Midline Shift

Purpose

Detect and measure midline shift

Tag(s)

 

Panel

Neuroradiology

TOUCH-AI ID

TAI-03180001

Originator

Sumit Niogi

Panel Chair

Alex Norbash

Panel Reviewers

Neuroradiology Panel 

License

Creative Commons 4.0

Status Public Commenting
                               

Clinical Implementation


Value Proposition

Midline shift is closely associated with intracranial pressure (ICP), leading to brain stem compression and eventual death if untreated. It is critical to manage ICP as quickly as possible. Identifying midline shift, especially early or subtle onset, can significantly improve patient outcomes. In emergency situations, it is not always a neuro-specialist taking the first look at the study. Automated midline shift measurement would provide value to nonspecialists, especially those who read images in emergency situations.

Narrative(s)

A 27-year-old male pedestrian is struck by a motor vehicle. The patient is reported to have five minutes of loss of consciousness after the injury. At presentation to the ED, the patient does not remember the accident or how he arrived there. The patient has obvious left-frontal-scalp hematoma and swelling. Given physical exam findings and history of present illness, the ED physician references the ACR Appropriateness Guidelines for Traumatic Brain Injury and orders a noncontrast CT.

Workflow Description

The patient receives CT for head trauma. An algorithm receives the entire CT data set. If the algorithm can determine a result (the presence or absence of midline shift, distance of midline shift, and direction of shift), it is returned. A reliability metric, assessing the accuracy of the measurement, would also be helpful. If the midline shift is significant (larger than 5 mm), a modest alert should notify the user.

Additional considerations are as follows: The algorithm executes after the exam is verified on PACS. The algorithm optimally integrates on PACS and dictation or reporting software. The user is then able to automatically populate the report or manually input the results. An indicator image may save to PACS as part of the medical record.

Considerations for Dataset Development


Procedures(s): CT, Head

Sex at Birth: {Male, Female}

 

Age: [16,90]

 

Comorbidities: {Hematoma, tumor, abscess}

Technical Specifications


Inputs

DICOM Study

Procedure

CT, Head

Data Type

DICOM

Modality

CT

Body Region

Head

Anatomic Focus

Brain

Primary Outputs

Midline Shift

RadElement ID

RDE237

Definition

Measurement of midline shift at maximum (septum pellucidum) and at level of foramen of Monro.

Data Type

Numeric

Value Set

[0,10]

Units

mm

Secondary Outputs

Midline Shift Direction

RadElement ID

RDE238

Definition

The direction of midline shift, if present

Data Type

Categorical

Value Set

0–Unknown

1–No midline shift

2–Left
3–Right

Units

N/A

Public Commenting


Use cases are meant to be a primary vehicle for distributing clinical information to the developer community. They pinpoint precise scenarios within radiology workflows where potential automation could add noticeable value and establish standards for interpreting and passing corresponding common data elements. Implementing effective standards requires the perspective from all stakeholders. So to that end, we encourage your feedback on use cases.

To submit comments, please email DSIUseCases@acr.org with the use case title(s) and relevant comments by January 1, 2019. If more convenient, you may also download this use case and comment directly on the PDF. Just attach the PDF copy on the email.