Fluid Status

Purpose	Determine if the more recent study has increased or decreased fluid in chest radiographs
Tag(s)
Panel	Thoracic Panel
Define-AI ID	19080006
Originator	Christopher P. Gange
Lead	Christopher P. Gange
Panel Chair	Eric Stern
Panel Reviewers	Thoracic Panel
License	Creative Commons 4.0
Status	Published
RadElement Set	RDES114

                               

Value Proposition

Chest radiographs are often used to quickly assess fluid status in patients who have trouble breathing while undergoing diuresis, or treatment for heart or renal failure, to evaluate for pleural effusions and pulmonary edema. Unfortunately, there is significant intraobserver and interobserver variability and not all radiologists report edema and effusions quantitatively to allow for comparison.

An algorithm which could take two sequential chest radiographs and determine if the more recent study has increased or decreased fluid could reduce variability between studies and improve the subsequent clinical decisions regarding diuresis and heart failure management.

Narrative(s)

A 59 year old treated for mild chronic heart failure with oral home diuretics comes to the ED short of breath. A chest radiograph is performed that is read as “mild pulmonary edema”. At least two other studies over the past month have also been read this way. On review at the heart failure clinic weeks later, it was determined that the pulmonary edema has been increasing on these X-rays. The patient’s diuretic dose is increased and they feel better in a few days. More quantitative reads could have alerted clinicians to this change more quickly and improved the heart failure management.

Workflow Description

The images are obtained from modality and sent to PACS and the AI engine. The image is analyzed by the engine. The system then quantifies fluid volume on the radiograph and determines if the volume has changed from prior imaging. An alert message is sent to PACS from the engine with the information about the current study.

Procedure	Chest XRAY
View(s)	AP, PA, Lat, inclination, upright, semi-upright, supine
Size of pleural effusion	varied
Sex at birth	Male, Female
Comorbidities	pleural air or fluid (including air/fluid levels), lung disease (e.g., Pneumonia/lung abscess, bullous emphysema, bronchiectasis), pneumomediastinum, other extrapleural air collections
Skin fold artifacts	Absent, present
Heart size	normal, enlarged
Age	[18,100]
Non-cardiogenic pumonary edema	absent, present
Pleural effusions of other etiology	absent, present
Congestive heart failure	absent, present

Inputs

Current Chest Radiograph

 

 

Prior Chest Radiograph

 

Primary Outputs

Fluid Volume

Change in Fluid Volume

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