Artificial Intelligence- a paradigm shift in Health care Management

Introduction

Artificial Intelligence (AI) is gradually changing the practice of surgery with the
advanced technological development of imaging, navigation, and robotic intervention. In this
article, the recent successful and influential applications of AI in medicine are reviewed from
preoperative planning and intra-operative guidance to the integration of surgical robots. We
end with summarizing the current state, emerging trends, and significant challenges in the
future development of AI in surgery. Robotic surgery is the use of computer technologies
working in conjunction with robot systems to perform medical procedures. The technology is
also known as computer-aided surgery and robot-assisted surgery. Robotic surgery, or robot-
assisted surgery, allows doctors to perform many types of complex processes with more
precision, flexibility, and control than is possible with conventional techniques. Robotic
surgery is usually associated with minimally invasive surgery procedures performed through
tiny incisions. It is also sometimes used in specific traditional open surgical procedures. The
Food and Drug Administration approved robotic surgery with the da Vinci Surgical System
in 2000. "The technique has been rapidly adopted by hospitals in the United States and
Europe for use in the treatment of a wide range of conditions. The most widely used clinical
robotic surgical system includes a camera arm and mechanical arms with surgical instruments
attached to them. The surgeon controls the arms while seated at a computer console near the
operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the
surgical site. The surgeon leads other team members who assist during the operation".

Research Objective
This paper reviews the critical capabilities of AI to help surgeons understand and
critically evaluate new AI applications and to contribute to new developments in the field of
Neuro Surgery.
Subfields in AI
AI's roots are found across multiple fields, including robotics, philosophy, psychology,
linguistics, and statistics. Significant advances in computer science, such as improvements in
processing speed and power, have functioned as a catalyst to allow for the base technologies
required for the advent of AI. The growing popularity of AI across many different industries
has attracted venture capital investment up to $5 billion in 2016 alone. Much of the current
attention on AI has focused on the four core subfields introduced below.

AI for surgical robots

Figure 1

AI in upskilling neurosurgical procedures

Brain tumor ablation has been identified as an ideal procedure for autonomous robotic
surgery. "It involves the perception of the environment by the robotic system and a
corresponding adaption of its behavior to the changing environmental parameters. Knot tying
in suturing is also a challenge for the deployment of AI. The shape and exact location of
cortical motor areas vary among individuals. The exact knowledge of these locations is
crucial for the planning of neurosurgical procedures. Robot-assisted image-guided
transcranial magnetic stimulation (Ri-TMS) to elicit motor evoked potential responses
recorded for individual muscles have been used to reconstruct functional motor maps of the
primary motor cortex (Little, S.,2016). It is becoming increasingly difficult for a
neurosurgical resident to "learn" on a patient in the OT. Realistic neurosurgical simulations
are the need of the hour. A computer-based, virtual reality platform offers simulated
resistance and relaxation, with passage of a virtual three-dimensional (3D) ventriculostomy
catheter through the brain parenchyma into the ventricle. Advances in AI and science and
technology of haptics (recognizing objects through touch) is improving the learning of
clinical skills and procedures" ( Beudel, M.,2016).

AI in seizure disorders
A machine learning approach to predict the outcome of epilepsy surgery, based on supervised
classification and data mining, taking into account not only the standard clinical variables but
also the pathological and neuropsychological evaluations, is now available. The outcome
could be predicted with an accuracy of almost 90% using some clinical and
neuropsychological features(Senova S,2018). Importantly, not all the elements were needed
to perform the prediction. Automatic seizure detection using scalp electroencephalogram
(EEG) and advanced artificial intelligence techniques have been reported following pre-
processing with filtering and artifact removal(Harris, J. J.,2012).
AI in the Neurosurgical OT
It is now accepted that brain tumors cause substantial reorganization of functional
systems. "AI-assisted functional registration exhibits higher predictive power than anatomical
registration(Vassileva, A.,2018). Functional localization of activated but displaced regions is
necessary, particularly in cases where tumor-induced changes of the haemodynamics make
direct localization difficult. Matching functional brain regions across individuals is
challenging, largely due to variability in their location and extent. The addition of pathology
can cause substantial reorganization of functional systems. Advances in neural information
processing systems using AI addresses these issues" (Fomenko, A., & Serletis, D. (2018).
AI in Neuro-Oncology
Current machine learning techniques provide the opportunity to develop non-invasive
and automated glioma grading tools, utilizing quantitative parameters derived from multi-
modal MRI data. Zhang et al. reported a classification accuracy of over 90%, which is more
than that of an experienced neuro-radiologist(Evangelista, E.,2015). "Prediction models based
on data-mining and machine-learning algorithms have provided a much more accurate
prediction of prognosis in malignant gliomas than is possible using histopathologic
classification alone. Fully automated enhanced tumor compartmentalization was compared
with semi-automatic segmentation done by four experts. Though feasible, the results were
similar and took a long time(Duun-Henriksen, J.,2012). The use of machine learning
algorithms along with the extraction of relevant features from MRI images and MR
spectroscopy holds the promise of replacing conventional invasive methods of tumor
classification".

