Identifying Small Bowel Obstruction

Purpose

Detect small bowel obstruction

Tag(s)

Panel

Abdominal Panel

Define-AI ID

20020014

Originator

Zerwa Farooq

Panel Chair

Luther B. Adair

Panel Reviewers

Luther B. Adair, Andrew Smith, and Kiran Thakrar

License

Creative Commons 4.0

Status Public Comment
RadElement Set RDES178

 
   
   
   
   
   
   
   
   
 

Clinical Implementation


Value Proposition

 

Small bowel obstruction is a common surgical condition accounting for up to 20% of surgical admissions. Evaluation of the presence, severity, cause and complications of small bowel obstruction on cross sectional imaging provides the basis of surgical or conservative management strategies. An algorithm evaluating the above mentioned characteristics can expedite management and aid radiologists in accurately and quickly classifying small bowel obstruction cases. 


Narrative(s)

 

A 50-year-old woman presented with a 2-day history of worsening nausea, vomiting, and constipation.   She had a surgical history of  appendectomy.  An algorithm evaluates the small bowel and informs the radiologist regarding the presence or absence of obstruction.


Workflow Description

 

Images are obtained from the CT and sent to PACS and the AI engine. The image is then analyzed by the AI engine and an alert is sent to PACS with the classification information. An alert is also sent to the ordering provider so that appropriate consultation and management can be initiated without unnecessary delay.


Considerations for Dataset Development



Procedure

CT, CECT, CT with or without oral contrast

Sex at birth

Male, female

Age

0-90

Presence of SBO

Dilated proximal loops of small bowel with relatively collapsed distal small bowel loops (in contradistinction to ileus where no transition point is identified), extent of dilation of small bowel loops that can be measured as maximum diameter in millimeters

Degree of obstruction

Complete obstruction, high grade or low grade partial obstruction, based on the passage of oral contrast beyond the point of obstruction.

Transition point

High or low transition point

Cause of obstruction

Intrinsic (inflammatory, neoplasm, hematoma), extrinsic (adhesions, hernias, external mass effect) or intraluminal (foreign body, gallstones, bezoars)

Presence of complications 

Closed loop obstruction, bowel wall thickening, bowel wall enhancement, pneumatosis, ascites, pneumoperitoneum

Technical Specifications


Inputs


DICOM Study

Procedure

CT

Data Type

DICOM

Modality

CT

Body Region

Abdomen Pelvis

Anatomic Focus

Small bowel



Primary Outputs


Small bowel obstruction

RadElement ID

RDE1237

Definition

Small bowel obstruction

Data Type

Categorical

Value Set

  • SBO absent

  • SBO present

  • undetermined

Units

N/A





Secondary Outputs



Severity of obstruction

RadElement ID

RDE1238

Definition

Severity of obstruction

Data Type

Categorical

Value Set

  • partial low grade

  • partial high grade

  • complete obstruction

  • undetermined

Units

N/A


Small bowel diameter

RadElement ID

RDE1239

Definition

Maximum small bowel diameter

Data Type

Numeric

Value Set

0-100

Units

mm


Location of obstruction

RadElement ID

RDE1240

Definition

Location of obstruction

Data Type

Categorical

Value Set

  • proximal

  • mid

  • distal

  • undetermined

Units



Cause of obstruction

RadElement ID

RDE1241

Definition

Cause of obstruction

Data Type

Categorical

Value Set

  • intrinsic

  • extrinsic

  • intramural

  • undetermined

Units

N/A


Small bowel wall enhancement

RadElement ID

RDE1242

Definition

Small bowel wall enhancement

Data Type

Categorical

Value Set

  • diffuse present

  • partial absent

  • completely absent

  • undetermined

Units

N/A


Small bowel wall thickness

RadElement ID

RDE1243

Definition

Small bowel wall thickness

Data Type

Numeric

Value Set

0 - 10

Units

mm


Presence of ascites

RadElement ID

RDE1244

Definition

Ascites

Data Type

Categorical

Value Set

  • absent

  • present

  • undetermined

Units

N/A


Presence of pneumatosis

RadElement ID

RDE1245

Definition

Pneumatosis

Data Type

Categorical

Value Set

  • absent

  • present

  • undetermined

Units

N/A


Presence of pneumoperitoneum

RadElement ID

RDE1246

Definition

Pneumoperitoneum

Data Type

Categorical

Value Set

  • absent

  • present

  • undetermined

Units

N/A


Future Development Ideas


The algorithm can compare studies with prior established SBO and appropriately assess resolution or worsening of obstruction e.g. interim resolution of bowel dilation or development of indicators suggesting complications as explained above.