Intelligent Clinical Decision Support System Research Articles

Automated Classification of Abdominal Ultrasound lmages of the Pancreas Based on the Spectral Representation of the Border’s Contours

The purpose of the research is to develop a methodology for classifying complexly structured halftone images based on a multimodal approach using methods of morphological analysis, spectral analysis and neural network modeling.Methods. А method for classifying the contours of the boundaries of segments of a complexly structured image is described. Тhe method is based on the fact that in chronic diseases of the pancreas, there is a violation of the integrity of the contour of its border and its waviness increases due to retractions and bulges caused by an alterative inflammatory process. Тhe method includes the stages of normalization of ultrasound images and image segmentation with the selection of the contour of the object of interest. Тo classify the contour of a segment boundary, it is proposed to use Fourier analysis and neural network technologies. Тhe method is illustrated using the example of classifying the contour of the border of the pancreas on its transcutaneous acoustic image.Results. Еxperimental studies of the proposed methods and means for classifying medical risk were carried out on diagnostic tasks according to the following classes: "chronic pancreatitis" – "without pathology". For experimental studies, video sequences of ultrasound images of the pancreas provided by an endoscopist were used. Тhe purpose of the experimental studies was to analyze the classification quality indicators of image classifiers with class segments "Chronic pancreatitis" and "Without pathology". Тhe training sample of video images (frames of video sequences) included 200 examples, one hundred from each class. Тhe quality indicator "Sensitivity" of classification for two classes is 85,7%, the indicator "Specificity" is 87,1%.Тhe use of the contour analysis method in classifiers of ultrasound images of the pancreas opens up new opportunities for accessible and objective diagnosis of pancreatic diseases, expanding the capabilities of intelligent clinical decision support systems.

Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Prediction of Dyspnea after 12 Months of an Acute Episode of COVID-19.

Long COVID is a condition that affects a significant proportion of patients who have had COVID-19. It is characterised by the persistence of associated symptoms after the acute phase of the illness has subsided. Although several studies have investigated the risk factors associated with long COVID, identifying which patients will experience long-term symptoms remains a complex task. Among the various symptoms, dyspnea is one of the most prominent due to its close association with the respiratory nature of COVID-19 and its disabling consequences. This work proposes a new intelligent clinical decision support system to predict dyspnea 12 months after a severe episode of COVID-19 based on the SeguiCovid database from the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain). The database is initially processed using a CART-type decision tree to identify the variables with the highest predictive power. Based on these variables, a cascade of expert systems has been defined with Mamdani-type fuzzy-inference engines. The rules for each system were generated using the Wang-Mendel automatic rule generation algorithm. At the output of the cascade, a risk indicator is obtained, which allows for the categorisation of patients into two groups: those with dyspnea and those without dyspnea at 12 months. This simplifies follow-up and the performance of studies aimed at those patients at risk. The system has produced satisfactory results in initial tests, supported by an AUC of 0.75, demonstrating the potential and usefulness of this tool in clinical practice.

Development and evaluation of a clinical decision support system for early diagnosis of acute appendicitis

The most frequent reason for individuals experiencing abdominal discomfort to be referred to emergency departments of hospitals is acute appendicitis, and the most frequent emergency surgery performed is an appendectomy. The purpose of this study was to design and develop an intelligent clinical decision support system for the timely and accurate diagnosis of acute appendicitis. The number of participants which is equal to 181 was chosen as the sample size for developing and evaluating neural networks. The information was gathered from the medical files of patients who underwent appendicectomies at Shahid Modarres Hospital as well as from the findings of their appendix samples' pathological tests. The diagnostic outcomes were then ascertained by the development and comparison of a Multilayer Perceptron network (MLP) and a Support Vector Machine (SVM) system in the MATLAB environment. The SVM algorithm functioned as the central processing unit in the Clinical Decision Support System (CDSS) that was built. The intelligent appendicitis diagnostic system was subsequently developed utilizing the Java programming language. Technical evaluation and system usability testing were both done as part of the software evaluation process. Comparing the output of the optimized artificial neural network of the SVM with the pathology result showed that the network's sensitivity, specificity, and accuracy were 91.7%, 96.2%, and 95%, respectively, in diagnosing acute appendicitis. Based on the existing standards and the opinions of general surgeons, and also comparing the results with the diagnostic accuracy of general surgeons, findings indicated the proper functioning of the network for the diagnosis of acute appendicitis. The use of this system in medical centers is useful for purposes such as timely diagnosis and prevention of negative appendectomy, reducing patient hospital stays and treatment costs, and improving the patient referral system.

