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Toward normative expert systems: Part II. Probability-based representations for efficient knowledge acquisition and inference.

We address practical issues concerning the construction and use of decision-theoretic or normative expert systems for diagnosis. In particular, we examine Pathfinder, a normative expert system that assists surgical pathologists with the diagnosis of lymph-node diseases, and discuss the representation of dependencies among pieces of evidence within this system. We describe the belief network, a graphical representation of probabilistic dependencies. We see how Pathfinder uses a belief network to construct differential diagnosis efficiently, even when there are dependencies among pieces of evidence. In addition, we introduce an extension of the belief-network representation called a similarity network, a tool for constructing large and complex belief networks. The representation allows a user to construct independent belief networks for subsets of a given domain. A valid belief network for the entire domain can then be constructed from the individual belief networks. We also introduce the partition, a graphical representation that facilitates the assessment of probabilities associated with a belief network. We show that the similarity-network and partition representations made practical the construction of Pathfinder.

Algorithms↗

[A computer expert system for malignant lymphoma].

Structure of a data base for histo-oncological diagnosis of malignant lymphomas by expert system Fel-Expert 2.9 is introduced. The data base has a 110,000 byte range and an average consultation with user's high diagnostic certainty lasts 2-3 minutes and comprises 20-25 inquiries. Possible acceleration of consultation process is discussed.

Expert Systems↗

Evaluation of an expert system on lymph node pathology.

BACKGROUND: Pathfinder is an Expert System that assists pathologists in making accurate diagnoses in the domain of lymph-node pathology. Pathfinder provides a differential diagnosis based on the initial histological feature(s) observed by the pathologist, and suggests to the user additional histological features for observation that are likely to narrow the differential diagnosis. PURPOSE: To evaluate the diagnostic accuracy of pathologists with and without the Pathfinder. METHODS: Thirty H&E stained slides from 30 lymph node biopsy specimens on which a Consensus diagnosis was made by two experts were reviewed by 19 pathologists to evaluate Pathfinder. After a period of training, 10 pathologists using Pathfinder (Interactive Computer Method) and 9 pathologists using the Routine Method (diagnosis without computer) determined a differential diagnosis for 15 slides (Test 1). Pathologists were then crossed over, trained, and evaluated the remaining 15 slides (Test 2). For each test, the proportion of "correct" diagnoses was compared between methods. In addition, the information integration attributes (making logical diagnosis given a set of specific histologic features) of Pathfinder and pathologists were compared. Finally, feature identification and quantification skills of pathologists were determined and correlated with the percent correct diagnosis. RESULTS: The diagnostic accuracy using Pathfinder was greater than that using the Routine Method (40% v 32%, P = .02). Diagnostic accuracy for the group of pathologists who made diagnosis using the Routine Method in Test 1 increased when they made diagnosis using Pathfinder in Test 2 (27% to 44%, P < .0001). The proportion of correct diagnosis for the group of pathologists who used Pathfinder in Test 1 remained virtually unchanged when they gave up Pathfinder in Test 2 (35% to 37%). The percentage of incompatible feature identification ("atypical proliferation" diagnosis) was significantly lower after using Pathfinder (P < .0001). In addition, information integration attributes of Pathfinder were significantly superior than that of the pathologists (P < .0001). CONCLUSIONS: Pathfinder is a valuable tool that assists pathologists in making accurate diagnosis because it has superior attributes than pathologists to integrate information and to screen for observations incompatible with any specific disease.

Biopsy↗

[Computer-assisted cardiotocogram analysis--from descriptive to perinatal expert system].

The interpretation of cardiotocograms is essentially for perinatal management, it remains labour intensive and depends on training and experience. With the development of modern analysing systems with conventional classification techniques, it seems possible to introduce expert systems and neuronal networks for a better interpretation and classification of cardiotocograms. Techniques of artificial intelligence are powerful tools and should be integrated in future systems. Because CTG-analysis--as a single procedure--is only of limited value for sufficient fetal prognosis, we conclude that computer aided CTG-analysis in combination with additional fetal parameters, for example partial oxygen pressure, will allow the development of future sufficient perinatal expert systems. Nothing should hinder future integration of computerized cardiotocogram analysing systems into everyday clinical routine and to connect it to obstetrical databases.

Cardiotocography↗

Probabilistic expert systems for DNA mixture profiling.

We show how probabilistic expert systems can be used to structure and solve complex cases of forensic identification involving DNA traces that might be mixtures of several DNA profiles. In particular, this approach can readily handle cases where the number of contributors to the mixture cannot be regarded as known in advance. The flexible modularity of the networks used also allows us to handle still more complex cases, for example where the finding of a mixed DNA trace is compounded by such features as missing individuals or the possibility of unobserved alleles.

Alleles↗

The MICROSTROKE expert system for stroke type diagnosis.

