Complex Occurrents in Clinical Terminologies

1
Complex Occurrents in Clinical Terminologies

• Stefan Schulz, Kornél Markó
• Department of Medical Informatics, Freiburg
  University Hospital, Germany
• Boontawee Suntisrivaraporn
• Department of Computer Science, Technical
  University of Dresden, Germany

2
Understanding Clinical Terminologies from an
Ontological Point of View
Append-ectomy

• Terms / Concepts / Nodes represent Types (common
  properties) used to classify

Append-ectomy,open
Append-ectomy,laparo-scopic
Taxonomy(subtype hierarchy)
Individual objects (instances) in clinical
reality An individual object is instance of one
or more concept according to the properties
defined for this concept
3
Understanding Clinical Terminologies from an
Ontological Point of View
Append-ectomy

• Terms / Concepts / Nodes represent Types (common
  properties) used to classify

Append-ectomy,open
Append-ectomy,laparo-scopic
Taxonomy(subtype hierarchy)
Proc. 62846
Individual objects (instances) in clinical
reality An individual object is instance of one
or more concepts according to the properties
defined for this concept
Proc. 67129
Proc. 81196
Proc. 64518
Proc. 67599
Proc. 87918
Proc. 69129
Proc. 95541
Proc. 15541
Proc. 66629
Proc. 10196
Proc. 87101
Proc. 63281
Proc. 89006
Proc. 68816
Proc. 24095
Proc. 10541
Proc. 12345
Proc. 87888
Proc. 87877
Proc. 22345
Proc. 89201
Proc. 68876
Proc. 20095
Proc. 68881
4
Understanding Clinical Terminologies from an
Ontological Point of View
Append-ectomy
T-BoxTerminological Level Concepts / Types /
Universal Properties General axioms about
individuals
Append-ectomy,open
Append-ectomy,laparo-scopic
Taxonomy(subtype hierarchy)
All open appendectomies are appendectomies All
appendectomies act on some appendix
instance-of
instance-of
Proc. 62846
A-BoxAssertional LevelAssertions about
instances (individuals, tokens) concrete
objects in the world
Proc. 67129
Proc. 81196
Proc. 64518
Proc. 67599
Proc. 87918
Proc. 69129
Proc. 95541
Proc. 15541
Proc. 66629
Proc. 10196
Proc. 87101
Proc. 63281
Proc. 89006
Proc. 68816
Proc. 24095
Proc. 10541
Procedure 67129 is a laparoscopic
appendectomy Procedure 67129 is performed by
Dr. Petersson Procedure 67129 is complicated
by some infection
Proc. 12345
Proc. 87888
Proc. 87877
Proc. 22345
Proc. 89201
Proc. 68876
Proc. 20095
Proc. 68881
5
Understanding Clinical Terminologies from an
Ontological Point of View
Append-ectomy
ClinicalTerminology
Append-ectomy,open
Append-ectomy,laparo-scopic
Taxonomy(subtype hierarchy)
instance-of
instance-of
MedicalRecords
Proc. 62846
Proc. 67129
Proc. 81196
Proc. 64518
Proc. 67599
Proc. 87918
Proc. 69129
Proc. 95541
Proc. 15541
Proc. 66629
Proc. 10196
Proc. 87101
Proc. 63281
Proc. 89006
Proc. 68816
Proc. 24095
Proc. 10541
Proc. 12345
Proc. 87888
Proc. 87877
Proc. 22345
Proc. 89201
Proc. 68876
Proc. 20095
Proc. 68881
6
Understanding Clinical Terminologies from an
Ontological Point of View
Append-ectomy
ClinicalTerminology
Append-ectomy,open
Append-ectomy,laparo-scopic
Taxonomy(subtype hierarchy)
instance-of
instance-of
MedicalRecords
Proc. 62846
Proc. 67129
Proc. 81196
Proc. 64518
Proc. 67599
Proc. 87918
Proc. 69129
Proc. 95541
Proc. 15541
Proc. 66629
Proc. 10196
Proc. 87101
Proc. 63281
Proc. 89006
Proc. 68816
Proc. 24095
Proc. 10541
Proc. 12345
Proc. 87888
Proc. 87877
Proc. 22345
Proc. 89201
Proc. 68876
Proc. 20095
Proc. 68881
7
Thing
Upper Ontology
Occurrent
Continuant
SurgicalProcedure
Phys.Object

• Taxonomy(subtype hierarchy,is-a hierarchy)
• All appendectomies are surgical procedures
• All surgical procedures are occurrents
• All appendices are body parts
• All body parts are physical objects
• All physical objects are continuants
• ()

Domain Ontology
Append-ectomy
Append-ectomy
BodyPart
Append-ectomy,open
Append-ectomy,laparo-scopic
Appendix
Heart
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Thing
Upper Ontology
Occurrent
Continuant
SurgicalProcedure
Phys.Object

• Taxonomy(subtype hierarchy,is-a hierarchy)
• All appendectomies are surgical procedures
• All surgical procedures are occurrents
• All appendices are body parts
• All body parts are physical objects
• All physical objects are continuants
• ()

Domain Ontology
Append-ectomy
Append-ectomy
BodyPart
Append-ectomy,open
Append-ectomy,laparo-scopic
Appendix
Heart
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Partonomies (Compositional Hierarchies) of
Continuants
Appendix
part-of some

• General axioms about parts and holes
• All appendices are part of some large
  intestine
• All colons are part of some large intestine
• All large intestines are part of
• some digestive tract
• ()

LargeIntestine
Colon
part-of some
part-of some
DigestiveTract
Ileum
part-of some
SmallIntestine
part-of some
Jejunum
part-of some
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Partonomies (Compositional Hierarchies) of
Continuants
Gastrotomy
has-part some

