Transcript Semantic Representation of Workflows in Healthcare

RPGOntology
- A Semantic Webized Knowledge Base for
Referral Guidelines for Imaging
Helen Chen, Ph.D
Advanced Clinical Applications
Agfa Healthcare
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RPGOntology – Imaging Ontology Workshop 2006
Purposes of Radiation Protection Guidelines
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To recommend appropriate investigation means
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Did I have this investigation already or recently?
Am I paying for an expansive study (such as nuclear medicine) while a cheaper
investigation means can archive the same goal?
To protect patients from harmful and unnecessary exposure
to radiation
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Am I benefit from the new research findings and capacity of newly invented
modalities?
To reduce wastefulness in radiology practices
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Is this investigation most effective for my prognosis or diagnosis?
Is my body or my unborn child being exposed to radiation which can be or should be
avoid?
Am I getting too high dosage of radiation that is not necessary for the study?
RPGOntology – Imaging Ontology Workshop 2006
Guideline Original Format: Tabulated
Recommendation
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RPGOntology – Imaging Ontology Workshop 2006
Guideline Original Format: Rule-Like Statement
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Pregnancy and protection of the foetus
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…….
Optimizing Investigation
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“Irradiation of a foetus should be avoided whenever possible (23-25). This includes
situations where pregnancy is not suspected by the woman herself. The prime
responsibility for identifying such patients lies with the referring clinician”
“Women of reproductive age presenting for an examination in which the primary beam
irradiates directly, or by scatter, the pelvic area (essentially any ionising irradiation
between the diaphragm and the keens), or for a procedure involving radioactive
isotopes, should be asked whether they are or may be pregnant.”
“For investigation of Space-occupying Lesion(SOL), MRI more sensitive for early
tumours, in resolving exact position (useful for surgery) and for posterior fossa lesions.
CT often sufficient in supratentorial lesions and subdural haematomas. MRI superior in
the posterior fossa and for vascular lesions. NM may be useful in tumour viability posttherapy, especially post-radiotherapy”
…….
RPGOntology – Imaging Ontology Workshop 2006
RPGOntology: Taxonomy – Some Examples
•BodyParts
•ClinicalProblem
•HeadProblem
•NeckProblem
•SpineProblem
•GeneralSpineProblem
•CervicalSpineProblem
•ThoracicSpineProblem
•LumbarSpineProblem
•MusculoskeletalSystemProblem
•CardiovascularSystemProblem
•ThoracicSystemProblem
•GastrointestinalSystemProblem
•GastrointestinalTractProblem
•GeneralAbdominalProblemsProblem
•LiverGallbladderPancreasProblem
•FullBody
•Head
•Neck
•Spine
•UpperLimb
•LowerLimb
•Abdomen
•RedCellStudy
•NMRenogram
•NMSkeletal
•PET
•SPECT
•UrologicalAdrenalGenitoSystemProblem
•ObstetricsGynaecologyProblem
•BreastDiseaseProblem
•AsymptomaticProblem
•SymptomaticProblem
•Trauma
•HeadTrauma
•CervicalSpineTrauma
•ThoracicLumbarTrauma
•PelvisSacrumTrauma
•…….
•ChestTrauma
•Cancer
•…….
•PaediatricsProblem
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RPGOntology – Imaging Ontology Workshop 2006
•InvestigationMethod
•MRI
•NM
•RedCellStudy
•NMRenogram
•NMSkeletal
•PET
•SPECT
•US
•USAorta
•USCardiac
•USKidneys
•USLivers
•USCarotids
•XR
•…….
•CT
•…….
PRGOntology: Properties – Relations Between
Concepts
•applyToClinicalProblem
•Domain: Investigation
•Range: ClinicalProblem
•applyToBodyPart
•Domain: Investigation
•BodyParts
•applyToPatientType
•Domain:Investigation
•Range: PatientType
•hasRadiationDose
•Domain:InvestigationDetails
•Range: RadiationDoes
•FunctionalProperty
•…………
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RPGOntology – Imaging Ontology Workshop 2006
RPGOntology: Example
Table M: Paediactrics
Clinical Problem
Investigation
{Dose}
Back or neck pain
XR (I)
Recommendation
{Grade}
Indicated (B)
M10
:m10_1
Comment
Back pain is uncommon in children
without a cause. Follow-up is needed
if infection is suspected
a :Investigation;
:applyToAnatomicParts :head;
:applyToClinicalProblem :clinicalProblemM10;
:hasInvestigationDetails :InvestigationDetail_1034;
:hasRecommendation :Indicated;
:applyToPatientType :paediatricPatient;
:hasRecommendationGrade :gradeB;
rdfs:comment “Back pain is uncommon in children without a cause. Follow-up is needed if infection is
suspected."^^xsd:string .
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RPGOntology – Imaging Ontology Workshop 2006
Use Cases
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Validation of radiological orders
Provide recommendations for a complicated investigation
Offer proofs and explanations of a suggestion or a decision
Given facts as patient context
:Ann a patient:Patient;
rpg:hasClinicalProblem rpg:clinicalProblemB8, rpg:mouthFloorCalculus.
Get recommendation from reasoning engine by querying RPGOntology
rpg:Ann rpg:isRecommended (rpg:b8_1 rpg:US rpg:indicated).
rpg:Ann rpg:isRecommended (rpg:b8_2 rpg:MRSialography rpg:indicated).
rpg:Ann rpg:isRecommended (rpg:b8_3 rpg:XR rpg:notIndicatedRoutinely).
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RPGOntology – Imaging Ontology Workshop 2006
Rules
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Sets of rules are derived for different use cases of RPGOntology
Example: rules for recommending investigation using RPGOntology
{?A :hasClinicalProblem ?C.
?X rpg:applyToClinicalProblem ?C;
rpg:hasRecommendation rpg:Indicated;
rpg:hasInvestigation ?Y.
?Y rpg:modalityType ?Z.}=> {?A :isRecommended (?X ?Z rpg:Indicated)}.
{?A :hasClinicalProblem ?C, ?V.
?X rpg:applyToClinicalProblem ?C;
rpg:hasRecommendation rpg:NotIndicatedRoutinely;
rpg:applyOnlyTo ?V;
rpg:modality ?Y.
?Y rpg:modalityType ?Z.} => {?A :isRecommended (?X ?Z rpg:NotIndicatedRoutinely)}
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RPGOntology – Imaging Ontology Workshop 2006
Beyond the Tables in Guidelines: Connecting
Knowledge Bases
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RPGOntology becomes one of corpuses of specialized medical knowledge –
guidelines and protocols
This knowledgebase is a part of a semantically connected medical
knowledgebase, to be used to generate patient-centric care plan for complicated
medical investigation and treatment.
When connecting with existing terminology services used in hospital information
systems, for example, ICD terminology server and other external reference
knowledge bases, the medical expertise is enlarged and enhanced (reuse of
knowledge bases).
The health information system built on these connected knowledge bases shall
be capable of offering advises based on best practices and guidelines, and also
issue flags when a prescribed radiological procedure is not safe for a patient or
is not normally the most effective means for the reason for study
RPGOntology – Imaging Ontology Workshop 2006
RPGOntology in Action – An Illustration
ICD Terminology Service
Request for recommendation or validation
Order
forms
Domain Ontology 1
Reasoning Engines
External knowledge
Recommendations and Proof
Domain Ontology 2
Patient information
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Guidelines and rules
RPG Recommendation Rules
Patient Categorization Rules
Electronic Patient Record System
PRGOntology
Business Process
and Resource Rules
RPGOntology – Imaging Ontology Workshop 2006
PatientOntology