Semantic decision trees editing for decision support with KcatoS - Application in oncology

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KcatoS - Application in oncology

Thomas Meilender, Jean Lieber, Fabien Palomares, Nicolas Jay

To cite this version:

Thomas Meilender, Jean Lieber, Fabien Palomares, Nicolas Jay. Semantic decision trees editing for

decision support with KcatoS - Application in oncology. SIMI 2012: Semantic Interoperability in

Medical Informatics, May 2012, Heraklion, Greece. �hal-00736710�

ThomasMeilender

1 , 2

,Jean Lieber

2

,FabienPalomares

1

,andNiolasJay

2

1

A2ZI-61terruedeSaint-Mihiel-55200Commery

{thomas.meilender,fabien.paloma res} a2zi .fr

2

UHP-Nany1LORIA(UMR7503 CNRS-INPL-INRIA-Nany2-UHP)

{thomas.meilender,jean.lieber,niol as.j ay}l oria .fr

Abstrat. During the last two deades, the interest for omputer-

interpretableguidelineshaskeptgrowingtobeomeamajorissueinmed-

ialinformatis.Clinialguidelinesusuallyontaindeisionalknowledge

thatanberepresentedbydeisiontrees.ThispaperpresentsKatoS,a

semantideisiontreeeditor,whihprovidesaollaborativetooltosim-

plifyknowledgeaquisition.Usingasimplegraphiallanguage,KatoS

allowsexportingdeisiontreestoformalisedknowledge,byproposingan

originalexportalgorithmtoOWL.Easytointegrateinwebappliations,

KatoS ispart ofa larger workaboutollaborative editing oflinial

guidelines.Theoverallobjetiveistoprovidetoolstoassisteditingand

storageofdeisionalknowledgeintheeldofonology.

1 Introdution

Knowledge aquisition is a well-known bottlenek in knowledge management.

Experts have to provide aurate models of a domain by using omplex for-

malisms.Itappearsthat knowledgeeditingwouldbesimpliedifthere existed

asimpleformalismthatbothexperts andmahineswouldunderstand.

Asin mostof mediine areas,onologyexpertsrelyupon apartiularkind

ofknowledgealleddeisionknowledge.Deisionknowledgeassoiatesdeisions

(or,atleast,reommendations)tosituations.Alsoknownasmedialguidelines,

medial deision knowledge is often formalised as deision trees that an be

understoodbyamahineiftheyarewell-formed.

Onolor is an assoiation gathering physiians from the Frenh region of

Lorrainethatareinvolvedinonology 3

.Oneofitsrolesisthereationoflinial

pratieguidelines (CPGs) that aredened in [7℄ assystematiallydeveloped

statementstoassistpratitionerandpatientdeisionsaboutappropriatehealth

areforspei linialirumstanes. Onitsstatiwebsite,Onolorprovides

to pratitionersmore thanonehundred CPGs.This base iswritten in HTML

and ontainsa lot of deision trees drawn with dediated graphis standards.

Beauseofthelargeamountofdataandtheimportaneofkeepingthemupto

3

date, maintenane is a hard task. Moreover, the lak of semanti information

assoiatedto themmakesthisknowledgeunavailableforanautomatiuse.

This paper presents KatoS, atool that aims at failitating maintenane

andbringingasemantilayertothedata.KatoSproposesasemantigraphis

editorallowingtodrawdeisiontreesinasimplelanguageandexporttheminto

mahine-understandablepiees ofknowledgethankstoatranslationalgorithm.

Theresultingformalisation anbeexportedinOWL.

Afterthe presentation of the ontext ofappliation in Setion 2,Setion 3

desribes the deisiontree languageof KatoSand the translationfrom this

languagetoOWL.TheeditorispresentedinSetion4withitsuserinterfaeand

itsembedding insemantiweb,partiularlywiththeknowledgeserverKOWL

and thesemantiform editor EdHibou.An evaluationbased onexisting data

transformationandOnolorfeedbakisproposedonSetion5.Setion 6draws

aonlusionandseveralongoingandfuturework.

2 Context of appliation

2.1 Onolor guidelinesand The Kasimirprojet

Onolorhasedited144guidelinesgivingreommendationsforthearesofmany

dierentanerloalisations(forexampleervialanerlimitedtotheervix)

orafew moregeneraltypes ofare relatedto onology suh asdental ares.