Effectiveness of an artificial intelligence clinical assistant decision support system to improve the incidence of hospital-associated venous thromboembolism: a prospective, randomised controlled study

BackgroundThromboprophylaxis has been determined to be safe, effective and cost-effective for hospitalised patients at venous thromboembolism (VTE) risk. However, Chinese medical institutions have not yet fully used or improperly used...

Intelligent Clinical Decision Support System for Managing COPD Patients.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Health remote monitoring systems (HRMSs) play a crucial role in managing COPD patients by identifying anomalies in their biometric signs and alerting healthcare professionals. By analyzing the relationships between biometric signs and environmental factors, it is possible to develop artificial intelligence models that are capable of inferring patients' future health deterioration risks. In this research work, we review recent works in this area and develop an intelligent clinical decision support system (CIDSS) that is capable of providing early information concerning patient health evolution and risk analysis in order to support the treatment of COPD patients. The present work's CIDSS is composed of two main modules: the vital signs prediction module and the early warning score calculation module, which generate the patient health information and deterioration risks, respectively. Additionally, the CIDSS generates alerts whenever a biometric sign measurement falls outside the allowed range for a patient or in case a basal value changes significantly. Finally, the system was implemented and assessed in a real case and validated in clinical terms through an evaluation survey answered by healthcare professionals involved in the project. In conclusion, the CIDSS proves to be a useful and valuable tool for medical and healthcare professionals, enabling proactive intervention and facilitating adjustments to the medical treatment of patients.

Usability and performance expectancy govern spine surgeons' use of a clinical decision support system for shared decision-making on the choice of treatment of common lumbar degenerative disorders.

Quantitative survey study is the study design. The study aims to develop a model for the factors that drive or impede the use of an artificial intelligence clinical decision support system (CDSS) called PROPOSE, which supports shared decision-making on the choice of treatment of ordinary spinal disorders. A total of 62 spine surgeons were asked to complete a questionnaire regarding their behavioral intention to use the CDSS after being introduced to PROPOSE. The model behind the questionnaire was the Unified Theory of Acceptance and Use of Technology. Data were analyzed using partial least squares structural equation modeling. The degree of ease of use associated with the new technology (effort expectancy/usability) and the degree to which an individual believes that using a new technology will help them attain gains in job performance (performance expectancy) were the most important factors. Social influence and trust in the CDSS were other factors in the path model. r2 for the model was 0.63, indicating that almost two-thirds of the variance in the model was explained. The only significant effect in the multigroup analyses of path differences between two subgroups was for PROPOSE use and social influence (p = 0.01). Shared decision-making is essential to meet patient expectations in spine surgery. A trustworthy CDSS with ease of use and satisfactory predictive ability promoted by the leadership will stand the best chance of acceptance and bridging the communication gap between the surgeon and the patient.

An Intelligent Clinical Decision Support System based on Attentive Federated Learning

An Intelligent Clinical Decision Support System based on Attentive Federated Learning

Integration of the Wang & Mendel Algorithm into the Application of Fuzzy Expert Systems to Intelligent Clinical Decision Support Systems

