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A Model-Based Method for Computer-Aided Medical Decision


Orlando Chacón
Universidad Politécnica de Madrid, Spain

This document is a brief review of the causal-association network(CASNET), which tries to show
the most relevant parts of the paper A Model-Based Method for Computer-Aided Medical Decision
Makin written by Sholom M. Weiss, Casimir A. Kulikowski, Saul Amarel, and Aran Sar.

KEY WORDS: Probability; Utility

1 Introduction
Many researchers came together to develop a computer-assisted medical decision making, this was
based on causal-associational network (CASNET) models of disease. This project started on Rutgers
University, at the same time that some other research universities were developing MYCIN.
CASNET relies on a symbolic model that concerns about causality and temporal sequences of
events rather than mathematical models(That were usually used before that time). This approach
allowed to demonstrate that explicit knowledge representation not only oers a good diagnostic but
also allows a powerful reasoning about the deceases or treatment.

2 About CASNET
The use of large knowledge-based systems allows ease of knowledge management but also makes the
migration from one domain to another(related) feasible an practical. Therefore, CASNET tries to
benet from the goodness that this kind of "databases" provide.
The power of CASNET relies on the ability to suggest treatment plans according to the current
state of the decease, but also takes care of the progression of the decease, therefore it's able to predict
and make use of external predictions to of future events, this characteristic makes CASNET dierent
from other AIM(Articial Intelligence in Medicine) approaches.
CASNET is a special kind of semantic network that has the following objectives:

• Describe dynamic processes in terms of (loop-free) causal relationships among a set of internal

• Relate this description to external variables that are considered to be manifestations of the
internal processes.

• Describe various classications imposed on the dynamic processes.

In the CASNET scheme, to help understand the problem at hand, the knowledge representation
has been separated in three types of data elements:

1. Observations of the patient;

2. Pathophysiological states.

3. Diagnostic, prognostic, and therapeutic categories.

2.1 Causal Network of States

In CASNET, most events are expressed in a cause-and-eect relationships. That is, the pathogenesis
and mechanisms of a disease process depends on a cause-and-eect relationships between pathophysi-
ological states. There is no strict relation between causes and eects, there may exist multiple causes
and eects related. However, there are many causes that can lead to many eects; also, a cause may
not manifest any eect.
To understand how the knowledge is represented, it's crucial to know (taking as a starting point
one decease, see Fig 1) that:

• Generally, a complete pathway from the starting point to a terminal node represents a complete
disease process.

• A partial pathways, from the starting point to nonterminal nodes, shows the degrees of evolution
within the disease process.

The resultant cause-eect network is a directed acyclic graph(DAG) of states, dened by (S, F, N, X)
S → set of starting states. F → nal states. N → total set of states. X → set of mappings
between states indicating causal relationships. Despite not a complete or exhaustive representation,
the resultant network becomes extremely useful as a diagnosis tool, that unies many concepts related
with the decease. As we go deeper in one pathway of the causal network the seriousness of the decease
can be seen as increases in seriousness.

2.2 Rules for Associating States with Observations

States in the network can be denied or conrmed according to the information according to the real
observations about a patient. The test-state relation is not causal but associational, the observation
may be not exact, then a degree of belief is specied.

2.3 Rules for Associating Disease Categories with State

Diagnostic an prognostic are represented as ordered patterns of rules(Classication tables)

n1 ∧ ¬n2 . → D1
n1 ∧ n2 ∧ ¬n3 → D2
n1 ∧ n2 ∧... ¬ni → Di−1
n1 ∧ n2 ∧... ni → Di
D1 represents the diagnosis and prognostic, given by the ordered pattern: n1 ∧ n2 ... ∧ ni .

3 Test Result Interpretation

The result is a collection of evidence for one single state. Then, it result better and intuitive to take the
result with greatest condence. When new evidence is received, the state can change, e.g if the result
has the same condence but opposite to the previous evidence, then, an evidential conict appears and
consequently, the state will change to undetermined.

Figure 1: Partial causal network for glaucoma.

4 Test selection
For this process it's important to note which paths are admissible and which are not. It's posible to
note to important facts: Forward Weights for Test Selection and Inverse Weights for Test Selection.

4.1 Forward Weights for Test Selection

This can be seen as the product of all transitions from the last conrmed node.

4.2 Inverse Weights for Test Selection

This is sum of all weight that are actually entering to the node.

5 Conclusions
A model based expert system has been created, in this process, two tasks can be distinguished: (1)de-
sign and representation of models and (2)general problem solving algorithms.
CASNET (specically for Glaucoma) was tested and the highly ecient results show that it can
be trusted by ophthalmologist.
When we take into account measure uncertainty and also establishing some threshold for this un-
certainty it's possible to whether the state should be considered as: conrmed,denied, or undetermined.
This is a referential model for constructing robust medical decision systems. When reasoning is
judgmental and based more on empirical information than knowledge of the disease mechanisms, it
could be convenient to use other approaches.

Weiss, S., Kulikowski, C., Amarel, S. and Sar, A. (2007) A Model-Based Method for Computer-Aided
Medical Decision Making. Artijiriallntelligen((" , 11, 146172.