on to diagram
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OntoDiagram
Application for pediatric cardiologythatgenerates Mullins like diagram based on domaindescriptions, clinical observations andmeasurements Mullins AtlasA collection of widely used
diagrammatic representation of anatomy of heartstructure (Mullins Diagram)
Mullins Diagrams are useful in hospital reporting
tools as they efficiently represent the defects Given a description of heart by domain experts, the
system should automatically generate the Mullinsdiagram representing the conditions as described
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Sample Mullins D
iagramsPulmonary
Atresia
Tricuspid
Atresia
ComplexTOF
TAPVR LSVC
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Why Generate Diagrams?
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Situs and Relations:
There is levocardia with visceral and atrial situs solitus, atrioventricular concordance (D-looped ventricles) andnormally related great arteries {S,D,S} noteVenous Connections:There are normal systemic and pulmonary venous connections, with the superior and inferior vana cavae returning
normally to the right atrium, and all four pulmonary identified returning normally to the left atrium. noteAtria:The left and right atria have normal chamber size, structure, and relations. noteAtrioventricular Valves:The mitral and tricuspid valves have normal structure, size, placement and function. There is no mitral insufficiency
and only physiologic tricuspid insufficiency. noteVentricles:There is normal left ventricular chamber size and normal subjective left ventricular funtion with flattened
interventricular septal motion. noteThere is normal right ventricular chamber size. noteThe right ventricle wallthickness is moderately increased. noteThere is normal global left ventricular function. noteThere is flattened
interventricular septal motion. noteOutflow Tracts:The left ventricular outflow tract has normal size and geometry, without stenosis or narrowing. noteThe right
ventricular outflow tract has moderate hypoplasia. noteThere is no subaortic conus. noteThere is marked rightventricular outflow tract turbulence (stenosis). noteThe peak right ventricular outflow tract velocity is 4.1meters/second. noteThe peak right ventricular outflow tract gradient is 67 mmHg. noteSemilunar Valves:
The aortic valve is normal, with three normal leaflets, normal mobility and no prolapse. noteThere is non-turbulentflow and a normal flow velocity across the aortic valve with no evidence of stenosis. noteThere is markedhypoplasia of the pulmonary valve annulus. noteThe pulmonary valve annulus measures 2.1 mm in the long axisoutflow view. noteThe peak velocity across the aortic valve is 1.3 meters/second. noteThe pulmonary valve leafletsare moderately thickened. noteAortic Root Ascending Aorta:
The aortic root, including the sinuses of valsalva, sinotubular ridge, and proximal ascending aorta are normal withoutstenosis, narrowing, or dilation. notePulmonary and Thoracic Arteries:There was supravalvular pulmonary stenosis present. noteThere was hypoplasia of the main pulmonary artery. note
The left pulmonary artery appeared hypoplastic. noteThe right pulmonary artery appeared hypoplastic. noteTherewas a right-sided aortic arch present. noteThere was a patent ductus arteriosus visualized. noteThere was a right-sided patent ductus arteriosus present. noteThere was left-to-right shunting demonstrated across the patentductus arteriosus. noteThere was a right aortic arch with a retroesophageal segment and left descending aortaforming a vascular ring. noteSeptal Defects:
There is a malalignment type ventricular septal defect present. noteThe ventricular septal defect measures 12 mm fromthe apical four-chamber view. noteThere is a moderate degree of aortic override. Fibro-annular continuity of theaortic and mitral valves is present. noteThe aorta has about 50 per cent override. note
Comprehending textualdescriptions is time consuming!
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Diagram is easier to understand!
ComplexTOF
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Motivation
Visual representation is intuitively easier tounderstand than text information.
Pediatric Cardiology faces new or variations ofheart defects
Mullins atlas are comprehensive but notcomplete
Difficult to search and retrieve similar
diagrams Domain experts manually draw diagrams by
hand or modify existing ones in Mullin's atlas
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Pulmonary Artery
Aortic stenosis
Tricuspidinsufficiency
Normal Bicuspid valve
Mitral valve cleft
Coarctation
Right-left shunt
PDA
Patent Foramen Ovale
Bifurcation of PAanterior
Overriding Aorta
True PA
Parachute
Mitral Valve
hypoplasia
above
below
Hidden behind
Component sheared
Scaled along long axis
connections
missing
translation
transposition
translation
Ontological Framework
Diagram World
Domain World
Domain Experts Perspective
Diagram Perspective
Heterogeneityof
Perspectives
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Challenges Heart Structuresimple & complex
Mapping domain knowledge onto diagram specifications
Perspective and representational gap between medicaldomain and diagram domain
Domain Modeling
Modeling congenital defect information Modeling anatomical structure
Implicit domain knowledge
Anatomical consequence of defects
Diagram Modeling Individual component modeling
Spatial orientation between components
Transformations on components to reflect changes
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Heart StructureSimple & Complex
Simple An anatomically simple structure
Intuitively hierarchical part-of relationships (leftheart, right heart, etc.)
