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MSK Extremity Mismatch

These topics describe the MSK Extremity Mismatch alert.

Purpose

To identify discrepancies in the upper and lower extremity exams documented across specific sections of a radiology report. The use cases for the MSK alerts identify the following:

  • When the following upper extremity concepts are detected on a lower extremity exam:

    • Metacarpal

    • Metacarpophalangeal

    • Humeral (on hip/femur exam)

  • When the following lower extremity concepts are detected on an upper extremity exam:

    • Metatarsal

    • Metatarsophalangeal

    • Femoral (on shoulder/humerus exam)

  • 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 RIGHT SHOULDER or LEFT FOOT 3 VIEWS

Details

Natural language processing (NLP) identifies the specific upper and lower extremity concepts listed above and compares them across specific sections of the radiology report to identify misspoken body structures., e.g., metatarsal misspoken on an upper extremity report.

Modalities, body structures, and sections

The NLP reasons over specific modalities, body parts, and report sections. Some modalities, body parts and sections are intentionally excluded in order to prevent false positives. A summary of the inclusions and exclusions for "MSK Extremity Mismatch" is provided below.

Table 10. MSK Extremity Mismatch included and excluded modalities, body structures, and sections

Included

Excluded

Modalities/body structures

Modality

Body Structures

  1. XR/CR (X-ray; Computed radiography)

  2. CT (Computerized tomography)

  3. MR (Magnetic Resonance Imaging (MRI))

  1. Metatarsal/Metatarsophalangeal on upper extremity exams

    1. Finger

    2. Hand

    3. Wrist

    4. Forearm

  2. Metacarpal/Metacarpophalangeal on lower extremity exams

    1. Toes

    2. Foot

    3. Ankle

    4. Lower leg

  3. Humeral on lower extremity

    1. Hip

    2. Femur

  4. Femoral on upper extremity

    1. Shoulder

    2. Humerus

Modalities:

  1. PET-CT

  2. Ultrasound

Body Structures:

  1. Whole Body

  2. Head and neck

  3. Spine

Report sections

  1. Examination

  2. Findings

  3. Impression

  4. Recommendation

  1. Addendum



Examples for testing

The following examples are provided to help you understand which reports will appear in Scout. The dictation phrases are for demonstration purposes only and may not be clinically accurate.

Table 11. MSK Extremity Mismatch testing examples

Exam type

Dictation phrase to be added to Findings, Impression, Recommendation section (select one of these sections)

Expected content alert

CR Right hand

Fracture at the neck of the 5th metatarsal indicative of a Boxer's fracture.

Metatarsal detected on upper extremity exam

XR Left hand

Findings are similar to the abnormalities seen in the 2nd MTP joint of the left handand consistent with seronegative inflammatory arthritis.

Metatarsophalangeal detected on upper extremity exam

CT Left foot

Suspected sesamoid bones are noted at all metacarpal heads. Mild degenerative change with mild cartilage space loss at multiple DIP joints

Metacarpal detected on lower extremity exam

X-Ray Right toe(s)

Instrumented fusion first metatarsophalangeal joint without complications, unchanged since prior. No acute abnormalities at the right foot.

Metacarpophalangeal detected on lower extremity exam

MRI Rt hip

Right subcapital humeral neck fracture with impaction superior laterally.

Humeral detected on lower extremity exam

CT Left shoulder

No evidence of left femoral shaft fracture.

Femoral detected on upper extremity exam