Choledocholithiasis Detection on Ultrasound

Purpose	Detection of choledocholithiasis on ultrasound
Tag(s)
Panel	Abdominal
Define-AI ID	20020010
Originator	Luther B. Adair, II
Lead	Luther B. Adair, II
Panel Chair	Arun Krishnaraj
Panel Reviewers	Abdominal Panel
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES160

Clinical Implementation

Value Proposition

Choledocholithiasis is a potentially life-threatening but treatable emergency. AI meeting this use case would help in detecting, quantitating, 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 non-radiologists such as technologists who would perform an ultrasound for this disease entity. 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.

Narrative(s)

A 44-year old patient presents with constant right upper quadrant pain and is taken to the emergency room at which time a right upper quadrant ultrasound is ordered.

A 67-year old patient presents to an outpatient clinic with jaundice and right upper quadrant pain and is sent to the emergency room, at which time a right upper quadrant ultrasound is ordered.

Workflow Description

An algorithm evaluates the ultrasound and categorizes whether choledocholithiasis is present, absent, or indeterminate and measures the stone size. If present, it then assesses whether there is biliary ductal dilatation present, absent, or undetermined and measures the common bile duct. For cases returned where the algorithm returns choledocholithiasis, the radiologist is made aware of the need for further evaluation or intervention. If the radiologist is not available, the non-radiologist is made aware of the need for further evaluation or intervention.

Considerations for Dataset Development

Procedures	{Ultrasound limited; Ultrasound of the abdomen complete, Ultrasound of the right upper quadrant}
Age	[0,90]
Sex at Birth	{Male, Female}
Abdominal pain	{right upper quadrant pain}
Comorbidities	{diabetes, sickle cell anemia, obesity}
Catheter	{common bile duct stent, common bile duct drain}
Other	{soft tissue mass in the common bile duct, pneumobilia, choldechocal cysts, distal soft tissue obstruction, cholelithiasis, cholecystectomy}

Technical Specifications

Inputs

DICOM Study

Procedure	ultrasound limited, abdominal ultrasound complete, right upper quadrant ultrasound
Views	Images of common bile duct
Data Type	DICOM
Modality	Ultrasound
Body Region	Abdomen
Anatomic Focus	Common bile duct

Primary Outputs

Choledocholithiasis Detection

RadElement ID	RDE1122
Definition	Presence of choledocholithiasis
Data Type	Categorical
Value Set	Absent Present Undetermined
Units	N/A

Choledocholithiasis Measurement

RadElement ID	RDE1120
Definition	If choledocholithiasis present then determine maximal stone diameter
Data Type	Numeric
Value Set	N/A
Units	mm

Secondary Outputs

Biliary Ductal Dilation Measurement

RadElement ID	RDE1121
Definition	Maximal common bile duct measurement
Data Type	Numeric
Value Set	N/A
Units	mm

Biliary Ductal Dilation Detection

RadElement ID	RDE1123
Definition	Biliary ductal dilation detection based on measurement. Absent if measurement is less than 6 mm for patients younger than 60 years, allow 1 mm for each decade over 60 years. Present if measurement is less than or equal 6-9 mm for patients younger than 60 years, allow 1 mm for each decade over 60 years. Present if measurement is greater than 15 mm in the setting of prior cholecystectomy.
Data Type	Categorical
Value Set	Absent Present Undetermined
Units	N/A

Periductal Fluid Detection

RadElement ID	RDE1124
Definition	Periductal fluid detection
Data Type	Categorical
Value Set	Absent Present Undetermined
Units	N/A

Future Development Ideas

Specify minimal acceptable imaging using ultrasound. For example, RAO parasagittal views of the common bile duct from the porta hepatis to the pancreas and then transverse images of the common bile duct through the head of the pancreas.
Possible extension to this use case is to detect choledocholithiasis on ultrasound and assess the need for further evaluation with MRCP
In the case of biliary ductal dilatation without an identified stone, soft tissue mass obstruction within the common bile duct, ampulla, or pancreas should be considered. Consider using this algorithm as an adjunct to the gallstone detection algorithm.

Related Datasets

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