Midline Shift

Purpose	Detect and measure midline shift
Tag(s)
Panel	Neuroradiology
Define-AI ID	18030001
Originator	Sumit Niogi
Panel Chair	Alex Norbash
Panel Reviewers	Neuroradiology Panel
License	Creative Commons 4.0
Status	Published
Related RadElement Sets	RDES39

                               

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.

Procedures(s): CT, Head

Sex at Birth: {Male, Female}

 

Age: [16,90]

 

Comorbidities: {Hematoma, tumor, abscess}

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

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