MYCIN

Case Study: MYCIN
INTRODUCTION
MYCIN was an early expert system developed over five or six years in the early
1970s at Stanford University. It was written in Lisp as the doctoral dissertation of
Edward Shortliffe under the direction of Bruce Buchanan, Stanley N. Cohen and
others. This expert system was designed to diagnose and recommend treatment for
certain blood infections. It was also used to identify bacteria causing severe
infections, such as bacteremia and meningitis, and to recommend antibiotics, with
the dosage adjusted for patient's body weight — the name derived from the
antibiotics themselves, as many antibiotics have the suffix "-mycin".
To do the diagnosis “properly” involves growing cultures of the infecting organism.

Unfortunately this takes around 48 hours, and if doctors waited until this was
complete their patient might be dead! So, doctors have to come up with quick
guesses about likely problems from the available data, and use these guesses to
provide a “covering” treatment where drugs are given which should deal with any
possible problem.
PRACTICAL USE
MYCIN was never actually used in practice. This wasn't because of any weakness in
its performance. As mentioned, in tests it outperformed members of the Stanford
medical school faculty. Some observers raised ethical and legal issues related to the
use of computers in medicine — if a program gives the wrong diagnosis or
recommends the wrong therapy, who should be held responsible? However, the
greatest problem, and the reason that MYCIN was not used in routine practice, was
the state of technologies for system integration, especially at the time it was
developed. MYCIN was a stand-alone system that required a user to enter all
relevant information about a patient by typing in response to questions that MYCIN
would pose. The program ran on a large time-shared system, available over the
early Internet, before personal computers were developed. In the modern era, such
a system would be integrated with medical record systems, would extract answers
to questions from patient databases, and would be much less dependent on
physician entry of information. In the 1970s, a session with MYCIN could easily
consume 30 minutes or more—an unrealistic time commitment for a busy clinician.
Mycin represented its knowledge as a set of IF-THEN rules with certainty factors.
The following is an English version of one of Mycin's rules:
IF the infection is pimary-bacteremia

AND the site of the culture is one of the sterile sites
AND the suspected portal of entry is the gastrointestinal tract
THEN there is suggestive evidence (0.7) that infection is bacteroid.
The 0.7 is roughly the certainty that the conclusion will be true given the evidence.
If the evidence is uncertain the certainties of the bits of evidence will be combined
with the certainty of the rule to give the certainty of the conclusion.
Mycin was written in Lisp, and its rules are formally represented as Lisp
expressions. The action part of the rule could just be a conclusion about the
problem being solved, or it could be an arbitrary lisp expression. This allowed great
flexibility, but removed some of the modularity and clarity of rule-based systems, so
using the facility had to be used with care.
CASE STUDY:
Patient's name: SYLVIA_FISHER
Sex: FEMALE
Age: 27
------- culture-1 -------
From what site was specimen CULTURE-1 taken?

BLOOD
How many days ago was this culture (CULTURE-1) obtained?

3
------- organism-1 -------
Enter the identity (genus) of ORGANISM-1?

UNKNOWN
The gram strain of ORGANISM-1?
NEG
Is ORGANISM-1 a rod or coccus?

ROD
Is PATIENT-1 a burn patient? If so, mild or serious?

WHY
[Why is the value of burn being asked for?]
It is known that:
The site of the culture is blood
The gram of the organism is neg
The morphology of the organism is rod
Therefore,
Rule 52:
If The burn of the patient is serious
Then with certainty of 0.4
The identity of the organism is pseudomonas
Is PATIENT-1 a burn patient? If so, mild or serious?

SERIOUS
What is the aerobicity of ORGANISM-1?

AEROBIC
Is PATIENT-1 a compromised host?

YES
Findings for ORGANISM-1

for these goals: identity
IDENTITY: ENTERO 0.8, PSEUDOMONAS 0.76
Is there another organism?

YES
------- organism-2 -------
Enter the identity (genus) of ORGANISM-2?

UNKNOWN
The gram strain of ORGANISM-2?
NEG 0.8 POS 0.2
Is ORGANISM-2 a rod or coccus?

ROD
What is the aerobicity of ORGANISM-2?

ANAEROBIC
Findings for ORGANISM-2

for these goals: identity
IDENTITY: BACTEROIDES 0.72, PSEUDOMONAS 0.6464
Is there another organism?

NO
Is there another culture?

NO
Is there another patient?

NO

MYCIN

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Case Study: MYCIN

To do the diagnosis “properly” involves growing cultures of the infecting organism.

IF the infection is pimary-bacteremia

Patient's name: SYLVIA_FISHER

------- culture-1 -------

From what site was specimen CULTURE-1 taken?

How many days ago was this culture (CULTURE-1) obtained?

------- organism-1 -------

Enter the identity (genus) of ORGANISM-1?

Is ORGANISM-1 a rod or coccus?

Is PATIENT-1 a burn patient? If so, mild or serious?

Is PATIENT-1 a burn patient? If so, mild or serious?

What is the aerobicity of ORGANISM-1?

Is PATIENT-1 a compromised host?

Findings for ORGANISM-1

Is there another organism?

------- organism-2 -------

Enter the identity (genus) of ORGANISM-2?

Is ORGANISM-2 a rod or coccus?

What is the aerobicity of ORGANISM-2?

Findings for ORGANISM-2

Is there another organism?

Is there another culture?

Is there another patient?

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