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Pneumothorax Triage Algorithm Prioritizes X-Ray Scheduling

By MedImaging International staff writers
Posted on 26 Sep 2019

Image: A novel X-Ray scheduling algorithm prioritizes pneumothorax triage X-Ray scheduling (Photo courtesy of GE Healthcare).

A novel artificial intelligence (AI) algorithm analyzes chest x-rays for pneumothorax and helps flag suspected cases for radiologists to prioritize reading.

The GE Healthcare (GE; Little Chalfont, United Kingdom) Critical Care Suite is designed to automatically scan images for pneumothorax immediately upon acquisition, without any additional infrastructure or IT networking. Notifications arrive in picture archiving and communication systems (PACS) at the exact same time as the original digital imaging and communications in medicine (DICOM) image, causing no additional delay or processing time, thus enabling the escalation of image review and shorter turn-around times for prioritized cases.

Developed using more than 12,000 images from six total data sources in three different countries, the pneumothorax triage algorithm detects nearly all large pneumothoraxes, with 96% sensitivity, 75% sensitivity, and 94% specificity. The positive predictive value (PPV) ranges from 35%-70%, depending on the prevalence of pneumothorax; for 4% prevalence, the algorithm had one true notification per two false notifications, and for 15% prevalence, it had seven true notifications per three false notifications. The negative predictive value ranged from 97-99%, based on the same prevalence range.

“Since thousands of chest x-rays are taken in a hospital every day, looking for pneumothorax in critical patients is kind of like trying to find a needle in a haystack,” said Rachael Callcut, MD, MSPH, director of data science for the Center for Digital Health Innovation at the University of California, San Francisco (UCSF), who was involved in the development of the Critical Care Suite. “The algorithms themselves are not making diagnoses, but draw everyone's attention to finding something potentially life-threatening for patients.”

Primary spontaneous pneumothorax is an abnormal accumulation of air in the pleural space that can result in the partial or complete collapse of a lung. It is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space, creating pressure that is manifest as chest pain on the side of the collapsed lung and shortness of breath. Often, people who experience a primary spontaneous pneumothorax have no prior sign of illness; the blebs themselves typically do not cause any symptoms and are visible only on medical imaging. Affected individuals may have one to more than thirty blebs.

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69 (52.213668823242): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (398.87428283691): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (366.9261932373): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.028366088867): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (84.877014160156): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (44.107437133789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.014785766602): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

105 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

106 (79.870223999023): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (80.108642578125): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

109 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

110 (74.148178100586): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294779470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (715.01731872559): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294779470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (809.1926574707): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (569.82040405273): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

115 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

116 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

117 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

118 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

119 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

120 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

121 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

122 (553.84635925293): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779470 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779470 AND type='deeppockets_item' AND published='1' LIMIT 1

123 (!!!!! 728797.91259766): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

124 (94.175338745117): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

125 (72.002410888672): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

126 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

127 (72.956085205078): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

128 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

129 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

130 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

131 (696.89750671387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

132 (488.0428314209): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

133 (336.88545227051): SELECT name FROM jos_deeppockets WHERE id=211

134 (48.87580871582): SELECT name FROM jos_deeppockets WHERE id=211

135 (699.99694824219): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

136 (540.97175598145): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

137 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

138 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

139 (492.09594726562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

141 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

142 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

143 (!!!!! 1518.0110931396): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

144 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

145 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

146 (57.220458984375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779470 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779470 AND type='deeppockets_item' AND published='1' LIMIT 1

147 (51.021575927734): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

148 (41.961669921875): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

149 (49.829483032227): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

150 (154.97207641602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

151 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779470 AND published='1' LIMIT 1

152 (97.036361694336): select jos_twitters.link from jos_twitters where cat=10

153 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

154 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

155 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

156 (371.93298339844): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

157 (!!!!! 1530.8856964111): insert into jos_banners_delta values (14615,'2025-05-02 02:03:27','3.142.135.246','view'),(14202,'2025-05-02 02:03:27','3.142.135.246','view'),(14203,'2025-05-02 02:03:27','3.142.135.246','view')

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