Typially, guidelines are strutured douments that are omposed of various

kinds of ontents: texts, deision trees, medial lassiations, pitures, refer-

enes, andglossaries.Theyarepublished ontheOnolorwebsiteandareavail-

able for both pratitionersand patients. As medial knowledge is ritial and

ontinuallyevolving,guidelines havealimitedlifetime and mustbekeptupto

date. Onoloronstrainstheirupdates toeverytwoyears.

Aguideline update an be viewedasaworkow, whereaguideline is aset

of data that has to be modied by several users at dierent times. From an

organisationalpoint ofview,Onolornamesaoordinatorwhohasto validate

eah step of the proess. This latter invites a ommittee of domain experts

to hekand update guidelines when needed. Then, the resultingdoument is

validated by alargerregional audieneseminarand an be possibly sentbak

totheommittee.Afterthisagreement,Onolormembersproposeanewedited

versionthatwill beonlineifaeptedbytheoordinator.

Atthispoint,numerousneedshaveemergedforOnolor.Oneofthemisthe

needforaollaborativetooltoallowtheommitteetoexhangeduringtherst

step of the update. At present,orretions of ommittee experts are provided

to the oordinator asa listof written notes that haveto be adapted to t to

the guideline standard.It would beeasier ifexperts ould diretly hange the

guideline. That means nding anediting toolthat would be simpleenough to

beusedbyspeialistswithlimitedskillsinomputersiene.Moreover,keeping

ahistoriofguidelinemodiationswouldbehelpful.Anotherneedomesfrom

thenal guidelineediting.Onolordoesnothaveanywebmasterin itssta so

OnolorisinvolvedinaresearhprojetalledKasimir,whihaimsatprovid-

ingtoolsfordeisionknowledgemanagementanddeisionsupportinonologyby

exploitingCPGs.Startedin1997,Kasimirisamultidisiplinaryprojetinvolv-

ingindustrial(A2ZI)andaademi(LORIA,CNAMLaboratoryofErgonomi)

partners. Kasimir led to the development of software suh as the knowledge

serverKOWL,andtheinstaneeditorEdHibou[3℄.But,untilnow,mostOn-

olorguidelines arenotformalised sothetoolsmiss realknowledgeto beused

in alinialontext.

2.2 Towardsa semanti wiki

Coneived in 1995 by Ward Cunningham, wikis are websites for reating and

ollaborativeeditingofontentinasimpleway[6℄.Traditionalwikisareusually

based on a set of editable pages, organized into ategories and onneted by

hyperlinks.Semantiwikisarebornfromthemergingofwikisandthesemanti

web. Berners-Lee and Fishetti dene them as improved wikis by the use of

semantiwebtehnologies[2℄.

Semantiwikisan beasolutionto bothOnolorandKasimirneeds.They

provide a ollaborative editing tool with numerous features suh as software

versioningorlayouteditor.Moreover,withthesemantilayer,Kasimirwillhave

aesstonewknowledgeformalisationtehniques.Semantiwikisalsobringnew

perspetivesforindexingandminingCPGs.

The only elements of CPGs that annot be diretly edited in a wiki are

deision trees. No semanti wikis provide that kindof extension. That is why

KatoS has been reated. It also allows to formalise trees and to deal with

deisionknowledgeinsemantiwebappliations.

3 KatoS framework

3.1 KatoS deisiontree language

Generalpresentation.KatoSdeisiontreelanguageisagraphialrepresen-

tation basedonasmall setof geometrialshapesonneted bydireted edges.

In this way, shapesare onsidered asnodes of a simple deision tree. From a

semantipoint of view,there are severalkinds of node, eah onewith its own

meaningasshowninFigure1.

Thisrepresentationwasdiretlyinspiredfromgraphisstandardsofourpart-

nerOnolor.Indeed,OnolorCPGsusevisualrepresentationsthat anbeon-

sideredastreesformostofthem.Anadvantagetousethesegraphisstandardsis

thatOnolorexpertsalreadyknowthem.WewanttopreserveOnolor'sgraphis

semantisinorder tofailitatefutureuseofCPGsbyphysiians.

Syntax. Toavoidambiguitiesandinsureonsisteny,lassialsyntatialrules

oftreesareused:

Shape Comments

Roundedretanglesrepresentmedialsituations.Amedialsituation

anbedenedbyapatientstatedesribedbyasetofvariablessuh

asmedialexamresults,physiology,et.

Reommendationsarehighlightedbyregularretangles.Theyontain

theadviethattheCPGs wouldgivethepratitioner.Theretangle

olorhasalsoameaning:itspeiesthekindofreommendation,for

examplesurgery,speitreatment,orhemotherapy.

