title: Neurologist consistency in interpreting information provided by an interactive visualization software for deep brain stimulation postoperative programming assistance.
abstract: BACKGROUND
  Postoperative programming in deep brain stimulation (DBS) therapy for movement disorders can be challenging and time consuming. Providing the neurologist with tools to visualize the electrode location relative to the patient's anatomy along with models of tissue activation and statistical data can therefore be very helpful. In this study, we evaluate the consistency between neurologists in interpreting and using such information provided by our DBS programming assistance software.
  
  
  METHODS
  Five neurologists experienced in DBS programming were each given a dataset of 29 leads implanted in 17 patients. For each patient, probabilistic maps of stimulation response, anatomical images, models of tissue activation volumes, and electrode positions were presented inside a software framework called CRAnialVault Explorer (CRAVE) developed in house. Consistency between neurologists in optimal contact selection using the software was measured.
  
  
  RESULTS
  With only the efficacy map, the average consistency among the five neurologists with respect to the mode and mean of their selections was 97% and 95%, respectively, while these numbers were 93% and 89%, respectively, when both efficacy and an adverse effect map were used simultaneously. Fleiss' kappa statistic also showed very strong agreement among the neurologists (0.87 when using one map and 0.72 when using two maps).
  
  
  CONCLUSIONS
  Our five neurologists demonstrated high consistency in interpreting information provided by the CRAVE interactive visualization software for DBS postoperative programming assistance. Three of our five neurologists had no prior experience with the software, which suggests that the software has a short learning curve and contact selection is not dependent on familiarity with the program tools.
authors: Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA.
authors: Srivatsan
authors: S
authors: Pallavaram
authors: Fenna T
authors: FT
authors: Phibbs
authors: Christopher
authors: C
authors: Tolleson
authors: Thomas L
authors: TL
authors: Davis
authors: John
authors: J
authors: Fang
authors: Peter
authors: P
authors: Hedera
authors: Rui
authors: R
authors: Li
authors: Tatsuki
authors: T
authors: Koyama
authors: Benoit M
authors: BM
authors: Dawant
authors: Pierre-François
authors: PF
authors: D'Haese
mesh_terms: D001931:Brain Mapping / Q000295:instrumentation; D032882:Comprehension; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008959:Models, Neurological; D015233:Models, Statistical; D009069:Movement Disorders / Q000473:pathology / Q000628:therapy; D009119:Muscle Contraction; D009127:Muscle Rigidity; D059906:Neuroimaging; D009462:Neurology; D015203:Reproducibility of Results; D012984:Software; D014584:User-Computer Interface
keywords: 3D anatomical structures; computer-assisted postoperative programming assistance; deep brain stimulation; electrophysiological statistical atlases; nonrigid image registration
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