The use of intelligent systems in clinical diagnostics has evolved, integrating statistical learning and knowledge-based representation models. Two recent works propose the identification of risk factors for the diagnosis of obstructive sleep apnea (OSA). The first uses statistical learning to identify indicators associated with different levels of the apnea-hypopnea index (AHI). The second paper combines statistical and symbolic inference approaches to obtain risk indicators (Statistical Risk and Symbolic Risk) for a given AHI level. Based on this, in this paper we propose a new intelligent system that considers different AHI levels and generates risk pairs for each level. A learning-based model generates Statistical Risks based on objective patient data, while a cascade of fuzzy expert systems determines a Symbolic Risk using symptom data from patient interviews. The aggregation of risk pairs at each level involves a fuzzy expert system with automatically generated fuzzy rules using the Wang-Mendel algorithm. This aggregation produces an Apnea Risk indicator for each AHI level, allowing discrimination between OSA and non-OSA cases, along with appropriate recommendations. This approach improves variability, usefulness, and interpretability, increasing the reliability of the system. Initial tests on data from 4400 patients yielded AUC values of 0.74–0.88, demonstrating the potential benefits of the proposed intelligent system architecture.

Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Screening and Early Diagnosis of Breast Cancer.

Breast cancer is the most frequently diagnosed tumor pathology on a global scale, being the leading cause of mortality in women. In light of this problem, screening programs have been implemented on the population at risk in the form of mammograms, starting in the 20th century. This has considerably reduced the associated deaths, as well as improved the prognosis of the patients who suffer from this disease. In spite of this, the evaluation of mammograms is not without certain variability and depends, to a large extent, on the experience and training of the medical team carrying out the assessment. With the aim of supporting the evaluation process of mammogram images and improving the diagnosis process, this work presents the design, development and proof of concept of a novel intelligent clinical decision support system, grounded on two predictive approaches that work concurrently. The first of them applies a series of expert systems based on fuzzy inferential engines, geared towards the treatment of the characteristics associated with the main findings present in mammograms. This allows the determination of a series of risk indicators, the Symbolic Risks, related to the risk of developing breast cancer according to the different findings. The second one implements a classification machine learning algorithm, which using data related to mammography findings as well as general patient information determines another metric, the Statistical Risk, also linked to the risk of developing breast cancer. These risk indicators are then combined, resulting in a new indicator, the Global Risk. This could then be corrected using a weighting factor according to the BI-RADS category, allocated to each patient by the medical team in charge. Thus, the Corrected Global Risk is obtained, which after interpretation can be used to establish the patient's status as well as generate personalized recommendations. The proof of concept and software implementation of the system were carried out using a data set with 130 patients from a database from the School of Medicine and Public Health of the University of Wisconsin-Madison. The results obtained were encouraging, highlighting the potential use of the application, albeit pending intensive clinical validation in real environments. Moreover, its possible integration in hospital computer systems is expected to improve diagnostic processes as well as patient prognosis.

Design and Conceptual Proposal of an Intelligent Clinical Decision Support System for the Diagnosis of Suspicious Obstructive Sleep Apnea Patients from Health Profile

Obstructive Sleep Apnea (OSA) is a chronic sleep-related pathology characterized by recurrent episodes of total or partial obstruction of the upper airways during sleep. It entails a high impact on the health and quality of life of patients, affecting more than one thousand million people worldwide, which has resulted in an important public health concern in recent years. The usual diagnosis involves performing a sleep test, cardiorespiratory polygraphy, or polysomnography, which allows characterizing the pathology and assessing its severity. However, this procedure cannot be used on a massive scale in general screening studies of the population because of its execution and implementation costs; therefore, causing an increase in waiting lists which would negatively affect the health of the affected patients. Additionally, the symptoms shown by these patients are often unspecific, as well as appealing to the general population (excessive somnolence, snoring, etc.), causing many potential cases to be referred for a sleep study when in reality are not suffering from OSA. This paper proposes a novel intelligent clinical decision support system to be applied to the diagnosis of OSA that can be used in early outpatient stages, quickly, easily, and safely, when a suspicious OSA patient attends the consultation. Starting from information related to the patient's health profile (anthropometric data, habits, comorbidities, or medications taken), the system is capable of determining different alert levels of suffering from sleep apnea associated with different apnea-hypopnea index (AHI) levels to be studied. To that end, a series of automatic learning algorithms are deployed that, working concurrently, together with a corrective approach based on the use of an Adaptive Neuro-Based Fuzzy Inference System (ANFIS) and a specific heuristic algorithm, allow the calculation of a series of labels associated with the different levels of AHI previously indicated. For the initial software implementation, a data set with 4600 patients from the Álvaro Cunqueiro Hospital in Vigo was used. The results obtained after performing the proof tests determined ROC curves with AUC values in the range 0.8-0.9, and Matthews correlation coefficient values close to 0.6, with high success rates. This points to its potential use as a support tool for the diagnostic process, not only from the point of view of improving the quality of the services provided, but also from the best use of hospital resources and the consequent savings in terms of costs and time.