Hexagonsrepresentquestions thatwillhelptodesribethesituation

inordertodenetherightreommendation.

Ellipsesarelinksfrom/toanothertree:thisenablestodrawabigtree

inseveralwebpages,eahofthemontainingsmallertrees.

Edges are shown by simple arrows. When they onnet a question

to anothernode,linksaretyped,whihmeansthat theyontainan

answer tothepreviousquestion.

Options arepartiularkindsofedge:theyorrespond totherapeuti

optionswhihanbeappliedtoasituation.Fromamedialpointof

view,itmeansthatahoiedoesnotdependonpartiularparameters,

butletpratitionershoosediretlythepreferredoption.

Fig.1. Shapesandtheirmeanings.

nodesareonnetedbydiretededges;

textson edge represent transition onditions, andmay ontain simplefor-

mulas:AND,OR,NOTaretheonlyreognisedbooleanoperators.

Moreover,afewrulesareaddedtoguaranteeaorretsemantisforthetrees:

therootisneessarilyasituation oralink fromanothertree;

aquestionhasat least oneanswer,and everyedgethat followsaquestion

mustontainananswer;

atextonanedgeisanansweriftheedgefollowsaquestion;

a node may have several parents but direted yles are forbidden, i.e. a

nodeannotappearsmorethanonein apath;

anodeanbeonnetedto itssonsonlybyusingedgesoroptions;

asasituationanhavemorethanonereommendation,somereommenda-

tionsanbegathered.

An exampleofsyntatiallyorrettreeisshowninFigure 2.

Semantis. AKatoSdeisiontreeanbeexportedtoOWL,asshowninthe

nextsetion.ItssemantisisthesemantisoftheOWLknowledgebase.

3.2 Export from KatoS to OWL

In this paper, the desription logis

SROIQ(D)

^{, whih is equivalent to}

Fig.2.An exerptof theOnolortreatment guidelinefor ervialaner limited to

theervix editedwithKatoSeditor.

KatoS's export algorithm denestwolasses:Situation andReommen-

dation.Therstonerepresentsthesituation(e.g., in theonology appliation,

somepatientdesription)whiletheseondonerepresentsthedesriptionofthe

deisionproposedbythesystem.These lassesarelinkedin thisway:

Situation

⊑ ∃

hasReommendation.Reommendation

This means that for eah situation

σ

⁽

σ ∈

^Situation

^I

^{) there is a re-}

ommendation

ρ

⁽

ρ ∈

Reommendation

I

) that is assoiated to

σ

⁽

(ρ, σ) ∈

hasReommendation

I

). The property hasReommendation relates a situation

to a reommendation. It uses the lass Situation as domain and the lass

Reommendationasrange.

New sublasses for Situation and Reommendation are dened by

the translation proess. For example, let us onsider a patient who has

a headahe and whose reommendation is to have some aspirin. Classes

PatientWithHeadahe,sublassofSituation,andAspirinPresription,sub-

lassofReommendation,anbedenedin thisway:

PatientWithHeadahe

≡

^Situation

⊓ ∃

hasSymptom.HeadaheSymptom

AspirinPresription

⊑

Reommendation

Then,thefollowingformulaformalisesthe(ontroversial)senteneEahpatient

withaheadahehastobepresribedaspirin.:

PatientWithHeadahe

⊑ ∃

hasReommendation.AspirinPresription

3.3 Translationrules

Atreeisreadusingdepth-rstsearh.Eahnodeistransformedusingtherules

Awhole exampleofexportfromgraphialdeisiontreetoOWLisshownin

Figure3.

, 1

^SitCCLTC

⊑

Situation

, 2

^{hasCVL :funtionaldatatypeproperty}

domain:SitCCLTC

range:boolean

, 3

SitCVL_False

≡

^SitCCLTC

⊓ ∋

^hasCVL

.

^false

, 4

SitCVL_False

⊑ ∃

hasReommendation.Conisation

, 5

hasFigoStaging:funtionalobjetproperty domain:SitCVL_False

range:RespFigoStaging

, 6

RespFigoStaging

(

^IA1

)

SitFigoStagingIA1

≡

SitCVL_False

⊓ ∋

hasFigoStaging

.

^IA1

, 7

SitFigoStagingIA1

⊑ ∃

hasReommendation

.

^PiverI

, 8

RespFigoStaging

(

^IA2

)

SitFigoStagingIA2

≡

SitCVL_False

⊓ ∋

hasFigoStaging

.

