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. In certain cases, when oral contrast does not reach the terminal ileum or was not provided during a CT scan, it is not possible to distinguish a complete from a partial small bowel obstruction or ileus. This is especially important in a postsurgical patient with a history of recurrent small bowel obstructions. Additionally, a radiologist often has to disrupt their workflow by assessing the fluoroscopy examination using barium-based or gastrografin contrast material and, in some instances, performing it. An algorithm evaluating the above mentioned characteristics on fluoroscopy scan and follow up radiographs can expedite management and aid radiologists and technologists in accurately and quickly classifying small bowel obstruction cases by fluoroscopy.
A 49-year-old man presenting with a past surgical history of small bowel obstruction presented with a 2- day history of nausea, vomiting and constipation. Nausea and vomiting have worsened over the past two days. An algorithm evaluates the small bowel follow through images and informs the radiologist and ordering provider regarding the presence or absence of contrast material reaching the colon in order to determine whether this is a recurrent complete small bowel obstruction.
Images are obtained from the fluoroscopy examination and follow up radiographs that are then sent to PACS and the AI engine. The images are then analyzed by the AI engine and an alert is sent to PACS with the classification information.
|
Procedure |
Small bowel follow through with barium-based or gastrografin contrast material. |
|
Sex at birth |
Male, female |
|
Age |
0-90 |
|
Presence of SBO |
Dilated loops of small bowel containing contrast that does not reach the colon in 24 hours. |
|
Degree of obstruction |
Complete obstruction vs partial obstruction (delayed transit of contrast) vs ileus |
|
Transition point |
High or low transition point |
|
Cause of obstruction |
Bowel wall/mucosal edema, stricture, mass, adhesions |
|
Variables |
Cholecystectomy clips, NG tube, metallic vascular stent, biliary stent, spinal hardware, embolization coils |
DICOM Study
|
Procedure |
Small bowel follow through using barium-based or gastrografin contrast material |
|
Views |
|
|
Data Type |
DICOM |
|
Modality |
Fluoroscopy, radiography |
|
Body Region |
Abdomen Pelvis |
|
Anatomic Focus |
Small bowel |
Small bowel obstruction
|
RadElement ID |
|
|
Definition |
Small bowel obstruction |
|
Data Type |
Categorical |
|
Value Set |
|
|
Units |
N/A |
Severity of obstruction
|
RadElement ID |
|
|
Definition |
Severity of obstruction |
|
Data Type |
Categorical |
|
Value Set |
|
|
Units |
N/A |
Small bowel diameter
|
RadElement ID |
|
|
Definition |
Maximum small bowel diameter |
|
Data Type |
Numeric |
|
Value Set |
0-100 |
|
Units |
mm |
Location of obstruction
|
RadElement ID |
|
|
Definition |
Transition point |
|
Data Type |
Categorical |
|
Value Set |
|
|
Units |
N/A |
Status of exam
|
RadElement ID |
|
|
Definition |
Exam complete or further follow up radiographs required |
|
Data Type |
Categorical |
|
Value Set |
|
|
Units |
N/A |