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<article xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Comparing SNOMED CT and the NCI Thesaurus through Semantic Web Technologies</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Bethesda</string-name>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Maryland</string-name>
        </contrib>
        <contrib contrib-type="author">
          <string-name>USA olivier@nlm.nih.gov</string-name>
        </contrib>
      </contrib-group>
      <pub-date>
        <year>2008</year>
      </pub-date>
      <fpage>37</fpage>
      <lpage>43</lpage>
      <abstract>
        <p>Objective: The objective of this study is to compare two large biomedical terminologies, SNOMED CT and the National Cancer Institute (NCI) Thesaurus, through Semantic Web technologies. Methods: The two terminologies are converted into the Resource Description Framework (RDF) and loaded into a common triple store. The Unified Medical Language System (UMLS) is used to identify correspondences between concepts across terminologies. Concepts common to both terminologies are compared based on shared relations to other concepts. Results: A total of 20,369 pairs of equivalent SNOMED CT and NCI Thesaurus concepts were identified through the UMLS. The highest proportion of shared relata is for the superclasses traversed recursively (75% of the concepts share at least one superclass). Slightly more than half of the concepts studied share at least one associative relation (direct relation or inherited from some ancestor). Conclusions: Overall, SNOMED CT and NCI Thesaurus concepts exhibit a relatively small proportion of shared relata. Semantic Web technologies, including RDF and triple stores, are suitable for comparing large biomedical ontologies, at least from a quantitative perspective.</p>
      </abstract>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>INTRODUCTION</title>
      <p>In the era of translational medicine, i.e., the
application of the discoveries of basic research (made at the
bench) to clinical medicine (the patient’s bedside)
and the refinement of research hypotheses based on
clinical findings, basic researchers and healthcare
practitioners need to exchange information back and
forth. In order to be processed efficiently, both
research data and clinical data must be annotated to
some reference terminology or ontology. Although
some research ontologies and clinical ontologies have
a significant degree of overlap, there has typically
been little coordination between the groups
developing them. As a consequence, the definitions – textual
or formal – provided in research ontologies and
clinical ontologies for the same biomedical entity may
vary significantly, which constitutes a hindrance to
the effective integration of data from basic research
and clinical practice.</p>
      <p>The evaluation of biomedical terminologies for
completeness and accuracy remains largely an open
research question. In this paper, we propose to compare
two large biomedical ontologies developed for
different purposes: the NCI Thesaurus (NCIt), used for the
annotation of cancer research data, and SNOMED
CT, the largest clinical terminology used in electronic
patient records. We take advantage of the fact that
both ontologies were developed using Description
Logic-based systems. Although most classes are not
defined with a set of necessary and sufficient
conditions, the set of relations in which a given concept is
involved still provides a formal definition for this
concept, which can be used to compare it to other
concepts. We also take advantage of the fact that both
ontologies are represented in the Unified Medical
Language System (UMLS), which asserts the
equivalence between concepts across biomedical ontologies.
Finally, we exploit Semantic Web technologies, such
as the Resource Description Framework (RDF) to
carry out the comparison between these two
ontologies.</p>
      <p>The objective of this study is to compare the formal
definitions of SNOMED CT and NCIt concepts,
using Semantic Web technologies. The assumption
underlying this study is that two concepts, one from
SNOMED CT and one from NCIt, when identified as
equivalent in the UMLS, should have similar formal
definitions. In other words, our hypothesis is that
equivalent concepts from SNOMED CT and NCIt
should have related concepts that are also equivalent.
To our knowledge, this is the first study to compare
biomedical ontologies on a large scale using RDF.</p>
    </sec>
    <sec id="sec-2">
      <title>BACKGROUND</title>
      <p>The general framework of this study is that of quality
assurance in biomedical terminologies and
ontologies, which is known to be is a difficult task [1].
Several approaches to auditing terminologies have been
proposed, including semantic methods [2], structural
methods [3] and linguistic and formal ontological
approaches [4]. Methods based on description logics
have also been proposed, but have generally been
restricted to subsets of large medical ontologies [5].
