Pneumothorax

Purpose	Detection and quantification of pneumothorax on chest radiograph
Tag(s)
Panel	Thoracic
Define-AI ID	18080001
Originator	Thoracic Panel
Panel Chair	Eric J. Stern
Panel Reviewers	Thoracic Panel
License	Creative Commons 4.0
Status	Published
RadElement Set	RDES44

Clinical Implementation

Value Proposition

Pneumothorax is a potentially life-threatening but readily treated emergency. AI meeting this use case would help in detecting, quantitating, comparing, and alerting both nonspecialists and radiologists to this potentially life-threatening abnormality. In clinical settings where a radiologist is not readily available, such detection would be of value to nonradiologists. In clinical settings where radiologists are available, such detection could be used to alert the radiologist and prioritize its reporting and notification to the treating physicians. One possible extension to this use case is to track changes in size of previously detected pneumothoraces and those under treatment.

Narrative(s)

A 25-year-old patient presents after a motor vehicle accident, and a chest x-ray (CXR) is taken in the emergency room. An algorithm evaluates the image and categorizes the chest as pneumothorax present, absent, or undetermined. For cases when the algorithm returns pneumothorax present, if a radiologist is not present at the time of imaging, an alert is provided to the ordering physician. If a radiologist is present, the exam is prioritized in the radiologist worklist for urgent interpretation and reporting. Cases of potential pneumothorax without a chest tube should take higher priority in the reading queue compared with cases with a chest tube. Tension-pneumothorax cases also should be highly prioritized for reading.

A 70-year-old patient admitted to the ICU has several physiologic and monitoring interventions that have a risk of pneumothorax as a complication. An algorithm evaluates the image and categorizes the chest as being normal, abnormal, or undetermined. For cases when the algorithm returns pneumothorax present, if a radiologist is not present at the time of imaging, an alert is provided to the ordering physician. If a radiologist is present, the exam is prioritized in the radiologist worklist for urgent interpretation and reporting (particularly for new or enlarging pneumothorax or for possible tension).

Workflow Description

The image is obtained from modality and sent to PACS and the AI engine. The image is analyzed by the engine. The system then detects and estimates pneumothorax size. An alert message is sent to PACS from the engine with the information, identification, and graphic highlighting the pneumothorax.

Considerations for Dataset Development

Procedures(s):

XRAY, Chest; CT, Chest

View(s):

AP, PA/Lat, inclination e.g., upright, semi-upright, supine

Clinical Note: Subtle cases of PTX on supine CXRs manifested by “deep sulcus sign” can be overlooked by less experienced radiologists

Sex at Birth:

Male, Female

Age:

[0,90]

Chest Trauma (or intervention):

blunt injury, blast injury, chest wall injury, rib fracture, lung contusions, lacerations, pleural fluid

Comorbidities:

pleural fluid (including air/fluid levels), lung disease (e.g., Pneumonia/lung abscess, bullous emphysema, bronchiectasis), pneumomediastinum, other extrapleural air collections

Lung Tissue Involvement:

Complete Collapse, Partial collapse

Chest Tube:

{With one or more chest tubes/drainage catheters, interval placement, or former tubes

Tension Pneumothorax:

Tension pneumothorax (flattening of ipsilateral hemi-diaphragm or contralateral shift of the mediastinum)

Other:

Skin fold artifacts, Pleural fluid

Clinical Note: Skin fold artifacts are the most common cause of a false positive diagnosis of PTX

Technical Specifications

Inputs

DICOM Study

Procedure	XRAY, Chest
Views	AP, PA/Lat, inclination e.g., upright, semi-upright, supine
Data Type	DICOM
Modality	XRAY
Body Region	Chest
Anatomic Focus	Lung

Primary Outputs

Pneumothorax Detection

RadElement ID	RDE421
Definition	Detection of pneumothorax
Data Type	Categorical
Value Set	0–Unknown 1–Pneumothorax present 2–Pneumothorax absent
Units	N/A

Secondary Outputs

Pleural Separation

RadElement ID	RDE422
Definition	Measure pleural separation in mm
Data Type	Numerical
Value Set
Units	mm
Max Length	N/A

Pneumothorax Side

RadElement ID	RDE423
Definition	Defines the side of pneumothorax when present
Data Type	Categorical
Value Set	0-Right Side Pneumothorax 1-Left Side Pneumothorax 2-Bilateral
Units	N/A

Pneumothorax Size

RadElement ID	RDE424
Definition	Classify the size of pneumothorax (or pneumothoraces) as a function of interpleural distance. Launch if pneumothorax is detected.
Data Type	Categorical
Value Set	0–Small pneumothorax 1–Moderate pneumothorax 2–Large pneumothorax
Units	N/A

Chest Tube

RadElement ID	RDE425
Definition	Detect the presence of chest tube(s)
Data Type	Categorical
Value Set	0–Unknown 1–Tube(s) present 2–Tube(s) absent
Units	N/A

Future Development Ideas

The algorithm compares prior imaging and returns differences in output elements (pneumothorax detection, pleural separation, and pneumothorax size). By further extension, the algorithm may return percent of total volume of hemithorax or volume of pleural fluid.

Related Datasets

No known related public datasets at this time, please alert us if you know of any.