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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 tion of new biomedical data in electronic format in particu-

lar favors the development of approaches such as case-based
This special issue features recent advances in applications of reasoning, which has the advantage of being a data driven
case-based reasoning to the health sciences. Case-based rea- methodology from artificial intelligence.
soning (CBR) is a problem solving paradigm that exploits This editorial presents the high quality contributions se-
the contextual knowledge of previously experienced situ- lected for this special issue from researchers in case-based
ations, called cases. It basically consists in retrieving past reasoning in the health sciences, as well as highlights some
cases that are similar to the current one and in reusing past of the main research questions and advances in this domain.
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 2 Special issue contents
case base. The retrieve, reuse, revise, and retain processes
are known as the steps of the CBR cycle. Four of the six papers collected in this special issue are ex-
In recent years, there has been an explosion of interest in tended versions of works which were selected among the
health sciences applications of CBR, not only in the tradi- contributions presented at a workshop on CBR in the Health
tional CBR in medicine domain, but also in bioinformatics, Sciences, held in Ölüdeniz, Turkey, in September 2006, and
in enabling home health care technologies, in CBR integra- hosted by the ECCBR-06 (European Conference on Case-
tion, and in synergies between CBR and knowledge discov- based Reasoning) conference. This workshop built upon
ery. Health care and health sciences research are expanding progress made at the First Workshop on CBR in the Health
with population aging as well as increased access to health Sciences, held at ICCBR-03 (International Conference on
services, which fosters the growing development of compu- Case-based Reasoning), in Trondheim, Norway, at the Sec-
tational methods in the health sciences. The rate of genera- 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,
I. Bichindaritz () Illinois, USA. The main objectives of these workshops were
Institute of Technology, University of Washington, to identify challenges specific to applying CBR to the health
1900 Commerce Street, Box 358426, Tacoma, WA 98402, USA sciences, required methodological improvements to fit this
e-mail: context needs, preferred types and domains of application,
S. Montani · L. Portinale
and guidelines to better develop CBR systems in this field.
Dipartimento di Informatica, University of Piemonte Orientale, The four pre-selected papers, together with the two addi-
Via Bellini 25/g, 15100 Alessandria, Italy tional contributions independently submitted and accepted
S. Montani for this special issue, address some of the objectives above.
e-mail: In particular, among the emerging challenges related to
L. Portinale adopting CBR in the medical and biological domain, the
e-mail: complexity of case mining, feature representation, and case
208 I. Bichindaritz et al.

retrieval is one of the most critical. As a matter of fact, on The paper by J. Lieber et al. identifies a very interesting
the one hand, a proper case mining strategy would enable application domain for CBR: the one of medical protocols
CBR to capitalize on clinical databases, electronic patient adaptation. Protocol adaptation can be seen as a knowledge-
records, and biomedical literature databases. Resorting to intensive case-based decision support process. Several is-
prototypical cases definition may prove to be a very use- sues need to be addressed while trying to model such
ful methodological choice to accomplish such a goal, espe- process, such as the lack of relevant information about the
cially in the initial case base set up, but also in the case base patient, or the closeness to decision thresholds. As handling
maintenance phase. On the other hand, recent technologi- these issues requires some additional knowledge, which has
cal advances and specific domain needs frequently lead to to be acquired, different methods are presented to perform
deal with case data which are intrinsically high-dimensional, adaptation knowledge acquisition either from experts, or in
making feature representation and case retrieval potentially a semi-automatic manner.
non-trivial. This holds true e.g. for data represented in the The topic of proposing guidelines to develop CBR sys-
form of time series and of images. tems in the health sciences is afforded in the paper by
Prototype definition is afforded in the paper by M. Atz- S. Montani, which provides a detailed analysis of the
mueller et al., which proposes a case-based approach for
reasons why CBR is not more integrated today in main-
characterizing and analyzing subgroup patterns. It presents
stream clinical practice. As a solution, the author suggests
techniques for retrieving characteristic factors and a set of
a closer synergy between CBR and other artificial intelli-
corresponding cases for the inspection and analysis of a spe-
gence methodologies, giving birth to a modular architecture,
cific subgroup pattern. Then, the set of factors and cases are
able to provide decision support. In the resulting framework,
merged into prototypical cases for presentation to the user.
CBR, originally conceived as a well suited reasoning para-
This enables a convenient retrieval of (meta-)information as-
sociated with subgroup objects. This article provides an in- digm for medical applications, can extend its original roles,
teresting synergy work between CBR and data mining in the and cover a set of additional tasks, such as parameter con-
service of data mining. figuration.
The topic of mining for prototypical cases is central in the In summary, in the opinion of the international review
paper by I. Bichindaritz, where the close synergy between committee, the six papers collected in this special issue rep-
knowledge discovery, data mining, and CBR is explored for resent an excellent sample of the most recent advances of
supporting automatic prototypical case learning from bio- CBR in the health sciences, both as regards methodologi-
medical literature. The article validates the approach by pre- cal enhancements and as regards interesting practical expe-
senting a comparison between the prototypical cases learnt riences, carried out by an international group of researchers
from stem-cell transplantation domain with those created by from five different countries.
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 3 Main accomplishments and future issues
of case-based reasoning in biomedicine.
The paper by P. Perner explores the problem of image
The complexity of medical and biological domains has en-
data management, addressed by a case-based object recog-
couraged major advances in CBR methodology over the
nition system reasoning from prototypical cases. The paper
years. In addition, CBR systems in the health sciences have
details a method of catalogue-based classification for image
proved to be efficient at providing decision support recom-
interpretation that can be easily adapted to different biomed-
ical domains. The performance of the catalogue-based clas- mendations, accurate classifications, and health care quality
sifier is assessed and successfully validated by studying the monitoring. The accomplishments of the collection of pa-
accuracy and the reduction of the prototypes after applying pers featured in this special issue encompass providing ex-
a prototype-selection algorithm. planations for clusters learnt in cluster analysis, keeping the
High-dimensional data, this time in the form of time se- knowledge in a CBR system up-to-date, improving image
ries, are also dealt with in the paper by N. Xiong et al., and time series signal classification, providing care proto-
where a knowledge discovery approach to identify signif- cols more closely adapted to fit individual patients, and im-
icant sequences for depicting symbolic time series cases proving parameter configuration and other tasks in artificial
is presented. Such discovered sequences are highly valu- intelligence systems. All of these accomplishments rely on
able in case characterization to capture important properties case-based reasoning for advancing a particular set of prob-
while ignoring random trivialities. Moreover, they serve as lems in a particular application domain. They can be sum-
a means for reducing data dimensionality. Indexing mech- marized as advancing case-based image and time series sig-
anisms for case retrieval are also proposed, and verified by nal classification (P. Perner and N. Xiong et al.), improv-
means of some experiments. ing decision-support (I. Bichindaritz and J. Lieber et al.),
Special issue on case-based reasoning in the health sciences 209

