Detection of Retained Surgical Foreign Body

Purpose 

If counts are off after a surgical procedure or multiple surgical teams were involved in a case, a radiograph is used to assess a patient for a retained foreign body (a missing needle or surgical sponge).

Tag(s)

 

Panel

Abdominal

Define-AI ID

20020011

Originator

Christopher P. Gange

Lead  Christopher P. Gange 

Panel Chair

Luther B. Adair

Panel Reviewers

Abdominal Panel

License

Creative Commons 4.0 

Status

RadElement Set

Public Comment

RDES175

   
                               

Clinical Implementation


Value Proposition


At the end of an operation, a count of all the surgical instruments is performed and matched with the initial counts with the intent of not leaving anything in the patient that should not be there.  If the counts do not match, it is critical to determine whether the missing item is in the patient, and this is often done by taking an X-ray of the operative area. Some complicated operative protocols always require these X- rays due to the risk involved. An immediate decision must be made as to whether any surgical object (a foreign body) is within the patient, so it can be removed promptly.

Unfortunately these objects are not always easy to recognize. This is a clinical scenario where speed and accuracy are essential, and an algorithm that could aid these interpretations could prevent surgical complications and costly lawsuits.


Narrative(s)


A 58-year-old man underwent an exploratory laparoscopy for bowel obstruction which was converted to an open procedure after a mass lesion was seen.  At the end of this 3 hr procedure, the surgical counts were off, and a sponge was missing.  A radiograph of the surgical area was performed.  The surgeons did not see the sponge, nor did the radiology resident who first reviewed the case as it was partially obscured by mesh that was used during the procedure.  An attending radiologist spotted the foreign body and the surgical team was notified and removed the sponge before closing the patient.

Workflow Description


The images are obtained from modality and a member of the surgical team verifies that the image field of view covers the operative field. The images are then sent to PACS and the AI engine. The image is analyzed by the engine. The system determines if a foreign body is present. If present,  an alert message is sent to PACS from the engine with the information about the current study,  and a graphic highlighting the finding.


Considerations for Dataset Development



Procedure

Chest X-ray or abdominal X-ray

View(s)

AP, Lat, supine

Age

0-100

Sex at birth

Male, Female

Comorbidities

Pleural air or fluid (including air/fluid levels), lung disease (e.g., Pneumonia, emphysema, bronchiectasis), recent trauma, abdominal disease (bowel obstruction, cholelithiasis), intra-abdominal free air recent surgery

Other lines, tubes, and pre-existing/intended foreign bodies present

Central venous catheters, pleural chest tubes, ECMO cannulas, enteric tubes, pacer devices, biliary drains, abdominal surgical drains, ureteral catheters, temperature probes, surgical clips, skin staples, pre-existing hardware (spinal fixation hardware, fixation plates/screws, etc), cardiac devices (pacing leads, valve replacement), sternotomy wires, retractors (if patient is still open), shrapnel.


Types of foreign bodies

Suture needles, surgical sponges, surgical instruments

Technical Specifications


Inputs

DICOM Study

Procedure

X-Ray, Chest/Abdomen

Views

AP, LAT

Data Type

DICOM

Modality

X-Ray

Body Region

Chest/Abdomen

Anatomic Focus

Surgical Site

Scenario

On the operating table before final closure




Primary Outputs


Detect presence of foreign body

RadElement ID

RDE1227

Definition

Detect if an unexpected foreign body is present

Data Type

Categorical

Value Set

  • Absent

  • Present

  • Undetermined

Units

N/A



Secondary Outputs


Foreign body location

RadElement ID

RDE1228

Definition

If a foreign body is present determine the bounding box of the foreign body

Data Type

Coordinate

Value Set

N/A

Units

N/A




Foreign body type 

RadElement ID

RDE1229

Definition

If a foreign body is present determine the type of the foreign body

Data Type

Categorical

Value Set

  • Suture needle

  • Surgical sponge

  • Surgical instrument

Units

N/A