1. Case-based Adaptations in Medicine Focusing on Hypothyroidism Rainer Schmidt, Olga Vorobieva, Lothar Gierl Institute for Medical Informatics and Biometry University of Rostock, Germany

2. Contents 1. Adaptation Problem in Medicine 2. Hypothyroidism 3. Support Programs for Hypothyroidism 4. Conclusion:Adaptation Techniques for Medical Therapy Problems 5. Future Work

3. 1. Adaptation Problem in Medicine So far, CBR in medicine not as successful as in some other domains Main problem: Adaptation In medicine many details and complex features (interactions, exceptions, contradictions) Medicine never is a closed world, but continuously changing

4. Avoiding Adaptations Many medical applications avoid adaptations: - Retrieval-only systems: image interpretation and other visualisations (of organ functions: e.g. kidney or liver) - Multi-modal reasoning systems: incorporate only CBR-retrieval (mainly to support evidences)

5. Adaptation Techniques in Medical CBR Systems Adaptation Techniques in Medical CBR Systems - Adaptation Rules and Operators: CASEY - Constraints: ICONS, GS.52 - Compositional Adaptation: TA3-IVF, (TeCoMed) ? Abstraction: MEDIC, MNAOMIA, GS.52

6. Our Project Our Project Adaptation is the main bottleneck for medical CBR systems. So, the goals of our project are to develop general adaptation models, methods and operators for the main medical tasks: diagnosis, prognosis and therapy. We have started with therapeutic problems and have developed some support programs in the endocrinology domain.

7. 2. Hypothyroidism Thyroid gland produces thyroid hormones Too much: Hyperthyroidism Too less: Hypothyroidism Diagnosis can be established by blood tests Therapy for Hypothyroidism is Levothyroxine Problem: Determine therapeutic dose

8. 3. Support Programs for Hypothyroidism 3. Support Programs for Hypothyroidism - Computing an initial dose (new-born babies) - Updating in a patient’s lifetime - Additional diseases or complications

9. Program Flow Program Flow

10. Therapy Recommendation Therapy Recommendation

11. Computing an Initial Dose Computing an Initial Dose

12. Updating in a Patient‘s Lifetime Updating in a Patient‘s Lifetime

13. Additional Diseases or Complications Additional Diseases or Complications

14. 4. Conclusion: Adaptation Techniques for Medical Therapy Problems 4. Conclusion: Adaptation Techniques for Medical Therapy Problems ? Abstraction: in form of Guidelines - Constraints: for Initial Therapy - Compositional Adaptation:for Dose Calculation - Adaptation Rules: typical tasks - Substitution - Compensation - Calculation

15. Adaptation Model for Therapies Adaptation Model for Therapies

16. 5. Future Work Develop General Adaptation Models and Operators