Ultrasound reports standardisation using rhetorical structure theory and domain ontology

Ultrasound reporting plays an important role in diagnosis as images produced during an ultrasound examination do not give the whole view of the medical conditions. However, in practice there are many issues that are inherent to ultrasound reporting and the most important was identified to be the lack of standardisation when producing these reports. There is a resistance to change from some radiologists preferring the free writing style, making any attempt to computerise the processing of these reports difficult. This paper explores the possibility of using Rhetorical Structure Theory (RST) together with a domain ontology to transform free-form ultrasound reports into a structured form. It discusses a new approach in segmenting and identifying rhetorical relations that are more applicable to ultrasound reports from classical RST relations. The approach was evaluated on a sample ultrasound reports where the system’s parsing was compared to the manual parsing performed by experts. The results show that discourse parsing using RST in ultrasound reports can be performed effectively using the support of a domain ontology. The results also demonstrate that the transformation of free-form ultrasound reports into a structured form can be performed with the support of RST relations identified and the domain ontology

A medical ultrasound reporting system based on domain ontology

Ultrasound reports are produced in different ways by radiologists. These variations in reporting style could impact on the value of the report and the way it is interpreted, which in turn may have implications for patients’ management and decision making. As the images produced will not give the whole view of the examination, it is vital that a high quality and standardised ultrasound report is produced. In addition to their medical value, ultrasound reports contain a lot of important information that can be very useful in research and education. Reports can contain a variety of terms or heterogeneous terminologies used for describing similar findings. This research project aims to develop a medical ultrasound reporting system that uses domain ontology as its knowledge base to support the generation of standardised reports as well as Rhetorical Structure Theory (RST) to transform free text reports to the preferred structured and standardised format. The domain ontology will specifically focus on abdominal ultrasound scanning which includes both the anatomy and pathology of the organs in the abdominal area. The ontology was developed using an ontology reuse methodology where terms from the sample reports were mapped to existing biomedical ontologies. It is anticipated that a standardised report based on domain ontology will improve the quality of ultrasound reports and encourage its implementation

An architecture to support ultrasound report generation and standardisation

Ultrasound reports are developed in different ways by clinicians and radiologists. These variations in reporting style, content and format could impact on the value of the report and the way it is interpreted, which in turn have implications on patient management and decision making. There are many reasons for the poor success rate of some reporting systems which is usually down to poor adaptability and the main one being the human factor. In this paper, we present a system architecture model for a proposed medical ultrasound reporting system that attempt to address some of these problems. In this system, we propose a solution where humans will not need to adapt to the system, instead the system acknowledge the various styles, contents and format being produced by the humans and uses an ontology to standardise the terminology and Natural Language Processing techniques to transform free text reports to the preferred proposed model of a structured and standardised report

Array comparative genomic hybridisation and the newborn intensive care unit: Sociological perspectives on mainstreaming medical genetics

This thesis presents the findings of a UK-based ethnography of the mainstreaming of array comparative genomic hybridisation in the neonatal intensive care unit. Mainstreaming refers to the strategies employed to embed genetic/genomic technologies for patient benefit, incorporating genome-wide methods in everyday, mundane clinical work, beyond the specialist genetic realm. It draws on observations in the laboratory and the clinic alongside interviews with members of the extended bioclinical collective (Bourett, 2005). This constructs an ethnography of the activity of doing chromosomal microarray (Mol, 2002). I describe how three important traditions in sociological thought – namely (medical) uncertainty, processes of classification and categorisation and expertise – can be applied to the activity of mainstreaming. In the laboratory, I explore the role of standardisation and how despite calls for rigid adherence to technical rules, it is the subversion of standards – through appeals to expertise – that renders the technology workable for the messy clinical context. I continue by describing the dividing practices of the clinic, which designate infants as (potentially) genetically problematic, demonstrating how discourses between professionals and with parents serve to seek the assent of parents for chromosomal microarray testing through a highly directive process. I show how rhetorical discourse devices are using in ‘consent conversations’ as a tool in information sharing and as a means of persuasion. For the parents of infants having aCGH testing, uncertainty around decisions to test and the information genetic testing can generate are woven into personal narratives of restitution, chaos and quest (Frank,1995). I conclude by reflecting upon how the ability and means by which uncertainty is tolerated differs vastly between the laboratory, the clinic and the family and the way in which diverging practices enact ontology in medicine as bound to specific sites and situations (Mol, 2002)

