Predictive medicine: Computational techniques in therapeutic decision-making

TLDR

Current cardiovascular surgery planning relies on imaging, empirical data, and surgeon judgment, yet the inherent variability of human biology limits the ability of these sources alone to predict individual treatment outcomes. We introduce a predictive medicine paradigm that employs computational tools to build a combined anatomico‑physiologic model for forecasting the outcomes of alternative treatment plans in individual patients. This paradigm is realized in a Simulation‑Based Medical Planning software that integrates an internet interface, image segmentation, solid modeling, mesh generation, CFD, and visualization to evaluate patient‑specific treatment alternatives for lower‑extremity occlusive disease.

Abstract

AbstractThe current paradigm for surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We propose a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomidphysiologic model to predict the outcome of alternative treatment plans for an individual patient. The predictive medicine paradigm is implemented in a software system developed for Simulation-Based Medical Planning. This system provides an integrated set of tools to test hypotheses regarding the effect of alternate treatment plans on blood flow in the cardiovascular system of an individual patient. It combines an internet-based user interface developed using Java and VRML, image segmentation, geometric solid modeling, automatic finite element mesh generation, computational fluid dynamics, and scientific visualization techniques. This system is applied to the evaluation of alternate, patient-specific treatments for a case of lower extremity occlusive cardiovascular disease.