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Improving Early Detection
of Serious Disease
Natural Language Processing to increase follow-up
on significant incidental findings
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Clinical Information:
38 year old female with diabetes, status post MVA, restrained
passenger, with no head trauma or loss of consciousness.
Assess for skeletal and internal injuries.
Current Imaging Procedure Description:
CT Chest Abdomen
Oral contrast: Oral contrast was administered.
IV contrast:
90 mL
Chest: with intravenous contrast
Abdomen: with intravenous contrast
status post MVA … Assess
for skeletal and internal
injuries.
Radiology Comparison study:
None.
Procedure Findings:
Chest
Lungs and large airways: Lungs are clear bilaterally.
Pleura: Normal.
Vessels: Normal.
Atherosclerosis: No evidence.
Heart: Heart size normal with no pericardial effusion.
Mediastinum and hila: Subcentimeter axillary nodes.
Chest wall: The bony structures of the thorax are WNL. No acute
rib fractures. There is a 1.8 cm breast mass in the right upper
quadrant of the right breast appreciated on image 4.
Abdomen
Liver: Normal.
Bile ducts: Normal.
Gallbladder: No calcified gallstones. Normal caliber wall.
Pancreas: Normal.
Spleen: The spleen is enlarged, but homogenous.
Adrenals: Normal.
Kidneys: Small 8 mm left superior renal cyst.
Bowel: Normal caliber.
Mesenteric lymph nodes: No enlarged mesenteric lymph nodes.
Peritoneum: No ascites or free air; no fluid collection.
Abdominal wall: Normal.
Impressions:
Essentially negative CT scans for acute traumatic injuries.
There is a 1.8 cm breast
mass in the right upper
quadrant …
Impressions … negative …
for acute traumatic injuries.
Incidental Finding
Unexpected medical result not related to the
reason for an ordered study
lung scan
clogged artery
x-ray for back pain
spot on liver
cystitis urinalysis
trace protein in liver
3
Mean frequency of incidental
findings in CT imaging is 31%
Lumbreras et al. 2010. Incidental findings in imaging diagnostic
tests: a systematic review. The British Journal of Radiology.
4
28% of incidental breast lesions
were unsuspected breast cancers
Moyle et al. 2010. Incidental breast lesions detected on CT: what
is their significance? The British Journal of Radiology.
5
Most concerning findings referred
for follow-up in only 49% of cases
Munk et al. 2010. Frequency and Follow-up of Incidental Findings
on Trauma Computed Tomography Scans: Experience at a
Level One Trauma Center. The Journal of Emergency Medicine.
6
Substantial disability and medical
cost, cause for malpractice claims
Daugherty et al. 2014. Tracking Incidental Findings. Radiology
Today.
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Low follow-up
Volume of exams
Impressions vs Findings
Complexity
Priority
Omission of non-suspicious
Familiarity with finding
User interfaces
8
Demonstration
Automated Flagging of
Significant Incidental Findings
LifeCode® Natural Language Processing
Optum Enterprise & Professional CAC & CDI
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Interoperability
Communicating non-significant incidentals may:
Overwhelm and panic the patient
Divert attention from primary conditions
Lead to unnecessary tests
Lead to additional treatments with risk
Selective targeting with scenario driven logic
Flag
Abdominal Aortic
Aneurysm
Flag
Lung Cancer
Scenario
Abdominal aorta,
unusual size
Scenario
Weak evidence with
prior exam change
 abdominal aorta
 diameter > 3.0 cm
 lung consolidation
 worsening
“The proximal abdominal
aorta measures 3.1
centimeters in diameter.”
“... there is interval increase
in left upper greater than
lower lung consolidation …”
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Selective targeting with natural language processing
• Synonymy, paraphrase, word variants
lung, pulmonary, pleural, subpleural, midlung, …
breast, nipple, retroareolar, subareolar, …
nodule, nodules, nodular, nodularity, …
• Negation and History
“No sonographic evidence
of a liver mass.”
Evidence negated,
does not support
flagging
“History: History of ovarian
cancer, status post surgery
and chemotherapy.”
Historical reference,
does not support
flagging
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