Brief information for installation and usage of Rhinobase

Rhinobase is an innovative comprehensive computerized database application for rhinoplasty that facilitates storage and retrieval of patient information, serves as an educational and self-assessment tool to help both novice and experienced surgeons guide through the art and science of rhinoplasty, helps make facial analysis an easy task for the surgeon, and archives the pictures and video images of the patients within the database.

The authors contributing in the development of Rhinobase are:

 

Rhinobase was prepared using questionnaires, previously published articles and the experience of the authors both on rhinoplasty and on computerized patient databases. Its content was prepared by all of the authors and then two of the authors (FA, SA) developed Rhinobase using Borland® Delphi® 4.0 for Windows® (Inprise Corp. Scotts Valley, Ca), a popular visual application development environment.

The program must first be loaded into a computer having Microsoft® Windows 95© or a higher operating system. The computer should carry at least a 500 MHz CPU, 20 GB hard disk, 128 MB system memory, a display adapter with 16 MB RAM and preferably a USB (Universal Serial Bus) connection for rapid transfer from a digital photo camera or a scanner. A video capture card allows capturing of still images or video clips from endoscopic examinations or surgical procedures.

The program setup files can be downloaded free of charge from http://www.rhinobase.net. When it is loaded into the computer by following the user friendly instructions on the screen, an icon will be created on the desktop for an easy start. After double clicking on the "Rhinobase" icon, the program starts and asks for user name and password. Default username is "rhino" and password is "base" (without quotes) and they can be changed later. This step prohibits unauthorized use of the program. What follows this security barrier is the startup menu that allows the user to add a new record, to make a query regarding the data entered, to give an appointment, to define users and to search a previous record using the first and/or last name. When a <New record> button or a previous record is chosen, the main menu (Fig 1) including a frame for the patient's photograph, patient demographics and shortcut buttons for clinical history, examination, photographic analysis, operative-planning, operation, follow-up and photographs comes into view.

The "clinical history" window is designed using five different frames: "complaints", "past medical history", "family history", "past surgical history", "psychological status", and "outcomes research" (Fig 2). Each frame generated helps the surgeon to collect data in an organized manner during history taking. This module is of special importance since it provides the surgeon with clues regarding the psychological status of the patient by asking the same questions to every patient that may be neglected in routine history taking.

The "examination window" incorporates a detailed "nasal examination" section that includes a dynamic nasal examination, internal valve changes and a new classification system (SL-classification) for recording nasal airway pathology (Fig 3). In this section, if drawing button is chosen, a media editing window is opened where one can either record the lesions on preprinted figures in the MS Paint© or load patient's digital images taken during the patient's endoscopic endonasal examination from the hard disk or from any other storage media. The "otolaryngologic examination" section can be recorded either in separate fields or on preprinted figures as previously described. General examination findings and objective nasal patency measurements can be entered in this module. Since the same patient can visit the clinic more than once, data from each visit can be stored in this window by adding a new record by means of a navigation bar situated on the upper part of the window.

The "photographic analysis" button brings separate windows for frontal, lateral and basal views (Fig 4). Three calibrated views (frontal, right lateral and basal with a ruler) are loaded for completing the aesthetic and photometric analyses. After the calibration is done by means of the ruler in the picture, the landmarks are marked on the pictures and this helps Rhinobase automatically calculate the required distances and angles and display them at the bottom right of the screen (Fig 5). The picture and the calculated data can be printed out for the patient's chart. When the measurements are done initially, the pop-up menus of the aesthetic analysis can be filled in more efficiently to complete the facial analysis.

After completing the facial analysis it is strongly recommended to make an operative planning. In this module, the surgeon can note the details of an operation, such as the type of approach and incisions, the need for changing the rotation and projection, and the need for grafts and sutures (Fig 6). It is also possible to take a print-out of the operative plan.

The "operation" module consists of seven sections (Fig 7). The "surgical notes" section is used to enter data regarding the surgical team, duration of the operation, estimated blood loss, type of anesthesia and type of procedure. The type and side of the incisions used and the type and size of the suture materials can be noted in the "incisions" section. The rhinoplasty steps performed can be documented in the "rhinoplasty" section by clicking on the radio buttons and/or pop-up menus. The status of the anatomical structures seen during the operation can be noted in the "surgical findings" window. Data regarding procedures of the inferior turbinate, nasal packing, other intranasal surgery and other facial plastic procedures can be recorded in the "additional procedures" section. The "grafts" window includes a list of 16 different grafts, their application site, and anchoring sutures. The "graphic documentation" section includes six drawings on which the operative steps can be marked in MS-Paint© (Fig 8).

Since septal surgery is of key importance in septorhinoplasty, special emphasis is given in the "septum" section to record the data obtained during surgery in detail (Fig 9).

The "follow-up" module is used to enter data regarding the postoperative period, regular follow-up, outcomes research and complications (Fig 10). The information regarding outcomes research during the postoperative period can be noted here, whereas preoperative documentation can be done in the "complaints" section.

The "photographs" module is a powerful digital image archiving and browsing module that is designed to store six standard rhinoplasty views (Fig 11). Preoperative, intraoperative and postoperative photographs can be recorded with each patient's data. The dates, a description area for the photographs and six frames for standard rhinoplasty photographs can be seen on this screen. The addition of a picture browser is a very important detail which enables us to compare pre- and postoperative images on the same screen. Moreover, the pictures taken during the operation can be transferred into the program by means of this module. If there is plenty of space available in the computer, video clips of the patient captured during examination, endoscopic examination and surgery can be digitized and added to this section as well. A print-out of the patient's pictures can also be obtained to add to the patient's chart.

The query utility is very helpful to obtain any kind of information within a very short time (Fig 12). It is an SQL (structured query language) builder utility which is relatively simple to learn for the end user.