Various methods have been applied to SNOMED CT
[3, 4] and to the NCIt [6]. In contrast to these
approaches, we propose to evaluate SNOMED CT and
the NCIt simultaneously and against each other. In
other words, we want to cross-validate the definitions
or assertions provided in one ontology for a given
entity with the definitions or assertions provided in
the other ontology for the same entity.</p>
      <p>The Semantic Web provides a common framework
that enables the integration, sharing and reuse of data
from multiple sources. Recent research in Semantic
Web technologies has delivered promising results to
enable information integration across heterogeneous
knowledge sources, particularly in the biomedical
domain [7]. Semantic Web technologies are a
collection of formalisms, languages and tools created to
support the Semantic Web. Among them, the
Resource Description Framework (RDF) is a
W3Crecommended framework for representing data in a
common format that captures the logical structure of
the data [8]. The RDF representational model uses a
single schema in contrast to multiple heterogeneous
schemas or Data Type Definitions (DTD) used to
represent data in XML by different sources. In
conjunction with a single Uniform Resource Identifier
(URI), all data represented in RDF form a single
knowledge repository that may be queried as one
knowledge resource. An RDF repository consists of a
set of assertions or triples. Each triple comprises three
entities namely, subject, predicate and object. A
collection of triples forms a graph and can be stored in a
specialized database called a triple store.</p>
    </sec>
    <sec id="sec-3">
      <title>MATERIALS</title>
    </sec>
    <sec id="sec-4">
      <title>SNOMED CT</title>
      <p>SNOMED CT is a concept system and an associated
terminology for healthcare [9].. It is managed by the
International Health Terminology Standards
Development Organisation (IHTSDO), a not-for-profit
international standards body with nine member
countries. Although its development is based on the
Description Logic system KRSS, SNOMED CT is
provided as a set of relational tables corresponding to an
“inferred view”, i.e., the set of non-redundant
defining relations for each concept. The July 2007
international release contains 310,311 active elements
(309,175 concepts and 1,136 relationships, of which
only 61 are actually used to relate concepts) and
1,218,983 relations (pairs of semantically-related
concepts). The source files for SNOMED CT
(sct_concepts and sct_relationships) were
downloaded from the UMLS Knowledge Source Server
(http://umlsks.nlm.nih.gov/).</p>
    </sec>
    <sec id="sec-5">
      <title>NCI Thesaurus</title>
      <p>The National Cancer Institute Thesaurus (NCIt) is a
“terminology based on current science that helps
individuals and software applications connect and
organize the results of cancer research” [10]. The
NCIt is produced by the National Cancer Institute,
and is a key element of the cancer common ontologic
representation environment (caCORE) [11]. The
NCIt uses the description logic flavor of the Web</p>
      <p>Ontology Language (OWL-DL) for its representation
[12]. Version 07.05e of the NCIt contains 58,869
active classes, 123 associative relationships and
124,775 relations (subsumption and equivalence
relations, as well as restrictions in the OWL file). The
OWL file for the NCIt was downloaded from the
caCORE FTP site (ftp://ftp1.nci.nih.gov/pub/cacore/),
under EVS.</p>
    </sec>
    <sec id="sec-6">
      <title>Unified Medical Language System</title>
      <p>The Unified Medical Language System (UMLS) is a
terminology integration system developed at the U.S.
National Library of Medicine [13]. The UMLS
Metathesaurus is a repository of integrated biomedical
terms drawn from 143 biomedical vocabularies and
ontologies. Terms referring to the same entity in
several vocabularies are clustered together and given the
same concept unique identifier (CUI). Both
SNOMED CT (July 31, 2007) and NCIt (07.05e) are
integrated in version 2007AC of the Metathesaurus,
which provides a convenient way of identifying
equivalences between terms from these two ontologies.