MICROSTROKE is a prototype expert system designed to categorize and diagnose stroke types based on clinical information. The knowledge base of MICROSTROKE includes information from large stroke registries. The system first queries the physician-user for details of the patient's history, information about the onset of stroke, accompanying symptoms, and pertinent neurologic findings and then sums the individual data items, factors in the a priori odds, and arrives at the probabilities of different stroke types for a given patient. Specific diagnosis of stroke type includes thrombosis, embolus, lacune, intracerebral hemorrhage, and subarachnoid hemorrhage. Stroke type diagnoses by MICROSTROKE were correct in 72.8% of 250 cases in the Hamburg Stroke Data Bank. MICROSTROKE runs on any MS-DOS microcomputer and is intended as a practical aid for physicians not fully familiar with the diagnosis of stroke types.

Cerebrovascular Disorders↗

An expert system applied to the physiological analysis of early stage of beer fermentation.

A fuzzy expert system was applied to the knowledge analysis of yeast physiology in the early stage of beer fermentation, when the wort was aerated. We used ergosterol and glycogen concentration in the wort as a suitable marker of physiological state of the cell population. The amount of both compounds influences the rate of fermentation, cell growth and the final taste of beer. The concentrations of ergosterol and glycogen including the number of cells can not be measured immediately during the relatively short aeration period, and incomplete experimental data are therefore found in laboratory logbooks. We therefore suggested that the fuzzy relation between the directly measurable dissolved oxygen concentration and the rate of ergosterol or glycogen formation should be identified and a fuzzy expert system should be used to analyze the behavior of the yeast.

Beer↗

The examination of the effects of obesity on a number of arteries and body mass index by using expert systems.

In this study, the areas affected from obesity were examined by classifying divergent arteries and body mass index (BMI) of 30 healthy persons and 52 obese persons by using expert systems, and the classifying performances of NEFCLASS and CANFIS, which are expert systems were compared. As a result of this comparison, it is observed that the classifying performance of NEFCLASS is better than that of CANFIS, and the causes of this are examined. Furthermore, it is observed that after these classifications, obesity affects the BMI rather than divergent arteries.

Arteries↗

Dealing with brittleness in the design of expert systems for immunohematology.

In recent years, there has been increased discussion about the potential of expert systems to support medical decision-making tasks, including applications in clinical laboratory settings. This study provides data regarding the cognitive errors that technologists make on an important problem-solving task: the identification of antibodies in a patient's blood. It explores alternative designs for expert systems developed to reduce such errors. It also evaluates the effects of these alternative designs on the ability of the users to effectively stay "in the loop," applying their own expertise and judgment while using the computer as a tool to assist with their analyses. A pilot study was conducted involving 32 certified medical technologists, which compared two alternative roles for the computer: (1) use of the computer to automatically complete subtasks upon request, and (2) use of the computer as a monitoring device to critique technologists as they completed the analyses themselves. The system design that automatically completed subtasks for the technologist induced a 29 percent increase in errors relative to the design that critiqued technologists as they completed the analyses themselves.

Journal Article↗

[Development and application of an expert system for analysis of the functional continuum of regulatory peptides].

An expert computer system was developed to analyze the effects of regulatory peptides (RPs) and some other biologically active compounds. The database includes information on their structures and physiological and inductive effects taking in account the method of administration, doses, and types of organisms. The developed method of vector representation of RP effects and the software modules provide for the estimation of the role of single RPs and their combinations in the regulatory system of organism. The expert system was used for solving the following tasks: (1) an analysis of the structural and functional organization of the RP continuum and a search for effective RP combinations regulating the levels of anxiety, depression, cognitive processes, etc; (2) design of a network of complicated cross inductive connections of major members of RP families; and (3) an analysis of the peculiar features of functioning of numerous internal reward factors. The English version of the paper: Russian Journal of Bioorganic Chemistry, 2006, vol. 32, no. 3; see also http://www.maik.ru.

Animals↗

An expert system for performance-based direct delivery of published clinical evidence.

OBJECTIVE: To develop a system for clinical performance improvement through rule-based analysis of medical practice patterns and individualized distribution of published scientific evidence. METHODS: The Quality Feedback Expert System (QFES) was developed by applying a Level-5 expert system shell to generate clinical direct reports for performance improvement. The system comprises three data and knowledge bases: 1) a knowledge base of measurable clinical practice parameters; 2) a practice pattern database of provider-specific numbers of patients and clinical activities; and 3) a management rule base comprising "redline rules" that identify providers whose practice styles vary significantly. Clinical direct reports consist of a table of practice data highlighting individual utilization vs recommendation and selected pertinent statements from medical literature. RESULTS: The QFES supports integration of recommendations from several guidelines into a comprehensive and measurable quality improvement plan, analysis of actual practice patterns and comparison with accepted recommendations, and generation of a confidential individualized direct report to those who significantly deviate from clinical recommendations. The feasibility of the practice pattern analysis by the QFES was demonstrated in a sample of 182 urinary tract infection cases from a primary care clinic. In a set of clinical activities, four questions/procedures were associated with significant (p < 0.001) and unexplained variation. CONCLUSION: The QFES provides a flexible tool for the implementation of clinical practice guidelines in diverse and changing clinical areas without the need for special program development. Preliminary studies indicate utility in the analysis of clinical practice variation and deviations. Using data obtained through a retrospective chart audit, the QFES was able to detect overutilization, and to identify nonrandom differences in practice patterns.

