Hypothesis Formation and Evaluation in Medical Diagnosis

This thesis describes some aspects of a computer system for doing medical diagnosis in the specialized field of kidney disease. Because such a system faces the spectre of combinatorial explosion, this discussion concentrates on heuristics which control the number of concurrent hypotheses and efficient "compiled" representations of medical knowledge. In particular, the differential diagnosis of hematuria (blood in the urine) is discussed in detail. A protocol of a simulated doctor/patient interaction is presented and analyzed to determine the crucial structures and processes involved in the diagnosis procedure. The data structure proposed for representing medical information revolves around elementary hypotheses which are activated when certain disposing of findings, activating hypotheses, evaluating hypotheses locally and combining hypotheses globally is examined for its heuristic implications. The thesis attempts to fit the problem of medical diagnosis into the framework of other Artifcial Intelligence problems and paradigms and in particular explores the notions of pure search vs. heuristic methods, linearity and interaction, local vs. global knowledge and the structure of hypotheses within the world of kidney disease.

Heterogeneous Multi-Robot Cooperation

This report addresses the problem of achieving cooperation within small- to medium- sized teams of heterogeneous mobile robots. I describe a software architecture I have developed, called ALLIANCE, that facilitates robust, fault tolerant, reliable, and adaptive cooperative control. In addition, an extended version of ALLIANCE, called L-ALLIANCE, is described, which incorporates a dynamic parameter update mechanism that allows teams of mobile robots to improve the efficiency of their mission performance through learning. A number of experimental results of implementing these architectures on both physical and simulated mobile robot teams are described. In addition, this report presents the results of studies of a number of issues in mobile robot cooperation, including fault tolerant cooperative control, adaptive action selection, distributed control, robot awareness of team member actions, improving efficiency through learning, inter-robot communication, action recognition, and local versus global control.

Compact Representations for Fast Nonrigid Registration of Medical Images

We develop efficient techniques for the non-rigid registration of medical images by using representations that adapt to the anatomy found in such images. Images of anatomical structures typically have uniform intensity interiors and smooth boundaries. We create methods to represent such regions compactly using tetrahedra. Unlike voxel-based representations, tetrahedra can accurately describe the expected smooth surfaces of medical objects. Furthermore, the interior of such objects can be represented using a small number of tetrahedra. Rather than describing a medical object using tens of thousands of voxels, our representations generally contain only a few thousand elements. Tetrahedra facilitate the creation of efficient non-rigid registration algorithms based on finite element methods (FEM). We create a fast, FEM-based method to non-rigidly register segmented anatomical structures from two subjects. Using our compact tetrahedral representations, this method generally requires less than one minute of processing time on a desktop PC. We also create a novel method for the non-rigid registration of gray scale images. To facilitate a fast method, we create a tetrahedral representation of a displacement field that automatically adapts to both the anatomy in an image and to the displacement field. The resulting algorithm has a computational cost that is dominated by the number of nodes in the mesh (about 10,000), rather than the number of voxels in an image (nearly 10,000,000). For many non-rigid registration problems, we can find a transformation from one image to another in five minutes. This speed is important as it allows use of the algorithm during surgery. We apply our algorithms to find correlations between the shape of anatomical structures and the presence of schizophrenia. We show that a study based on our representations outperforms studies based on other representations. We also use the results of our non-rigid registration algorithm as the basis of a segmentation algorithm. That algorithm also outperforms other methods in our tests, producing smoother segmentations and more accurately reproducing manual segmentations.

Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.