The Cancer Registry of Norway (CRN) uses an automated cancer registration support system (CaReSS) to support core cancer registry activities, i.e., data capture, data curation, and producing data products and statistics for various stakeholders. GURI is a core component of CaReSS, which is responsible for validating incoming data with medical rules. Such medical rules are manually implemented by medical experts based on medical standards, regulations, and research. Since large language models (LLMs) have been trained on a large amount of public information, including these documents, they can be employed to generate tests for GURI. Thus, we propose an LLM-based test generation and differential testing approach (LLMeDiff) to test GURI. We experimented with four different LLMs, two medical rule engine implementations, and 58 real medical rules to investigate the hallucination, success, time efficiency, and robustness of the LLMs to generate tests, and these tests' ability to find potential issues in GURI. Our results showed that GPT-3.5 hallucinates the least, is the most successful, and is generally the most robust; however, it has the worst time efficiency. Our differential testing revealed 22 medical rules where implementation inconsistencies were discovered (e.g., regarding handling rule versions). Finally, we provide insights for practitioners and researchers based on the results.

The Cancer Registration Support System (CaReSS), built by the Cancer Registry of Norway (CRN), is a complex real-world socio-technical software system that undergoes continuous evolution in its implementation. Consequently, continuous testing of CaReSS with automated testing tools is needed such that its dependability is always ensured. Towards automated testing of a key software subsystem of CaReSS, i.e., GURI, we present a real-world application of an extension to the open-source tool EvoMaster, which automatically generates test cases with evolutionary algorithms. We named the extension EvoClass, which enhances EvoMaster with a machine learning classifier to reduce the overall testing cost. This is imperative since testing with EvoMaster involves sending many requests to GURI deployed in different environments, including the production environment, whose performance and functionality could potentially be affected by many requests. The machine learning classifier of EvoClass can predict whether a request generated by EvoMaster will be executed successfully or not; if not, the classifier filters out such requests, consequently reducing the number of requests to be executed on GURI. We evaluated EvoClass on ten GURI versions over four years in three environments: development, testing, and production. Results showed that EvoClass can significantly reduce the testing cost of evolving GURI without reducing testing effectiveness (measured as rule coverage) across all three environments, as compared to the default EvoMaster. Overall, EvoClass achieved ≈31% of overall cost reduction. Finally, we report our experiences and lessons learned that are equally valuable for researchers and practitioners.

The Cancer Registry of Norway (CRN) collects, curates, and manages data related to cancer patients in Norway, supported by an interactive, human-in-the-loop, socio-technical decision support software system. Automated software testing of this software system is inevitable; however, currently, it is limited in CRN’s practice. To this end, we present an industrial case study to evaluate an AI-based system-level testing tool, i.e., EvoMaster, in terms of its effectiveness in testing CRN’s software system. In particular, we focus on GURI, CRN’s medical rule engine, which is a key component at the CRN. We test GURI with EvoMaster’s black-box and white-box tools and study their test effectiveness regarding code coverage, errors found, and domain-specific rule coverage. The results show that all EvoMaster tools achieve a similar code coverage; i.e., around 19% line, 13% branch, and 20% method; and find a similar number of errors; i.e., 1 in GURI’s code. Concerning domain-specific coverage, EvoMaster’s black-box tool is the most effective in generating tests that lead to applied rules; i.e., 100% of the aggregation rules and between 12.86% and 25.81% of the validation rules; and to diverse rule execution results; i.e., 86.84% to 89.95% of the aggregation rules and 0.93% to 1.72% of the validation rules pass, and 1.70% to 3.12% of the aggregation rules and 1.58% to 3.74% of the validation rules fail. We further observe that the results are consistent across 10 versions of the rules. Based on these results, we recommend using EvoMaster’s black-box tool to test GURI since it provides good results and advances the current state of practice at the CRN. Nonetheless, EvoMaster needs to be extended to employ domain-specific optimization objectives to improve test effectiveness further. Finally, we conclude with lessons learned and potential research directions, which we believe are applicable in a general context.

The Cancer Registry of Norway (CRN) collects information on cancer patients by receiving cancer messages from different medical entities (e.g., medical labs, hospitals) in Norway. Such messages are validated by an automated cancer registry system: GURI. Its correct operation is crucial since it lays the foundation for cancer research and provides critical cancer-related statistics to its stakeholders. Constructing a cyber-cyber digital twin (CCDT) for GURI can facilitate various experiments and advanced analyses of the operational state of GURI without requiring intensive interactions with the real system. However, GURI constantly evolves due to novel medical diagnostics and treatment, technological advances, etc. Accordingly, CCDT should evolve as well to synchronize with GURI. A key challenge of achieving such synchronization is that evolving CCDT needs abundant data labelled by the new GURI. To tackle this challenge, we propose EvoCLINICAL, which considers the CCDT developed for the previous version of GURI as the pretrained model and fine-tunes it with the dataset labelled by querying a new GURI version. EvoCLINICAL employs a genetic algorithm to select an optimal subset of cancer messages from a candidate dataset and query GURI with it. We evaluate EvoCLINICAL on three evolution processes. The precision, recall, and F1 score are all greater than 91%, demonstrating the effectiveness of EvoCLINICAL. Furthermore, we replace the active learning part of EvoCLINICAL with random selection to study the contribution of transfer learning to the overall performance of EvoCLINICAL. Results show that employing active learning in EvoCLINICAL increases its performances consistently.

The Cancer Registry of Norway (CRN) employs a cancer registry system to collect cancer patient data (e.g., diagnosis and treatments) from various medical entities (e.g., clinic hospitals). The collected data are then checked for validity (i.e., validation) and assembled as cancer cases (i.e., aggregation) based on more than 1000 cancer coding rules in the system. However, it is frequent in practice that the collected cancer data changes due to various reasons (e.g., different treatments) and the cancer coding rules can also change/evolve due to new medical knowledge. Thus, such a cancer registry system requires an efficient means to automatically analyze these changes and provide consequent impacts to medical experts for further actions. This paper proposes an automated Rule-based Change Impact Analysis (CIA) approach named RCIA that includes: 1) a change classification to capture the potential changes that can occur at CRN; 2) in total 80 change impact analysis rules including 50 dependency rules and 30 impact rules; and 3) an efficient algorithm to analyze changes and produce consequent impacts. We evaluate RCIA via a case study with 12 real change sets from CRN and a conducted interview. The results showed that RCIA managed to produce 100% actual change impacts and the medical expert at CRN is quite positive to apply RCIA to facilitate their cancer registry system. We also shared a set of lessons learned based on the collaboration with CRN.