Towards ontology-based decision support systems for complex ultrasound diagnosis in obstetrics and gynecology

J Gynecol Obstet Hum Reprod. 2017 May;46(5):423-429. doi: 10.1016/j.jogoh.2017.03.004. Epub 2017 Mar 31.


Introduction: We have developed a new knowledge base intelligent system for obstetrics and gynecology ultrasound imaging, based on an ontology and a reference image collection. This study evaluates the new system to support accurate annotations of ultrasound images. We have used the early ultrasound diagnosis of ectopic pregnancies as a model clinical issue.

Material and methods: The ectopic pregnancy ontology was derived from medical texts (4260 ultrasound reports of ectopic pregnancy from a specialist center in the UK and 2795 Pubmed abstracts indexed with the MeSH term "Pregnancy, Ectopic") and the reference image collection was built on a selection from 106 publications. We conducted a retrospective analysis of the signs in 35 scans of ectopic pregnancy by six observers using the new system.

Results: The resulting ectopic pregnancy ontology consisted of 1395 terms, and 80 images were collected for the reference collection. The observers used the knowledge base intelligent system to provide a total of 1486 sign annotations. The precision, recall and F-measure for the annotations were 0.83, 0.62 and 0.71, respectively. The global proportion of agreement was 40.35% 95% CI [38.64-42.05].

Discussion: The ontology-based intelligent system provides accurate annotations of ultrasound images and suggests that it may benefit non-expert operators. The precision rate is appropriate for accurate input of a computer-based clinical decision support and could be used to support medical imaging diagnosis of complex conditions in obstetrics and gynecology.

Keywords: Decision support system; Ectopic pregnancy; Image annotations; Knowledge base; Ontology; Ultrasound imaging.

Publication types

  • Evaluation Study

MeSH terms

  • Biological Ontologies / organization & administration
  • Decision Support Systems, Clinical / trends*
  • Diagnosis, Differential
  • Expert Systems
  • Female
  • Gynecology / methods
  • Gynecology / trends*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Internet / standards
  • Knowledge Bases
  • Obstetrics / methods
  • Obstetrics / trends*
  • Pregnancy
  • Pregnancy, Ectopic / diagnosis*
  • Pregnancy, Ectopic / therapy
  • Ultrasonography / methods
  • Ultrasonography, Prenatal* / methods