What is a finding?
vRad utilizes NLP (Natural Language Processing) technology to process each report and determine if findings are present. Findings are determined to be present if sufficient text is found to support a positive finding related to a Systematized Nomenclature of Medicine (SNOMED) code. A normal, or no findings present, is determined by the lack of positive SNOMED code generating text within the findings and impression sections of the report.
There are five finding types:
1.Positive Finding
A positive finding is any abnormality identified by the radiologist, whether or not it is related to the reason for exam. Language specifically referencing a positive finding must be present in the Findings or Impression sections of the radiologist’s report. A positive finding indication results in an overall positive report; a report that has both positive and negative findings also results in an overall positive report.
Examples of Positive Findings:
- There is a small left pleural effusion
- There is an uncomplicated nephrolith
2.Critical Finding
A critical finding is any abnormality identified by the radiologist that may need immediate patient treatment and physician intervention. vRad’s NLP technology recognizes predefined diseases or conditions and automatically flags the study for immediate follow-up. Critical results are always positive, however, positive findings are not always critical.
Examples of Critical Findings:
- There is a right frontal subdural hematoma
- There is a large, left-sided pneumothorax
3.Incidental Finding
An incidental finding is any abnormality identified by the radiologist which is not indicative of acute pathology. Incidental findings are unexpectedly encountered, often benign and of little clinical significance. However, they may still require clinical follow up. An incidental finding by itself does not result in an overall positive report.
Examples of Incidental Findings:
- There are mild degenerative changes of the cervical spine
- Prior cholecystectomy
4.Negative Finding
A negative finding is the absence of a disease or a condition within a specific area of the anatomy. If a report has both positive and negative findings, the overall report is positive.
Examples of Negative Findings: (“no _”)
- There is no intracranial hemorrhage
- No findings to suggest acute appendicitis
5.Normal Finding
A normal finding is the absence of abnormality in the anatomy. Specific language within the radiology report often include “normal” and “unremarkable”
Examples of Normal Findings:
- The heart is normal in size
- The appendix is within normal limits