A comparative study of teledermatoscopy and face-to-face examination of pigmented skin lesions.

We examined the agreement between diagnoses of pigmented skin lesions based on an in-person (face-to-face) dermatological examination and diagnoses based on the study of medical records and images transferred through the web (teledermatoscopy). Two experienced dermatologists examined and diagnosed 64 pigmented skin lesions, which had been surgically excised and undergone histopathology examination. Two years later, the same cases were studied and diagnosed once again by the same dermatologists via the web. There was 72% agreement between the in-person diagnoses and the biopsy results (the gold standard), and 66% agreement between the telediagnoses and the biopsy results. Telemedicine had high sensitivity (87%) and specificity (73%), although there were 4 false-negative diagnoses. A web-based dermatoscopic diagnostic service appears to be feasible and would meet the needs for access to specialized services in rural areas. However, further work is required to decrease the number of false negative cases.

Associating semantic grammars with the SNOMED: processing medical language and representing clinical facts into a language-independent frame.

We describe one approach for natural language processing of medical texts that associates a semantic grammar with the SNOMED (Systematized Nomenclature of Medicine). Our research hypothesis is that the combination of the nomenclature's declarative knowledge with a formal grammar would create a scientific sublanguage embedded with medical knowledge that could be used for analyzing and formatting medical texts. This combination permitted the abstraction of templates we call "semantic patterns." These patterns represent both linguistic and medical knowledge, packed into a hybrid information format. We analyzed manually case reports described in the New England Journal of Medicine (NEJM) from 1985 to 1988 and extracted empirically a semantic grammar. Over 2,000 sentences were analyzed. About 160 structural semantic patterns were abstracted and included in the database of one parser. We tested the parser using reports from 1989 to 1990. Results show that this approach is efficient for processing, indexing, and structuring diverse parts of case reports narrative. The analyzed medical sentences are structured into a language-independent semantic frame format. We conclude that the association of semantic grammars with the SNOMED enabled the construction of a formal system for analysis and representation of clinical facts. The transformation of the structured information from its frame format into other representational schemes, like conceptual graphs, is straightforward. Another application includes the use of the formatted language-independent frame for telegraphic English-Japanese translations of medical sentences.