Electrical and Electronic Engineering

Department

ARTIFICIAL INTELLIGENCE IN MEDICAL

APPLICATION
By
Muhimin Ghanem Khudair
Supervisor by
Prof.Dr.Hanan A.R Akkar

2020\2019
 ]ARTIFICIAL INTELLIGENCE IN MEDICAL APPLICATION [ 2019\2020

:Abstract
The advancement in computer technology has encouraged
the researchers to develop software for assisting doctors in
making decision without consulting the specialists directly.
The software development exploits the potential of human
intelligence such as reasoning,making decision, learning (by
experiencing) and many others. Artificial intelligence is not a
new concept, yet it has been accepted as a new technology in
computer science. It has beenapplied in many areas such as
education, business, medical and manufacturing. This paper
explores the potential of artificial intelligence techniques
particularly for web-based medical applications. In addition,
a model for web-based medical diagnosis and prediction is
proposed

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Introduction:
In most developing countries insufficient of medical specialist has
increase the mortality of patients suffered from various diseases. The
insufficient of medical specialists will never be overcome within a short
period of time. The institutions of higher learning could however,
take an immediate action to produce as many doctors as possible.
However, while waiting for students to become doctors and the doctors
tobecome specialists, many patients may already die. Current practice for
medical treatment required patients to consult specialist for further
diagnosis and treatment. Other medical practitioner may not have
enough expertise or experience to deal with certain high-risk diseases.
However, the waiting time for treatments normally takes a few days,
weeks or even months. By the time the patients see the specialist, the
diseases may have already spread out. As most of the high-risk disease
could only be cured at the early stage, the patients may have to suffer for
the rest of their life. Computer technology could be used to reduce the
number of mortality and reduce the waiting time to see the specialist.
Computer program or software developed by emulating human
intelligence could be used to assist the doctors in making decision
without consulting the specialists directly. The software was not meant
to replace the specialist or doctor, yet it was developed to assist general
practitioner and specialist in diagnosing and predicting patient’s condition
from certain rules or "experience". Patient with high-risk factors or
symptoms or predicted to be highly effected with certain diseases or
illness, could be short listed to see the specialist for further treatment.
Employing the technology especially Artificial Intelligence AI)
techniques in medical applications could reduced the cost, time, human
expertise and medical error.
Computer program known as Medical Decision-Support System was
designed to help health professionals make clinical decision (see
Shortliffe, 1987). The system deals with medical data and knowledge
domain in diagnosing patients conditions as well as recommending
suitable treatments for the particular patients. Patient-Centred Health
Information Systems is a patient centered medical information system
developed to assist monitoring, managing and interpret patient’s medical
history (Szolovits et al., 1994). In addition the system provides
assistance to patient and medical practitioner. The system serves to
improve the quality of medical decision-making, increases patient
compliance and minimizes iatrogenic disease and
medical errors

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Computer technology also helps reducing the cost and time during
registration process. Hospital attendance could simply key in patient’s
ID and update patient’s record. Signal are sent to notify the doctor.
While diagnosing the patient, doctor can refer to patient’s history record
for a history treatment. A prescription of medicine can automatically
sent to the dispensary. Using the technology, problems in preparing the
medicine and drug complication can be avoided (Mohd Rais and Zahari,
1988).
The advancement in computer technology and communication
encourages health-care provider to provide health-care over the
Internet or telemedicine (Shortliffe, 1998). Telemedicine is the
integration of telecommunications technologies, information
technologies, human-machine interface technology and medical care
technologies for the purpose of enhancing health care delivery across
space and time (Warner, 1997). Rusovick and Warner (1997) define
telemedicine as any instance of medical care occurring via the
Internet and using real-time video-teleconferencing equipment as well
asmore specialized medical diagnostic equipment. In general,
telemedicine means the use of computer and communications
technologies to augment the delivery of health-care services
(Chellappa, 1995). Telemedicine can improve access to care, increase
health-care quality and reduce the cost (Warner, 1997). Patients from
rural areas can access to the same quality of health-care as
those in big city. As an example patients suffered from heart-attack do
not have to consult cardiologist directly. Local doctors or medical
practitioners could perform the diagnosis with the help from cardiologist
using communication channel such as Internet, telephone line and others.
The approach reduces the cost and time for both patients and doctors. The
benefits of the electronic records would be many, namely enhance
traditional records, fast storage and retrieval, promote telemedicine
and encourage research in medical applications. As many applications
are geared toward web-based, this paper proposed a model
for web-based medical diagnosis and prediction, specifically for
medical practitioners. Several artificial intelligence techniques for
diagnosis and prediction tasks were explored and identified.