The UMLS is available for download from the UMLS
Knowledge Source Server
(http://umlsks.nlm.nih.gov/). (A free license is required).</p>
    </sec>
    <sec id="sec-7">
      <title>METHODS</title>
      <p>The method developed for comparing concepts from
SNOMED CT and NCIt can be summarized as
follows. The formal definition of concepts is extracted
from SNOMED CT and NCIt and converted to RDF
triples. Equivalence relations between SNOMED CT
and NCIt concepts are extracted from the UMLS . All
triples are loaded into a triple store. Additional triples
are generated from inference rules applied to the
original knowledge base. The triple store is then
queried to compare the representation of concepts in
SNOMED CT and NCIt.</p>
    </sec>
    <sec id="sec-8">
      <title>Acquiring RDF triples</title>
      <p>For each concept and relationship from SNOMED
CT and NCIt, we extract the following information:
original identifier, preferred name, source (SNOMED
CT or NCIt), type (concept or relationship). RDF
triples are created to represent this information, in
which the subject is the concept itself. The predicates
corresponding to the properties listed above are hasID,
hasName, hasSource and hasType, respectively. The
object of these triples is a literal corresponding to, for
example, the concept name for the predicate hasName.
Triples are also created for representing the relations
of each concept to other concepts from the same
source. The relationship indicated in the source is
used as predicate for these triples, whose objects are
concepts. Similarly, triples are created for
representing relations among relationships (e.g.,
sub</p>
      <p>PropertyOf). Finally, we create triples to represent the
mapping of concepts to the UMLS Metathesaurus.
For each concept from SNOMED CT and NCIt, we
create one triple with the predicate hasCUI and the
corresponding UMLS CUI as object literal.
SNOMED CT. The fields ‘CONCEPTID’ and
‘FULLYSPECIFIEDNAME’ from the table
stc_concept were used to instantiate the properties
hasID and hasName, respectively. All nodes were
assigned the value ‘concept’ for the property hasType,
except for the elements of the table stc_concept
actually corresponding to relationships, namely,
Linkage concept (linkage concept) and its descendants,
to which the value ‘relationship’ was assigned. All
nodes were assigned the value ‘SNOMEDCT’ for the
property hasSource.</p>
      <p>NCI Thesaurus. The elements ‘code’ and
‘Preferred_Name’ from the ‘&lt;owl:Class&gt;’ sections of the
OWL file were used to instantiate the properties hasID
and hasName, respectively. All nodes were assigned
the value ‘concept’ for the property hasType.
Analogously, information extracted from the
‘&lt;owl:ObjectProperty&gt;’ sections of the OWL file was
used to create the corresponding triples for properties
(i.e., predicates). These nodes were assigned the
value ‘relationship’ for the property hasType. All
nodes were assigned the value ‘NCI’ for the property
hasSource.</p>
      <p>UMLS Metathesaurus. The table MRCONSO.RRF
from the UMLS distribution was used for acquiring
the mapping between terms from SNOMED CT and
the UMLS concepts, as well as between terms from
the NCIt and the UMLS concepts. We used the
source abbreviation (SAB) to identify strings
contributed by SNOMED CT (SAB = ‘SNOMEDCT’) or
NCTt (SAB = NCI). We extracted the concept
identifier in the source (SCUI) and UMLS concept unique
identifier (CUI) and created triples of the form
(concept, hasCUI, CUI) for each pair (SCUI, CUI).</p>
    </sec>
    <sec id="sec-9">
      <title>Creating the triple store</title>
      <p>These triples generated from SNOMED CT, NCIt
and the UMLS were represented in N-triple format
and loaded into the open source triple store
Mulgara™ (http://mulgara.org/) in a linux environment.
Mulgara automatically indexes the triples, as well as
the subject, predicate and object elements of each
triple.</p>
    </sec>
    <sec id="sec-10">
      <title>Inference rules</title>
      <p>Inference rules are typically added to a triple store in
order to infer new RDF statements (i.e., triples) from
existing RDF statements. Mulgara provides a series
of rules, which implement RDF Schema (RDFS)
entailment, including rules for the transitivity of the
relationships rdfs:subClassOf and rdfs:subPropertyOf. We
found the set of rules for RDFS impractical to use on
this triple store and ended up not using it. (The lack
of generalized transitive closure in the triple store was
compensated for by graph traversal functions in the
queries.)
