The neural network conclusion-making system For foot abnormality recognition

J. Piecha

Abstract The devices and software units partly presented in the paper have been developed for data collection, visualisation and automatic conclusion in orthopaedics. This equipment provides the user with various tools for analysis, diagnostics and data handling. The diagnostics tools are having a pressure and load distribution on the foot, while taking into account the individual needs of the patient [1, 2, 3]. A big set of options in the system presented in the paper gives the user different aims in putting the diagnosis [5]. The product described in this paper makes the orthopaedic expertise faster and easier. Due to make the system friendlier and easier to use, to not very experience users, several options have been offered. They allow comparing the pattern record of the patient way of walking (for a healthy man) with pathological objects. The neural network implemented for that purpose is used as an engine for an automatic data record recognition (read on a sensors-set of insoles) concerning the orthopaedic diseases. The current data records are compared with several classes of records describing the knowledge database of the patients diseases. The comparison procedures use the expert knowledge that has been created by simulation processes using several functions of a class co-relation. The records in-coming into the network are matched with the most relevant model of the pathology or abnormality.

Key words: neural networks, pedobarography, conclusion-making systems, orthopaedic diagnostics, diagnostics in neurology.

1 Introduction
The automatic conclusion-making systems and computer diagnostic tools are often used in different elds of medicine. The paper presents an example of expert system that has been developed for PSW (Parotec System for Windows) diagnostic device [8]. The PSW works as a visual interface using several options that support feet abnormalities recognition [7, 9]. The data record is collected by sensor set installed in insoles of patient shoes, then the data is converted into relevant format and visualised by several units on a computer screen. The data allows analysing the patients footprint and a way of walking [8, 9, 10]. Fig. 1 shows the example record of two-dimensional picture of the patients footprint that shows the pressure distribution on a foot. Any better form of the visual interface is still a source of the information that is estimated by the user and it can not be used as a measure. Only a very well trained in the PSW usage operator is able to put proper diagnosis, observing the visual forms of the data. The quality of diagnosis depends mostly on how the user is able to handle with the options and how the various forms of data can be put into the diagnosis. The doubts concerning diagnosis are reasonable smaller when the measuring system uses conclusion-making formulas. Knowledge database concerning specic diseases classies the current record, as the computer system allows collecting conclusions dened by very experience doctors.

Dept. of Electronics & Computer Systems, Institute of Informatics Silesian University, Str. piecha@us.edu.pl

Be dzi nska 60, 41-200 Sosnowiec, Poland email:

16th IMACS World Congress ( c 2000 IMACS)

Figure 1: The example footprint of the PSW/Static data.

2 The conclusion-making unit

The automatic conclusion unit makes the diagnosis easier and faster [4, 6, 11]. It contains several formulas used for ltering and extracting a specied data that are linked together into the decision-making system, mentioned in Fig. 2. The conclusion-making unit consists of two independent blocks: - a pre-processor that collects the data, converts and visualises the data-record into a relevant format for the user interface, - a user visual an processing interface with a database for pre-processed data records and for patients personal data. The database contains two data frames: the personal data of the patient, with the diagnosis keywords and the data comments describing the medical check-up. The conclusion making part of the system consists of: - the neural network processing unit, overworking the data into a format convenient for the neural network structure, - the explanations unit, converting the diagnosis given in the neural network output matrix into the data record with adequate comments, - a visual interface that contains dialogue for users interaction with the system, in time of the network teaching and using.

3 The neural network

The neural network allows describing the conclusion-making formulas, difcult to dene by classical algorithms using mathequations. They bound the object variables by the formulas that simulate functions of a human brain, while the teaching procedures dene the neural network features. To main tasks of the neural network designer belong: the relevant set of network input and output variables selection, the neurone structure denition, the network dimensions denition, the network training process selection.

Figure 2: A block diagram of the conclusion making system.

The input and output variables: The size of the data record depends on measurement duration, walking speed and a clock frequency of the data recorder. That is why any different records need standardisation, to release them from time relations mentioned above. Due to make the identication process simpler the user has to use a limited number of key words (outputs) describing diseases. During the network teaching process the same set of keywords is used.

The network neurone equation: The neural network cell implemented in this work has been built using sigmoid functions: y

1 e

The coecient denes the function shape, from nearly linear function (for small values of ) into relay curve characteristics (for big values of ).

