An artificial intelligence deep learning model for identification of small bowel obstruction on plain abdominal radiographs

Abstract

Objectives: Small bowel obstruction is a common surgical emergency which can lead to bowel necrosis, perforation and death. Plain abdominal X-rays are frequently used as a first-line test but the availability of immediate expert radiological review is variable. The aim was to investigate the feasibility of using a deep learning model for automated identification of small bowel obstruction. Methods: A total of 990 plain abdominal radiographs were collected, 445 with normal findings and 445 demonstrating small bowel obstruction. The images were labelled using the radiology reports, subsequent CT scans, surgical operation notes and enhanced radiological review. The data were used to develop a predictive model comprising an ensemble of five convolutional neural networks trained using transfer learning. Results: The performance of the model was excellent with an area under the receiver operator curve (AUC) of 0.961, corresponding to sensitivity and specificity of 91 and 93% respectively. Conclusion: Deep learning can be used to identify small bowel obstruction on plain radiographs with a high degree of accuracy. A system such as this could be used to alert clinicians to the presence of urgent findings with the potential for expedited clinical review and improved patient outcomes. Advances in knowledge: This paper describes a novel labelling method using composite clinical follow-up and demonstrates that ensemble models can be used effectively in medical imaging tasks. It also provides evidence that deep learning methods can be used to identify small bowel obstruction with high accuracy.

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“…In a recent paper, Kim et al investigated the feasibility of a DL model for the automated identification of small bowel obstruction: they collected 990 plain abdominal radiographs (445 with normal findings and 445 with small bowel obstruction), and used the data to develop a predictive model comprising an ensemble of five CNNs: they reported a good diagnostic performance, with an area under the curve of 0.961, 91% sensitivity, and 93% specificity [ 77 ].…”

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