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Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities.

Publication ,  Journal Article
Wildman-Tobriner, B; Ngo, L; Mammarappallil, JG; Konkel, B; Johnson, JM; Bashir, MR
Published in: J Am Coll Radiol
July 2021

PURPOSE: Incidental pulmonary embolism (IPE) can be found on body CT. The aim of this study was to evaluate the feasibility of using artificial intelligence to identify missed IPE on a large number of CT examinations. METHODS: This retrospective analysis included all single-phase chest, abdominal, and pelvic (CAP) and abdominal and pelvic (AP) CT examinations performed at a single center over 1 year, for indications other than identification of PE. Proprietary visual classification and natural language processing software was used to analyze images and reports from all CT examinations, followed by a two-step human adjudication process to classify cases as true positive, false positive, true negative, or false negative. Descriptive statistics were assessed for prevalence of IPE and features (subsegmental versus central, unifocal versus multifocal, right heart strain or not) of missed IPE. Interrater agreement for radiologist readers was also calculated. RESULTS: A total of 11,913 CT examinations (6,398 CAP, 5,515 AP) were included. Thirty false-negative examinations were identified on CAP (0.47%; 95% confidence interval [CI], 0.32%-0.67%) and nineteen false-negative studies on AP (0.34%; 95% CI, 0.21%-0.54%) studies. During manual review, readers showed substantial agreement for identification of IPE on CAP (κ = 0.76; 95% CI, 0.66-0.86) and nearly perfect agreement for identification of IPE on AP (κ = 0.86; 95% CI, 0.76-0.97). Forty-nine missed IPEs (0.41%; 95% CI, 0.30%-0.54%) were ultimately identified, compared with seventy-nine IPEs (0.66%; 95% CI, 0.53%-0.83%) identified at initial clinical interpretation. CONCLUSIONS: Artificial intelligence can efficiently analyze CT examinations to identify potential missed IPE. These results can inform peer-review efforts and quality control and could potentially be implemented in a prospective fashion.

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Published In

J Am Coll Radiol

DOI

EISSN

1558-349X

Publication Date

July 2021

Volume

18

Issue

7

Start / End Page

992 / 999

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Quality Improvement
  • Pulmonary Embolism
  • Prospective Studies
  • Prevalence
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Artificial Intelligence
  • 3202 Clinical sciences
 

Citation

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Chicago
ICMJE
MLA
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Wildman-Tobriner, B., Ngo, L., Mammarappallil, J. G., Konkel, B., Johnson, J. M., & Bashir, M. R. (2021). Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities. J Am Coll Radiol, 18(7), 992–999. https://doi.org/10.1016/j.jacr.2021.01.014
Wildman-Tobriner, Benjamin, Lawrence Ngo, Joseph G. Mammarappallil, Brandon Konkel, Jacob M. Johnson, and Mustafa R. Bashir. “Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities.J Am Coll Radiol 18, no. 7 (July 2021): 992–99. https://doi.org/10.1016/j.jacr.2021.01.014.
Wildman-Tobriner B, Ngo L, Mammarappallil JG, Konkel B, Johnson JM, Bashir MR. Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities. J Am Coll Radiol. 2021 Jul;18(7):992–9.
Wildman-Tobriner, Benjamin, et al. “Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities.J Am Coll Radiol, vol. 18, no. 7, July 2021, pp. 992–99. Pubmed, doi:10.1016/j.jacr.2021.01.014.
Wildman-Tobriner B, Ngo L, Mammarappallil JG, Konkel B, Johnson JM, Bashir MR. Missed Incidental Pulmonary Embolism: Harnessing Artificial Intelligence to Assess Prevalence and Improve Quality Improvement Opportunities. J Am Coll Radiol. 2021 Jul;18(7):992–999.
Journal cover image

Published In

J Am Coll Radiol

DOI

EISSN

1558-349X

Publication Date

July 2021

Volume

18

Issue

7

Start / End Page

992 / 999

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Quality Improvement
  • Pulmonary Embolism
  • Prospective Studies
  • Prevalence
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Artificial Intelligence
  • 3202 Clinical sciences