A Decision Tree-Initialised Neuro-fuzzy Approach for Clinical Decision Support

• Published in: Artificial intelligence in medicine 2021-01, Vol.111, p.101986-101986, Article 101986
• Main Authors: Chen, Tianhua, Shang, Changjing, Su, Pan, Keravnou-Papailiou, Elpida, Zhao, Yitian, Antoniou, Grigoris, Shen, Qiang
• Format: Article
• Language: English
• Subjects: Clinical decision support; Fuzzy rule-based systems; Medical diagnostic systems
• ISSN: 0933-3657; 1873-2860
• DOI: 10.1016/j.artmed.2020.101986

•A practical case study on diabetes is conducted, illustrating how the overall diagnosis may be achieved and validated in a step-by-step manner.•A decision tree-initialised neuro-fuzzy system is proposed, which tolerates uncertainties embedded in medical entities and facilitates approximate reasoning, supporting linguistic delivery of medical expertise.•Experimental studies on popular medical benchmarks are reported, demonstrating statistically better or comparable performance to state-of-the-art fuzzy classifiers, with compact rule bases generated involving simple antecedents. Apart from the need for superior accuracy, healthcare applications of intelligent systems also demand the deployment of interpretable machine learning models which allow clinicians to interrogate and validate extracted medical knowledge. Fuzzy rule-based models are generally considered interpretable that are able to reflect the associations between medical conditions and associated symptoms, through the use of linguistic if-then statements. Systems built on top of fuzzy sets are of particular appealing to medical applications since they enable the tolerance of vague and imprecise concepts that are often embedded in medical entities such as symptom description and test results. They facilitate an approximate reasoning framework which mimics human reasoning and supports the linguistic delivery of medical expertise often expressed in statements such as ‘weight low’ or ‘glucose level high’ while describing symptoms. This paper proposes an approach by performing data-driven learning of accurate and interpretable fuzzy rule bases for clinical decision support. The approach starts with the generation of a crisp rule base through a decision tree learning mechanism, capable of capturing simple rule structures. The crisp rule base is then transformed into a fuzzy rule base, which forms the input to the framework of adaptive network-based fuzzy inference system (ANFIS), thereby further optimising the parameters of both rule antecedents and consequents. Experimental studies on popular medical data benchmarks demonstrate that the proposed work is able to learn compact rule bases involving simple rule antecedents, with statistically better or comparable performance to those achieved by state-of-the-art fuzzy classifiers.