Analysis of Watson for oncology and clinicians' treatment recommendations for patients with breast cancer in Korea: A single center experience.

Various clinical applications have been attempted using artificial intelligence (AI) clinical decision support system (CDSS), and it has become a starting point for personalized cancer treatment. We aimed to identify the degree of agreement between the AI-CDSS, Watson for Oncology (WFO), and the clinician in treatment recommendations for Korean breast cancer patients and to provide guidelines for future improvement. One hundred and eighty-three breast cancer patients who underwent treatment at the Pusan National University Hospital between January 1, 2016 and May 31, 2017 were enrolled in this study. The concordance between WFO's and clinicians' treatment recommendations were examined according to various factors. WFO gave the same treatment option recommendations as clinicians in 74 (40.4%) of the cases. According to the logistic regression, the difference in recommendation concordance between stage I and stage III was statistically significant (P = 0.004), and there was no difference among other factors. The concordance of treatment recommendations was low overall. However, this is largely attributable to the differences of medical insurance system and healthcare environment between the United States and Korea. In the future, region-specific features should be considered or reflected during the development of AI-CDSS.

Ontology for Symptomatic Treatment of Multiple Sclerosis.

Symptomatic treatment is an essential component in the overall treatment of multiple sclerosis (MS). However, knowledge in this regard is confusing and scattered. Physicians also have challenges in choosing symptomatic treatment based on the patient's condition. To share, update, and reuse this knowledge, the aim of this study was to provide an ontology for MS symptomatic treatment. The Symptomatic Treatment of Multiple Sclerosis Ontology (STMSO) was developed according to Ontology Development 101 and a guideline for developing good ontologies in the biomedical domain. We obtained knowledge and rules through a systematic review and entered this knowledge in the form of classes and subclasses in the ontology. We then mapped the ontology using the Basic Formal Ontology (BFO) and Ontology for General Medical Sciences (OGMS) as reference ontologies. The ontology was built using Protégé Editor in the Web Ontology Language format. Finally, an evaluation was done by experts using criterion-based approaches in terms of accuracy, clarity, consistency, and completeness. The knowledge extraction phase identified 110 articles related to the ontology in the form of 626 classes, 40 object properties, and 139 rules. Five general classes included "patient," "symptoms," "pharmacological treatment," "treatment plan," and "measurement index." The evaluation in terms of standards for biomedical ontology showed that STMSO was accurate, clear, consistent, and complete. STMSO is the first comprehensive semantic representation of the symptomatic treatment of MS and provides a major step toward the development of intelligent clinical decision support systems for symptomatic MS treatment.

Applied picture fuzzy sets with knowledge reasoning and linguistics in clinical decision support system

Motivation: Healthcare systems globally face significant resource and financial challenges. Moreover, these challenges have resulted in an existential paradigm shift driven by: (i) the growth in the demand for healthcare services is exacerbated by a global population characterised by an ageing demographic with increasingly complex healthcare needs, and (ii) rapid developments in healthcare technologies and drug therapies which can be seen in the new and emerging treatment options. A potential solution to address [or at least mitigate] these challenges is ‘telemedicine’ with nurse-led ‘triage’ systems; however, a limiting factor for ‘telemedicine’ is the management of imprecision and uncertainty in the diagnostic process. Contribution: In this paper we introduce a novel rule-based approach predicated on picture fuzzy sets to enable intelligent clinical decision support system which builds on previous research to create an approach predicated on picture fuzzy sets. Our principal contribution lies in the use of expert clinician preferences in a rule-based system which implements knowledge reasoning along with linguistic information to improve the diagnostic performance. Results: In ‘real-world’ case studies (using ethically approved anonymised patient data) we have investigated heart conditions, kidney stones, and kidney infections. Reported results for the proposed approach demonstrate a high level of accuracy in clinical diagnostic accuracy terms with reported accuracy in the range [92% to 95%] and a high confidence level when compared to alternative diagnostic matching methods.

