Appl Intell (2008) 28: 207–209
DOI 10.1007/s10489-007-0100-0
Special issue on case-based reasoning in the health sciences
Isabelle Bichindaritz · Stefania Montani ·
Luigi Portinale
Published online: 6 October 2007
© Springer Science+Business Media, LLC 2007
1 Introduction
This special issue features recent advances in applications of
case-based reasoning to the health sciences. Case-based rea-
soning (CBR) is a problem solving paradigm that exploits
the contextual knowledge of previously experienced situ-
ations, called cases. It basically consists in retrieving past
cases that are similar to the current one and in reusing past
successful solutions, followed by, if necessary, revising the
proposed solution; the newly solved case can then be re-
tained and added to the system knowledge base, called the
case base. The retrieve, reuse, revise, and retain processes
are known as the steps of the CBR cycle.
In recent years, there has been an explosion of interest in
health sciences applications of CBR, not only in the tradi-
tional CBR in medicine domain, but also in bioinformatics,
in enabling home health care technologies, in CBR integra-
tion, and in synergies between CBR and knowledge discov-
ery. Health care and health sciences research are expanding
with population aging as well as increased access to health
services, which fosters the growing development of compu-
tational methods in the health sciences. The rate of genera-
I. Bichindaritz ()
Institute of Technology, University of Washington,
1900 Commerce Street, Box 358426, Tacoma, WA 98402, USA
e-mail: ibichind@u.washington.edu
S. Montani · L. Portinale
Dipartimento di Informatica, University of Piemonte Orientale,
Via Bellini 25/g, 15100 Alessandria, Italy
S. Montani
e-mail: stefania.montani@unipmn.it
L. Portinale
e-mail: luigi.portinale@unipmn.it
tion of new biomedical data in electronic format in particu-
lar favors the development of approaches such as case-based
reasoning, which has the advantage of being a data driven
methodology from artificial intelligence.
This editorial presents the high quality contributions se-
lected for this special issue from researchers in case-based
reasoning in the health sciences, as well as highlights some
of the main research questions and advances in this domain.
2 Special issue contents
Four of the six papers collected in this special issue are ex-
tended versions of works which were selected among the
contributions presented at a workshop on CBR in the Health
Sciences, held in Ölüdeniz, Turkey, in September 2006, and
hosted by the ECCBR-06 (European Conference on Case-
based Reasoning) conference. This workshop built upon
progress made at the First Workshop on CBR in the Health
Sciences, held at ICCBR-03 (International Conference on
Case-based Reasoning), in Trondheim, Norway, at the Sec-
ond Workshop on CBR in the Health Sciences, held at
ECCBR-04, in Madrid, Spain, and at the Third Workshop on
CBR in the Health Sciences, held at ICCBR-05, in Chicago,
Illinois, USA. The main objectives of these workshops were
to identify challenges specific to applying CBR to the health
sciences, required methodological improvements to fit this
context needs, preferred types and domains of application,
and guidelines to better develop CBR systems in this field.
The four pre-selected papers, together with the two addi-
tional contributions independently submitted and accepted
for this special issue, address some of the objectives above.
In particular, among the emerging challenges related to
adopting CBR in the medical and biological domain, the
complexity of case mining, feature representation, and case
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retrieval is one of the most critical. As a matter of fact, on
the one hand, a proper case mining strategy would enable
CBR to capitalize on clinical databases, electronic patient
records, and biomedical literature databases. Resorting to
prototypical cases definition may prove to be a very use-
ful methodological choice to accomplish such a goal, espe-
cially in the initial case base set up, but also in the case base
maintenance phase. On the other hand, recent technologi-
cal advances and specific domain needs frequently lead to
deal with case data which are intrinsically high-dimensional,
making feature representation and case retrieval potentially
non-trivial. This holds true e.g. for data represented in the
form of time series and of images.
Prototype definition is afforded in the paper by M. Atz-
mueller et al., which proposes a case-based approach for
characterizing and analyzing subgroup patterns. It presents
techniques for retrieving characteristic factors and a set of
corresponding cases for the inspection and analysis of a spe-
cific subgroup pattern. Then, the set of factors and cases are
merged into prototypical cases for presentation to the user.
This enables a convenient retrieval of (meta-)information as-
sociated with subgroup objects. This article provides an in-
teresting synergy work between CBR and data mining in the
service of data mining.
The topic of mining for prototypical cases is central in the
paper by I. Bichindaritz, where the close synergy between
knowledge discovery, data mining, and CBR is explored for
supporting automatic prototypical case learning from bio-
medical literature. The article validates the approach by pre-
senting a comparison between the prototypical cases learnt
from stem-cell transplantation domain with those created by
a team of experts in the domain. In comparison with the
previous paper, it provides an innovative synergy between
CBR, text mining, and knowledge discovery in the service
of case-based reasoning in biomedicine.
The paper by P. Perner explores the problem of image
data management, addressed by a case-based object recog-
nition system reasoning from prototypical cases. The paper
details a method of catalogue-based classification for image
interpretation that can be easily adapted to different biomed-
ical domains. The performance of the catalogue-based clas-
sifier is assessed and successfully validated by studying the
accuracy and the reduction of the prototypes after applying
a prototype-selection algorithm.