^IA2

, 9

SitFigoStagingIA2

⊑ ∃

hasReommendation

.

^PiverII

, 10

SitCVL_True

≡

^SitCCLTC

⊓ ∋

^hasCVL

.

^true

, 11

hasSizeSup4:funtionaldatatypeproperty domain:SitCVL_True

range:boolean

, 12

SitSizeSup4_False

≡

SitCVL_True

⊓ ∋

hasSizeSup4

.

^false

, 13

^SitFIGOIB1

⊑

SitSizeSup4_False

, 14

SitSizeSup4_True

≡

SitCVL_True

⊓ ∋

hasSizeSup4

.

^true

, 15

^SitFIGOIB2

⊑

SitSizeSup4_True

Fig.3.OWLtranslationofdeisiontreeeditedinFigure2.

Situations. AsituationshapeallowstoreatealassSit_Ythat isasublass

ofSit_X,thenearestsublassofSituation(i.e. thethesublassoftheparent

nodeorparentedge, ifany).

Sit_Y

⊑

^Sit_X

Reommendations. A reommendation shape shows that a situation lass

Sit_XislinkedtothereommendationReo1bythepreviouslydenedproperty

hasReommendation.

Sit_X

⊑ ∃

hasReommendation.Reo1

Questions. Aquestionshapeintroduesanewfuntional propertyhasAnswer

havingSit_X, thenearest sublass of situation,as domain. If the answersare

isanobjetpropertyhavinganewlassAnswerQuestionasrange.

hasAnswer

:f unctional property domain :

^Sit_X

range :

^boolean

or

AnswerQuestion

Links. Ellipses permitto dolinksbetweentreesand appearasroot orasleaf.

ItmeansthatthesituationSit_Xdesribedinthersttreesisequivalenttothe

initialsituation Sit_Ydesribedintheseondtree.

Sit_Y

≡

^Sit_X

Edges. An edge ontains ananswerANSWERto the questionhasAnswer itdi-

retlyfollows.ItintroduesanewsublassofSit_X,byspeifyingtheproperty

value.

Sit_Y

≡

^Sit_X

⊓ ∋

hasAnswer.ANSWER

Options. Thisarrowanbeviewedasapartiularkindofedge.But,byontrast

tolassialedges,theydeneasituationbyllingthepropertyhasOptionand

reateTherapeutiOptioninstanes.

Sit_Y

≡

^Sit_X

⊓ ∋

hasOption.OPTION

4 Embedding KatoS in the semanti web

4.1 Tehnologies in use

KatoS deision tree editor is a web-based appliation using Google Web

Toolkit 4

(GWT) that allows to reate omplex Ajax appliations. A few ad-

ditional APIs dediated to GWT are used to manage the interfae. Drawing

apabilitiesrelyonSVGandJavaSripttehnologieswhileOWLexportisdone

thankstoOWLAPI[5℄.Thus, KatoSisopentoollaborativeworkand web

servies.Itsframeworkanbeintegratedinmostofontentmanagementsystem:

sometestshavealreadybeensuessfullydonewithMediaWiki 5

.

A syntati module an be used to hek if the edited tree respets rules

denedinSetion3.Inludedintheinterfae,themoduleallowstovalidatetrees

stepbystepwhiledrawing,byidentifyingshapeswithmistakes.Asanoutput,

dierentformatsareproposed:bitmap(PNGandJPG),Vetorgraphis(SVG),

andontologies(OWL).Moreover,KatoSinludesitsownversionsystems.As

eahtreeiskeptonadistantserver,modiationsaresaved.Forthepresent,only

fewfuntions dealingwithhistoryareavailable:previousversionsof atreean

beviewedandrestoredwithsomeinformationsaboutauthoranddate.However,

someinformation issavedinto XML les that willallowto add funtionalities

suh omparison of versions and mergingalgorithms. Those improvementsare

planned tobepartofourfuture work.Asreenshotofastand-aloneversionis

shownin Figure2.Itwillbeshortlyavailableunder afreeliene(LGPL).

4

http://ode.google.om/intl/en /webt oolk it/

5

4.2 Querying knowledge with semantiweb appliations

ExporttoOWLallowstheKatoSuseinthesemantiweb.Previouslyreated

in the Kasimir projet, KOWL is a knowledge web server. KOWL an read

and edit aremote OWLle during asession.It supports SPARQL [9℄ queries

throughasimpleHTMLinterfae.Editing reliesonJenaAPI 6

whileinferenes

aredonewiththePellet reasoner[11℄.

