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Mini Expert System for Mini Expert System for Emergency Radiation Emergency Radiation
Accident Patient ManagementAccident Patient Management
Instructor: Dinesh P Mital
Ying-Fong [email protected]
2003.05.14
MotivationMotivation
Nuclear power project has long been a controversial issue in Taiwan
March 18, 2001: A site emergency event Level 3A was triggered of the Third Nuclear Power Plant.
Motivation (cont.)Motivation (cont.)
Drill of emergency medical management of multiple-casualty radiation accident
Doctors looked up the books and journals to make decision when patients of various conditions came in
They even worked on the patient while asked others how to do for next step
Motivation (cont.)Motivation (cont.)
Victims of radiation accident are very rare.
Not so proficiently
Can we help them?
Radiation AccidentRadiation Accident
Accident: An occurrence that results in personal injury, disease or death or property damage
Radiation Accident: An accident correlated to ionizing radiation
Types of Radiation AccidentTypes of Radiation Accident
Industrial and medical uses of radiation Transportation accidents Radiography over-exposuresReleased from fixed nuclear facility
(e.g., reactor)
Types of Radiation Accident Types of Radiation Accident (cont.)(cont.)
Malicious/terrorist events: – Radiological dispersal devices – Intentional irradiation – Nuclear weapon
Chernobyl Nuclear Power Chernobyl Nuclear Power Plant DisasterPlant Disaster
01:23, 1986.04.26 Chernobyl, former USSR Killed more than 30 peop
le immediately High radiation levels in t
he surrounding 20-mile radius, 135,00 people evacuated
Over 2,500 deaths
Radiation BioeffectRadiation Bioeffect
Deterministic Effects
(Non-stochastic effect)Stochastic Effects Radiation Hormesis
Deterministic EffectsDeterministic Effects
They have a threshold They are dose related They are predictable There is a gradation in response If the dose is received over a longer period
the effects will be less
Stochastic EffectsStochastic Effects
The severity of the response is independent of the dose
The total dose given is more important than the time period over which is was given
Effects may present many years later Cancer is the commonest stochastic effects
Radiation Protection Radiation Protection GuidelinesGuidelines
Time: the shorter, the saferDistance: the farther, the saferShielding: the more, the saferQuantity: the less, the safer
ExposureExposure
Occurs when entering an area there is a radiation source
The patient does not become radioactive. Example: Receiving a chest X-ray
ContaminationContamination
External contamination: Radioactive material on the surface of a patient
Internal contamination: Some radioactive material entered into the body
The patient may have radiation hazard to others
Hospital Emergency Care of Hospital Emergency Care of Radiation Accident PatientRadiation Accident Patient
REAC/TS. Guidance for Radiation Accident Management. <http://www.orau.gov/reacts/guidance.htm>
Mansfield G. Planning for Management of Radiation Incidents. <http://www.llnl.gov/seaborginstitute/training/planning_radiation.pdf>
Wagner RH, Henkin RE, Halama JR. The Medical Management of Radiation Accidents. <http://www.meddean.luc.edu/lumen/MedEd/radiation/Radaccident/HOMEPAGE.html>
FORMAL DEFINITION OF A DECISION SUPPORT SYSTEM
A DSS is an interactive, flexible and adaptive system, specifically developed for supporting solutions of management decision problems for improved decision making or diagnosis of some problems.
It supports all the phases of the decision making and includes a knowledge-base.
In order for this to be successful, the system must be:
• Simple • Adaptive
• Robust • Complete , on important issues
•Easy to control/use • Easy to communicate
COMPONENTS OF DSS
1. Data Management: Includes a database and is managed by the DBMS software.
Expert systems (Decision Support Systems):
When an organization has a complex decision to make or a problem to solve, it has to turn to experts, which could be difficult to find and at times very expensive.
Expert systems are attempts to mimic human experts
Expert systems are branch of “applied artificial intelligence”. They are used frequently in medical diagnostic systems, mineralexploration, managing assets and liabilities, corporate planning, organizational management and administration, etc.
Differences Between DSS and ESDifferences Between DSS and ESDSS ES
Objective Assist human decision maker
Replicate (mimic) human advisers and replace them
Who makes the recommendations (decisions)
The human and the system The system
Major orientation Decision making Transfer of expertise and rendering of advice
Major query direction Human query the machine Machine queries the humans
Nature of support Personal, groups, and institutional
Personal (mainly), and groups
Characteristics of problem area
Complex, integrated, wide Narrow domain
Types of problems Ad-hoc, unique Repetitive
Content of database Factual knowledge Factual and procedural knowledge
Reasoning capability None Yes, limited
Manipulation method Numerical Symbolic
Computerized Decision Computerized Decision Support SystemsSupport Systems
DSS: Decision Support Systems ES: Expert SystemsGDSS: Group DSSEIS: Executive Information Systems ANNs: Artificial Neural Networks
DSS-ES connections
These two seems to be completely different. These differences are technological as well as managerial.
