EMGView8: a software for Intraoperative Nerve Monitoring

EMGView8: a software for Intraoperative Nerve Monitoring. Supervising and guiding actions of a surgeon in the operating room and give him/her as much information as possible is one of the most innovative research goals in the medical field. Till approximately fifty years ago patients were often left with huge scars after surgery operation and a lot of damage has been caused to unaware patients due to human errors or poor equipment. This problems can now be avoided thank to the introduction of a new technique, based on the proper combination of instruments, electronic devices, and algorithms. Operating rooms are becoming some of the most innovative and modern places of work. This thesis describes in details a software application and all of its principal components used in conjunction with two hardware modules, for intraoperative nerve monitoring during a surgery exam. The presented software allows to monitor nerve stimulation response applied on a patient in order to avoid injuries caused by nerves resection during the operation. This software is called EMGView8 and is part of an Intraoperative Nerve Monitoring product called Nerveäna, distributed by Neurovision Medical Products, a company specialized in innovative surgical products, based in Ventura (California). The design of both software and hardware parts belongs to Neurovision together with OTBioelettronica s.r.l, an italian company based in Torino, specialized in R&D in the bio-electronic field. From the 60s and due to the increasing amount of hospitalized people and higher attention to hygiene inside operating room, surgery space starts to fill up with pre-sterilized products, disposable needles and other equipments such as gloves, masks, syringes and so on. With the incoming Digital Era operating room were integrated also with high technology devices, from operating tables to surgical lights or stimulator scissors. In the future and with the further development of new algorithms, e.g. based on Artificial Intelligence, considering the enormous amount of available medical data that would be used to train machine learning algorithms, we will probably observe a progressive replacement of doctors with autonomous robots.I won’t discuss here the moral code at the base of this new debate but the truth is: devices are key components and are strongly integrated in surgery operations. The systems I worked on, monitors the state of the nervous system in real-time during surgery, alerting the surgeons of potential evolving neurologic injuries and allowing the application of corrective actions to prevent permanent deficits. Regarding the software part, the main tasks can be regrouped in three different groups: • Real-time signals visualization: values received from hardware modules must be interpreted, converted to EMG wave form, and graphically visualized on a screen. • Setting hardware configuration: software must be capable to configure hardware internal parameters based on doctor preferences. A database must be included to store information about settings, doctors and occasionally patient. • Allow offline visualization of recorded exams: real-time signals must be saved to files to be successively examined for research or legal purpose. The design of each key point while be described, analyzing the needs of a new monitoring device and describing the use cases. I will show a general overview of the product itself and how macro components are integrated with each other.