Pneumothorax
| Purpose | Detection and quantification of pneumothorax on chest radiograph |
| Tag(s) |
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| Panel | Thoracic |
| Define-AI ID | 18080001 |
| Originator | Thoracic Panel |
| Panel Chair | Eric J. Stern |
| Panel Reviewers | Thoracic Panel |
| License | |
| Status | Published |
| RadElement Set | RDES44 |
Clinical Implementation
Value Proposition
Pneumothorax is a potentially life-threatening but readily treated emergency. AI meeting this use case would help in detecting, quantitating, comparing, and alerting both nonspecialists and radiologists to this potentially life-threatening abnormality. In clinical settings where a radiologist is not readily available, such detection would be of value to nonradiologists. In clinical settings where radiologists are available, such detection could be used to alert the radiologist and prioritize its reporting and notification to the treating physicians. One possible extension to this use case is to track changes in size of previously detected pneumothoraces and those under treatment.Narrative(s)
A 25-year-old patient presents after a motor vehicle accident, and a chest x-ray (CXR) is taken in the emergency room. An algorithm evaluates the image and categorizes the chest as pneumothorax present, absent, or undetermined. For cases when the algorithm returns pneumothorax present, if a radiologist is not present at the time of imaging, an alert is provided to the ordering physician. If a radiologist is present, the exam is prioritized in the radiologist worklist for urgent interpretation and reporting. Cases of potential pneumothorax without a chest tube should take higher priority in the reading queue compared with cases with a chest tube. Tension-pneumothorax cases also should be highly prioritized for reading.
A 70-year-old patient admitted to the ICU has several physiologic and monitoring interventions that have a risk of pneumothorax as a complication. An algorithm evaluates the image and categorizes the chest as being normal, abnormal, or undetermined. For cases when the algorithm returns pneumothorax present, if a radiologist is not present at the time of imaging, an alert is provided to the ordering physician. If a radiologist is present, the exam is prioritized in the radiologist worklist for urgent interpretation and reporting (particularly for new or enlarging pneumothorax or for possible tension).
Workflow Description
The image is obtained from modality and sent to PACS and the AI engine. The image is analyzed by the engine. The system then detects and estimates pneumothorax size. An alert message is sent to PACS from the engine with the information, identification, and graphic highlighting the pneumothorax.
Considerations for Dataset Development
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Procedures(s):
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XRAY, Chest; CT, Chest
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View(s):
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AP, PA/Lat, inclination e.g., upright, semi-upright, supine Clinical Note: Subtle cases of PTX on supine CXRs manifested by “deep sulcus sign” can be overlooked by less experienced radiologists
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Sex at Birth:
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Male, Female
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Age:
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[0,90]
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Chest Trauma (or intervention):
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blunt injury, blast injury, chest wall injury, rib fracture, lung contusions, lacerations, pleural fluid
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Comorbidities:
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pleural fluid (including air/fluid levels), lung disease (e.g., Pneumonia/lung abscess, bullous emphysema, bronchiectasis), pneumomediastinum, other extrapleural air collections
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Lung Tissue Involvement:
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Complete Collapse, Partial collapse
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Chest Tube:
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{With one or more chest tubes/drainage catheters, interval placement, or former tubes
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Tension Pneumothorax:
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Tension pneumothorax (flattening of ipsilateral hemi-diaphragm or contralateral shift of the mediastinum)
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Other:
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Skin fold artifacts, Pleural fluid Clinical Note: Skin fold artifacts are the most common cause of a false positive diagnosis of PTX
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Technical Specifications
Inputs
DICOM Study
| Procedure | XRAY, Chest |
| Views | AP, PA/Lat, inclination e.g., upright, semi-upright, supine |
| Data Type | DICOM |
| Modality | XRAY |
| Body Region | Chest |
| Anatomic Focus | Lung |
Primary Outputs
Pneumothorax Detection
| RadElement ID | RDE421 |
| Definition | Detection of pneumothorax |
| Data Type | Categorical |
| Value Set | 0–Unknown 1–Pneumothorax present 2–Pneumothorax absent |
| Units | N/A |
Secondary Outputs
Pleural Separation
| RadElement ID | RDE422 |
| Definition | Measure pleural separation in mm |
| Data Type | Numerical |
| Value Set |
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| Units | mm |
| Max Length | N/A |
Pneumothorax Side
| RadElement ID | RDE423 |
| Definition | Defines the side of pneumothorax when present |
| Data Type | Categorical |
| Value Set | 0-Right Side Pneumothorax 1-Left Side Pneumothorax 2-Bilateral |
| Units | N/A |
Pneumothorax Size
| RadElement ID | RDE424 |
| Definition | Classify the size of pneumothorax (or pneumothoraces) as a function of interpleural distance. Launch if pneumothorax is detected. |
| Data Type | Categorical |
| Value Set | 0–Small pneumothorax 1–Moderate pneumothorax 2–Large pneumothorax |
| Units | N/A |
Chest Tube
| RadElement ID | RDE425 |
| Definition | Detect the presence of chest tube(s) |
| Data Type | Categorical |
| Value Set | 0–Unknown 1–Tube(s) present 2–Tube(s) absent |
| Units | N/A |