Choledocholithiasis Detection on Ultrasound

Purpose

Detection of choledocholithiasis on ultrasound

Tag(s)

 

Panel

Abdominal

Define-AI ID

20020010

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 RDES160
                       

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 an ultrasound 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.

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 right upper quadrant ultrasound 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 right upper quadrant ultrasound is ordered.

Workflow Description


An algorithm evaluates the ultrasound and categorizes whether choledocholithiasis is present, absent, or indeterminate and measures the stone size. If present, it then assesses whether there is biliary ductal dilatation present, absent, or undetermined and measures the common bile duct. For cases returned where the algorithm returns choledocholithiasis, the radiologist is made aware of the need for further evaluation or intervention. If the radiologist is not available, the non-radiologist is made aware of the need for further evaluation or intervention.

Considerations for Dataset Development



Procedures

{Ultrasound limited; Ultrasound of the abdomen complete, Ultrasound of the right upper quadrant}

Age

[0,90]

Sex at Birth

{Male, Female}

Abdominal pain

{right upper quadrant pain}

Comorbidities

{diabetes, sickle cell anemia, obesity}

Catheter

{common bile duct stent, common bile duct drain}

Other

{soft tissue mass in the common bile duct, pneumobilia, choldechocal cysts, distal soft tissue obstruction, cholelithiasis, cholecystectomy}

Technical Specifications


Inputs

DICOM Study

Procedure

ultrasound limited, abdominal ultrasound complete, right upper quadrant ultrasound

Views

Images of common bile duct

Data Type

DICOM

Modality

Ultrasound

Body Region

Abdomen

Anatomic Focus

Common bile duct




Primary Outputs


Choledocholithiasis Detection


RadElement ID

RDE1122

Definition

Presence of choledocholithiasis

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

N/A


Choledocholithiasis Measurement


RadElement ID

RDE1120

Definition

If choledocholithiasis present then determine maximal stone diameter

Data Type

Numeric

Value Set

N/A

Units

mm


Secondary Outputs


Biliary Ductal Dilation Measurement 

RadElement ID

RDE1121

Definition

Maximal common bile duct measurement

Data Type

Numeric

Value Set

N/A

Units

mm


Biliary Ductal Dilation Detection

RadElement ID

RDE1123

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

N/A


Periductal Fluid Detection

RadElement ID

RDE1124

Definition

Periductal fluid detection

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

N/A

Future Development Ideas


  • Specify minimal acceptable imaging using ultrasound. For example, RAO parasagittal views of the common bile duct from the porta hepatis to the pancreas and then transverse images of the common bile duct through the head of the pancreas. 

  • Possible extension to this use case is to detect  choledocholithiasis on ultrasound and assess the need for further evaluation with MRCP

  • In the case of biliary ductal dilatation without an identified stone, soft tissue mass obstruction within the common bile duct, ampulla, or pancreas should be considered.  Consider using this algorithm as an adjunct to the gallstone detection algorithm.