Mini Expert System for Emergency Radiation Accident Patient Management Instructor: Dinesh P Mital Ying-Fong Huang [email protected] 2003.05.14.

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

TAIWANTAIWAN

Population: 22,370,461 Land Area: 32,260 sq km

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>

DSS vs. ESDSS vs. ES

Please Review Dr. Mital’s teaching materials……

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