The network dimensions: High quality of the conclusion depends more on teaching process of the network then on the network complexity. The neural network designed for the PSW [6] software consists of three levels, with one hidden level (Fig. 3). Any neurone in the network layer is linked with every neurone in a next layer. It is obvious that this is the most simplied structure of the network. Anyhow this assumption has not any important meaning in making the automatic conclusion, what is more this starting structure of neural network is automatically modied during the training process of the network. From all links between the neurones remain only these well dened during the training processes of the network.

Figure 3: The three-level neural network.

The example for the network dimensions: The number of input variables directly denes the dimension of input level of the network. The dynamic data of PSW record concerns ve steps (two feet) with twenty samples for the step and 24 sensors on the insole. That numbers produce 4800 inputs in the network. The output variables set size depends on fully dened pathological features that the network is able to distinguish. For starting experiments the size of hidden level of the network has been dened as a square root of product from input and output variables number. For 4800 inputs and 10 output variables the size of the hidden level of the network is equal 219. When that value is not big enough the network is unable to project all data characteristics (of a data record) into a proper diagnosis. When the neurone number of the network is to big the network will work on the memorised examples, not being able to develop its knowledge mechanisms and the database content.

The network training methods: In the neural network learning process several example data sets on network inputs have been given. After some modications of the neurones weight the network improved its conclusions with correct answers for the data record used in the teaching process. In case the transition function of the neurone, number of linkages between neurones, topology of the network and teaching methods have been selected properly we can expect exact conclusions for examples not tested in the process of training. For the network learning/training process the back-propagation algorithm has been implemented [4]. In this way of training the neural network inputs weights are controlled due to obtain minimal differences between the results generated by the network and the expected diagnosis.

One of the important advantages of the neural network is its ability to collect knowledge, concerning specied objects, during the network training. A main condition of putting a proper diagnosis is to provide the network with the diseases representatives during the training process.

4 The experiments in clinics

For the experiments in clinics several neural network structures have been implemented. They have been trained for the foot abnormality recognition. The example network (1.x):

Layers - three layers of the network: input/hidden/output-layer with 4800/219/10 neurones respectively.

The computer characteristics

5 at least 8MB operating memory available for the network description, the control unit of the network uses additional 8MB memory, the memory space for operating facilities 16 MB, that means 32 MB of a total operating memory space, the speed of the computer, with Pentium 133 MHz processor, has been estimated as 15 calculations per minute.

The neural network case 1.0: - a total number of data records: 26 - two active outputs with: A. 13 records belonging into physiological group of features (pg), B. 13 records with bunion pathology (bp). Tasks: the neural network has to recognise the group, into which the current data record belongs, Training: the training data set of the network has been limited into 20 records: - 10 records from physiological group (pg), - 10 with bunion pathology (bp). The training record format: pxxxxxxx.sto pg or bp empty line pxxxxxxx.sto ... the name of the patient, the name of the pathology class, for comments, next patient

In the training process of the network a random data records have been selected. They have been put onto the network input and the adequate output of the network has been assigned; representing the specied diagnosis (pg lub bp). The network training functions select the neurones weights to match the current data record with active outputs of the diagnosis, dened by medical experts. The training process has been stopped when number of iterations has reached 1000 while diagnosis faults do not reached 0,5%. The exam: The neural network has been examined by six data records not used in training process; three for both group. These records have been examined by the conclusions that were in accordance with diagnosis of experts. The exam results have been mentioned in table 1. The expert diagnosis bp (bunion pathology) pp pp pg (physiolog. group) pg pg The not experienced user diagnosis by the PSW visual interface ? (not recognised case) bp pg (wrong diagnosis) ? pg (wrong diagnosis) bp Table 1: The exam statistics The neural network has made a proper diagnosis in the following cases: - undoubted cases of the disease, - when not experienced medical stuff has doubts to dene the disease . Anyhow, when not qualied network user put a wrong conclusion the same mistake made the network. The wrong conclusion has been made because of: - not sufcient number of records in the network training process, - a wrong description (recognition) of the disease, - the structure of neural network not properly selected, The neural network conclusion bp bp pg pg pg bp

6 - not effective training algorithm of the network. The neural network, case 1.1: - a total number of data records: 53 (47 for training, and six for examination). - active outputs: 6 Task: the network has to recognise the group of the most relevant to the current record. The network training: the data set for network training consisted of 47 records. physiological group (pg) with 12 records, 7 records of the bunion pathology (bp), 6 records with a left-sided paresis, 4 records with a right-sided paresis, 7 records with a left-sided ischialgia, 11 records with a right-sided ischialgia.