(a)SPARQLqueryintheKOWLinterfae.

Y

http://kasimir.loria.fr/uterus.owl#Conisation

http://www.w3.org/2002/07/owl#Thing

http://kasimir.loria.fr/uterus.owl#Reommendation

(b)XMLanswertothepreviousquery.

Fig.4.AnexampleofSPARQLquery(a)togetreommendationlasses(b).

A KOWL query to the knowledge base reated in Figure 3 is shown in

Figure 4. The goal of this example is to get a reommendation for a patient

PATIENT_Awhohasaervialanerlimitedtotheervixwithoutanyvisiblele-

sion.First,twoinstanesarereated,aninstanePATIENT_AinlassSituation

andaninstaneMY_RECOMMENDATIONinlassReommendationwhiharelinked

bythepropertyhasReommendation.Then,thepropertyhasCVLissettofalse

fortheinstanePATIENT_A.Finally,aSPARQLrequestissenttogetlassesof

MY_RECOMMENDATION(Figure 4(a)). Answeran be seen in Figure 4(b). Three

lassesaregiven:lassesThingandReommendationanbeeasilydeduedand

lass Conisationisinferred.It meansthat aonization(i.e., aspeial kindof

biopsyof theervix)isreommendedforPATIENT_A,whihorrespondstothe

reommendationgivenin thepreviousdeisiontree.

Interation apabilitieswith EdHibou[1℄areanother exampleof KatoS

useinthesemantiwebontext.EdHibouisaframeworkthataimsatproviding

auserinterfaefortheKasimirprojet.Itallowstodesribeamedialsituation

stepbystepbyusingquestionsdesribedashexagonsindeisiontrees.Questions

appear in a HTML form, following the order of the tree. Aording to user

answer,reommendationsanthenbededuedand shown.

6

Tehnially, EdHibou edits OWL ontologies. Its priniple is to reate an

instane and to onsider relatedpropertiesasquestions.Editing and inferene

inEdHibourelyonthepreviouslypresentedknowledgeserverKOWL.Froma

visualpointofview,EdHibouoersmanyustomisationpossibilities.Multiple

ongurableviews areproposedin ordertokeepahekonelementevolutions

depending on userhoies. In this way, aview that showsthe inferred lasses

of the reated instane an be made. This view is kept up to date at every

userinteration.Graphialwidgetontainedinformsanalsobeustomisedfor

apartiular appliation. All those graphialomponent ustomisationsan be

donebyeditinganinterfae-dediatedontology.

Combined to KatoS, EdHibou uses exported OWL les. It reates an

instaneofSituationandaninstaneofReommendationandlinksthemwith

the property hasReommendation. A viewis launhed to visualize the label of

thelassesoftheinstaneofReommendation.EdHiboutransformsintoHTML

form widgets eah property whih hasasdomain thelassesof theinstane of

Situation.Whilellingtheform,valuesaregiventopropertiesintheontology

forreatedinstaneof Situation. Asthislast instanebeomesmorespei,

morespei lassesof the instane of Reommendationare inferred and their

labels areshownin the reommendationpartof theview.An exampleof suh

useisshownin Figure5.

Fig.5.KatoSombinedwithEdHibou.

4.3 Using KatoS in semantiwiki ontext

KatoShasbeenintegratedinasemantiwiki,OnologiK 7

[8℄.Asemantiwiki

is similar to atraditional one in the sense that it is a website where ontents

areaddedbyusers.Thisontentisorganizedintoeditableandsearhablepages,

aessibletoallusers.However,unliketraditionalwikis,semantiwikisarenot

limitedtonaturallanguagetext.Theyharaterizeresouresandlinksbetween

them. This information is formalized and thus beome usable by a mahine,

throughproessesofartiialreasoning.

Fromatehnialpointofview, OnologiKusesasawikiengineMediawiki

anditsextensionSemantiMediawiki(SMW)[12℄.Theyallowtheuseofseman-

tiappliationssuhassemantiformsandSPARQLaess.KatoShasbeen

integrated as an extension and uses templates and parsers funtions of SMW

toimportknowledgeabouttrees.Inthisway,treesareindexedinthesemanti

wiki.Forexample,thesystemallowstondbyaquerywhihtreesareonerned

aboutdigestivetrat.

5 Evaluation

5.1 Dealing with existing trees

Onolorexpertshavealreadywritten144guidelinesthatontainmorethan600

deisiontrees.MostofthemhaveasizeequivalenttothetreeshowninFigure2.

