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RPGOntology - A Semantic Webized Knowledge Base for Referral Guidelines for Imaging Helen Chen, Ph.D Advanced Clinical Applications Agfa Healthcare 1 RPGOntology – Imaging Ontology Workshop 2006 Purposes of Radiation Protection Guidelines To recommend appropriate investigation means 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 2 Am I benefit from the new research findings and capacity of newly invented modalities? To reduce wastefulness in radiology practices 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 3 RPGOntology – Imaging Ontology Workshop 2006 Guideline Original Format: Rule-Like Statement Pregnancy and protection of the foetus ……. Optimizing Investigation 4 “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 5 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 •………… 6 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 . 7 RPGOntology – Imaging Ontology Workshop 2006 Use Cases 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). 8 RPGOntology – Imaging Ontology Workshop 2006 Rules 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)} 9 RPGOntology – Imaging Ontology Workshop 2006 Beyond the Tables in Guidelines: Connecting Knowledge Bases 10 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 11 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