Generic Fuzzy Bayesian Expert System in Cardiology

Hossein Rahnama, Ryerson University Dr.Alireza Sadeghian, Ryerson University Dr.William Melek, University of Waterloo

Introduction

Introduction

Expansion of the medical knowledge

Introduction
Difficulty of the General practitioners to remain up to date

Expansion of the medical knowledge

Introduction
Difficulty of the General practitioners to remain up to date

Expansion of the medical knowledge

Access to specialist is limited

Introduction
Difficulty of the General practitioners to remain up to date

Expansion of the medical knowledge

Intolerant patients

Access to specialist is limited

Introduction
Difficulty of the General practitioners to remain up to date

Expansion of the medical knowledge

Intolerant patients

Access to specialist is limited

Introduction
Difficulty of the General practitioners to remain up to date

Expansion of the medical knowledge

Intolerant patients

Misdiagnosis

Access to specialist is limited

Previous work

Previous work
Non-Generic/Specific expert systems

Previous work
Non-Generic/Specific expert systems

Decision Makers vs. Decision Supporters

Previous work
Non-Generic/Specific expert systems

Decision Makers vs. Decision Supporters

No systematic guidelines for creating a generic medical system

Objective
Develop a framework that mimics the reasoning methods of a physician.
Diagnosis Treatment

Target Users:
Physicians and General Practitioner

Rudiments

Understanding the diagnosis Researching the patient encounter Creating a logic from the patients encounter

Patient Encounter:

Physicians reasoning model:

Patients Demography
Patient

History

Symptoms

Subjective Analysis

Subjective Analysis

Symptoms

History

Knowledge for Subjective Analysis

Different techniques can be considered for Subjective Analysis:
A scoring system Bayesian Inference Fuzzy Logic History Smoking Hypertension High Stress Obesity Atherosclerosis Diabetes mellitus Hyperlipidemia Present symptoms Syncope Anxiety Chest ache Cough, acute Dizziness Nausea, vomiting Shortness of breath Sweating

Simple scoring system can effectively represent this stage Ability to capture required information without complicating the process

Subjective Analysis
The presence of absence of any symptom is presented by one or zero in a ones-row symptom matrix:

Where X1 is the finding or symptom that can be either Absent or Present The Weight vector of n symptoms is given by a onecolumn matrix as follows:

Subjective Analysis
The multiplication of the one-row symptom matrix of every disease Ds by a one-column weight matrix yields the result of the symptoms scoring of this disease as follows:

Similar forms of equation can be used to asses the history array H with a similar weighting system WH for every history finding:

DH = H.WH

Subjective Analysis: Creating a threshold

Two separate scores are calculated with two separate thresholds:
Symptom score with threshold of 50 History score with threshold of 30

Simple Rule to every disease rule-base: IF Symptom-Score >50 AND History-Score >30 Then disease will be in the Probable_Diagnosis_List Upon obtainment of Ws and Wh the subjective rule base is complete

Classification

Classification
Unclassified diseases

Classification
Unclassified diseases Subjective Analysis

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Objective Analysis

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Objective Analysis

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Objective Analysis

Probable diagnosis list

Classification
Unclassified diseases Subjective Analysis Hypothesis reduction

Hypotheses

Objective Analysis

Probable diagnosis list

In Cardiology cases: 10 Disease category Subjective Analysis 75 specific final diagnoses Objective Analysis

Cardiac Classifications

Objective Analysis

Using labs and imaging studies to reduce the number hypotheses Creation of a probable diagnosis list Creating data sets for each classified disease

Objective Analysis
Creating an Acyclic graph for objective scoring

Objective Analysis
Disease name

Test Weights

Rule base Total Test Score Disease Probability

Objective Tables Tables in many cases are big Cannot be used to deal with missing information A method that can be used to create rules from such tables Inability to process missing information Fuzzy Logic

Trapezoids membership functions

Membership functions

Examples: Number of rules in Aortic Stenosis reduced from 1728 to 20 fuzzy rules Number of rules in Unstable Angina reduced from 2304 to 24 fuzzy rules

Probable diagnosis list

Bayesian Decisions
Decision in the probable diagnosis list Calculating the risk of the decision Calculating the error of diagnosis

Bayesian Approach in Diagnosis

Deciding between the probable diagnosis list:
If the likelihood of two diseases are equivalent Disease1 : Disease2:

Prior probabilities

Observation based on lab result

If is an observation from a lab test:
Posterior

True state of disease: True state of disease: Simple Diagnosis rule based on a shared feature

Deciding between an array of diagnoses

Dual Category Classification: Deciding between multiple diseases:

Loss in making a wrong diagnosis

Diagnosis spaces

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Decision in Cardiomyopathies

Decision in Cardiomyopathies

Based on three labs

Multi Category classification

Case Study 2:
Class: Vulvular Heart Diseases Diseases: Tricsupid Stenosis and Mitral Regurgitation

Class: Vulvular Heart Diseases Diseases: Tricsupid Stenosis and Mitral Regurgitation

Class: Vulvular Heart Diseases Diseases: Tricsupid Stenosis and Mitral Regurgitation

Pulmonary Hypertension vs. Pulmonary Edema Overlapping

Restrictive vs. Dilated Cardiomyopathies

Prinzmetal Angina vs. Unstable Angina

Overview

True state of diagnosis

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Suggested Architecture