iRENEX: a clinically informed decision support system for the interpretation of ⁹⁹mTc-MAG3 scans to detect renal obstruction.
iRENEX: a clinically informed decision support system for the interpretation of ⁹⁹mTc-MAG3 scans to detect renal obstruction.
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DOI：
10.1007/s00259-012-2151-7
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发表时间：
2012-09
影响因子：
9.1
通讯作者：
Dubovsky, Eva
中科院分区：
文献类型：
--
作者：
Garcia, Ernest V.;Taylor, Andrew;Folks, Russell;Manatunga, Daya;Halkar, Raghuveer;Savir-Baruch, Bital;Dubovsky, Eva
用于成像分析和解释的决策支持系统正在迅速发展，并将对医学实践产生越来越大的影响。RENEX是一种肾脏专家系统，用于协助医生评估接受巯基乙酰三甘氨酸（MAG 3）肾造影术的患者的疑似梗阻。RENEX使用QuantEM™II从动态肾脏扫描数据中提取的定量参数和从专家那里收集的知识库形式的启发式规则来确定肾脏是否阻塞;然而，RENEX无法访问也无法考虑诊断医生解释这些研究的临床信息。我们设计并实施了一种方法，将临床信息纳入RENEX，实施运动检测，并在51名肾病患者的试验组中评估这种新的综合系统（iRENEX）。为了得出关于肾脏是否阻塞的结论，将56个新的临床规则添加到先前报道的用于解释定量MAG 3参数的60个规则中。在iRENEX基于定量MAG 3参数得出阻塞结论后，实施所有临床规则，然后根据新的临床规则修改阻塞证据。iRENEX由一个将参数值转换为确定性因素的库、一个具有116条启发式解释规则的知识库、一个确定障碍物的前向链接推理机和一个调整引擎组成。开发了一个临床数据库，其中包含从与相关MAG 3研究相关的医院信息系统中获得的患者病史和成像报告数据。该系统进行了微调和测试，使用一个试点组的51名患者（21名男性，平均年龄58.2±17.1岁，100个肾脏）被专家小组认为有61个通畅和39个阻塞的肾脏。iRENEX仅使用定量MAG 3数据，在87%（34/39）的梗阻肾和90%（55/61）的通畅肾中与专家小组一致。iRENEX使用定量和临床数据，在95%（37/39）的梗阻肾和92%（56/61）的通畅肾中与专家小组一致。与单独使用定量数据相比，临床信息显著（p<0.001）增加了iRENEX检测梗阻的确定性。我们用于检测肾梗阻的肾脏专家系统已大幅扩展，以纳入医生可用的临床信息以及先进的质量控制功能，并在标准化专家水平上解释试点组中的肾脏研究。这些令人鼓舞的结果证明了在大量有和无肾梗阻的患者中进行前瞻性研究，以确定iRENEX的诊断性能。
Decision support systems for imaging analysis and interpretation are rapidly being developed and will have an increasing impact on the practice of medicine. RENEX is a renal expert system to assist physicians evaluate suspected obstruction in patients undergoing mercaptoacetyltriglycine (MAG3) renography. RENEX uses quantitative parameters extracted from the dynamic renal scan data using QuantEM™II and heuristic rules in the form of a knowledge base gleaned from experts to determine if a kidney is obstructed; however, RENEX does not have access to and could not consider the clinical information available to diagnosticians interpreting these studies. We designed and implemented a methodology to incorporate clinical information into RENEX, implemented motion detection and evaluated this new comprehensive system (iRENEX) in a pilot group of 51 renal patients. To reach a conclusion as to whether a kidney is obstructed, 56 new clinical rules were added to the previously reported 60 rules used to interpret quantitative MAG3 parameters. All the clinical rules were implemented after iRENEX reached a conclusion on obstruction based on the quantitative MAG3 parameters, and the evidence of obstruction was then modified by the new clinical rules. iRENEX consisted of a library to translate parameter values to certainty factors, a knowledge base with 116 heuristic interpretation rules, a forward chaining inference engine to determine obstruction and a justification engine. A clinical database was developed containing patient histories and imaging report data obtained from the hospital information system associated with the pertinent MAG3 studies. The system was fine-tuned and tested using a pilot group of 51 patients (21 men, mean age 58.2±17.1 years, 100 kidneys) deemed by an expert panel to have 61 unobstructed and 39 obstructed kidneys. iRENEX, using only quantitative MAG3 data agreed with the expert panel in 87 % (34/39) of obstructed and 90 % (55/61) of unobstructed kidneys. iRENEX, using both quantitative and clinical data agreed with the expert panel in 95 % (37/39) of obstructed and 92 % (56/61) of unobstructed kidneys. The clinical information significantly (p<0.001) increased iRENEX certainty in detecting obstruction over using the quantitative data alone. Our renal expert system for detecting renal obstruction has been substantially expanded to incorporate the clinical information available to physicians as well as advanced quality control features and was shown to interpret renal studies in a pilot group at a standardized expert level. These encouraging results warrant a prospective study in a large population of patients with and without renal obstruction to establish the diagnostic performance of iRENEX.
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影响因子：
4.5
作者：
Eskild-Jensen, A;Gordon, I;Frokiær, J
通讯作者：
Frokiær, J
影响因子：
3.2
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1.5
作者：
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作者：
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作者：
Taylor, Andrew;Garcia, Ernest V.;Dubovsky, Eva
通讯作者：
Dubovsky, Eva