Towards ontology-based decision support systems for complex ultrasound diagnosis in obstetrics and gynecology
Abstract
Introduction We have developed a new knowledge base intelligent system for obstetrics and gynecology ultrasound imaging, based on an ontology and a reference image collection. This study evaluates the new system to support accurate annotations of ultrasound images. We have used the early ultrasound diagnosis of ectopic pregnancies as a model clinical issue.Material and methods The ectopic pregnancy ontology was derived from medical texts (4260 ultrasound reports of ectopic pregnancy from a specialist center in the UK and 2795 Pubmed abstracts indexed with the MeSH term "Pregnancy, Ectopic") and the reference image collection was built on a selection from 106 publications. We conducted a retrospective analysis of the signs in 35 scans of ectopic pregnancy by six observers using the new system.Results The resulting ectopic pregnancy ontology consisted of 1395 terms, and 80 images were collected for the reference collection. The observers used the knowledge base intelligent system to provide a total of 1486 sign annotations. The precision, recall and F-measure for the annotations were 0.83, 0.62 and 0.71, respectively. The global proportion of agreement was 40.35% 95% CI [38.64-42.05].Discussion The ontology-based intelligent system provides accurate annotations of ultrasound images and suggests that it may benefit non-expert operators. The precision rate is appropriate for accurate input of a computer-based clinical decision support and could be used to support medical imaging diagnosis of complex conditions in obstetrics and gynecology.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In high-risk patients with ectopic pregnancies, reduced timing of diagnosis may result in an improved outcome.
“in high-risk patients with ectopic pregnancies, reduced timing of diagnosis may result in an improved outcome [224].”
A knowledge base for US image annotations as a clinical decision support system based on this ontology significantly improved the timing of diagnosis.
“the research groups Maurice et al. and Dhombres et al. showed that a knowledge base for US image annotations as a clinical decision support system based on this ontology significantly improved the timing of diagnosis [224,225].”
Cites
A translation approach to portable ontology specifications
Gruber, T. (1993) · Knowledge Acquisition · doi:10.1006/knac.1993.1008 · Cited by 13,568 · see citing works
Ontologies: principles, methods and applications
Uschold, M., & Grüninger, M. (1996) · The Knowledge Engineering Review · doi:10.1017/s0269888900007797 · Cited by 3,544 · see citing works
Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008
Cantwell, R., Clutton-Brock, T. H., COOPER, G. M., Dawson, A. H., Drife, J., Garrod, D., Harper, A., Hulbert, D., Lucas, S. B., McClure, J. H., et al. (2011) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02847.x · Cited by 3,024 · see citing works
Hunt, D. L., Haynes, R. B., Hanna, S., & Smith, K. (1998) · JAMA · doi:10.1001/jama.280.15.1339 · Cited by 1,684 · see citing works
A reference ontology for biomedical informatics: the Foundational Model of Anatomy
Rosse, C., & Mejino, J. L. (2003) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2003.11.007 · Cited by 1,167 · see citing works
Agreement, the F-Measure, and Reliability in Information Retrieval
Hripcsak, G. M. (2005) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1733 · Cited by 949 · see citing works
Clinical Diagnostics in Human Genetics with Semantic Similarity Searches in Ontologies
Köhler, S., Schulz, M. H., Krawitz, P., Bauer, S., Dölken, S., Ott, C. E., Mundlos, C., Horn, D., Mundlos, S., & Robinson, P. N. (2009) · The American Journal of Human Genetics · doi:10.1016/j.ajhg.2009.09.003 · Cited by 590 · see citing works
Barnhart, K. T. (2009) · New England Journal of Medicine · doi:10.1056/nejmcp0810384 · Cited by 512 · see citing works
Development of a Nomogram for Prediction of Vaginal Birth After Cesarean Delivery
Grobman, W. A., Lai, Y., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., et al. (2007) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000259312.36053.02 · Cited by 498 · see citing works
Shortliffe, E. H., Davis, R., Axline, S. G., Buchanan, B. G., Green, C. C., & Cohen, S. N. (1975) · Computers and Biomedical Research · doi:10.1016/0010-4809(75)90009-9 · Cited by 493 · see citing works
Ontologies: How can They be Built?