High-dimensional data, this time in the form of time se-
ries, are also dealt with in the paper by N. Xiong et al.,
where a knowledge discovery approach to identify signif-
icant sequences for depicting symbolic time series cases
is presented. Such discovered sequences are highly valu-
able in case characterization to capture important properties
while ignoring random trivialities. Moreover, they serve as
a means for reducing data dimensionality. Indexing mech-
anisms for case retrieval are also proposed, and verified by
means of some experiments.
I. Bichindaritz et al.
The paper by J. Lieber et al. identifies a very interesting
application domain for CBR: the one of medical protocols
adaptation. Protocol adaptation can be seen as a knowledge-
intensive case-based decision support process. Several is-
sues need to be addressed while trying to model such
process, such as the lack of relevant information about the
patient, or the closeness to decision thresholds. As handling
these issues requires some additional knowledge, which has
to be acquired, different methods are presented to perform
adaptation knowledge acquisition either from experts, or in
a semi-automatic manner.
The topic of proposing guidelines to develop CBR sys-
tems in the health sciences is afforded in the paper by
S. Montani, which provides a detailed analysis of the
reasons why CBR is not more integrated today in main-
stream clinical practice. As a solution, the author suggests
a closer synergy between CBR and other artificial intelli-
gence methodologies, giving birth to a modular architecture,
able to provide decision support. In the resulting framework,
CBR, originally conceived as a well suited reasoning para-
digm for medical applications, can extend its original roles,
and cover a set of additional tasks, such as parameter con-
figuration.
In summary, in the opinion of the international review
committee, the six papers collected in this special issue rep-
resent an excellent sample of the most recent advances of
CBR in the health sciences, both as regards methodologi-
cal enhancements and as regards interesting practical expe-
riences, carried out by an international group of researchers
from five different countries.
3 Main accomplishments and future issues
The complexity of medical and biological domains has en-
couraged major advances in CBR methodology over the
years. In addition, CBR systems in the health sciences have
proved to be efficient at providing decision support recom-
mendations, accurate classifications, and health care quality
monitoring. The accomplishments of the collection of pa-
pers featured in this special issue encompass providing ex-
planations for clusters learnt in cluster analysis, keeping the
knowledge in a CBR system up-to-date, improving image
and time series signal classification, providing care proto-
cols more closely adapted to fit individual patients, and im-
proving parameter configuration and other tasks in artificial
intelligence systems. All of these accomplishments rely on
case-based reasoning for advancing a particular set of prob-
lems in a particular application domain. They can be sum-
marized as advancing case-based image and time series sig-
nal classification (P. Perner and N. Xiong et al.), improv-
ing decision-support (I. Bichindaritz and J. Lieber et al.),
Special issue on case-based reasoning in the health sciences
and expanding further the scope of CBR applications to im-
proving other methodologies, such as data mining (M. Atz-
mueller et al.) or artificial intelligence methodologies like
expert systems (S. Montani). The approaches have been val-
idated through significant accuracy and/or precision and re-
call ratios, user satisfaction, or expert rating.
However encouraging may be this current state of re-
search in CBR in medicine and biology, the complexity
of these domains provides many more opportunities for
improvement of CBR methodology. Among technical im-
provements, we can cite advancing how to perform adapta-
tion, evaluating similarity between cases involving continu-
ous data, time series, images, texts, or genetic data, tailoring
clinical guidelines and treatment protocols to a patient case,
modeling more closely expert reasoning, and a smooth inter-
action between the user and the CBR system. Synergies be-
tween CBR, data mining, and knowledge discovery require
more research too given the rate of increase in medical data
available from electronic medical records, databases, and lit-
erature. Similarly, synergies between CBR and other com-
putational methods such as expert systems, statistical analy-
sis and inference are crucial to the development of CBR. All
of these improvements should lead to CBR systems better
integrated in clinical settings, and to the opportunity to eval-
uate these systems in real clinical environments, with the
ultimate goal of showing positive clinical outcomes. Long
209
term research objectives are to convince clinicians to rou-
tinely adopt CBR methodology integrated with electronic
medical records in the clinic. With the rate of increase in
quality of CBR systems in biology and medicine as show-
cased in this special issue, this ultimate objective may be
closer than we think.
Acknowledgements We would like to thank all the authors for hav-
ing decided to contribute to this special issue, and Prof. Moonis Ali,
the chief editor of Applied Intelligence Journal, for his support in this
project.
We are also very grateful to the reviewers for their careful work:
Syed Sibte Raza Abidi, Dalhousie University, Canada, Klaus-Dieter
Althoff, University of Hildesheim, Germany, Paolo Avesani, Instituto
Trentino di Cultura, Italy, Riccardo Bellazzi, University of Pavia, Italy,
Peter Funk, Malardalen University, Sweden, Daniel Hennessy, Univer-
sity of Pittsburgh, USA, Alec Holt, Department of Information Sci-
ence, University of Otago, New Zealand, Lakhmi C. Jain, University
of South Australia, Australia, Jean Lieber, Loria, France, Cindy Mar-
ling, Ohio University, USA, Stefan V. Pantazi, University of Victoria,
Canada, Enric Plaza, Spanish Scientific Research Council, Spain, Pe-
tra Perner, Institute of Computer Vision and Applied Computer Sci-
ences, Germany, Francesco Ricci, University of Bolzano, Italy, Rainer
Schmidt, Institut fur Medizinische Informatik und Biometrie, Ger-
many, Olga Vorobieva, Institut fur Medizinische Informatik und Bio-
metrie, Germany.
Guest Editors