Gestalt Biometrics and their Applications; Instrumentation, objectivity and poetics

This thesis is about the relationship between human bodies and instrumental technologies that can be use to measure them. It adopts the position that instruments are technological structures that evoke and manifest particular phenomena of embodied life. However, through their history of association and use in the sciences and scientific medicine, instruments tend to be attached to a particular ontology, that of mechanical objectivity. Embarking from research into the artistic uses of physiological sensor technology in creative practices such as performance and installation art, this thesis asks whether it is possible to use instruments in a way that departs from their association with scientific objectivity. Drawing on philosophers who have developed an understanding of the relationship of instrumental technologies and human bodies as co-constructive, it explores how this model of con-construction might be understood to offer an alternative ontology for understanding the use of instruments in practices outside of science and scientific medicine. The project is therefore suggestive of degrees of freedom and flexibility that are open to exploitation by creative practices in the realm of instrumentation as an alternative to orthodox rationalisations of the value of scientific equipment as authentic, revealing and objective. The major contribution of the thesis is that transfers and synthesises arguments and evidence from the history and philosophy of sciences that serve to demonstrate how the instrumental measurement of human bodies can be considered to be a form of creative practice. It assembles a position based on the work of thinkers from a number of disciplines, particularly philosophy of science, technology, and the medical humanities. These offer examples of ontological frameworks within which the difference between the realm of the instrumental, material, biological, and the objective, and the phenomenal, meaningful and subjective, might be collapsed. Doing this, the thesis sheds light on how physical devices might enter into the interplay of making, mattering and objectifying the immaterial, a realm that it might be considered the role of artists to manifest. Drawing on contemporary, and secondary, accounts of the development of empirical testing in the medical sciences, the thesis agues for the recovery of a romantic account of human physiology, in which the imagination and meaning are active and embodied. It therefore offers to link the bodily and the instrumental through an extended-materialist account in which the physiological, rather than the psychological, is central. Developing a response to constructionist models of the body and instrumentation, the thesis concludes that a model of the poetic may be adopted as a method for understanding the opportunities and imperatives inherent in the avoidance of deterministic approaches to biosignalling technologies. In doing this, the thesis contributes particularly to the creative arts and technology research practices concerned with the use of body sensor technologies in humanistic applications. It complements the existing works by artists in this area that make use of instruments by assembling a number of theoretical readings and interpretations of how instruments work – among them the thermometer, lie detector, and automatograph – which illustrate the argument that that is possible to operate from a theoretical position within which instruments are both material, performative and symbolic.Engineering and Physical Sciences Research Counci

Making Research Translatable: Articulating and Shaping Synthetic Biology in the UK

Synthetic biology, an engineering approach to genetic modification, has emerged at a time when academics are increasingly expected to translate research to other domains of society. Proponents of synthetic biology often deploy promissory rhetoric to create expectations of major improvements in medicine, energy and food production. How else are actors in the field of synthetic biology addressing these translational expectations? This thesis takes synthetic biology in the UK as an empirical site to explore the various ways in which research translation involves multiple rhetorical, organisational and material transformations. In this project I developed a conceptual framework using post-Actor Network Theory, post-social theory and other STS concepts. I generated data by employing qualitative research methods including observations, interviews and by collecting documentation from various institutions. I visited field sites such as academic science laboratories, academic events and administrative offices. Participants included scientific researchers, research administrators, industry representatives and policymakers. I transcribed the interview data, typed up field notes and iteratively coded the texts and documents to generate themes. From my analysis I identified a variety of strategies and practices that appear to make synthetic biology translatable. These included: articulating synthetic biology research with absences in other areas of society (e.g. state economic and industrial deficits, problems with private-public collaborations) and imagining a future industry; demarcating synthetic biology research from other programmes such as genetically modified organisms; realising rhetorical promises in the everyday organisation, research training and material work of synthetic biology practices. My research indicates that translation in synthetic biology involves multiple groups orientating research facilities and researcher training, particularly towards industrial manufacturing. I go on to theorise synthetic biology as an unfolding multiple. Actors expand synthetic biology and in the process they entangle the state, institutions, laboratories, cells and molecules. To achieve this, actors mobilise vulnerabilities that others have identified in science, state and society to create a central heroic object of synthetic biology. These conclusions offer a conceptual framework to further investigate and interpret contemporary technoscience and its connections in society

