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

19080009

Originator

Christopher P. Gange
Lead Christopher P. Gange

Panel Chair

Eric Stern

Panel Reviewers

Thoracic Panel

License

Creative Commons 4.0 
Status Public Commenting 
RadElement Set RDES114 
                               

Clinical Implementation


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.

Considerations for Dataset Development



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

Technical Specifications


Inputs

Current Chest Radiograph

 

Procedure

Chest X-ray 

Views

AP, PA, LAT 

Data Type

DICOM

Modality

X-Ray

Body Region

Chest

Anatomic Focus

Lung

Pharmaceutical

N/A

Scenario

Similar view to prior image in order to compare the change in fluid

 

Prior Chest Radiograph

 


Procedure

Chest X-ray

Views

AP, PA, LAT

Data Type

DICOM

Modality

X-Ray

Body Region

Chest

Anatomic Focus

Lung

Pharmaceutical

N/A

Scenario

Similar view to current image in order to compare the change in fluid

Primary Outputs


Fluid Volume

RadElement ID

RDE739

Definition

Fluid volume in patients suspect for pleural effusions and pulmonary edema

Data Type

Categorical

Value Set

  • None

  • Mild

  • Moderate

  • Severe

Units

N/A

Change in Fluid Volume

RadElement ID

RDE740

Definition

Change in fluid volume in patients suspect for pleural effusions and pulmonary edema.

Data Type

Categorical

Value Set

  • Decrease in fluid volume from prior

  • No change in fluid volume from prior

  • Increase in fluid volume from prior

Units

N/A