and expanding further the scope of CBR applications to im- term research objectives are to convince clinicians to rou-
proving other methodologies, such as data mining (M. Atz- tinely adopt CBR methodology integrated with electronic
mueller et al.) or artificial intelligence methodologies like medical records in the clinic. With the rate of increase in
expert systems (S. Montani). The approaches have been val- quality of CBR systems in biology and medicine as show-
idated through significant accuracy and/or precision and re- cased in this special issue, this ultimate objective may be
call ratios, user satisfaction, or expert rating. closer than we think.
However encouraging may be this current state of re-
search in CBR in medicine and biology, the complexity Acknowledgements We would like to thank all the authors for hav-
ing decided to contribute to this special issue, and Prof. Moonis Ali,
of these domains provides many more opportunities for
the chief editor of Applied Intelligence Journal, for his support in this
improvement of CBR methodology. Among technical im- project.
provements, we can cite advancing how to perform adapta- We are also very grateful to the reviewers for their careful work:
tion, evaluating similarity between cases involving continu- Syed Sibte Raza Abidi, Dalhousie University, Canada, Klaus-Dieter
ous data, time series, images, texts, or genetic data, tailoring Althoff, University of Hildesheim, Germany, Paolo Avesani, Instituto
Trentino di Cultura, Italy, Riccardo Bellazzi, University of Pavia, Italy,
clinical guidelines and treatment protocols to a patient case, Peter Funk, Malardalen University, Sweden, Daniel Hennessy, Univer-
modeling more closely expert reasoning, and a smooth inter- sity of Pittsburgh, USA, Alec Holt, Department of Information Sci-
action between the user and the CBR system. Synergies be- ence, University of Otago, New Zealand, Lakhmi C. Jain, University
tween CBR, data mining, and knowledge discovery require of South Australia, Australia, Jean Lieber, Loria, France, Cindy Mar-
ling, Ohio University, USA, Stefan V. Pantazi, University of Victoria,
more research too given the rate of increase in medical data Canada, Enric Plaza, Spanish Scientific Research Council, Spain, Pe-
available from electronic medical records, databases, and lit- tra Perner, Institute of Computer Vision and Applied Computer Sci-
erature. Similarly, synergies between CBR and other com- ences, Germany, Francesco Ricci, University of Bolzano, Italy, Rainer
putational methods such as expert systems, statistical analy- Schmidt, Institut fur Medizinische Informatik und Biometrie, Ger-
many, Olga Vorobieva, Institut fur Medizinische Informatik und Bio-
sis and inference are crucial to the development of CBR. All metrie, Germany.
of these improvements should lead to CBR systems better
integrated in clinical settings, and to the opportunity to eval- Guest Editors
uate these systems in real clinical environments, with the
ultimate goal of showing positive clinical outcomes. Long