Unfortunately, throughout suessive updates, medial experts didnot always

take are of respeting neither lassial rules of deision trees, nor graphial

standards. Resultingtrees are still readable and understandable by speialists

but arefarfrombeingsystematiallyreognizable.KatoSsyntaxveriation

algorithmswillnotaeptsyntatiallyinorretdeisiontrees.Afteranalysing

150existingdeisiontrees,ithasappearedthat only44ouldbeonsidered as

well-formed.Bystudyingtheausesoferrors,frequentmistakesanbeidentied

andeasilyorretedsuhastheabseneofinitialsituation.

However,62treespresentedmistakesthatneedspei orretions.Aord-

ing tothe ritialnature of data,these trees havetobeorreted byonology

experts,andmaysometimeshavetoberewritteninaorretmanner.Consider-

ingthenatureoferrors,somehavebeenorretedafterthisevaluationbyadding

theOptionshapepresentedinSetion3.1thatdidnotexistpreviously.Other

minor orretions were made suh asadapting ashape ora olor,drawing or

ompleting missingtransitions,et. Anexampleofomplexorretioninvolved

the presene of a direted yle. It wasdue to the meaning of the desribed

proess:amedialexamhasto bedoneseveraltimesuntiltheresultissatisfy-

ing. Until now,no OWLformalisationhas been found to express that kind of

knowledge.

7

5.2 Analysingexisting trees expressiveness

If KatoSallows to formalise most of the knowledge ontained in the trees,

an extended expressiveness is needed in a few ases. The previousexample of

forbidding direted yle revealed alimit of the KatoS language.Moreover,

deision knowledge may also depend on various fators suh as time, ompu-

tation of asore,oraomplex set of riteria.Inluding those partiularkinds

of transitionwouldmeanextendingKatoSvoabulary.Theriskwould beto

make the system more omplex and inrease the barriers to medial experts.

From a formal stand point, they refer to omplex subjetsalready takled in

the literature. Dealingwith time in OWLis madepossible by OWL-Time[4℄.

Conerningsetsofriteria,theyarepresentwhenthedeisiondependsonmany

fators,linialommonsenseorpratitionerexperiene.Insomeases,itseems

that afuzzylogiapproahwouldbehelpful.

5.3 Feedbaks from medialexperts

KatoS has already been presented to Onolor experts and has been in use

sinetheendofAugust.Medialexperts viewofdeisionisabitdierentfrom

knowledgeengineerones.Theyonsiderdeisiontreesasaompromisebetween

a logialview and agraphial representation that is lear for liniians. From

this point ofview, ambiguities are minorsproblems that most ofthe timean

be solved using domain knowledge. Cliniians have this knowledge, but it is

hard for automati systemsto get them. That is why newwork is planned in

ollaboration with Onolor experts to make expliit some parts of trees. The

diultywill beto extendtreeswhilekeepingasimplerepresentationthatan

beunderstood quiklybyphysiians.

6 Disussion and Future work

Clinialguidelinesgenerallyontaindeisionknowledgethatanberepresented

by deision trees. In this paper, the framework KatoS has been presented.

BasedonOWLandusingasimplelanguage,KatoSprovidesaollaborative

editor,easyto integratein semantiwebappliations.

KatoShasbeenpresentedto Onolorsta. Atthis point,exhangeswith

experts led us to enlarge the voabulary by adding two shapes: links and op-

tion.Moreover,reommendationshapeshavespeiolorswhih preisetheir

meaning.ThispartiularitywillbeaddedinOWLexportbydeningsublasses

of Reommendation. Transitionsan also be improved by taking into aount

temporalityandsoring.Anotherproblemisthat, insomeases,somedireted

yles representedin guidelines annotbeapartofwell-formedtrees. Inorder

tosolvethisissue,KatoShastotakemoregeneralstruturesintoaount.

KatoS is a part of a larger work about ollaborative editing of linial

guidelines.Theoverallobjetiveistoprovidetoolsthat anassistdomain spe-

in knowledge-basedsystems,thesemantiwikitehnologyis used.Itwill bring

ustoolstofailitatealignmentwithexistingbiomedialontologiesandthesaurus

suh as SNOMED [10℄. Annotating guidelines with those ontologies will bring

several benets. At rst, it will allow to deal more easily with other seman-

tiwebappliationsand exhangedata andservies.Then, pratitionersusing

SNOMED ouldhaveasignianthelp whileenodingmedialreords.

Aknowledgements. Theauthorswishtothankthereviewersfortheirhelpful

omments.

Referenes

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