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Acad Radiol. 2018 Nov;25(11):1422-1432. doi: 10.1016/j.acra.2018.03.008. Epub 2018 Mar 28.

Comparison of Natural Language Processing Rules-based and Machine-learning Systems to Identify Lumbar Spine Imaging Findings Related to Low Back Pain.

Author information

1
Department of Biostatistics, University of Washington, Seattle Washington; Center for Biomedical Statistics, University of Washington, Seattle Washington.
2
Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire.
3
Department of Health Services, University of Washington, Box 357660, Seattle WA 98195-7660; Department of Rehabilitation Medicine, University of Washington, SeattleWashington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105.
4
Department of Rehabilitation Medicine, University of Washington, SeattleWashington; Division of Rehabilitation Care Services, Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle,Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105.
5
Radia, Inc. 19020, Lynwood, Washington.
6
Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle WA 98195; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105.
7
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
8
Department of Radiology, Stanford University, Palo Alto, California.
9
Department of Radiology Mayo Clinic, Rochester, Minnesota.
10
Department of Radiology, Henry Ford Hospital, Detroit, Michigan.
11
Neuroscience Institute, Henry Ford Hospital, Detroit, Michigan.
12
Department of Health Services, University of Washington, Box 357660, Seattle WA 98195-7660; Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle WA 98195; Department of Neurological Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105. Electronic address: jarvikj@uw.edu.

Abstract

RATIONALE AND OBJECTIVES:

To evaluate a natural language processing (NLP) system built with open-source tools for identification of lumbar spine imaging findings related to low back pain on magnetic resonance and x-ray radiology reports from four health systems.

MATERIALS AND METHODS:

We used a limited data set (de-identified except for dates) sampled from lumbar spine imaging reports of a prospectively assembled cohort of adults. From N = 178,333 reports, we randomly selected N = 871 to form a reference-standard dataset, consisting of N = 413 x-ray reports and N = 458 MR reports. Using standardized criteria, four spine experts annotated the presence of 26 findings, where 71 reports were annotated by all four experts and 800 were each annotated by two experts. We calculated inter-rater agreement and finding prevalence from annotated data. We randomly split the annotated data into development (80%) and testing (20%) sets. We developed an NLP system from both rule-based and machine-learned models. We validated the system using accuracy metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

RESULTS:

The multirater annotated dataset achieved inter-rater agreement of Cohen's kappa > 0.60 (substantial agreement) for 25 of 26 findings, with finding prevalence ranging from 3% to 89%. In the testing sample, rule-based and machine-learned predictions both had comparable average specificity (0.97 and 0.95, respectively). The machine-learned approach had a higher average sensitivity (0.94, compared to 0.83 for rules-based), and a higher overall AUC (0.98, compared to 0.90 for rules-based).

CONCLUSIONS:

Our NLP system performed well in identifying the 26 lumbar spine findings, as benchmarked by reference-standard annotation by medical experts. Machine-learned models provided substantial gains in model sensitivity with slight loss of specificity, and overall higher AUC.

KEYWORDS:

Natural language processing; low back pain; lumbar spine diagnostic imaging

PMID:
29605561
PMCID:
PMC6162177
[Available on 2019-11-01]
DOI:
10.1016/j.acra.2018.03.008

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