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Artificial Intelligence in Medicine:

Artificial Intelligence (AI) is a study to emulate human intelligence into
computer technology. The potential of AI in medicine has been
expressed by a number of researchers. Hoong
(1988) summarized the potential of AI techniques in medicine as follows:
x
1-Provides a laboratory for the examination,
organization,representation and cataloguing of medical knowledge.
x
2-Produces new tools to support medical decision-making, training and
research.
x
3-Integrates activities in medical, computer, cognitive and other sciences.
x
4-Offers a content-rich discipline for future scientific medical specialty.
Many intelligent system have been developed for the purpose of
enhancing health-care and provide a better health care facilities, reduce
cost and etc. As express by many studies (such as Mahabala et al., 1992;
Manickam and Abidi, 1999; Alexopoulos et al., 1999; Zelic et al.,
1999; Ruseckaite, 1999; Bourlas et al., 1999), intelligent system was
developed to assist users (particularly doctors and patients) and
provide early diagnosis and prediction to prevent serious illness.
Even though the system is equipped with "human" knowledge, the system
will never replace human expertise as human are required to frequently
monitor and update the system’s knowledge. Therefore, the role of
medical specialist and doctors (or medical practictioner) are important to
ensure system validity. Early studies in intelligent medical system such as
MYCIN, CASNET, PIP and Internist-I have shown to out performs
manual practice of diagnosis in several disease domain (Shortliffe,
1987). MYCIN was developed in the early 1970s to diagnose
certain antimicrobial infections and recommends drug treatment. It has
several facilities such as explanation facilities, knowledge acquisition
facilities, teaching facilities and system-building facilities. CASNET
(Causal ASsociational NETworks) was developed in early 1960s is a
general tool for building expert system for the diagnosis and treatment of
diseases. CASNET major application was the diagnosis and
recommendation of treatment for glaucoma. PIP an abbreviation for
Present Illness Program was developed in 1970s to simulates the
behaviour of an expert nephrologist in taking the history of the present

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illness of a patient with underlying renal disease. The work on

Internist-I in early 1982s was

concentrated on the investigation of heuristic methods for imposing

differential diagnostic task structures on clinical decision making. It was
applied in diagnoses of internal medicine.
In 1990s, the studies in intelligent system was enhanced to utilize the
system based on current needs. In several studies two or more
techniques were combined and utilized the function of the system to
ensure system performance. ICHT (An Intelligent Referral System for
Primary Child Health Care) developed to reduce children mortality
especially in rural areas (Mahabala et al., 1992). The system success in
catering common paediatric complaints, taking into consideration the
important risk factors such as weight monitoring, immunization,
development milestones and nutrition. ICHT utilized expert system in
the process of taking the history data from patients. Other expert system
have been developed such as HERMES (HEpathology Rule-based
Medical Expert System) an expert system for prognosis of chronic liver
diseases (Bonfa et al., 1993), Neo-Dat an expert system for clinical trails
(Theodorou and Ketikidis, 1995), SETH an expert system for the
management on acute drug poisoning (Droy et al., 1993), PROVANES
a hybrid expert system for critical patients in Anesthesiology
(Passold et al., 1996) and ISS (Interactive STD Station) for
diagnosis of sexually transmitted diseases (Walker and Kwon, 1997).
Experienced Based Medical Diagnostics System an interactive medical
diagnostic system is accessible through the Internet (Manickam and
Abidi, 1999). Case Based Reasoning (CBR) was employed to utilize
the specific knowledge of previously experienced and concrete
problem or cases. The system can be used by patients to diagnose
themselves without having to make frequent visit to doctors and as well
as medical practitioner to extend their knowledge in domain cases (breast
cancer). Data mining is an AI technique for discovery of knowledge in
large databases, could be used to collect hidden information for medical
purposes (Siti Nurul Huda and Miswan, 1999; Siti Fatimah and Rogayah,
1999; Neves et al., 1999). It could also be combined with neural
network for classification of fuzzy pattern of HIV and AIDS using
unsupervised learning (Siti Nurul Huda and Miswan, 1999). Patients
status life or dead was classified as training and testing pattern. Data
mining was also used to generate a scatter diagram and a model of rules
statement to enhance current rule base system (Siti Fatimah and Rogayah,
1999). Neves et al (1999) developed information system that
supports knowledge discovery and mining in medical imaging.