In practice, the only rule we created and applied to
the store makes a concept from SNOMED CT
equivalent to a concept from NCIt when both
concepts are mapped to the same UMLS concept (i.e.,
share the same UMLS CUI). This relation was
implemented by creating an owl:sameAs relationship
between the two concepts, bidirectionally.</p>
      <sec id="sec-10-1">
        <title>SNOMED CT</title>
      </sec>
      <sec id="sec-10-2">
        <title>NCI Thesaurus</title>
      </sec>
    </sec>
    <sec id="sec-11">
      <title>Querying the triple store</title>
      <p>A set of queries was developed to explore the relata
of those concepts that are equivalent between
SNOMED CT and NCIt according to the UMLS.
More specifically, these queries explore the set of
relata of the SNOMED CT concept and that of the
NCIt concept, and select from the two sets the relata
identified as equivalent in the UMLS. For example,
as illustrated in Figure 1, the concepts S0 from
SNOMED CT and N0 from NCIt are equivalent
according to the UMLS. Among the relata of S0 (S1 to
S5) and N0 (N1 to N4), the pairs {S1, N1} and {S5, N3}
denote equivalent concepts and constitute the set of
shared relata of {S0, N0}.</p>
      <p>Each relation between two concepts (e.g., (S0, sr4,
S4)) is represented as a triple in the RDF store and the
set of all relations forms a graph. Comparing the set
of relata of two concepts can thus be expressed as a
set of constraints on the graph. For example, {S1, N1}
are shared relata of {S0, N0}, because there is a path
between S0 and N0, constituted of any link from S0 to
S1, any link from N0 to N1, and a “UMLS
equivalence” link between S1 and N1.</p>
      <p>The set of relata is not necessarily limited to direct
relata. Some relations can be traversed recursively in
order to explore, for example, the set of common
ancestors (as opposed to common direct subclasses).
Depending on the constraints put on the graph,
various kinds of relationships can be explored, together
or independently.</p>
      <p>One of the major query languages for RDF stores is
SPARQL. Mulgara currently provides no support for
SPARQL. Instead, it provides iTQLTM (Interactive
Tucana Query LanguageTM), which is functionally
equivalent to SPARQL for most purposes.
select $n_sub $n_rel $n_obj $s_sub $s_rel $s_obj
from &lt;rmi://localhost/server1#nci_snomed_full&gt;
where
(
# ---------- NCIT side
---------walk(&lt;ncit:C2986&gt; &lt;rdfs:subClassOf&gt; $n_obj</p>
      <p>and $n_sub_tmp &lt;rdfs:subClassOf&gt; $n_obj)
and $n_rel &lt;mulgara:is&gt; &lt;rdfs:subClassOf&gt;
and $n_sub &lt;mulgara:is&gt; &lt;ncit:C2986&gt;
)
and
(
# ---------- SNCT side
---------walk(&lt;snct:46635009&gt; &lt;snct:116680003&gt; $s_obj</p>
      <p>and $s_sub_tmp &lt;snct:116680003&gt; $s_obj)
and $s_rel &lt;mulgara:is&gt; &lt;snct:116680003&gt;
and $s_sub &lt;mulgara:is&gt; &lt;snct:46635009&gt;
)
and $n_obj &lt;owl:sameAs&gt; $s_obj
in &lt;rmi://localhost/server1#nci_snomed_full_ent_sameAs&gt;
;</p>
    </sec>
    <sec id="sec-12">
      <title>Comparing the shared relata of concepts</title>
      <p>In order to compare the formal definitions of a
concept S0 from SNOMED CT and N0 from NCIt, we
prepared queries to explore the following sets of
shared relata: all shared relata (including through
associative relations), shared superclasses, shared
wholes (of which the entity is a part of), shared
subclasses and shared parts. More precisely, these kinds
of relations were first explored directly to extract the
set of relata in direct relation to the original concepts,
and indirectly, allowing the recursive traversal of isa
and part_of relationships. Finally, in order to account
for the inheritance of properties from a superclass to
its subclasses, we also explored the concepts in
associative relation to any of the superclasses of the
original concepts.</p>
      <p>In practice, starting from the list of pairs of equivalent
concepts, we generated one query per pair for each
type of relationship to be explored. The relata in
common were recorded for each pair of equivalent
concepts for each type of relationship explored.
