Acute chest and abdominal conditions, namely pneumoperitoneum and small-bowel obstruction, are urgent and critical findings found on chest and abdominal radiographs that frequently require prompt medical or surgical intervention. Small bowel obstruction alone accounts for 12 to 20% of surgical admissions for acute abdominal pain and is a significant cause of morbidity and mortality [1][2]. Yet, timely interpretation for X-rays remains a significant challenge due to the high volume of cases, low prioritization compared to MRI, CT and ultrasound, and limited time and human resources...

Data Selection: Automated RIS keyphrase searches specific for acute chest and abdominal conditions were performed on all radiological reports from 2006-2017 on PACS. Alongside negation detection, the keyphrase extraction automatically identified 84,399 potential studies (Fig. 1). A DICOM-parsing algorithm was then applied to filter each study for non-radiograph modalities, and then used to classify radiographs under posteroanterior (PA), anteroposterior (AP), lateral view for chest X-rays, and supine, upright or decubitus views for abdominal X-rays. Refining the search to only include reports suggestive for pneumoperitoneum and...

Classification performance: For pneumoperitoneum, 5-fold cross-validation accuracies during training ranged from 96.2% to 99.5%. The final network epoch was selected for the epoch with the lowest cross-validation loss. Out-of-sample test accuracy of the network was 97.8%, while its AUC was 0.988 (Fig. 2). For small-bowel obstruction, 5-fold cross-validation accuracies during training ranged from 87.4% to 90.3%. Out-of-sample test accuracy of the network was 89.1%, while its AUC was 0.956 (Fig. 2). Model AUC greatly exceeds the initial model by Cheng et al. and matches the...

Future Directions Training and validation of the networks were limited by the low quantity of cases and controls, and by the severe class imbalance in the case of pneumoperitoneum. Given the relative lack of anatomical conservation for small-bowel obstruction, a larger dataset or improved engineering methods for dealing with small and imbalanced datasets are needed. We propose multiple avenues of engineering development within the context of computer-assisted triaging for acute conditions. In order to resolve the issue of data scarcity, especially for uncommon or rare...

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