Databases, Factual↗

HYCONES: a hybrid connectionist expert system.

This paper describes HYCONES, a tightly-coupled Hybrid Connectionist Expert System that integrates neural networks with a symbolic approach (frames). The symbolic paradigm provides rich and flexible constructs to describe the domain knowledge, while the connectionist one provides the system with learning capabilities. The paper describes the architecture of the system, focusing on the hybrid aspects of the knowledge base and on its automatic knowledge acquisition technique from a case database. The first validation of the system is presented. At the end, a comparison with related research efforts and future developments are discussed.

Database Management Systems↗

[Histological diagnosis of epithelial tumors of the skin using an expert system].

Database for histooncological diagnosis of epithelial skin tumours was tested on 32 verified cases from the Hlava Institute files. Expert systems Fel-Expert 2.9 produced a correct diagnosis in 19 cases, was partially correct in 11 cases and quite uncorrect in 2 cases. Causes of diagnostic dissent and tuning problems of the database were discussed.

Carcinoma↗

Neonatal assessment using the Apgar fuzzy expert system.

We applied fuzzy theory to the Apgar scoring system (APG) to devise an Apgar fuzzy expert system (AFES). Three AFESs were determined separately by each one of three doctor groups (four inexperienced obstetricians, four experienced obstetricians and four expert neonatologists) in order to demonstrate that the AFES reflected the examiner's expertise and situation. Two-hundred and sixty-seven neonates were assessed 1 min after birth by an experienced obstetrician using the APG and the three AFESs. Statistical analysis of the relationship between the APG and the three AFESs in the acidosis group showed that the AFES determined by four expert neonatologists had the highest sensitivity and were significantly different (p < 0.05) from the APG. The AFES determined by the four expert neonatologists was revealed to be a valuable tool.

Acidosis↗

Microcomputer-aided diagnosis in cardiology. An expert system based on clinical and phono-mechanocardiographic data.

A knowledge-based consultation system capable of making multiple diagnoses in noninvasive cardiology is presented here. The system, expressly designed for a personal computer, is able to provide assistance in the diagnosis of 49 disease-entities. When tested in 52 retrospective cases (33 patients with one disease-entity, 17 with two, 2 with three), it made 39 correct diagnoses (75%). The average score of the actually present disease-entities was 94 +/- 3.2 (mean +/- standard error of the mean), significantly higher than the highest score obtained by the incorrect diagnoses (87.2 +/- 3.1) (p less than 0.001). The system was able to correctly perform 1 triple diagnosis and 9 double diagnoses. The results obtained, comparable with those of well-known expert systems (MYCIN, INTERNIST-1), demonstrate the reliability of a microcomputer-based expert system for medical diagnosis in cardiology.

Diagnosis, Computer-Assisted↗

Investigation of an expert systems approach to bacterial identification.

An investigation was carried out to assess the feasibility of using an expert systems approach to assist in the identification of unknown isolates of bacteria. A system was developed using Lisp which utilized the knowledge stored in standard bacteriological texts. A comparison of the expert systems approach and the probabilistic approach based on Bayes Theorem was made together with the advantages and disadvantages of each approach.

Algorithms↗

Expert systems in psychiatry. A review.

Existing computer-based decision aids in the areas of psychiatric diagnosis and consultation are reviewed, and the prospects for expert system development within the mental health field are discussed. Emphasis is placed upon the decision-making models used in these systems rather than on their particular application area. The decision-making paradigms discussed are (1) data bank analysis, (2) statistical pattern recognition, (3) Bayesian analysis, (4) logical flow chart method, and (5) knowledge-based (expert system) approaches. For each paradigm, its essential features, its strengths and weaknesses, and some example applications are presented.

Diagnosis, Computer-Assisted↗

[Current aspects of creation of expert systems in aviation medicine].

Topical directions of developing the medical expert systems (MES) are considered. The problems to be solved by using programming and informational means as part of MES are discussed. A classification of the knowledge of expert physicians who directly deal with decision making is proposed. The characteristics of the developed MES well appreciated by the results of their operation are given. They show new trends associated with the update of medical knowledge and the developmental level of information technologies.

Adult↗