LateralityMismatchInference

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A laterality mismatch is flagged when the order specifies a body part with a laterality (for example, 'x-ray right foot') and the text refers to the opposite laterality (for example, 'left foot is normal'). The mismatch is also flagged when there's a body part with left or right in the finding section, and the same body part occurs with the opposite laterality in the impression section.

There are some restrictions to the code, because in many cases, when a body part is visualized, part of the contralateral body part is visible as well. See the standards for that.

Example (without token extensions):

{
	"kind": "lateralityDiscrepancy",
	"discrepancyType": "orderLateralityMismatch",
	"lateralityIndication": {
		"coding": [
			{
				"code": "7771000",
				"system": "http://snomed.info/sct",
				"display": "LEFT (QUALIFIER VALUE)"
			}
		]
	}
}

There are three possible discrepancy types:

• orderLateralityMismatch means that the laterality in the text conflicts with the one in the order.
• textLateralityContradiction means that there's a body part with left or right in the finding section, and the same body part occurs with the opposite laterality in the impression section. This occurs less often than an orderLateralityMismatch.
• textLateralityMissing means there's no mismatch of the other two kinds, but the laterality mentioned in the order never occurs in the text.

The lateralityIndication is:

• For orderLateralityMismatch: the concept in the text that the laterality was flagged for. This is either SNOMED code 24028007 ("RIGHT (QUALIFIER VALUE)") or 7771000 ("LEFT (QUALIFIER VALUE)").
• For textLateralityContradiction: the concept in the impression section that the laterality was flagged for. As for orderLateralityMismatch, this is either snomed code 24028007 or 7771000.
• For textLateralityMissing, this isn't filled in. A mismatch with discrepancy type textLaterityMissing has no token extensions. Also, for such a mismatch, if there are several orders, the JSON output doesn't show which order caused the mismatch.

Examples request/response JSON:

{
      "jobData": {
        "configuration": {
          "inferenceOptions": {
            "followupRecommendationOptions": {
              "includeRecommendationsWithNoSpecifiedModality": false,
              "includeRecommendationsInReferences": false,
              "provideFocusedSentenceEvidence": false
            },
            "findingOptions": {
              "provideFocusedSentenceEvidence": false
            }
          },
          "inferenceTypes": ["lateralityDiscrepancy"],
          "locale": "en-US",
          "verbose": false,
          "includeEvidence": false
        },
        "patients": [
          {
            "id": "111111",
            "details": {
              "sex": "female",
			  "birthDate" : "1986-07-01T21:00:00+00:00",
              "clinicalInfo": [
                {
                  "resourceType": "Observation",
                  "status": "unknown",
                  "code": {
                    "coding": [
                      {
                        "system": "http://www.nlm.nih.gov/research/umls",
                        "code": "C0018802",
                        "display": "MalignantNeoplasms"
                      }
                    ]
                  },
                  "valueBoolean": "true"
                }
              ]
            },
            "encounters": [
              {
                "id": "encounterid1",
                "period": {
                  "start": "2021-8-28T00:00:00",
                  "end": "2021-8-28T00:00:00"
                },
                "class": "inpatient"
              }
            ],
            "patientDocuments": [
              {
                "type": "note",
                "clinicalType": "radiologyReport",
                "id": "docid1",
                "language": "en",
                "authors": [
                  {
                    "id": "authorid1",
                    "fullName": "authorname1"
                  }
                ],
                "specialtyType": "radiology",
                "createdAt": "2021-8-28T00:00:00",
                "administrativeMetadata": {
                  "orderedProcedures": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "https://loinc.org",
                            "code": "26688-1",
                            "display": "US BREAST - LEFT LIMITED"
                          }
                        ]
                      },
                      "description": "US BREAST - LEFT LIMITED"
                    }
                  ],
                  "encounterId": "encounterid1"
                },
                "content": {
                  "sourceType": "inline",
                  "value" : "Exam:   US LT BREAST TARGETED\r\n\r\nTechnique:  Targeted imaging of the  right breast  is performed.\r\n\r\nFindings:\r\n\r\nTargeted imaging of the left breast is performed from the 6:00 to the 9:00 position.  \r\n\r\nAt the 6:00 position, 5 cm from the nipple, there is a 3 x 2 x 4 mm minimally hypoechoic mass with a peripheral calcification. This may correspond to the mammographic finding. No other cystic or solid masses visualized.\r\n"
				}
              }
            ]
          }
        ]
      }
    }

{
  "result": {
    "patientResults": [
      {
        "patientId": "111111",
        "inferences": [
          {
            "kind": "lateralityDiscrepancy",
            "lateralityIndication": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "24028007",
                  "display": "RIGHT (QUALIFIER VALUE)"
                }
              ]
            },
            "discrepancyType": "orderLateralityMismatch"
          }
        ]
      }
    ],
    "modelVersion": "2025-03-17"
  },
  "id": "fca110",
  "createdAt": "2025-04-30T11:18:36Z",
  "expiresAt": "2025-05-01T11:18:36Z",
  "updatedAt": "2025-04-30T11:18:41Z",
  "status": "succeeded"
}