Development of a Cost-Effective Intelligent Clinical Decision Support System for Breast Cancer Early Diagnosis and Triage

Women population screening using mammography has dramatically reduced breast cancer rates worldwide. Nowadays, in many countries, the prevention of breast cancer policy is based on frequent and repeated mammographies, followed by breast ultrasound and if necessary, by histological examination in the biological material of the biopsy. However, evaluating mammography findings is considered as a difficult process which can properly performed only by a highly experienced and well-trained medical staff. Subsequently, the interpretation of those findings could be easily influenced by subjective factors and therefore can be prone to diagnostic errors as evidenced in the present study. Breast MRI, is a diagnostic practice indicated in cases of high breast density and at the same time, a high-cost examination for healthcare systems. Furthermore, genetic testing that is used to diagnose hereditary breast cancer, represents a small proportion of breast cancers and at the same time it is a high-cost specialized test. Even the most widely used biopsy, Fine Needle Aspirate (FNA), in some cases involves risks and provides false negative results. This study presents a novel intelligent Clinical Decision Support System (CDSS), which uses data from common practice, non-invasive and low-cost diagnostic tests, together with medical health record, in order to provide clinicians with a viable, cost-effective and accurate diagnostic solution. After implementing several algorithms, Random Forest classifier showed the highest values of sensitivity 96,2 %, specificity 94,6%, PPV 96,2% and NPV 94,6%, being thus an effective algorithm in the development of our innovative CDSS model aiming to constitute a very useful tool in clinical practice for breast cancer early diagnosis.

Design and Development of an Intelligent Clinical Decision Support System Applied to the Evaluation of Breast Cancer Risk.

Breast cancer is currently one of the main causes of death and tumoral diseases in women. Even if early diagnosis processes have evolved in the last years thanks to the popularization of mammogram tests, nowadays, it is still a challenge to have available reliable diagnosis systems that are exempt of variability in their interpretation. To this end, in this work, the design and development of an intelligent clinical decision support system to be used in the preventive diagnosis of breast cancer is presented, aiming both to improve the accuracy in the evaluation and to reduce its uncertainty. Through the integration of expert systems (based on Mamdani-type fuzzy-logic inference engines) deployed in cascade, exploratory factorial analysis, data augmentation approaches, and classification algorithms such as k-neighbors and bagged trees, the system is able to learn and to interpret the patient’s medical-healthcare data, generating an alert level associated to the danger she has of suffering from cancer. For the system’s initial performance tests, a software implementation of it has been built that was used in the diagnosis of a series of patients contained into a 130-cases database provided by the School of Medicine and Public Health of the University of Wisconsin-Madison, which has been also used to create the knowledge base. The obtained results, characterized as areas under the ROC curves of 0.95–0.97 and high success rates, highlight the huge diagnosis and preventive potential of the developed system, and they allow forecasting, even when a detailed and contrasted validation is still pending, its relevance and applicability within the clinical field.

Development of an intelligent clinical decision support system for the early prediction of diabetic nephropathy

