There are two major areas of medical informatics related to the kidneys and body fluids:
- Imaging of the kidneys
- General diagnosis/decision aids related to the kidneys
- CT/MRI analysis of kidney size and shape using constraint satisfaction
- Russ Altman and Jim Brinkley, SCAMC 1993
- Goal: develop useful models for biological structure and its variability
- Ideally combine knowledge about generic features of the class of biological
structures with data that provide specific information about the particular
instance of the class
- Anaylysis of kidney size and shape can be useful for detecting certain
disorders...
- Shani (Rochester)
- Used a detailed anatomic model of the kidney to provide search regions for
finding the image of the kidney in a stack of CT slices
- PIP
- Pauker, Gorry, Kassirer, and Schwartz, 1976
- One of the first medical expert systems (often referenced with MYCIN,
CASNET, and INTERNIST-1) <-- KNOW THESE!!
- Computer program designed to take the present illness of a patient with
edema
- Attempt to model hypothetico-deductive approach
- Basic components of the program:
- Patient-specific data -- facts provided by the user either spontaneously or in response to questions asked by the program
- Supervisory Program
- Guides the system in taking the present illness and oversees the operation
of various subprocesses
- -selecting questions
- -seeking and applying relevant advice
- -processing algorithms (e.g. flowcharts)
- goal is to arrive at coherant formulation of the case
- -generate and test hypotheses
- -exclude competing hypothesis
- Short-Term Memory
- Place where info about patient interacts with general medical knowledge
kept in LT memory
- Supervisory program determines which pieces of general medical knowledge
should enter ST memory
- Long-Term Memory
- Knowledge stored in frames (diseases, physiologic states, clinical states)
- Frames are linked into a network
- Frames also contain knowledge about the real world -- relevant common sense
knowledge
- How does it work?
- characterize findings
- seek advice on how to proceed
- generate hypothesis
- test hypothesis
- select questions
- ABEL - Acid-Base Electrolyte program
- Patil, Szolovits, and Schwartz, 1981 (Patil's thesis)
- Consultation for electrolyte and acid-base disturbances
- Goal: construct a patient specific model (PSM)
- patient data
- hypothetical interpretations of these data in multilevel causal network
- Causal network
- several levels
- concepts and relations gradually shift in content from pathophysiological
to syndromic knowledge
- aggregate level of this description summarizes the patient data and
provides global perspective for efficient exploration of the diagnostic
possibilities
- pathophysiological description handles complex clinical situations arising
in illnesses with multiple etiologies
- Ex. Diarrhea --->
- metabolic acidosis
- dehydration
- hypotension
- weakness
- acute renal failure
Drug metabolism models
Cost-Effectiveness Analysis
NB: People with kidney failure who need dialysis are covered under Medicare.
Slow change in kidney function test is a problem for time oriented databases