Laterality Mismatch

These topics describe the Laterality Mismatch alert.

Purpose

To identify discrepancies in the laterality documented across specific sections of a radiology report.

Details

The natural language processing (NLP) identifies right and left laterality concepts related to specific body structures and compares them across specific sections of the radiology report to find discrepancies.
Only unilateral musculoskeletal (MSK) exams are included in the reasoning in the core module.
Hips, sacroiliac (SI) joints, and central body structures that occur in pairs (e.g., breasts, kidneys, ureters, ovaries, testes) are not included as part of the core module because the NLU engine would have diffculty in identifying when it is accurate vs erroneous to dictate a particular side.
Specialty alerts are available for the hip, SI join, and breast (see the "Optional setup of laterality alerts, no default" section below).
For these Assist alerts to fire, customer exam descriptions must include the following:
- Modality and/or number of views
- Laterality
- Body part
For example: CT LEFT FOOT or LEFT FOOT 3 VIEWS

Modalities, body structures, and sections

The NLP reasons over specific modalities, body parts, and report sections for each individual alert. Some modalities, body parts and sections are intentionally excluded in order to prevent false positive alerts. A summary of the includes and exclusions for the laterality mismatch alert are provided below.

Table 9. Laterality Mismatch included/excluded modalities, body structures, and sections

Included

Excluded

Modalities*

*For optimal Assist alerting, it is recommended that the modality is included in the description section of the Exam Code Dictionary.

1. XR/CR (including RF exams)
US
CT (including CTA exams)
MR (including MRA exams)

NM
PET
MG**

**MG is included for customers that have the breast alert enabled (see the "Optional setup for laterality alerts, not default" section below).

Body Structures

Upper Extremity	Lower Extremity
Finger Finger/Digit Phalanx Phalanges DIP or PIP joint Interphalangeal joint MCP joint Metacarpal	Toes Toe/Digit Phalanx Phalanges DIP/PIP joint Interphalangeal joint MTP join Metatarsal Forefoot Hindfoot Midfoot
Hand MCP joint Metacarpal CMC join Anything from the Finger section above Any of the 8 wrist bones listed under Wrist Radius/Ulna	Foot Forefoot Hindfoot Midfoot Heel/Calcaneus MTP joint Metatarsal TMT joint Anything from the Toe section above Any of the ankle bones listed below Tibia/Fibula Tibiotalar
Wrist Scaphoid (or Navicular) Luinate Triquetral (or Triquetrum) Pisiform Trapezium (or greater multangular) Trapezoid (or lesser multangular) Capitate Hamate Anything from the Hand section above Radius/Ulna	Ankle Cuneiform Cuboid Navicular Talus Calcaneus Os calcis Anything from the Foot section above Tibia/Fibula Tibiotalar
Forearm Radius Ulna Elbow Humerus Any of the 8 wrist bones listed above Metacarpal Coronoid Olecranon Trochlea Epicondyle Humerus Capitellum	Lower leg Tibia Fibula Knee/Ankle patella Malleolus Any of the ankle bones listed above Metatarsal Tibiotalar Condyle Tibial Plateau Patella Femur
Elbow Radius Ulna Humerus Capitulum Coronoid Olecranon Trochlea Epicondyle Capitellum	Knee Condyle Tibial Plateau Patella Tibia Fibula Femur
Humerus Elbow Shoulder Radius Ulna Clavicle Scapula Capitulum Trochlea Epicondyle Coronoid Coracoid Capitellum	Femur Condyle Femur Trochanter Epicondyle Hip Knee Tibia Fibula
Shoulder/Clavicle/Scapula Humerus Clavicle Scapula Tubercle Coracoid Glenoid Glenohumeral

Head
Neck
Chest
Abdomen
Pelvis
Hip(s)
Whole body
Thyroid
Lung
Rib
Breast**
Kidney
Ureter
Ovary
Fallopian tube
Testicle
Hip***
SI joint***
SC joint
AC joint

***Specialty alerts are available for the breast, hip, and SI joint (see the "Optional setup for laterality alerts, not default" section below.)