Figure 2 shows a typical query used to explore
(recursively) the common superclasses of two concepts.
Figure 3 displays the output of this query, showing
the 7 ancestors in common.</p>
    </sec>
    <sec id="sec-13">
      <title>Data analysis</title>
      <p>We analyzed the lists of shared relata resulting from
the queries from a quantitative perspective, in order
to examine the distribution of the number of common
relata for the various kinds of relationships under
investigation.</p>
    </sec>
    <sec id="sec-14">
      <title>RESULTS</title>
    </sec>
    <sec id="sec-15">
      <title>Triple store</title>
      <p>A total of 3,194,215 triples were created, 2,770,477
for SNOMED CT and 423,738 for NCIt. It took
about 20 minutes to load these N-triples into
Mulgara, including the creation of indexes.</p>
      <p>The rule asserting the equivalence of SNOMED CT
and NCIt concepts when they share the same UMLS
CUI generated 40,738 additional triples (representing
the owl:sameAs relations bidirectionally). It took about
5 minutes to apply this rule to the triple store.
Queries were executed in batches, one batch for each
set of equivalent concepts for a given kind of
relationship. Executing a batch of queries took anywhere
between several minutes (for direct relations) to
several hours (when relations are allowed to be traversed
recursively).</p>
    </sec>
    <sec id="sec-16">
      <title>Overlap between SNOMED CT and NCIt concepts</title>
      <p>Of the 309,175 SNOMED CT concepts, 19,506
(6.3%) mapped to the same UMLS concept as some
NCIt concept. Analogously, 14,054 (23.9%) of the
58,869 NCIT concepts mapped to the same UMLS
concept as some SNOMED CT concept. A total of
20,369 pairs of SNOMED CT and NCIt concepts
were identified in which the two concepts are deemed
equivalent based on their mapping to the UMLS.</p>
    </sec>
    <sec id="sec-17">
      <title>Quantitative results</title>
      <p>The distribution of the number of relata for several
types of relationships investigated is summarized in
Table 1. The first column (N) shows the total number
of pairs of concepts for which both concepts have at
least one related concept for this relation. This
number is used as the denominator for computing the
percentage of pairs of equivalent concepts having a
given number of related concepts in common. The
minimum, maximum and median number of shared
relata are presented in the last three columns. For
example, the row “Dir. Superclass” corresponds to
the shared direct parent classes (traversing isa in
SNOMED CT and subClassOf in NCIt). N = 20,360
indicates that almost all concepts have at least one
ancestor. 18.4% of the pairs of equivalent concepts
studied share a parent class and only 1.3% share two.
Over 80% of the pairs do not share any direct parents.
The row “Ind. Superclass” corresponds to the shared
ancestors (traversing isa or subClassOf recursively).
Only 25% of the pairs of equivalent concepts studied
do not have any ancestors in common. The largest
number of ancestors in common is 22.</p>
      <p>Details about shared relata for other kinds of
relationships are provided in the other rows of Table 1,
including direct parent and child classes for the
taxonomic relation (super/subclass) and for the
meronomic relation (whole/part). The identification of
indirect relata involves the recursive traversal of
taxonomic and meronomic relations and combination
of sucblassOf and associative relations.</p>
    </sec>
    <sec id="sec-18">
      <title>EXTENDED EXAMPLE</title>
      <p>In order to illustrate our approach to comparing
ontologies, we explore how Type 1 diabetes mellitus is
represented in SNOMED CT and NCIt. As shown in
Figure 4, this concept has many relata both in
SNOMED CT and in NCIt, of which a large number
are shared, including 7 shared ancestors (e.g.,
Disorder of pancreas) and 4 shared concepts in
associative relation (e.g., Gastrointestinal System). Dotted
lines represent indirect isa relations through concepts
that are not shown. The equivalence between
concepts in SNOMED CT and NCIt assessed through the
UMLS is shown with grey links. Of note, two distinct
concepts in one ontology can be equivalent to one
concept in the other (e.g., Endocrine Pancreas and
Islet of Langerhans in NCIt vs. Endocrine pancreatic
structure in SNOMED CT).</p>
    </sec>
    <sec id="sec-19">
      <title>DISCUSSION</title>
    </sec>
    <sec id="sec-20">
