Choledocholithiasis Detection on CT

Purpose

To detect choledocholithiasis on CT

Tag(s)

 

Panel

Abdominal

Define-AI ID

20020009

Originator

Luther B. Adair, II
Lead Luther B. Adair, II

Panel Chair

Arun Krishnaraj

Panel Reviewers

Abdominal Panel

License

Creative Commons 4.0
Status Public Comment
RadElement Set RDES161
                               

Clinical Implementation


Value Proposition


Choledocholithiasis is a potentially life-threatening but treatable emergency. AI meeting this use case would help in detecting, quantitating, 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 non-radiologists such as technologists who would perform a CT for this disease entity. 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 detect choledocholithiasis on CT and assess the need for further evaluation with MRCP.

Narrative(s)


A 44-year old patient presents with constant right upper quadrant pain and is taken to the emergency room at which time a CT scan is ordered.

A 67-year old patient presents to an outpatient clinic with jaundice and right upper quadrant pain and is sent to the emergency room, at which time a CT scan is ordered.

Workflow Description


The relevant images are obtained from modality and sent to PACS and the AI engine based on anatomic landmarks. The images are analyzed by the engine. The system then detects the relevant outputs providing associated categorical data and measurements. An alert message is sent to PACS from the engine with the information, identification, and graphics highlighting the common bile duct stone, the measurement of the stone, whether there is biliary ductal dilatation and measurement of the common bile duct, whether there is periductal fluid present, and whether there is gallbladder distention.

An algorithm evaluates the CT scan and categorizes whether a common bile duct stone is present, absent, or undetermined. If present, it then measures the maximal size of the stone; assesses whether biliary ductal dilatation is present, absent, or undetermined with a measurement of the common bile duct; assesses whether periductal fluid is present, absent, or undetermined; assesses whether the gallbladder is distended or not distended with a measurement of the gallbladder lumen from wall to wall. For cases where the algorithm returns a common bile duct stone present, the recommendation for gastroenterology consult, MRCP, or ERCP is made. For cases returned where the algorithm returns a stone absent or undetermined, but there are any secondary output elements present (biliary ductal dilatation, periductal fluid, or a distended gallbladder) an alert is provided to the ordering physician to order an ultrasound. If a radiologist is present, these exams are prioritized in the radiologist worklist for urgent interpretation and reporting.

Considerations for Dataset Development



Procedures

{CT Abdomen, with contrast, without contrast, CT Abdomen and pelvis}

View(s)

{Axial, Coronal, Sagittal}

Age

[0,90]

Sex at Birth

{Male, Female}

Other

{pneumobilia, vicarious excretion, reflux of oral contrast into the biliary tree, soft tissue mass anywhere in the biliary tree, streak artifact from cholecystectomy clips, choldechocal cysts, sclerosing cholangitis, hepaticojejunostomy/Whipple/etc}


Technical Specifications


Inputs

DICOM Study

Procedure

CT Abdomen with contrast, CT Abdomen without contrast, CT Abdomen and Pelvis with/without contrast

Views

axial, coronal, sagittal

Data Type

DICOM

Modality

CT

Body Region

Abdomen

Anatomic Focus

Common bile duct and gallbladder





Primary Outputs


Choledocholithiasis Detection

RadElement ID

RDE1127

Definition

Detection of gallstone

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

N/A


Gallstone Measurement

RadElement ID

RDE1125

Definition

If a gallstone is present then determine maximal size measurement .

Data Type

Numeric

Value Set

N/A

Units

mm




Secondary Outputs


Biliary Ductal Dilation Measurement 

RadElement ID

RDE1126

Definition

Biliary ductal dilation maximal measurement

Data Type

Numeric

Value Set

N/A

Units

mm


Biliary Ductal Dilation Detection

RadElement ID

RDE1128

Definition

Biliary ductal dilation detection based on measurement. Absent if measurement is less than 6 mm for patients younger than 60 years, allow 1 mm for each decade over 60 years. Present if measurement is less than or equal 6-9 mm for patients younger than 60 years, allow 1 mm for each decade over 60 years. Present if measurement is greater than 15 mm in the setting of prior cholecystectomy.

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

mm


Periductal Fluid Detection

RadElement ID

RDE1129

Definition

Periductal fluid detection

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

N/A


Gallbladder Lumen Distention Measurement

RadElement ID

RDE1130

Definition

Gallbladder lumen distention (a measurement greater than 45 mm is considered distention)


Data Type

Numeric

Value Set

N/A

Units

mm

Future Development Ideas


  • In the case of biliary ductal dilatation without a radiopaque stone, soft tissue mass obstruction within the common bile duct, ampulla, or pancreas should be considered. 

  • In the case of periductal fluid and ductal wall thickening, perhaps cholangitis should be considered.