title: A Natural Language Processing-based Model to Automate MRI Brain Protocol Selection and Prioritization.
abstract: Incorrect imaging protocol selection can contribute to increased healthcare cost and waste. To help healthcare providers improve the quality and safety of medical imaging services, we developed and evaluated three natural language processing (NLP) models to determine whether NLP techniques could be employed to aid in clinical decision support for protocoling and prioritization of magnetic resonance imaging (MRI) brain examinations.
  
  
  
  To test the feasibility of using an NLP model to support clinical decision making for MRI brain examinations, we designed three different medical imaging prediction tasks, each with a unique outcome: selecting an examination protocol, evaluating the need for contrast administration, and determining priority. We created three models for each prediction task, each using a different classification algorithm-random forest, support vector machine, or k-nearest neighbor-to predict outcomes based on the narrative clinical indications and demographic data associated with 13,982 MRI brain examinations performed from January 1, 2013 to June 30, 2015. Test datasets were used to calculate the accuracy, sensitivity and specificity, predictive values, and the area under the curve.
  
  
  
  Our optimal results show an accuracy of 82.9%, 83.0%, and 88.2% for the protocol selection, contrast administration, and prioritization tasks, respectively, demonstrating that predictive algorithms can be used to aid in clinical decision support for examination protocoling.
  
  
  
  NLP models developed from the narrative clinical information provided by referring clinicians and demographic data are feasible methods to predict the protocol and priority of MRI brain examinations.
authors.affiliation: Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: andrew.brown@sloan.mit.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Brown
authors.affiliation: Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Marotta
mesh_terms: D000465:Algorithms; D001927:Brain Diseases / Q000175:diagnosis*; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D006292:Health Priorities; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009323:Natural Language Processing; D018579:Patient Selection; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D060388:Support Vector Machine
keywords: Quality; machine learning; natural language processing; safety