      <title>SNOMED CT and NCIt</title>
      <p>Overall, the two ontologies under investigation in this
study were found to have a relatively small proportion
of relata in common, including when the properties
(e.g., associative relations) are explored in the
ancestors to simulate the inheritance of properties along isa
hierarchies. The highest proportion of shared relata is
for the superclasses traversed recursively (75% of the
concepts share at least one superclass). Slightly more
than half of the concepts studied share at least one
associative relation (direct relation or inherited from
some ancestor).</p>
      <p>Further research is needed to distinguish among
primitive concepts in both ontologies (e.g., Aneurismal
bone cyst), concepts for which a relatively rich
description is provided, but only in one ontology (e.g.,
the description provided for many cancers in NCIt is
typically richer than in SNOMED CT), and concepts
defined in both ontologies, but with minimal overlap
in their relata. We did not complete the comparison
of shared descendants, but, even in the absence of a
rich description, a large proportion of shared
descendants can be a good indicator of consistency between
ontologies (e.g., Sulfonamide agents share 18
descendants).</p>
    </sec>
    <sec id="sec-21">
      <title>Semantic Web technologies</title>
      <p>We found RDF to be suitable for comparing
terminological ontologies, especially when the two ontologies
are large and are not both available in OWL. While
OWL classifiers are useful for consistency checking
purposes, they tend to be limited in the number of
classes they can handle. Moreover, the queries
presented in this study arguably allow more flexibility
than OWL DL classifiers.</p>
      <p>The triple store approach also offers clear advantages
over relational databases, as SQL provides no support
for performing transitive closures (i.e., for performing
joint operations recursively). While ad hoc programs
(or stored procedures) embedding SQL queries can
be written against the database, we showed that
simple queries against the RDF store were sufficient to
carry out this study. Because it supports the seamless
traversal of complex graphs (recursive traversal of
one relationship and traversal of selected
combinations of relationships), RDF is an effective approach
to comparing terminologies.</p>
      <p>The comparison of large ontologies remains
nonetheless difficult. The inference engine of Mulgara could
not apply the set of rules defined for RDFS, including
the transitivity of subClassOf to large, heavily
hierarchical structures. However, the graph traversal
functions supported by the query language partially
compensated for the absence of precomputed transitive
closures.</p>
    </sec>
    <sec id="sec-22">
      <title>Limitations and future work</title>
      <p>This approach essentially provides a quantitative
comparison between two ontologies and is
insufficient for fine-grained comparisons. Although we did
not study whether pairs of related concepts in both
ontologies were linked by similar relations, the
information could be easily extracted from the triple
store. We also would like to test the structural
consistency of the combined ontologies (e.g., by testing the
presence of cycles in isa relations in the RDF store
containing both SNOMED CT and NCIt). The
advantage of using the UMLS perspective on concept
equi6.
7.
8.
9.</p>
      <p>Ceusters W, Smith B, Goldberg L. A
terminological and ontological analysis of the NCI
Thesaurus. Methods Inf Med 2005;44(4):498-507
Ruttenberg A, Clark T, Bug W, Samwald M,
Bodenreider O, Chen H, et al. Advancing
translational research with the Semantic Web. BMC
Bioinformatics 2007;8 Suppl 3:S2</p>
      <sec id="sec-22-1">
        <title>RDF: http://www.w3.org/RDF/</title>
      </sec>
      <sec id="sec-22-2">
        <title>SNOMED CT: http://www.ihtsdo.org/</title>
        <p>valence outweighs the potential bias it introduces
with its “concept view”.</p>
      </sec>
      <sec id="sec-22-3">
        <title>Acknowledgements</title>
        <p>This research was supported by the Intramural
Research Program of the National Institutes of Health
(NIH), National Library of Medicine (NLM). Our
thanks go to Ramez Ghazzaoui who helped create the
triple store and Lee Peters who processed SNOMED
CT.</p>
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  </body>
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