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Fuzzy logic is another branch of artificial intelligence techniques. It deals

with uncertainty in knowledge that simulates human reasoning in
incomplete or fuzzy data. Meng (1996) applied
fuzzy relational inference in medical diagnosis. It was used within the
medical knowledge-based system, which is referred to as Clinaid. It
deals with diagnostic activity, treatment recommendations and patient’s
administration. Neural Network (NN) is one of the powerful AI
techniques that has the capability to learn a set of data and constructs
weight matrixes to represent the learning patterns. NN is a network
of many simple processors or units (Sarle, 1999).
It simulates the function of human brain to performs tasks as human does.
As an example, a study on approximation and classification in medicine
with incremental neural network shows superior generalization
performance compared with other classification models (Jankowski,
1999). NN has been employed in various medical applications such
as coronary artery (Lippmann, 1995), Myocardial
Infarction (Heden et al.,1996), cancer (Street et al., 1996; Karkanis et al.,
1999), pneumonia (Caruana et al., 1996) and brain disorders
(Pranckeviciene, 1999). In Karkanis et al (1999) NN was implemented as
a hybrid with textual description method to detect abnormalities within
the same images with high accuracy. Partridge et al (1996) listed
several potential of NN over conventional computation and
manual analysis:
x
1-Implementation using data instead of possibly ill defined rules.
x
2-Noise and novel situations are handled automatically via data
generalization.
x
3-Predictability of future indicator values based on past data and trend
recognition.
x
4-Automated real-time analysis and diagnosis.
x
5-Enables rapid identification and classification of input data.
x
6-Eliminates error associated with human fatigue and habituation.

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Centralized Databases and WWW:

To date, most of the systems developed were standalone applications with
specific databases for certain diseases. This implies that patients
information in one system can only be used by that particular system. On
the other hand, other systems require another databases for other
patients or for the same patients whose records were kept in other
databases. Another problem with standalone database is that, the
database for the same system in another places would differ as the
number of patients using the systems increases. This problem affects the
knowledge acquired from the databases and thus influence the decision
made by the system. For system using AI techniques, when the number
of patients is high the system will produce more accurate results
compared to the system with less number of patients. The patients
records are valuable information for the knowledge-based system. The
current patients data would enhance and strengthen the validity of the
system reasoning (Manickam and Abidi, 1999). Current enhancements
in information technology such as development of information
superhighway inevitably encourage many organizations including
government to develop electronic medical information and make it
available on the Internet. The patients can use the information and
monitor their risk level from their home or office without having to
consult the physician (Manickam and Abidi, 1999). However, the
proposed model do not meant for the patients to monitor their health,
rather to assist clinician in making diagnosis and prediction of
patients illness. This will enable the clinician to access the system and
provide the consultation as expert does regardless of the location.
Patients record or patients database could be installed at the main server.
The electronic record could be accessed by health-care providers and the
data could be stored and updated frequently. By using this method, the
system knowledge will always be updated. The interface for the
interactions between the database (and the system) and the clinician
(health-care providers) would be through WWW.
The Internet supports two-ways communications between users around
the world at minimum cost (see Figure 1). In medical, communication is
very important as new information or new discovery is the key for the
future survival (see for example Shortliffe et al., 2000). In
addition, communications helps doctors sharing their knowledge or
expertise (Detmer and Shortliffe, 1997). As an example, a specialist
from Sydney can provide on-line medical assistance to doctor at Kuala
Lumpur who is treating a patient that suffers from serious cancer
problem. Another doctor from other country such as United
Kingdom can share his

