On the development of intelligent medical systems for pre-operative anaesthesia assessment
This thesis describes the research and development of a decision support tool for determining a medical patient's suitability for surgical anaesthesia. At present, there is a change in the way that patients are clinically assessedp rior to surgery. The pre-operative assessment, usually conducted by a qualified anaesthetist, is being more frequently performed by nursing grade staff. The pre-operative assessmenet xists to minimise the risk of surgical complications for the patient. Nursing grade staff are often not as experienced as qualified anaesthetists, and thus are not as well suited to the role of performing the pre-operative assessment. This research project used data collected during pre-operative assessments to develop a decision support tool that would assist the nurse (or anaesthetist) in determining whether a patient is suitable for surgical anaesthesia. The three main objectives are: firstly, to research and develop an automated intelligent systems technique for classifying heart and lung sounds and hence identifying cardio-respiratory pathology. Secondly, to research and develop an automated intelligent systems technique for assessing the patient's blood oxygen level and pulse waveform. Finally, to develop a decision support tool that would combine the assessmentsa bove in forming a decision as to whether the patient is suitable for surgical anaesthesia. Clinical data were collected from hospital outpatient departments and recorded alongside the diagnoses made by a qualified anaesthetist. Heart and lung sounds were collected using an electronic stethoscope. Using this data two ensembles of artificial neural networks were trained to classify the different heart and lung sounds into different pathology groups. Classification accuracies up to 99.77% for the heart sounds, and 100% for the lung sounds has been obtained. Oxygen saturation and pulse waveform measurements were recorded using a pulse oximeter. Using this data an artificial neural network was trained to discriminate between normal and abnormal pulse waveforms. A discrimination accuracy of 98% has been obtained from the system. A fuzzy inference system was generated to classify the patient's blood oxygen level as being either an inhibiting or non-inhibiting factor in their suitability for surgical anaesthesia. When tested the system successfully classified 100% of the test dataset. A decision support tool, applying the genetic programming evolutionary technique to a fuzzy classification system was created. The decision support tool combined the results from the heart sound, lung sound and pulse oximetry classifiers in determining whether a patient was suitable for surgical anaesthesia. The evolved fuzzy system attained a classification accuracy of 91.79%. The principal conclusion from this thesis is that intelligent systems, such as artificial neural networks, genetic programming, and fuzzy inference systems, can be successfully applied to the creation of medical decision support tools.