Lean in Healthcare: An Evaluation of Lean Implementation in NHS Lothian

The overarching aim of this thesis is to critically evaluate the implementation of Lean in NHS Lothian, a National Health Service (NHS) Health Board in Scotland. Against challenging financial times, Lean has been endorsed for adoption in the provision of healthcare by The Scottish Government and NHS Scotland and so the objectives are to understand how Lean is implemented in healthcare, the impact on the organisation and what role(s) are held by front-line staff including medical staff, in this implementation. This is an exploratory and descriptive interpretivist case study incorporating content analysis, observational and interview data which is based on a qualitative and inductive approach. The interpretative and inductive nature of the research is used to identify emergent themes and to afford greater insight into the implementation process, outcomes and the role of healthcare staff. The sociology of professions is used to evaluate the role of the medical professional within Lean from the emergent data, with the focus being on behaviours expected and demonstrated in Lean implementations. The findings provide a mapping of the process for implementing Lean. It is also demonstrated that although medical professionals are expected to hold a crucial role in Lean implementations, their identity as a professional with corresponding power and autonomy provides challenges for implementing Lean in hierarchical areas such as healthcare. This professional identity also impacts on project initiation and sustainability as other stakeholders recognise hierarchical constraints. However, evidence grounded in the data illustrates that Lean breaks down hierarchies and has resulted in improved working in services. The implementation of Lean has been programmatic in line with best-practice case examples and has been driven by strategy and target pressures faced by services.This research provides a contribution to knowledge in three key areas: firstly through mapping the approach to Lean implementation which is a contribution to Programme Theory. Secondly medical professionals are explored through the lens of professionalism which has received limited attention to date within Lean; and finally a set of propositions are generated as a framework for Lean implementation in healthcare

Bodies of Seeing: A video ethnography of academic x-ray image interpretation training and professional vision in undergraduate radiology and radiography education

This thesis reports on a UK-based video ethnography of academic x-ray image interpretation training across two undergraduate courses in radiology and radiography. By studying the teaching and learning practices of the classroom, I initially explore the professional vision of x-ray image interpretation and how its relation to normal radiographic anatomy founds the practice of being ‘critical’. This criticality accomplishes a faculty of perceptual norms that is coded and organised and also, therefore, of a specific radiological vision. Professionals’ commitment to the cognitivist rhetoric of ‘looking at’/‘pattern recognition’ builds this critical perception, a perception that deepens in organisation when professionals endorse a ‘systematic approach’ that mediates matter-of-fact thoroughness and offers a helpful critical commentary towards the image. In what follows, I explore how x-ray image interpretation is constituted in case presentations. During training, x-ray images are treated with suspicion and as misleading and are aligned with a commitment to discursive contexts of ‘missed abnormality’, ‘interpretive risk’, and ‘technical error’. The image is subsequently constructed as ambiguous and that what is shown cannot be taken at face value. This interconnects with reenacting ideals around ‘seeing clearly’ that are explained through the teaching practices and material world of the academic setting and how, if misinterpretation is established, the ambiguity of the image is reduced by embodied gestures and technoscientific knowledge. By making this correction, the ambiguous image is reenacted and the misinterpretation of image content is explained. To conclude, I highlight how the professional vision of academic x-ray image interpretation prepares students for the workplace, shapes the classificatory interpretation of ab(normal) anatomy, manages ambiguity through embodied expectations and bodily norms, and cultivates body-machine relations