PubMed · 8321461
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K Bobis, P Bachand. 1993. Expert systems: the nurses' toolbox.. https://pubmed.ncbi.nlm.nih.gov/8321461/
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PURPOSE: Many radiotherapy treatment plans involve some level of standardization (e.g., in terms of beam ballistics, collimator settings, and wedge angles), which is determined primarily by tumor site and stage. If patient-to-patient variations in the size and shape of relevant anatomical structures for a given treatment site are adequately sampled, then it would seem possible to develop a general method for automatically mapping individual patient anatomy to a corresponding set of treatment variables. A medical expert system approach to standardized treatment planning was developed that should lead to improved planning efficiency and consistency. METHODS AND MATERIALS: The expert system was designed to specify treatment variables for new patients based upon a set of templates (a database of treatment plans for previous patients) and a similarity metric for determining the goodness of fit between the relevant anatomy of new patients and patients in the database. A set of artificial neural networks was used to optimize the treatment variables to the individual patient. A simplified example, a four-field box technique for prostate treatments based upon a single external contour, was used to test the viability of the approach. RESULTS: For a group of new prostate patients, treatment variables specified by the expert system were compared to treatment variables chosen by the dosimetrists. Performance criteria included dose uniformity within the target region and dose to surrounding critical organs. For this standardized prostate technique, a database consisting of approximately 75 patient records was required for the expert system performance to approach that of the dosimetrists. CONCLUSIONS: An expert system approach to standardized treatment planning has the potential of improving the overall efficiency of the planning process by reducing the number of iterations required to generate an optimized dose distribution, and to function most effectively, should be closely integrated with a dosimetric based treatment planning system.
Medical terminology is now playing a key role in medical software. This requires new techniques with which many clinical users, classification experts and applications developers are unfamiliar. There is a conflict in that the more re-usable techniques for terminology needed to support sharing of information among many different applications are more difficult to use for any one application. A layered approach to re-use is described which combines techniques from first generation systems and relatively easily understood second generation systems with the formal rigour of third generation systems to resolve this conflict. The methodology also provides a potentially rigorous approach to defining the relationship between terminology and structure in the electronic healthcare record architecture. It provides a natural migration pathway from existing systems to powerful re-usable multilingual terminologies.
"GastroBase-II" is a module of the clinical information system "KIS-ComSyD"; The main part is represented by structured data-text with an expert system including on-line image digitalization in gastroenterology (incl. endoscopic, X-ray and endosonography pictures). The hardware and software of the GastroBase are described as well as six-years experiences with application of digitalized image data. An integration of a picture into text, reports, slides for a lecture or an electronic atlas is documented with examples. Briefly are reported out experiences with graphic editors (PhotoStyler), text editor (WordPerfect) and slide preparation for lecturing with the presentation software PowerPoint. The multimedia applications on the CD-ROM illustrate a modern trend using digitalized image documentation for pregradual and postgradual education.