Pinto, H. S., & Martins, J. P. (2004) · Knowledge and Information Systems · doi:10.1007/s10115-003-0138-1 · Cited by 380 · see citing works
Computer Programs to Support Clinical Decision Making
Shortliffe, E. H. (1987) · JAMA · doi:10.1001/jama.1987.03400010065029 · Cited by 320 · see citing works
MARION, L. L., & Meeks, G. R. (2012) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0b013e3182516d7b · Cited by 264 · see citing works
Creating and Curating a Terminology for Radiology: Ontology Modeling and Analysis
Rubin, D. L. (2007) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-007-9073-0 · Cited by 154 · see citing works
Diagnosis and management of ectopic pregnancy
Jurkovic, D., & Wilkinson, H. (2011) · BMJ · doi:10.1136/bmj.d3397 · Cited by 140 · see citing works
Self-citationCatch me if you scan: ultrasound diagnosis of ectopic pregnancy
Jurkovic, D., & Mavrelos, D. (2007) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.4077 · Cited by 128 · see citing works
Self-citationThe fetal heart rate trace is normal, isn't it?
Grant, J. M. F. (1991) · The Lancet · doi:10.1016/0140-6736(91)92169-3 · Cited by 128 · see citing works
Stein, J. C., Wang, R. C., Adler, N. E., Boscardin, W. J., Jacoby, V. L., Won, G. Y., Goldstein, R. B., & Kohn, M. A. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.06.563 · Cited by 120 · see citing works
Evaluation of research in biomedical ontologies
Hoehndorf, R., Dumontier, M., & Gkoutos, G. V. (2012) · Briefings in Bioinformatics · doi:10.1093/bib/bbs053 · Cited by 79 · see citing works
A nomogram for predicting lymph node metastasis of presumed stage I and II endometrial cancer
Bendifallah, S., Genin, A. S., Naoura, I., Chabbert‐Buffet, N., Clavel‐Chapelon, F., Haddad, B., Luton, D., Daraï, É., Rouzier, R., & Koskas, M. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.06.080 · Cited by 73 · see citing works
Richardson, A., Gallos, I. D., Dobson, S., Campbell, B. K., Coomarasamy, A., & Raine‐Fenning, N. (2015) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.14844 · Cited by 66 · see citing works
Economic evaluation of diagnosing and excluding ectopic pregnancy
Wedderburn, C. J., Warner, P., Graham, B. E., Duncan, W. C., Critchley, H., & Horne, A. W. (2009) · Human Reproduction · doi:10.1093/humrep/dep397 · Cited by 51 · see citing works
Towards quantitative measures in applied ontologyPreprint
Hoehndorf, R., Dumontier, M., & Gkoutos, G. V. (2012) · arXiv (Cornell University) · doi:10.48550/arxiv.1202.3602 · Cited by 49 · see citing works
Ultrasound imaging in the management of bleeding and pain in early pregnancy
Knez, J., Day, A., & Jurkovic, D. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2014.04.003 · Cited by 38 · see citing works
Self-citationBiomedical imaging ontologies: A survey and proposal for future work
Smith, B., Arabandi, S., Brochhausen, M., Calhoun, M., Ciccarese, P., Doyle, S. T., Bernard Gibaud, A., Goldberg, I., Kahn, C. E., Overton, J. A., et al. (2015) · Journal of Pathology Informatics · doi:10.4103/2153-3539.159214 · Cited by 36 · see citing works
Informatics in Radiology: Radiology Gamuts Ontology: Differential Diagnosis for the Semantic Web
Budovec, J. J., Lam, C. A., & Kahn, C. E. (2013) · Radiographics · doi:10.1148/rg.341135036 · Cited by 36 · see citing works
Kaushal, R., Shojania, K. G., & Bates, D. W. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.12.1409 · Cited by 30 · see citing works
Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents
Kim, D., Theoret, J., Liao, M. M., & Kendall, J. L. (2014) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2013.9.18025 · Cited by 26 · see citing works
The development and implementation of an expert system for the analysis of umbilical cord blood
Garibaldi, J. M., Westgate, J., Ifeachor, E., & Greene, K. R. (1997) · Artificial Intelligence in Medicine · doi:10.1016/s0933-3657(97)00390-4 · Cited by 25 · see citing works
Preliminary evaluation of an intelligent system for the management of labour.
