Uroradiology Error Prevention System (UEPS)

on
Unified UEPS Workspace (V1 & V2)
🔄 Workspace Toggle

Uroradiology Error Prevention System (UEPS)

Abstract: Uroradiology errors persist despite adequate knowledge due to non-deterministic interpretation, fragmented reasoning, and inconsistent integration of clinical triggers. The UEPS proposes a deterministic, rule-governed architecture that converts interpretation into an auditable control system, reducing perceptual, conceptual, and cognitive bias driven errors.

⚠️ Diagnostic Variability

Errors arise from failures in perception, multi-signal integration, and cognitive bias under time pressure. The chart illustrates common observed failure classes derived from project data.

  • Under-calling subtle hydronephrosis
  • Mislabeling partial obstruction on non-contrast CT
  • Equating perinephric stranding with infection
  • Bladder lesion misses (no trigger-based search)

Observed Failure Classes

System Architecture (DSEA-Aligned)

L1: Rule Engine

Encodes executable deterministic rules.

L2: Input Layer

Structured clinical triggers and study type.

L3: Decision Control

Signal aggregation and contradiction detection.

L4: Output Layer

Structured report with restricted vocabulary.

🧠 Visual Cognitive Map

Your mental dashboard while reading. This map compresses decision-making into a strict deterministic pipeline. If you skip a layer, everything below becomes unreliable.

🔴 LAYER 1 — TRIGGER (ENTRY POINT)

HISTORY
Hematuria ↓ Bladder Priority
Colic ↓ Stone + Obstruction
Post-procedure ↓ Complication Protocol

👉 If you skip this layer, everything below becomes unreliable

🟡 LAYER 2 — STRUCTURED SEARCH (ANATOMY LOOP)

KIDNEY
Compare Sides
↓
Hydronephrosis?
(graded, not yes/no)
URETER
Trace Fully
↓
PUJ → Mid → Iliac → UVJ
BLADDER
Actively Interrogate
↓
Distension → Wall → Lesion → UVJ

🟠 LAYER 3 — OBSTRUCTION ENGINE (CORE LOGIC)

CAUSE (stone/mass/stricture)
UPSTREAM (hydronephrosis/dilatation)
SECONDARY (stranding/asymmetry)
INTEGRATION

Decision Rule

≥ 2 Signals → OBSTRUCTION (probable)
< 2 Signals → INDETERMINATE
🚫 NEVER: NCCT → "partial obstruction"

🟣 LAYER 4 — RED FLAG FILTERS

1. Stranding Check ▼

+ Parenchymal change → Infection possible

Alone → NON-SPECIFIC

2. Intraluminal Density Gate ▼

Typical → Stone

Atypical → THINK: Papilla, Clot, Tumor, Matrix stone

3. Stent Present? (HIGH ALERT) ▼

ACTIVATE: Bone window, Thin slices, Coronal, Separate stone check.

Never assume treatment success.

4. Stone Burden Logic ▼
Looks long? → ASSUME MULTIPLE → Confirm on coronal.
5. Urine Density Check ▼
Hydronephrosis? → Check HU of urine → High = Infection/debris risk.

🔵 LAYER 5 — OUTPUT CONTROL

BLOCK ✗

  • Partial obstruction
  • Pyelonephritis (w/o proof)
  • Absolute negatives

ALLOW ✓

  • Subtle / Mild / Suggestive
  • Indeterminate
  • Correlate clinically

⚫ FINAL SAFETY LOOP (5-SEC SCAN)

  • [ ] Compare kidneys?
  • [ ] Trace ureter fully?
  • [ ] Use ≥2 signals?
  • [ ] Check bladder actively?
  • [ ] Respect NCCT limits?
If ANY = No → re-evaluate

Deterministic Rule Set

Every inference must be tied to explicit, executable rules to ensure determinism over intuition.

Rule K: Language Control (Safety)

Forbidden Phrase Mandatory Replacement
No hydronephrosisNo significant / subtle fullness
Partial obstructionSuggestive of obstruction; severity indeterminate on NCCT
Pyelonephritis (w/o signs)Suspicious for / correlate clinically

SM CT KUB / CTU Interactive Checklist

A brutal, simple, and enforceable mental loop. Print, Use, Audit.

Safety Protocol 0%

❌ Unsafe Report

MANDATORY

🔴 STEP 0 — Trigger Activation

🟡 STEP 1 — Kidney Context

Hydronephrosis graded:

🚫 Prohibited: "No hydronephrosis" w/o comparison

🟡 STEP 2 — Ureter Tracking

Trace completely (Mandatory Checkpoints):
🛑 STOP: Report incomplete until fully traced.

⚙️ STEP 3 — Multi-Signal Obstruction Logic

Select Present Signals:

Calculated Output
Select signals...

Requires ≥ 2 signals to suggest obstruction.

CRITICAL

🟢 STEP 9 — Bladder (Mandatory in ALL cases)

Forced Question: Have I actively ruled out a bladder lesion?

Audit & Governance

The SM KUB Score enforces continuous quality improvement. Reports scoring below 85 trigger conditional reviews or failure protocols.

SM KUB Score Weighting (100 pts)

Grading Matrix

✅ Pass≥ 85
⚠️ Conditional70 – 84
❌ Fail< 70

🔄 Implementation Blueprint

  • •
    Pre-read pop-up: Trigger checklist auto-filled from indication.
  • •
    Macro insertion: SM structured template with gated fields.
  • •
    Hard stops: Missing ureter tracking prevents finalization. NCCT + partial obstruction blocked.

UEPS Framework v1.0 • Educational Dashboard

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