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題名 | 自動化舌診系統與中醫師診斷之一致性研究=The Study on the Agreement between Automatic Tongue Diagnosis System and Traditional Chinese Medicine Practitioners |
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作 者 | 蔣依吾; | 書刊名 | 中醫藥年報 |
卷期 | 3 2014.12[民103.12] |
頁次 | 頁(26)1-(26)23 |
分類號 | 413.241 |
關鍵詞 | 自動化舌診系統; 自身一致性; 外部一致性; Tongue diagnosis system; Intra-agreement; Inter-agreement; |
語文 | 中文(Chinese) |
中文摘要 | 主持人執行衛生署中醫藥委員會 90至 92年度之中醫舌診標準化整合研究計畫( CCMP90-RD-017, 90.06.01~ 90.12.31、CCMP91-RD-110, 91.01.01~ 91.12.31、 CCMP92-RD-102, 92.01.01~ 92.12.31)中,業已發展一可自動分析舌部影像特徵之中醫舌診電腦化系統,並經中醫藥委員會申請專利,於 2008年 4月獲准發明專利( "舌診系統及其方法 ",中華民國專利證書發明第 I296110號),復於 98 年推動中醫藥(CCMP98-RD-031, 療效評估及診斷標準化類研究計畫, 98.01.21~99.12.31)中研究將自動化舌診系統小型化可行性,現正尋求將發明專利商業化,成為舌診臨床診治自動化儀器;然而一臨床輔助儀器商業化所面臨最大挑戰為必須提出一具可靠度相關佐證數據,方可獲得醫師及病患信任,換言之,自動化舌診系統之一致性量測為臨床判讀儀器所不可或缺,可令醫師於臨床診治上使用此系統輔助診斷時更具信心,因此,本計畫針對此一需求,探討前述自動化舌診系統之一致性,共區分為內部一致性 (intra-agreement)及外部一致性 (inter-agreement),內部一致性為舌診系統針對同一病人於短時間內拍攝兩張舌頭影像進行判讀後兩次結果相似程度;外部一致性則為系統與中醫師分別對同一舌頭影像觀測後所得結果相似度。 長期以來,國內學者對診斷基準研究貢獻許多心力,然而中醫望聞問切四診臨症技巧,並未建立共識,換言之,如何應用由中醫四診所擷取資訊並無一標準系統或具高度一致性方法提供對病人之病症進行審視,此於臨床研究上將嚴重影響中醫學術發展之延續性,因此望聞問切四診症狀判斷一致性與精準度應為中醫辨證首要解決課題,而在探討四診症狀診斷一致性前,應先探討醫師對由望診、聞診、問診及切診中任一診所得特徵資訊判斷之一致性,因此欲將現有自動化舌診系統商業化,做為醫師臨床時診斷輔助工具,必須先對此自動化舌診系統之自身一致性及外部一致性進行探討,以提供自動化舌診系統可靠度數據使得醫師於臨床診治時對其分析更具信心。 除了對自動化舌診系統進行自身一致性探討外,為使自動化舌診系統分析舌頭特徵而推導數據於臨床上更具說服力,將與已執業中醫師對同一影像之舌診特徵判斷進行一致性比較 (inter-agreement)。因此本計畫一致性比較對象共計三類,一為計畫主軸-自動化舌診系統;二為對舌頭特徵辨識已有高度共識彰化基督教醫院中醫部舌診小組(共計十三位中醫師);三則是於計畫實施前對舌頭特徵辨識並無共識或討論中醫師(共計十四位中醫師)。將分別針對自動化舌診系統、有共識之中醫師及無共識之中醫師三者進行自身一致性探討,並對自動化舌診系統與有共識之中醫師、自動化舌診系統與無共識之中醫師、有共識與無共識之中醫師共計三組進行外部一致性比較。 |
英文摘要 | Several continuous projects (CCMP90-RD-017, 90.06.01~90.12.31, CCMP91-RD-110, 91.01.01~91.12.31, CCMP92-RD-102, 92.01.01~ 92.12.31), supported by the Committee on Chinese Medicine and Pharmacy (CCMP), DOH, from 2001 to 2003, aiming at the standardization of tongue diagnosis procedure have successfully developed an automatic tongue diagnosis system. This research result has submitted for patent application by CCMP and granted invention in April, 2008 ("Tongue diagnosis system and its method", ROC Patent: Invention No. I296110). This year’s project (CCMP99-RD-037) aims at deriving inter-and intra-agreement information for the automatic tongue diagnosis system developed. Tongue diagnosis is an important inspection method practiced in traditional Chinese medicine (TCM) in diagnosing diseases before determining proper means of cures and treatment. Traditionally, tongue diagnosis depends solely on personal knowledge and experience of the practitioner, thereby being criticized as lacking in objectivity and quantification. Consequently, an automatic tongue diagnosis system (ATDS) is developed to extract a variety of tongue features and provide practitioners with objective data to assist diagnoses. To evaluate the stability of ATDS in clinical { , ,| i=1 ~ 20} PP applications, 20 sets of tongue images iT, iT, taken 1 hour apart from 12~20 patients with possible variations in lighting, and the length, shape and angle of extruding tongue, are employed. The features extracted by the ATDS for each set of tongue images are compared to derive the intra-agreement of ATDS. The image set {PiT| i=1 ~ 20} , 1 is used in a two-stage tongue diagnosis questionnaire to investigate the intra-agreement of doctors with consensus (DC). According to the diagnosis results {PiT| i= 1 ~ 20} of image set , 1 determined by ATDS and DC respectively, the inter-agreement between ATDS and DC, and the inter-agreement among doctors within DC are derived next. The results of this study lead us to conclude that ATDS is consistent even in the face of variations of environmental lighting and extruding tongue. The high agreement of ATDS can provide objective and reliable tongue features to facilitate studies relevant to the temporal progression of a patient’s disease or the finding of a significant index for a specific disease through the analysis of a large amount of tongue images. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。