BackgroundDiabetic nephropathy (DN) is the most common microvascular complication of diabetes mellitus (DM) and is identified as a leading cause of the end-stage renal disease (ESRD). Considering the importance of early prediction of individuals at risk of this complication, the use of intelligent models through machine learning (ML) algorithms can be helpful. Therefore, this study aimed to identify the influential variables in predicting DN and fed them as inputs to develop an ML-based decision support system (DSS) for DN diagnosis. MethodsThe data of 327 patients with diabetes (types 1 and 2) were retrospectively analyzed. After data preparation, the genetic algorithm (GA) feature selection method was used to identify the predictor variables affecting DN. Then, several ML algorithms, including the support vector machine (SVM), decision tree (DT), K-nearest neighbors (KNN), and artificial neural networks (ANN) were used to train predictive models based on the selected features. Afterward, the performance of the developed models was evaluated using sensitivity, specificity, and accuracy criteria in 10 independent runs. Finally, the DSS was developed based on the best fit model in the C# programming language. ResultsOur findings illustrated that age, hemoglobin A1c (HbA1c) test, diastolic arterial pressure (DAP), systolic arterial pressure (SAP), fasting glycemia rate (FGR), and DM involvement time were the most important factors in predicting DN. Moreover, to predict the DN, GA combined with the DT algorithm obtained the highest performance in terms of accuracy, sensitivity, specificity, and area under the curve (AUC), equal to 98.9, 98.6, 99.2, and 98.9%, respectively. ConclusionsThe results revealed that GA combined with the DT classifier predicted DN with significant accuracy. Thus, the DSS developed based on DT can be considered a reliable tool to help physicians make decisions. Future studies are warranted to further validate the applicability of our model in clinical settings.

A Specialized Shell for Intelligent Systems of Prescribing Medication

This paper analyzes the existing decision support systems for prescription of drug therapy. The main principles of development and architecture of an intelligent clinical decision support system that is implemented as a specialized shell are described. The unique features of the system, as well as information and software components that are part of it, are shown. The presented examples demonstrate all the proposed solutions.

Artificial intelligence: opportunities in lung cancer.

In this article, we focus on the role of artificial intelligence in the management of lung cancer. We summarized commonly used algorithms, current applications and challenges of artificial intelligence in lung cancer. Feature engineering for tabular data and computer vision for image data are commonly used algorithms in lung cancer research. Furthermore, the use of artificial intelligence in lung cancer has extended to the entire clinical pathway including screening, diagnosis and treatment. Lung cancer screening mainly focuses on two aspects: identifying high-risk populations and the automatic detection of lung nodules. Artificial intelligence diagnosis of lung cancer covers imaging diagnosis, pathological diagnosis and genetic diagnosis. The artificial intelligence clinical decision-support system is the main application of artificial intelligence in lung cancer treatment. Currently, the challenges of artificial intelligence applications in lung cancer mainly focus on the interpretability of artificial intelligence models and limited annotated datasets; and recent advances in explainable machine learning, transfer learning and federated learning might solve these problems. Artificial intelligence shows great potential in many aspects of the management of lung cancer, especially in screening and diagnosis. Future studies on interpretability and privacy are needed for further application of artificial intelligence in lung cancer.

High precision brain tumor classification model based on deep transfer learning and stacking concepts

In this article, we proposed an intelligent clinical decision support system for the detection and classification of brain tumor from risk of malignancy index (RMI) images. To overcome the lack of labeled training data needed to train convolutional neural networks, we have used a deep transfer learning and stacking concepts. For this, we choosed seven convolutional neural networks (CNN) architectures already pre-trained on an ImageNet dataset that we precisely fit on magnetic resonance imaging (MRI) of brain tumors collected from the brain tumor segmentation (BraTS) 19 database. To improve the accuracy of our global model, we only predict as output the prediction that obtained the maximum score among the predictions of the seven pre-trained CNNs. We used a 10-way cross-validation approach to assess the performance of our main 2-class model: low-grade glioma (LGG) and high-grade glioma (HGG) brain tumors. A comparison of the results of our proposed model with those published in the literature, shows that our proposed model is more efficient than those published with an average test precision of 98.67%, an average f1 score of 98.62%, a test precision average of 98.06% and an average test sensitivity of 98.33%.

Medical practitioner's adoption of intelligent clinical diagnostic decision support systems: A mixed-methods study

Artificial intelligence-based clinical diagnostic decision support systems promise transformational improvements in doctors’ efficiency and accuracy. Nevertheless, low adoption rates suggest that this innovation could fail without adequate uptake. This study uses a mixed-methods approach to develop and test a model based on theories of Unified Theory of Acceptance and Use of Technology, status quo bias, and technology trust. The results show that performance expectancy, effort expectancy, social influence, initial trust, and resistance to change predict intention to use. Further, inertia, perceived threat, and risks (medico-legal and performance) determine resistance to change. Measures for alleviating resistance and improving adoption are proposed.