Report sections

The laterality mismatch module compares laterality between the following pairs of sections.+

Exam/Technique
Exam/Findings
Exam/Impression
Technique/Findings
Technique/Impression
Findings/Impression

Example: the following document would trigger a laterality mismatch for use case #2 under Default section pairings above:

EXAMINATION PERFORMED: CR RIGHT WRIST 2 VIEWS

FINDINGS: Fracture of the left wrist.

+See the "Optional setup of laterality alerts, not default" section below for additional section pairings that can be enabled upon request.

History
Comparison

Examples for testing

The following examples are provided to help you test the Assist alerts in FFI. In order to test, actual test exams need to be set up in the Admin page. Changing the token wording or exam name will not produce good test results.

Laterality mismatch being tested between	Exam section	Technique section	Findings section	Impression section	Expected Assist alert
Exam and Technique sections	MRI OF THE RIGHT KNEE WITHOUT CONTRAST	MR images of the left knee were obtained on a 1.5 Tesla MRI system without intravenous contrast administration.	---	---	Laterality mismatch between Exam/Techniques (which laterality/body part)
Exam and Findings sections	CR ELBOW 3 VW LEFT	---	Evidence of right elbow fracture.	---	Laterality mismatch between Exam/Findings (which laterality/body part)
Exam and Impression sections	HAND LEFT ROUTINE	---	---	There is a boxer's fracture of the right 5th distal metacarpal.	Laterality mismatch -between Exam/Impression (which laterality/body part)
Technique and Findings sections	---	AP, LAT OBLIQUE VIEWS OF THE RIGHT ANKLE OBTAINED	Oblique fracture of the distal fibula identified with disruption of the ankle mortise and widening of the left tibial-talar joint	---	Laterality mismatch -between Exam/Impression (which laterality/body part)
Technique and Impression sections	---	XR FOOT 3 VIEWS COMPLETE RIGHT	---	Normal radiographs of the left foot.	Laterality mismatch between Technique/Impression (which laterality/body part)
Findings and Impression sections	---	---	Displaced angulated supracondylar fracture distal left humerus.	Acute traumatic closed displaced angulated supracondylar fracture of the distal right humerus.	Laterality mismatch between Findings/Impression (which laterality/body part)

Frequently Asked Questions

Will the alert fireif dictating the same body structure, using a more specific anatomical component, with opposing laterality in another section? YES
1. Example: Exam Performed = XR Right foot / Findings = Left metatarsal
Will the alert firewhen "comparison" (or variations thereof), i.e. "comparison of" or "similar" are detected in a section? NO
1. Example: Exam Performed = XR Right foot / Findings = "Advanced degenerative changes, to a lesser degree when compared to the left foot."
Will the alert fire if using the various abbreviations that indicate laterality i.e. LT, RT, Rt, Lt? YES
1. Example: Exam Performed = XR WRIST LT 2 VW
Will the alert fire if "left" and "right" are dictated in any one section? NO
1. Example: XR FOREARM RT: Dictation includes Right Ulna + Left Radius in Impression section
2. Example: Technique section - 3 views of the left foot, 3 views of the right foot
3. Example: Exam Section - Right Foot-3 views; Findings Section - Right foot appears slightly demineralized which may be related to protracted under use. Left forefoot is unremarkable.
Why is hip excluded from the Default Laterality Package?
1. In reviewing reports of hip, the majority of time both lateralities are mentioned so we excluded from the default package to reduce the number of false positives.
Why are specific body parts and organs excluded from receiving laterality mismatch alerts?
1. Kidney, lung, ovary, Fallopian tube, testes, ureter, thyroid, breast
  1. More times than not, both right and left are intentionally documented on these reports which would result in far too many false positive alerts.
2. AC joint, SC joint, SI joint are typically ordered bilaterally unless ordered as an injection or special views, therefore these reports are excluded.