Detect Injuries Correlated with Child Abuse - Posterior Rib Fractures

Purpose

Detect posterior rib fractures which are injuries correlated with Nonaccidental Trauma (NAT).

Tag(s)

 

Panel

Pediatric Panel

Define-AI 

19010005

Originator

Pediatrics Panel
Lead
Steven Blumer

Panel Chair

Steven Blumer

Panel Reviewers

Pediatric Panel

License

Creative Commons 4.0 
Status Public Commenting
RadElement Set RDES93
                               

Clinical Implementation


Value Proposition

Radiologists may be the first clinical staff to suspect non-accidental trauma when they are able to identify injuries associated with this entity. Identification of these injuries is critically important as it can save a child from potential serious long-term morbidity and mortality. A skeletal survey is performed in cases of suspected abuse to assess and document the extent of skeletal injuries. Different types of fractures have been recognized as highly specific to non-accidental injuries (rather than accidental injury).

Two such fractures include: Metaphyseal fractures (also known as classic metaphyseal lesions (CML), metaphyseal corner fractures or bucket handle fractures). It can be seen in up to 39-50% of abused infants less than 18 months of age. It is said to be virtually pathognomonic of Nonaccidental Injury. Rib fractures, especially of the posterior ribs may have no overlying bruising, although vigorous cardiopulmonary resuscitation can occasionally cause anterior rib fractures, posterior rib fractures do not occur in this setting.

Narrative(s)

A skeletal survey is ordered for a young child for suspected non accidental trauma.

Workflow Description

A skeletal survey performed in a young child for suspected non accidental trauma. The images in the skeletal survey are taken and sent to PACS and the AI engine. The algorithm identifies if any posterior rib fractures are present.


Considerations for Dataset Development



Procedures

Skeletal Survey

Age

[0,3]

In-Patient Location

Typically

Positioning

APPENDICULAR SKELETON


Right and left Humeri (AP)

Right and left Forearms (AP)

Right and left Hands (PA or oblique)

Right and left Femurs (AP)

Right and left Lower legs (AP)

Right and left Feet (AP)


AXIAL SKELETON

 

Thorax (AP, lateral, right and left obliques), to include sternum, ribs, thoracic and upper lumbar spine

Abdomen, to include the pelvis (AP) Lumbosacral spine (lateral)

Skull (frontal and lateral), cervical spine (if not completely visualized on lateral skull)

Technical Specifications


Inputs


DICOM Study


Procedure

Skeletal Survey

Views

AP Views of humeri, forearms, hands, femurs, lower legs, feet, thorax, abdomen and skull (including upper cervical spine)

Lateral views of thorax (including sternum, ribs, thoracic and upper lumbar spine), lumbosacral spine, skull (including cervical spine)

Data Type

DICOM

Modality

Radiographs

Body Region

Axial and Appendicular Skeletons

Anatomic Focus

Osseous structures


Primary Outputs


Posterior Rib Fracture(s) Detection


RadElement ID

RDE562

Definition

Presence or absence of posterior rib fracture(s).

Data Type

Categorical

Value Set

  • Absent
  • Present
  • Equivocal

Units

N/A



Affected Rib Segmentation


RadElement ID

RDE561

Definition

If posterior rib fracture is present, highlight affected ribs.

Data Type

Coordinates

Value Set

N/A

Units

N/A

Future Development Ideas


  • Algorithms that detect other injuries that are highly specific for nonaccidental trauma that can be seen on skeletal surveys such as fractures of the skull, scapula, sternum, digits, and outer third of the clavicle.
  • Algorithms that are able to date fractures seen on skeletal surveys.