Because of different capabilities, they can complement each other, creating powerful and integrated computer based systems that can improve managerial decision making capabilities ( or process).
Clinical Diagnostic Decision Clinical Diagnostic Decision Support System (CDDSS)Support System (CDDSS)
A computer-based algorithm that assists a clinician with one or more component steps of the diagnostic process
For most of the CDDSS to work, they must consist of two basic parts: – Knowledge Base– Inference Engine
Clinical Application of CDDSSClinical Application of CDDSS
Reported by many institutesMost of them began as funded academic
research projects Not all of them showed a favourable result
• Wolf FM, Friedman CP, Elstein AS, Millerd JG, Murphy GC, Heckerling P, Fine P, Miller T, Sisson J, Barlas S, Capitanod A, Ngc M, Franzc T. Changes in Diagnostic Decision-making After a Computerized Decision Support Consultation Based on Perceptions of Need and Helpfulness: A Preliminary Report. <http://www.amia.org/pubs/symposia/D004169.PDF>
CDDSS in Emergency CDDSS in Emergency MedicineMedicine
Usually designed for a specific purpose Acute myocardial infarction and/or ischemia
– Outer eye: Computers in Nursing. 19(3):114-7, 2001
– HAZMATs: Journal of Hazardous Materials. 71(1-3):503-21, 2000
– Chest Pain: Cardiology. 92(2):128-34, 1999 Artificial Intelligence in Medicine. 10(1):75-92, 1997 Computer Methods & Programs in Biomedicine. 52(2):93-103, 1997 Academic Emergency Medicine. 3(7):689-93, 1996 J Cardiovasc Nurs. 16(3):1-8, 2002
Stryer DB. The development and role of Stryer DB. The development and role of predictive instruments in acute coronary predictive instruments in acute coronary
events: improving diagnosis and management. events: improving diagnosis and management.
J Cardiovasc Nurs. 16(3):1-8, 2002J Cardiovasc Nurs. 16(3):1-8, 2002 “Approximately 6 million patients with chest
pain are seen annually in Eds. Together, AMI, angina, and nonspecific chest pain accounted for more than 2.5 million admissions and $47 billion in hospital charges in 1997. In 1998, AMI resulted in nearly 460,000 deaths, the leading cause of mortality in US……”
Evaluation of the GoalEvaluation of the Goal
Frequency -> Very rare – Not proficiently– Can not afford an expensive system
Doctors looked up the books -> Need experts’ help, possible contamination
Asked others -> Need experts’ helpExposure -> Shortest timeContamination Control -> Mouse operation onlyKnowledge -> Rule-based: “IF…THEN…”
Evaluation of the Goal (cont.)Evaluation of the Goal (cont.)
To build a simple, low-cost and easy-to-use mini expert system for emergency radiation accident patient management
Inference Engine SelectionInference Engine Selection
Free 30-day Exsys CORVID ver. 2.0 evaluation program
Up to 150 nodesWeb-based
Knowledge Base BuildingKnowledge Base Building
Extract knowledge from the documentsTranslate into “IF…THEN…”Cascade the rules to form a “decision tree”Define variables and valuesDivide “decision tree” into “logic blocks”Create “single variable” node to add
important notices
ImplementationImplementation
Copy the HTML file and “ExsysCorvid.jar” to a floppy disk and rename the HTML file to be “index.html” -> Run from disk
Transfer “index.html” and “ExsysCorvid.jar” to certain directory under httpd server root directory of a web server -> Run from web
DiscussionDiscussion
CDDSS applications seldom last long– Funded research projects – No knowledge base update
An exception: AMI/angina/chest pain– Markets (Population)– Mortality
Discussion (cont.)Discussion (cont.)
Should CDDSS be a sophisticated and expensive monster and can only serve the purpose of million patients a year.
In this project, we may provide a different point of view to build a simple mini expert system for a different kind of utility.
ConclusionConclusion
A simple, low-cost and easy-to-use mini expert system for emergency radiation accident patient management is built using the free 30-day Exsys CORVID evaluation program
http://njmsa.umdnj.edu/~huangy3Further clinical testing is necessary