Before we started the network training 6 records have been separated. They have not been used for the network training but for verifying effectiveness of the conclusion-making unit. After the 50000 training iterations the learning process of the network has been nished. The conclusion faults for records with similar features of the training records did not overcome 1%. The network has properly dened 41 records from 47, with the conclusion fault below 1%. The six remaining records have not been recognised at all. The diagnosis fault reached 100%, as this kind of the disease has not been represented the network training (5 records of para-paresis and 1 record of ischialgia). In spite of a big number of iterations, the network has not been able to generalise (to adopt) all of 47 data records. The zero level of the disease recognition concerns the records with neurological backgrounds - they were not well dened by medical experts in our system. What is more, the difculties with the disease recognition caused a big similarity of the disease data load spectrum. During the experiments with the neural network we discover the difculties with records recognition for left- and right-sided diseases. It is obvious that similar records are very difcult to distinguish and to classify. The effectiveness of the conclusion making system, that distinguishes one disease from many others and extracts the disease features in very similar cases depends directly on the record set size used in training process. In case the iteration number increases, when the training data record set is to small the neural network is unable to distinguish the specic features of pathologies belonging into similar groups. The exam: The six data records have been used in evaluation of the network: - physiological group of data (pg) with 3 records in it, - 2 records of the bunion pathology (bp), - 1 record with a right-sided paresis. The exam results: - record #1 (physiological group) 51% of a proper recognition with less then 1% features of another disease. - record #2 (physiological group): 59% of the a proper recognition with less then 1% features of another group. - record #3 (physiological group): 0% of a proper recognition with 82% features of a left-sided ischialgia (Fig.4). Looking at the load distribution on the left footprint we can say that this record can not be treated as the physiological one. The patient is walking on a right foot supporting only his body by the left foot (compare the load trajectories of several steps). The medical expert has dened this record wrong. The left footprint shows a deep pathology recognised properly by the computer system. - record #4 (the bunion pathology - Fig. 5): 0% of the recognition made by the medical expert with 99% features of physiological group. This example can be commented in the same way as a previous one. The medical expert has made the mistake of the expertise, anyhow the computer system corrected his mistake properly as the footprint shows regular trajectories of the load distribution on both feet.

Figure 4: Pathology on a left foot.

Figure 5: The proper footprint.

- record #5 (the bunion pathology): 2% of a proper recognition with 9% features of the physiology. More careful analysis convinced the users that the data has been recorded in a wrong way. Every step shows different map of the pressure distribution. That means this is a case with much more complex disease that the recognised one or the insoles were wrong fastened. - record #6 (a right-sided ischialgia): 0 % of a proper recognition with 57% features of right-sided paresis. It can be noticed as a wrong recognition of the pathology, as this patient suffers from neurological diseases. The clinical experiments mentioned above proved a high ability of the disease recognition by means of the neural network conclusion making system. The neural network theory has been successfully applied for expert systems development within the orthopaedic diagnostics. The growing number of the disease classes makes the pathology case recognition more difcult. When grows the number of records used in the network training process the disease recognition coefcient is also growing up. When the training sequence is not long enough the disease class recognition can not be possible. The experiments in clinics, reported in this paper, concern not only orthopaedic eld but also the neural source of the diseases - with similar footprint to orthopaedic abnormalities. These experiments make putting several key remarks possible: - when grows the neural network size (complexity) and the time of the network training is not long enough, the network collects many not important detail information that make the disease recognition very difcult or not possible, - the clinical evaluation process is more effective when the data records (for the network training and evaluation) are clear dened, strictly describing the pathology and physiology of the footprint.

5 Conclusions
The experiments with network 1.x gave the expert system designers several ideas how to modify the product, among them: to remove the patients weight in data records, the average load distribution from several steps (instead of a single step record) has been used for the records features recognition. The network structure developed for the experiments proved the practical ability of the neural network in the orthopaedic diseases recognition. Very encouraging results have also been noticed in the area of neurology. This area does not dene any formulas that allow describing the abnormalities of walking in neurological measuring systems. That is why we can assume that for this class of the disease, the only method for developing the automatic conclusion-making system one can nd within the neural-network formulas.

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