Keith, R. D. F., Westgate, J., Hughes, G. W., Ifeachor, E., & Greene, K. R. (1994) · PubMed · Cited by 14 · see citing works
Developing a knowledge base to support the annotation of ultrasound images of ectopic pregnancy
Dhombres, F., Maurice, P., Friszer, S., Guilbaud, L., Lelong, N., Khoshnood, B., Charlet, J., Perrot, N., Jauniaux, E., Jurkovic, D., et al. (2017) · Journal of Biomedical Semantics · doi:10.1186/s13326-017-0117-1 · Cited by 14 · see citing works
Self-citationAdvancing data reuse in phyloinformatics using an ontology-driven Semantic Web approach
Panahiazar, M., Sheth, A., Ranabahu, A., Vos, R. A., & Leebens‐Mack, J. (2013) · BMC Medical Genomics · doi:10.1186/1755-8794-6-s3-s5 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Dhombres, F., Bonnard, J., Bailly, K., Maurice, P., Papageorghiou, A. T., & Jouannic, J.-M. (2022) · Journal of Medical Internet Research · doi:10.2196/35465 · Cited by 93 · see citing works
Self-citationThe Infectious Disease Ontology in the age of COVID-19
Babcock, S., Beverley, J. R., Cowell, L. G., & Smith, B. (2021) · Journal of Biomedical Semantics · doi:10.1186/s13326-021-00245-1 · Cited by 67 · see citing works
A Census of Disease Ontologies
Haendel, M. A., McMurry, J. A., Relevo, R., Mungall, C. J., Robinson, P. N., & Chute, C. G. (2018) · Annual Review of Biomedical Data Science · doi:10.1146/annurev-biodatasci-080917-013459 · Cited by 49 · see citing works
Lin, X., Liang, C., Liu, J., Lyu, T., Ghumman, N., & Campbell, B. A. (2024) · Journal of Medical Internet Research · doi:10.2196/54737 · Cited by 49 · see citing works
Jost, E., Kosian, P., Jimenez Cruz, J., Albarqouni, S., Gembruch, U., Strizek, B., & Recker, F. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12216833 · Cited by 44 · see citing works
“In total, 11 articles were summarized in this section, including the topics of endometriosis [216,217], premature ovarian failure [218,219], uterine fibroids [220,221], follicle tracking [222,223], and ectopic pregnancies [224,225].”
BackgroundHolmes, J. H. (2023) · Springer eBooks · doi:10.1007/978-3-031-36678-9_14 · Cited by 42 · see citing works
Behzadpour, N., Ranjbar, A., Azarpira, N., & Sattarahmady, N. (2020) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2020.05.003 · Cited by 37 · see citing works
Obstetric ultrasound: where are we and where are we going?
Abramowicz, J. S. (2020) · ULTRASONOGRAPHY · doi:10.14366/usg.20088 · Cited by 37 · see citing works
Diagnosis and Analysis of Transabdominal and Intracavitary Ultrasound in Gynecological Acute Abdomen
Yang, H., Wang, R., Zhao, L., Ye, J., Li, N., & Kong, L. (2021) · Computational and Mathematical Methods in Medicine · doi:10.1155/2021/9508838 · Cited by 23 · see citing works
RetractedDhombres, F., Maurice, P., Guilbaud, L., Franchinard, L., Dias, B., Charlet, J., Blondiaux, É., Khoshnood, B., Jurkovic, D., Jauniaux, E. R. M., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/14286 · Cited by 18 · see citing works
Self-citationDrivers for the development of an Animal Health Surveillance Ontology (AHSO)
Dórea, F. C., Vial, F., Hammar, K., Lindberg, A., Lambrix, P., Blomqvist, E., & Revie, C. W. (2019) · Preventive Veterinary Medicine · doi:10.1016/j.prevetmed.2019.03.002 · Cited by 16 · see citing works
Ontologies, Machine Learning and Deep Learning in Obstetrics
Malgieri, L. E. (2023) · Springer eBooks · doi:10.1007/978-3-031-10067-3_3 · Cited by 8 · see citing works
Sadeghi‐Ghyassi, F., Damanabi, S., Kalankesh, L. R., de Velde, S. V., Feizi‐Derakhshi, M., & Hajebrahimi, S. (2022) · Systematic Reviews · doi:10.1186/s13643-022-02063-7 · Cited by 8 · see citing works
Reverse engineering approach for improving the quality of mobile applications
Elsayed, E. K., ElDahshan, K. A., El-Sharawy, E. E., & Ghannam, N. E. (2019) · PeerJ Computer Science · doi:10.7717/peerj-cs.212 · Cited by 7 · see citing works
Conventional and modern markers of pregnancy of unknown location: Update and narrative review
Hou, L., Liang, X., Zeng, L., Wang, Q., & Chen, Z. (2024) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.15807 · Cited by 5 · see citing works