• Every instance of Removal of Foreign Body from
  Stomach by Gastrotomy has as parts
• some Gastrotomy
• some Removal of Foreign Body from Stomach

Removal of Foreign Body from Stomach
by Gastrotomy
Removal of Foreign Body from Stomach
has-part some
has-part some in SNOMED CT expressed as Role
Groups (Schulz et al, Meth Inf Med 2006)
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Problems with Complex Occurrents in Clinical
Terminologies
Running Example

• Brain Concussion ( ) With Loss Of
  Consciousness ( ) BCLOC

accident
admission
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Brain Concussion With Loss Of Consciousness
(BCLOC) Different interpretations

• BCLOC One complex event which is the sum of two
  simple events, a BC and a LOC
• BCLOC One (simple) BC event which is followed by
  a LOC event
• BCLOC One (simple) LOC event which is preceded
  by a BC event
• Instances of BCLOC are not instances of BCLOC,
  they are BCs ontologically dependent on LOCs
• Instances of BCLOC are not instances of BCLOC,
  they are LOCs ontologically dependent on BCs

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Brain Concussion With Loss Of Consciousness
(BCLOC) and related types
Occurrent
subtype-of
has-part some
has-part some
BC
LOC
BCLOC
subtype-of
subtype-of
part-of some
part-of some
BCLOC
BCLOC
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Analogy Sums are not subtypes of their summands

Bride Groom
Couple
summands
sum

• An instance of Bride is not an instance of
  Couple, but for every instance of Bride there is
  some instance of Couple and some instance of
  Groom
• An instance of Groom is not an instance of
  Couple, but for every instance of Groom there is
  a some instance of Couple and some instance of
  Bride

cf. Straub et al. From Terminologies to
Classifications FCTC 2006
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Couple, Woman, Man, Bride, Groom
Continuant
subtype-of
has-part some
Man
Woman
Couple
has-part some
subtype-of
subtype-of
part-of some
part-of some
Groom
Bride
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Continuant
Occurrent
subtype-of
subtype-of
has-part some
has-part some
has-part some
has-part some
Man
Woman
Couple
BC
LOC
BCLOC
subtype-of
subtype-of
subtype-of
subtype-of
part-of some
part-of some
part-of some
part-of some
Groom
Bride
BCLOC
BCLOC
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T-Box
Occurrent
subtype-of
has-part some
has-part some
BC
LOC
BCLOC
subtype-of
subtype-of
part-of some
part-of some
BCLOC
BCLOC
A-Box
Patient 1
Patient 2
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Brain Concussion With Loss Of Consciousness
(BCLOC) More interpretations
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Brain Concussion With Loss Of Consciousness
(BCLOC) More interpretations

• BC?LOC complex event constituted by a BC being
  followed by a LOC
• LOC?BC complex event constituted by a LOC
  followed by a BC
• AnalogouslyBCLOC, LOCBC, BCLOC, , LOCBC

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Occurrent
has-part some
has-part some
BC
LOC
BCLOC
BC?LOC
LOC?BC
part-of some
part-of some
LOCBC
LOCBC
BCLOC
BCLOC
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Occurrent
has-part some
has-part some
BC
LOC
BCLOC
BC?LOC
LOC?BC
precedessome
precedes some
follows some
follows some
LOCBC
BCLOC
BCLOC
LOCBC
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Brain Concussion Without Loss Of Consciousness
(BC-LOC)

• Brain Concussion ( ) With Period Without Loss
  Of Consciousness ( )

accident
admission
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Brain Concussion Without Loss Of Consciousness
(BC-LOC)
?

• Brain Concussion ( ) With Period Without Loss
  Of Consciousness ( )

?
accident
admission
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Brain Concussion Without Loss Of Conscious-ness
(BC-LOC) and related types
Occurrent
subtype-of
allhas-partnot
has-part some
BC
LOC
BC-LOC

• Problems - Temporal Context must be
• considered
• Negation or at least
• disjointness must be
• supported

subtype-of
part-of some
BC- LOC
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Workaround Without Negation
Occurrent
absence of loss of consciousness between
traumatic event and examination
subtype-of
has-part some
has-part some
BC
ALOCBTEE
BC-LOC
subtype-of
part-of some
BC- LOC
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How Complex Occurrents can be expressed in SNOMED
CT

• SNOMED supports
• by underlying description logics
• ontological dependence by existential quantified
  roles (exists some)
• complex definitions by implicit conjunction (RG)
• context dependence by context model
• SNOMED does not support
• temporal reasoning
• temporal relations such as follows, precedes
• negations

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How Complex Occurrents are currently expressed in
SNOMED CT

• heterogeneous picture
• some are represented as sums (BCLOC)
• some are represented specialized concepts (BCLOC)
• post-coordination does not always allow to infer
  the pre-coordinated concept
• Definitions of simple occurrents exhibit
  unnecessary complexity (RG nesting)
• Conclusion
• Revision necessary !
• Examples

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Occurrent
Gastrotomy
(Group)has-part some
Removal of Foreign Body from Stomach
by Gastrotomy
Removal of Foreign Body from Stomach
(Group)has-part some
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Occurrent
subtype-of
has-part some
has-part some
BC
LOC
BCLOC
subtype-of
subtype-of
part-of some
part-of some
BCLOC
BCLOC
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Complex Occurrents in Clinical Terminologies
and their Representation in a Formal Language

• Stefan Schulz, Kornél Markó
• Department of Medical Informatics, Freiburg
  University Hospital, Germany
• Boontawee Suntisrivaraporn
• Department of Computer Science, Technical
  University of Dresden, Germany

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