Artificial Intelligence in Neuro-Traumatology

"Machine-learning models have been developed for predicting mortality following
trauma in motorcycle riders. Artificial neural networks (ANN) have been used to predict
outcome following head injury(Bidiwala, S., & Pittman, T. (2004). ANN significantly
outperformed regression models and clinicians on multiple performance measures. They
opine that this form of modeling could ultimately serve as a useful clinical decision support
tool. Fuzzy logic and machine learning algorithms have been used in the study of traumatic
brain injuries.
AI in Imaging Services
Filtering incoming images based on priority using deep learning is now well accepted.
The algorithm looks at the images to identify brain hemorrhage or stroke. If the computer
detects one of the flagged factors, the patient will move up on the priority list to have their
images analyzed first(Lin, C. C.,2017). If the algorithm does not detect any critical factors,
the record falls towards the bottom of the priority list. AI can help image quality control,
imaging triage, efficient image creation, computer-aided detection, computer aided-
classification, and automatic report drafting(Serletis, D.,2016). Deep learning algorithms can
improve MRI image quality, even notifying the technologist that images are too fuzzy to be
read accurately. MRI image quality will develop in reducing the patient's time in the
machine.
Along with neuroimaging technology, network analysis is improving, leading to better
preoperative evaluation(Vakharia, V. N.,2017). Presurgical localization of the eloquent
cortex, glioma grading measured by resting-state fMRI, and localization of epileptic focus are
a few examples of the use of AI. Big data analysis of healthy controls has led to the
quantification and visualization of individual variations for functional localization. A
functional cortical atlas has been developed using datasets from 1,000 healthy controls".

Figure 2

Among the medical disciplines, neurosurgery has been one of the most to benefit from
AI-driven technological innovations. In particular, the subspecialty of stereotactic and
functional Neuro-surgery has seen an explosion of research concerning ways to intelligently
automate the diagnosis and treatment of movement-related disorders and
epilepsy(Winters,2012). Critical neurosurgical applications of AI include robot-assisted
surgery, automated preoperative planning, diagnostic brain imaging classification, surgical
candidate selection, prediction of postoperative patient outcomes, and localization of epileptic
zones within the brain(Dorfer, C.,2017). Robotic neurosurgery is the first innovation that will
be examined in detail here and deals with the challenges of improving the accuracy, speed,
and safety of minimally-invasive targeting of deep brain regions(senders,2018). Second, the
role of machine learning (ML) in analyzing the brain's electrical activity will be presented,
with the goal of smarter diagnosis and more individualized therapy for disorders such as
Parkinson's Disease and epilepsy. Finally, the challenges of deploying AI into the operating
room will be examined, with a focus on ethical and practical implications.

Current Applications
ANNs within medicine currently fit into three categories:

 Diagnosis

 Prognosis

 Outcome prediction

Within neurosurgery, ANNs have been employed for analysis of:

 Lumbar spinal stenosis

 Disc herniation

 Brain tumors

 Epilepsy

 Trauma

 Cerebral vasospasm

Figure 3

Neurosurgeons and neurologists are often tasked with interpreting electrical

recordings from surface EEG, surgically implanted subdural grids, or intracranial electrodes
for the investigation of refractory epilepsy(Gonzalez-Martinez, J.,2014). These recordings
can be long and complicated, carrying information about dozens of channels of raw
electrophysiology data from brain regions interconnected in elaborate ways. Several ML
algorithms have been developed and tested in epilepsy patients to detect seizures before they
occur automatically. These seizure warning systems can be immensely helpful for the patient,
as they prompt administration of anticonvulsive medications or trigger the patient to move to
a safer area. (Rivkin, M. A., & Yocom, S. S. (2014). For instance, after training an algorithm
on publicly available intracranial EEG recordings, the software was able to automatically
select optimal channels for analysis and achieve a 96% sensitivity for seizure prediction, with
only 0.12 false detection per hour. Indeed, seizure advisory systems such as Neuro-Vista are
commercially available, though they currently lack a way to optimize their algorithms in real-
time based on the patient's pattern of electrical activity. Instead, automated seizure detection
systems can achieve sub-second latencies due to pre-programmed algorithms within the
device, which may have previously undergone the ML training process in the development
stage (Shigeki Yokoi, & Takami Yasuda. (1993). Taken a step further, closed-loop DBS
devices are being developed with algorithms that detect patterns highly suggestive of
impending seizures, and then automatically deliver electrical stimulation to abort the seizure.
Role of Artificial Intelligence in treating COVID 19 Crisis Situation
Regarding Data sharing and rapid analysis, there was a team at the University of
Oxford called the data lab, and they recently analyzed the electronic health records of more
than 17 million patients in the UK through a project called open safely. All of their software
is open again for scientific review and reuse, and they don't transfer the data, but they send
code to the place where the data is stored. They've been able to make rapid progress so that
they completed all of this research in just five weeks and the sheer size of the data has
allowed them to get some fascinating insights into the main risk factors of the disease which
found that there's an evident dependence on the obesity for the risk hazard ratios and
something similar again exciting is being seen for the deprivation index.
Kaggle is a very successful software competition platform where data scientists
around the world upload their best algorithms to answer the questions and what they did
about a month and a half or two ago it was to compile a data set of 47,000 journal articles
about COVID 19 and other coronaviruses that are related to it to answer all sorts of questions
about the disease including transmission incubation risk factors. Using natural language
processing and machine learning techniques and the issue of contact tracing, which is now
becoming automatic and in its again another example of a very advanced technology coupled
with essential strides in terms of deployment and data sharing with some caveats.
Of course, automatic contact tracing such as Bluetooth which logs an entry when two
smartphone owners are close to each other such that if someone develops COVID 19
symptoms, then an alert can be sent to the other users that may have also been infected as a
result of that contact now the question is how is that data is stored and shared. It's a matter of
controversy in different people, and different countries are doing different things. So
basically there are two main more that are being followed the centralized and a decentralized
and under the centralized model the anonymous data that is gathered is uploaded to a remote
server which analyzes the data and then decides who's been in contact with whom etc. and by
contrast, the decentralized model gifts the users' control of the data the phones are the ones
that gather all of the information necessary, and they're the ones that make the call so this
technology is evolving fast. However, of course, we all know there is no consensus yet.
AI smarter Wi-Fi that looks like a Wi-Fi router sits in the background at home. It
analyses the wireless signals in the environment and from that analysis and which is done
using artificial intelligence it extracts breathing heartbeat mobility, sleep stages, and from all
those physiological signals it can create the kind of like the status of the health of the
individual and in the environment and all without like putting sensors on people's bodies or
asking them to do anything. One of the most critical things in responding to coronavirus is, of
course, the contagious nature of the disease, so for the caregiver and people who are trying to
help and the health professionals, the interaction with the patient is highways. If they can
monitor and get all of these physiological signals from the patient without having to get into
post proximity of the patient or physical contact of the patient that can be in fact outside the
room in our case then actually it reduces risk dramatically both for the caregiver and also that
the caregiver himself or herself might spread the disease to other people.
One of the most vulnerable populations as you probably know is the population in
Nursing homes and assisted living communities because those people are older and they have
comorbidities, and at the same time they get this disease the retirement home typically has so
many people so it's very dense and the people who take care the caregiver to those people are
not as trained as people in the hospital, for example, one of the retirement homes in the
Boston area is deployed with the device with the people who are COVID positive, and
extracted the respiration signal, the mobility of the patient's asleep, and were able to provide
this information to the staff and also to serve it to the primary doctor who's taking care of that
patient so the primary doctor was able to access the data from his home and the staff at the
facility does not need as much to get inside the room as a patient to be able to get to vital
signs so this device that can monitor using the wireless signal and can monitor even patients
through walls and also so it is very careful that privacy is a priority for the firm the patient
owns the data, and the patient is the one who can decide how the data can be used for
example if they want to provide it to their primary care provider so that we need to encrypt
the data and separate that is entirely de-identified the data itself and the identifiers are stored
wholly supported.
Strategies for future implications

Figure 4

Conclusion

Neurosurgical robots and machine learning algorithms have the potential to save surgeons
time, streamline complex procedures, and deliver more individualized treatment to the
patient. Future study designs should assess the performance of clinical experts alone versus
AI-assisted therapies to determine whether patient outcomes benefit prospectively. As with
any new technology, graded and cautious incorporation guided by preclinical studies and
strong ethical principles is necessary.
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