Data Tagging in Medical Images: A Survey of the State-of-Art
Chaki, J., & Dey, N. (2020) · Current Medical Imaging Formerly Current Medical Imaging Reviews · doi:10.2174/1573405616666200218130043 · Cited by 5 · see citing works
Ali, M., Elhabeeb, S. M. A., Elsheikh, N. E. A., Mohammed, F. S. A., Ali, S. H. M., Abdelhalim, A. A. I., & Altom, D. S. (2025) · Cureus · doi:10.7759/cureus.80514 · Cited by 5 · see citing works
Metric Method for Long Life Semantic Applications
Elsayed, E. K., & Ghannam, N. E. (2019) · International journal of intelligent engineering and systems · doi:10.22266/ijies2019.1231.03 · Cited by 4 · see citing works
Ontology in Medicine as a Database Management System
Shobowale, K. O. (2020) · doi:10.1002/9781119641391.ch4 · Cited by 4 · see citing works
Ontology of clinical practice guidelines for Integrated Traditional Chinese and Western Medicine
Wang, Y., Ren, X., Gao, K., Chen, M., Huang, Q. Y., Yan, S., Zhu, Y., Sun, X., Chen, Y., Ge, L., et al. (2024) · Journal of Evidence-Based Medicine · doi:10.1111/jebm.12639 · Cited by 3 · see citing works
Building a Biomedical Ontology for Respiratory Tract Infection
Arif, K. S., Qamar, U., Wahab, K., & Riaz, M. Q. (2019) · International Conference on Computer and Communications Management (ICCCM) · doi:10.1145/3348445.3348461 · Cited by 1 · see citing works
Collecting specialty-related medical terms: Development and evaluation of a resource for Spanish
Úbeda, P. L., Pomares, A., Díaz–Galiano, M. C., & Schulz, S. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01495-w · Cited by 1 · see citing works
Feng, J., Zhang, R., Chen, D., & Shi, L. (2023) · Biomimetics · doi:10.3390/biomimetics8080560
A Reference Ontology for Putting Together Pregnancy and Mental HealthPreprint
Teixeira, M. D. G. D. S., Meireles, L., Cândido, C. P., Prado, K. D. S., Hisatugu, W. H., Garcia, A. S., Dias, R. D. S., Sousa, R. T., Mota, A. S., Galletta, M. A. K., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-4541012/v1
Sadeghi‐Ghyassi, F., Damanabi, S., Kalankesh, L. R., Van de Velde, S., Feizi-Derakhshi, M.-R., & Hajebrahimi, S. (2022) · Figshare · doi:10.6084/m9.figshare.20745405
Sadeghi‐Ghyassi, F., Damanabi, S., Kalankesh, L. R., Van de Velde, S., Feizi-Derakhshi, M.-R., & Hajebrahimi, S. (2022) · Figshare · doi:10.6084/m9.figshare.20745408
An Assisted Medical Diagnosis Question Answering System Based on Knowledge Graphs
Fang, L., Yang, C., & Jiansong, C. (2025) · International Conference on Pattern Recognition and Artificial Intelligence (PRAI) · doi:10.1109/prai67447.2025.11412494
Burek, P., Frank Loebe, A., Schäfermeier, R., Scherf, N., Uciteli, A., Kondracki, B., & Heinrich Herre, B. (2026) · Applied Ontology · doi:10.1177/15705838251389367
Koubanani, Z. G., & Ali, M. (2026) · Fetal and Pediatric Pathology · doi:10.1080/15513815.2026.2713544
- Authors
- Maurice, P., Dhombres, F., Blondiaux, E., Friszer, S., Guilbaud, L., Lelong, N., Khoshnood, B., Charlet, J., Perrot, N., Jauniaux, E., Jurkovic, D., & Jouannic, J.-M.
- Affiliations
- Inserm (FR)
- University College Hospital (GB)
- Corresponding author
- Dhombres, F.
- ORCID
- Venue
- Journal of Gynecology Obstetrics and Human Reproduction
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 46
- Issue
- 5
- Pages
- 423-429
- ISSN
- 2468-7847 (ISSN-L)
- OpenAlex
- W2601604902
- Cited by
- 33
- References
- 32
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 9 · 2018: 1
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gynecology Obstetrics and Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Biomedical Text Mining and Ontologies
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- ectopic pregnancy, obstetric and gynecologic ultrasound, computer-aided diagnosis
- MeSH terms
- Diagnosis, Differential, Expert Systems, Female, Gynecology, Humans, Image Interpretation, Computer-Assisted, Obstetrics, Pregnancy, Pregnancy, Ectopic, Ultrasonography, Ultrasonography, Prenatal, Decision Support Systems, Clinical, Internet, Knowledge Bases, Biological Ontologies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
