Epidural Hematoma

Purpose

Detect, classify and measure the size of an epidural hematoma

Tag(s)

 

Panel

Neuroradiology Panel

Define-AI ID

19020005

Originator

John Tsiouris
Lead John Tsiouris

Panel Chair

Alex Norbash

Panel Reviewers

Neuroradiology Panel

License

Creative Commons 4.0 
Status Public Commenting
RadElement Set RDES89
                     

Clinical Implementation


Value Proposition

Epidural hematomas are typically post-traumatic, resulting from direct blunt trauma to the skull. They are frequently associated with overlying skull fractures. They can occur in patients of any demographic but are more common in the young. They can compress the adjacent brain, causing midline shift and central downward brain herniation, leading to increased intracranial pressure (ICP), brainstem compression and death if untreated. Epidural hematomas are critical to identify and manage as quickly as possible, since they are typically associated with injury to a dural artery and can quickly increase in size. Identifying them as soon as possible can significantly improve patient outcomes. In emergency situations, automated identification and classification of epidural hematomas would assist case prioritization and interpretation. In busy private practices, outpatient CT scans that potentially demonstrate epidural hematomas may not be reviewed for days after completion, delaying management and potentially leading to poor patient outcomes. Automated identification and classification would also provide value to non-specialists, especially those who read images in emergency situations.

Narrative

A 17-year-old male is skiing without a helmet and catches an edge on the icy slope. He falls and lands on his side, hitting his head against the hard ice. He feels dazed and a bit dizzy but does not lose consciousness. The ski patrol takes him to the nearest care station where he is assessed. He still feels a bit dizzy and has a severe headache. A large subcutaneous hematoma is noted along his right temple. He is sent to the nearest community hospital for evaluation, where a CT scan is ordered.

Workflow Description

Patient receives a CT of their head; the clinical indication will usually be head trauma. Algorithm receives entire CT dataset. If the algorithm can determine a result, return: size, location (R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar), density of the epidural hematoma. A reliability metric, assessing the accuracy of the size measurement, would also be helpful. An alert should notify the user.
Additional considerations are as follows: Algorithm executes after exam is verified on PACS in the backend. Algorithm optimally integrates on PACS and dictation or reporting software. The user is able to automatically populate the report or manually input the results. Indicator image may save to PACS as part of the medical record.

Considerations for Dataset Development



Age

[0,100]

Sex at birth

Male, Female

Hematoma

Absent, present

Density (CT)

Varied

Location

R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar

Technical Specifications


Inputs

DICOM Study

Procedure

CT, Head

Views

All

Data Type

DICOM

Modality

CT

Body Region

Head

Anatomic Focus

Brain


Primary Outputs


Hematoma Shape/Configuration

RadElement ID

RDE524

Definition

Shape/configuration of extra-axial hematoma/collection

Data Type

Categorical

Value Set

  • Undetermined
  • Crescentic
  • Lentiform

Units

N/A


Hematoma Laterality

RadElement ID

RDE525

Definition

Laterality of extra-axial hematoma/collection

Data Type

Categorical

Value Set

  • Undetermined
  • Unilateral
  • Bilateral

Units

N/A

Hematoma Location

RadElement ID

RDE528

Definition

Location of extra-axial hematoma/collection

Data Type

Categorical

Value Set

  • Undetermined
  • Frontal
  • Parietal
  • Temporal
  • Occipital
  • Parafalcine
  • Cerebellar

Units

N/A


Hematoma Width

RadElement ID

RDE521

Definition

Maximum width of extra-axial hematoma/collection (mm)

Data Type

Numeric

Value Set

[0,40]

Units

mm

Hematoma Volume

RadElement ID

RDE522

Definition

Volume of extra-axial hematoma (mm3)

Data Type

Numeric

Value Set

[0,200]

Units

mm3


Hematoma Density 

RadElement ID

RDE526

Definition

Density of extra-axial hematoma

Data Type

Categorical

Value Set

  • Indeterminate
  • High homogeneous
  • Low homogeneous
  • High heterogeneous
  • Low heterogeneous

Units

N/A


Hematoma Septations

RadElement ID

RDE527

Definition

Presence of extra-axial hematoma septations

Data Type

Categorical

Value Set

  • Indeterminate
  • Present
  • Absent

Units

N/A