title: Developing a knowledge base to support the annotation of ultrasound images of ectopic pregnancy.
abstract: BACKGROUND
  Ectopic pregnancy is a frequent early complication of pregnancy associated with significant rates of morbidly and mortality. The positive diagnosis of this condition is established through transvaginal ultrasound scanning. The timing of diagnosis depends on the operator expertise in identifying the signs of ectopic pregnancy, which varies dramatically among medical staff with heterogeneous training. Developing decision support systems in this context is expected to improve the identification of these signs and subsequently improve the quality of care. In this article, we present a new knowledge base for ectopic pregnancy, and we demonstrate its use on the annotation of clinical images.
  
  
  RESULTS
  The knowledge base is supported by an application ontology, which provides the taxonomy, the vocabulary and definitions for 24 types and 81 signs of ectopic pregnancy, 484 anatomical structures and 32 technical elements for image acquisition. The knowledge base provides a sign-centric model of the domain, with the relations of signs to ectopic pregnancy types, anatomical structures and the technical elements. The evaluation of the ontology and knowledge base demonstrated a positive feedback from a panel of 17 medical users. Leveraging these semantic resources, we developed an application for the annotation of ultrasound images. Using this application, 6 operators achieved a precision of 0.83 for the identification of signs in 208 ultrasound images corresponding to 35 clinical cases of ectopic pregnancy.
  
  
  CONCLUSIONS
  We developed a new ectopic pregnancy knowledge base for the annotation of ultrasound images. The use of this knowledge base for the annotation of ultrasound images of ectopic pregnancy showed promising results from the perspective of clinical decision support system development. Other gynecological disorders and fetal anomalies may benefit from our approach.
authors.affiliation: UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France. ferdinand.dhombres@aphp.fr.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Dhombres
authors.affiliation: UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Maurice
authors.affiliation: UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Friszer
authors.affiliation: UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Guilbaud
authors.affiliation: INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology), Maternité Port Royal, 53 Avenue de l'Observatoire, 75014, Paris, UE, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lelong
authors.affiliation: INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology), Maternité Port Royal, 53 Avenue de l'Observatoire, 75014, Paris, UE, France.
authors.forename: Babak
authors.initials: B
authors.lastname: Khoshnood
authors.affiliation: APHP DSI, INSERM U1142 (LIMICS), 15, rue de l'École de Médecine, 75006, Paris, UE, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Charlet
authors.affiliation: Pyramides Medical Imaging Center, 13 av. de l'Opéra, 75001, Paris, UE, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Perrot
authors.affiliation: University College Hospital (UCLH) Department of Obstetrics and Gynaecology, Academic Department of Obstetrics and Gynaecology, University College London (UCL) Institute for Women's Health, 86-96 Chenies Mews, London, WC1E 6HX, UE, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Jauniaux
authors.affiliation: Department of Obstetrics and Gynaecology, Gynaecology Diagnostic and Outpatient Treatment Unit, University College Hospital (UCLH), 235 Euston Road, London, NW1 2BU, UE, UK.
authors.forename: Davor
authors.initials: D
authors.lastname: Jurkovic
authors.affiliation: UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Jouannic
mesh_terms: D064229:Biological Ontologies; D057225:Data Mining; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Application ontology; Ectopic pregnancy; Knowledge base