations Refining adjacency relation between disc and fossa Refining adjacency relation between disc and condyle Specifying relative location of condyle and fossa

Middle axis of the condyle Extension of The middle axis Shape landmarks of the condyle

Frames of reference Rigid does not change shape (bones) A B C D E F The extension of the axis of the condyle intersects the fossa in region C

Frames of reference Rigid does not change shape (bones) A B C D E F The extension of the axis of the condyle intersects the fossa in region D

Bringing the various ordering relations together

Ordering relations Refining adjacency relation between disc and fossa Refining adjacency relation between disc and condyle Specifying relative location of condyle and fossa

Ordering relations A B C D E F A B C D E F

bringing together multiple ordering structures: two frames of reference locates the position of the disc and condyle with respect to each other and to the fossa The extension of the axis of the condyle intersects the fossa in region D A B C D E F The disc is adjacent-to fossa regions C and D The disc is adjacent to the posterior and anterior head of the condyle

we now have a three dimensional combinatorial space of possible relationships contained in the domain of the TMJ

All combinatorial possible constellations Disc adjacent to posterior head

All combinatorial possible constellations Disc adjacent to anterior head Disc adjacent to posterior head

All combinatorial possible constellations ABCDEF Disc is adjacent to fossa region Disc adjacent to posterior head

All combinatorial possible constellations ABCDEF A B C D E F Axis Of Condyle intersects Disc is adjacent to fossa region Disc adjacent to posterior head

ABCDEF A BXXX C D E F Axis Of Condyle intersects Disc is adjacent to fossa region Disc adjacent to posterior & anterior head

ABCDEF A BX C D E F Axis Of Condyle intersects Disc is adjacent to fossa region Disc adjacent to anterior neck

ABCDEF A BXX C D E F Axis Of Condyle intersects Disc is adjacent to fossa region Disc adjacent to anterior head & neck

ABCDEF A B C D EXX F Axis Of Condyle intersects Disc is adjacent to fossa region Disc adjacent to posterior & anterior head

Conclusions/ Methodology

TMJ ontology Mereology How many parts What kind of parts Topology Which parts are connected Which parts are adjacent

TMJ ontology Mereology How many parts What kind of parts Topology Which parts are connected Which parts are adjacent Qualitative order How are things arranged with respect to each other How does relative location change during movement

TMJ ontology Qualitative order How are things arranged with respect to each other How does relative location change during movement A|B|C|D|E|F adjacent-to intersects