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