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experience dealing with the same cases. Communications between

doctors or specialist from other region helps doctor at Kuala Lumpur
diagnosing his patient and provides appropriate treatment. In
telemedicine, Multimedia and Internet (or computer network) are two of
the main tools that support the collaboration and distribution of
information. Multimedia is a combination of media such as text,
audio, visual and graphics can be used in medical application such as
in image transmission (X-Ray images, pictures and etc.).

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Web-Based Medical Diagnosis and Prediction:

The proposed model for Web-Based medical diagnosis and prediction
(see Figure 2) consists of four components, they are databases,
prediction module, diagnosis module and user interface. The
databases consist of patients database and patients-disease database.
Patients database will be used to store patient’s information such as
name, addresses, and others particulars details. Patients-disease
database stored all the information about patients and their illness. The
information stored in the database includes types of diseases, the
treatments and other details about the test and administering therapy.
Patients information are separated in a different database to enhance the
patients records storage, so that other departments could use the records
when the patients are referred to them. This method could prevent
other departments or unauthorized users from accessing the information
about patients diseases and provide a centralized information access for
the patients records. Prediction module and diagnosis module are two of
the main features in Web-Based Medical Diagnosis and Prediction.
Prediction module utilizes neural networks techniques to predict
patients illness or conditions based on the previous similar cases. Data
from the patients and patients-disease database will be used for training
and testing. The weight from the training will be stored to predict a new
data fed into the system. Diagnosis module consists of expert
system and fuzzy logic techniques to perform diagnosis tasks. A set of
rules will be defined using the patients and patients-disease databases
as well as the expert knowledge on the disease domain. Expert
system uses the rules to diagnose patient’s illness based on their
current conditions or symptoms. In addition, fuzzy logic is
integrated to enhance the reasoning when dealing with fuzzy data. The
combination of expert system and fuzzy logic
that forms a hybrid (expert-fuzzy) system could increase the system
performance. In the proposed model, WWW acts as the user interface
for the interaction between the users and the systems. Several
processes involve in the models are collection data (patients
information and patients illness), diagnosis, prediction and managing
databases or systems
administering.

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Conclusion:
The future for medicine will be better and better (Altman, 1999). The
used of computer and communication tools can change the medical
practice into a better implementation. Consolidation in health-care
provider will happen by focusing on cost and later on quality of
services (Chellappa, 1995). Advancement in technology will form a
platform for development a better design of telemedicine application.
Telephone line and Internet will be the most important tools in medical
applications.
The main features in medical diagnosis and prediction using artificial
intelligence techniques will make the consultation to be more interactive.
As clinical decision making inherently requires reasoning under
uncertainty, expert systems (Shortliffe, 1987) and fuzzy logic
(Meng, 1996) will be suitable techniques for dealing with partial
evidence and with uncertainty regarding the effects of proposed
interventions. For the prediction tasks, Neural Networks have been
proven to produce better results compared to other techniques (such as
statistics) (Partridge et al., 1996; Machado, 1996). Such techniques are
worth to explore and integrate in the system for medical diagnosis and
prediction. The Internet or the WWW will be used as the medium to
provide the tele-healthcare to the clinician or to the public.
Centralized databases over the WWW have many advantages.
Information sharing, collaboration between medical practitioners, on-
line discussion, on-line treatment and diagnosis are among the main
features which enable the doctors from around the world to
share their knowledge and expertise. Centralized medical record helps
doctors to improve the quality of treatment and provide a better
diagnosis based on patients medical history. In addition, researchers in
medical applications could use the data in their investigation of a new
medical solution, patient’s management and treatment (Shortliffe et al.,
1996a; Shortliffe et
al., 1996b).

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