1. 1 RPGOntology – Imaging Ontology Workshop 2006 RPGOntology - A Semantic Webized Knowledge Base for Referral Guidelines for Imaging Helen Chen, Ph.D Advanced Clinical Applications Agfa Healthcare

2. 2 RPGOntology – Imaging Ontology Workshop 2006 Purposes of Radiation Protection Guidelines l To recommend appropriate investigation means l Is this investigation most effective for my prognosis or diagnosis? l Am I benefit from the new research findings and capacity of newly invented modalities? l To reduce wastefulness in radiology practices l 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? l To protect patients from harmful and unnecessary exposure to radiation 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?

3. 3 RPGOntology – Imaging Ontology Workshop 2006 Guideline Original Format: Tabulated Recommendation

4. 4 RPGOntology – Imaging Ontology Workshop 2006 Guideline Original Format: Rule-Like Statement l Pregnancy and protection of the foetus l “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” l “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.” l ……. Optimizing Investigation “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 post- therapy, especially post-radiotherapy” l …….

5. 5 RPGOntology – Imaging Ontology Workshop 2006 RPGOntology: Taxonomy – Some Examples ClinicalProblem HeadProblem NeckProblem SpineProblem GeneralSpineProblem CervicalSpineProblem ThoracicSpineProblem LumbarSpineProblem MusculoskeletalSystemProblem CardiovascularSystemProblem ThoracicSystemProblem GastrointestinalSystemProblem GastrointestinalTractProblem GeneralAbdominalProblemsProblem LiverGallbladderPancreasProblem UrologicalAdrenalGenitoSystemProblem ObstetricsGynaecologyProblem BreastDiseaseProblem AsymptomaticProblem SymptomaticProblem Trauma HeadTrauma CervicalSpineTrauma ThoracicLumbarTrauma PelvisSacrumTrauma ……. ChestTrauma Cancer ……. PaediatricsProblem InvestigationMethod MRI NM RedCellStudy NMRenogram NMSkeletal PET SPECT US USAorta USCardiac USKidneys USLivers USCarotids XR ……. CT ……. BodyParts FullBody Head Neck Spine UpperLimb LowerLimb Abdomen RedCellStudy NMRenogram NMSkeletal PET SPECT

6. 6 RPGOntology – Imaging Ontology Workshop 2006 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 …………

7. 7 RPGOntology – Imaging Ontology Workshop 2006 RPGOntology: Example Clinical ProblemInvestigation {Dose} Recommendation {Grade} Comment Back or neck pain M10 XR (I)Indicated (B)Back pain is uncommon in children without a cause. Follow-up is needed if infection is suspected :m10_1 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. Table M: Paediactrics

8. 8 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).

9. 9 RPGOntology – Imaging Ontology Workshop 2006 Rules l Sets of rules are derived for different use cases of RPGOntology l 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)}

10. 10 RPGOntology – Imaging Ontology Workshop 2006 Beyond the Tables in Guidelines: Connecting Knowledge Bases 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

11. 11 RPGOntology – Imaging Ontology Workshop 2006 RPGOntology in Action – An Illustration Electronic Patient Record System PRGOntology PatientOntology ICD Terminology Service Domain Ontology 1 RPG Recommendation Rules Patient Categorization Rules Business Process and Resource Rules Domain Ontology 2 Order forms Reasoning Engines External knowledge Patient information Guidelines and rules Request for recommendation or validation Recommendations and Proof