Heart components are less in count Anatomically new additions are very less and
predictable
Complex
Variations of each component are large
Variations of heart as a whole are diverse
Complex relationship between various anomalousconditions
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Simple Complex
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OntoDiagram: Focus
Translation from domain description to diagram
Key issues
Domain modeling (Ontology approach) Diagram modeling (Component based approach)
Mapping domain onto diagram (Domain rules)
OntoDiagram
Physicians description Diagram
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OntoDiagram ArchitectureCongenital
Heart Defect
Ontology
HeartAnatomy
Ontology
DiagramOntology
OntoDiagramQuery
Interface
DiagramComposer
Diagramrepository
DatabasesMedicalDatabase
MedicalDatabase
MeasurementOntology
Domain Ontologies
Domain Rules
Diagram Ontology
Mapping System
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Walk through the System
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Ontologies
An ontology is an explicit formal specification of theterms in the domain and relations among them (Gruber1993).
To share common understanding of the domain
knowledge on congenital heart defects amongcardiologists, nurse, database engineer or softwareagents
To make domain assumptions explicit so that defectassociations patterns could be extracted
To separate domain knowledge from operationalknowledge
To map different perspectives of domain and diagram
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Domain Modeling
Modularizing domain knowledge Congenital Heart Defect Ontology [UMLS]
Classification of defects, anomalous conditions
Definition for domain terms like stenosis, atresia, etc.
Anatomical consequences of defects Association between defects
Anatomy ontology [FMA]
Multi-perspective classification of heart anatomy
Possible anatomical changes in each heart component Orientation between components
Measurement and Diagram Ontology [LOINC]
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Diagram Modeling Diagram Models
Component Association Model (Spatial Orientationbetween components)
Structure Model (Component hierarchy)
Conversion Model (Transformations)
Annotation Model (Relevant annotations)
Diagram perspective of changes Abnormal growth
Missing parts
Transposition
Transformation
Combination
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Component Association Model
Spatial relations with components and their neighboringcomponents
Six-tuple {Ct, Cn,D,A, O,P} where
Ctand Cncomponents,Dspatial orientation of Ctwith respect to Cn,Ainterface presence, Oorientation,Ppresence of component
e.g. {Descending Aorta, Aortic Arch, bottom, attached, below, present}
bottom
top
right
top
top top
right right
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StructureModel
The heart is considered to be made oftwo layers
The first layer consisting of thechambers of the heart (wall of atriaand ventricles)
The second layer consists of theother components of heart(Pulmonary arteryandPulmonary
valves,AortaandAorta valves, etc.)
The relationships between the first andthe second layer components
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Interface Points & Gate Points
ComponentComponent LayerLayer
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Conversion Model Transformation of components
Geometric transformation (e.g., Scale, Rotate, Translate)
Polynomial transformation (e.g., Shear)
Domain specific transformation (e.g, dilation, coarctation)
Transformation model defined as {CT,T, P} CTcomponent being transformed
Tname of the transformation Ptransformation parameters
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Hierarchical Composition
Hierarchicalmodelcloser todomainperspective
Faster diagramgenerationfewcomponentschange
Optimal selectionof components
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Hierarchical Composition Steps
Step 1: Configuration
1. Identify an appropriate set of components and theirabstraction level to be composed [Congenital Defects andAssociation models]
2. Determine the components to be transformed [ConversionModel]
3. Determine the relationships between components (below,
above) [Component Structure Model]Step 2: Composition
Starting from the most specific level to the root1. Transform component images using the transformation
operations if necessary (scale, rotation, etc)
2. Rank the components [Image Model - Color Schema]3. Compose the components using interface points [Structure
Model]4. Forward the interface points to the upper level
Step 3: Annotation
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Diagram
Composer
Congenital
Heart Defect
Ontology
Anatom
y
Ontolog
y
Measurement
Ontology
Diagram
Ontology
Mapping System
Domain
Description
Diagram Instruction Files
Domainontologies
Ontological Framework
OntoDiagramSystem
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OntoDiagram Prototype
Constructed domain ontologies using theprotg in OWL.
Implemented the query interface in Javausing the Jena.
Implemented the image compositionmodule using the Java Advanced Imaging
package.
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Sample Output(Patent Ductus Arteriosus)
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Conclusion
The domain descriptions of the congenital heartdefects are mapped to generate a diagrammaticrepresentation of defects. Ontology based domain modeling Component based diagram modeling Rule based mapping between domain and diagram Hierarchical composition of components
A prototype system is currently under testing at
the Childrens Mercy Hospitals and Clinics facilitate existing treatments for managing patients
with severe heart disorders.