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Case-based Adaptations in Medicine Case-based Adaptations in Medicine
Focusing on Hypothyroidism Focusing on Hypothyroidism
Rainer Schmidt, Olga Vorobieva, Lothar Gierl
Institute for Medical Informatics and Biometry
University of Rostock, Germany
ContentsContents
1. Adaptation Problem in Medicine
2. Hypothyroidism
3. Support Programs for Hypothyroidism
4. Conclusion:Adaptation Techniques for Medical
Therapy Problems
5. Future Work
1. Adaptation Problem in Medicine1. Adaptation Problem in Medicine
So far, CBR in medicine not as successful as in some other domains
Main problem: Adaptation
In medicine many details and complex features (interactions, exceptions, contradictions)
Medicine never is a closed world, but continuously changing
Avoiding AdaptationsAvoiding Adaptations
Many medical applications avoid adaptations:
- Retrieval-only systems: image interpretation and other visualisations (of organ functions: e.g. kidney or liver)
- Multi-modal reasoning systems: incorporate only CBR-retrieval (mainly to support evidences)
Adaptation Techniques in Adaptation Techniques in Medical CBR SystemsMedical CBR Systems
- Adaptation Rules and Operators: CASEY
- Constraints: ICONS, GS.52
- Compositional Adaptation: TA3-IVF, (TeCoMed)
? Abstraction: MEDIC, MNAOMIA, GS.52
Our ProjectOur Project
Adaptation is the main bottleneck for medical CBR systems.
So, the goals of our project are to develop general adaptation models, methods and operators for the main medical tasks: diagnosis, prognosis and therapy.
We have started with therapeutic problems and have developed some support programs in the endocrinology domain.
2. 2. HypothyroidismHypothyroidism
Thyroid gland produces thyroid hormones
Too much: Hyperthyroidism
Too less: Hypothyroidism
Diagnosis can be established by blood tests
Therapy for Hypothyroidism is Levothyroxine
Problem: Determine therapeutic dose
3. Support Programs for Hypothyroidism3. Support Programs for Hypothyroidism
- Computing an initial dose (new-born babies)
- Updating in a patient’s lifetime
- Additional diseases or complications
Program FlowProgram Flow
Additional Medical Knowledge Requirements
Actual Case
Guidelines
REFINEMENT UNIT
Initial Dose
Lab. tests & Physical Examinations
Is Therapy Guideline in Knowledge Base?
ADAPTATION UNIT
Retrived CaseAdditional Disease
Additional Lab.tests & Patient's Information Requirements
Knowledge Base (Guidelines and Adaptation Rules)
Adapted Case
Case Base
yes
no
yes
no
Newborn Baby?
Therapy RecommendationTherapy Recommendation
Computing an Initial DoseComputing an Initial Dose
Hypothyroidism Patient: Dose?
Guideline
Determination
Optimized Dose
Range of Dose
Adaptation by Calculation
Retrieval
Similar Former Cases
Check: Best Therapy Results
Best Similar Cases
Compositional Adaptation
Updating in a Patient‘s LifetimeUpdating in a Patient‘s Lifetime
Patient
Lab.tests and physicial examinations
Retrieved Case
Adaptation
New Patient adapted Therapy
Further Lab.tests and physical examinations
Additional Diseases or ComplicationsAdditional Diseases or Complications
Hypothyroisdm Additional Complication
Levothyroxine Therapy Additional Therapy
Contraindications?
Adverse Effects?
Interactions?
Substitution or Compensation
Adaptation Rules
Modifications
4. 4. Conclusion: Adaptation Techniques Conclusion: Adaptation Techniques for Medical Therapy Problemsfor Medical Therapy Problems
? Abstraction: in form of Guidelines
- Constraints: for Initial Therapy
- Compositional Adaptation:for Dose Calculation
- Adaptation Rules: typical tasks
- Substitution
- Compensation
- Calculation
Adaptation Model for TherapiesAdaptation Model for Therapies
Therapeutic Adaptation Task
Dose Calculation
Dose Update
Initial Therapy
Additional Therapies
Constraints Prototypes, Guidelines
Compositional Adaptation
Calculation, Guidelines Substitution Compensation
5. 5. Future WorkFuture Work
Develop General Adaptation Models and Operators
Adaptation in Medicine
Therapy PrognosisDiagnosis
A1 (T) An (T) A1 (D) An (D) A1 (P) An (P)
Adaptation-Method-1 Adaptation-Method-N
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