# Risk of malignancy index (RMI) RMI Status: LIVE Price: $0.005 USDC `GET /api/calc/rmi` HTML: https://magentlab.com/docs/rmi Markdown: https://magentlab.com/docs/rmi.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Jacobs 1990 risk of malignancy index as ultrasound score × menopausal score × CA125 (U/ml), then whether that product exceeds the published cutoff of 200. ## When to use When an agent has a caller-assigned ultrasound score (0, 1, or 3), postmenopausal flag, and CA125 in U/ml and needs the published Jacobs 1990 RMI and >200 cutoff, not a diagnosis of ovarian cancer and not later RMI-2 or RMI-3. ## When not to use - Not a medical device. magent does not diagnose ovarian cancer. - Jacobs 1990 RMI (RMI-I) only. Not later RMI-2 or RMI-3. - Caller assigns ultrasound_score (0 if no features, 1 if one of the five findings, 3 if two or more) and postmenopausal (more than one year since final period, or age >50 after hysterectomy). magent does not read ultrasound or date menses. - Published cutoff is RMI > 200 (exactly 200 does not exceed). magent does not invent probability tiers. ## Formula ``` RMI = U × M × CA125 (U/ml); U is ultrasound_score 0, 1, or 3 (never 2); M is 1 if premenopausal, 3 if postmenopausal; exceeds_200 if RMI > 200 (Jacobs 1990) ``` ## Citation [A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer](https://doi.org/10.1111/j.1471-0528.1990.tb02448.x) Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG Br J Obstet Gynaecol. 1990;97(10):922-929 DOI: [10.1111/j.1471-0528.1990.tb02448.x](https://doi.org/10.1111/j.1471-0528.1990.tb02448.x) ## Worked example ### CA125 50 U/ml, ultrasound 3, postmenopausal (exceeds 200) Given: `ca125_u_ml=50, postmenopausal=true, ultrasound_score=3` 1. U = 3 (two or more ultrasound features) 2. M = 3 (postmenopausal) 3. RMI = 3 × 3 × 50 = 450.0 4. 450.0 > 200 → exceeds_200 true ### CA125 200 U/ml, ultrasound 1, premenopausal (exactly 200) Given: `ca125_u_ml=200, postmenopausal=false, ultrasound_score=1` 1. U = 1, M = 1, CA125 = 200 2. RMI = 1 × 1 × 200 = 200.0 3. 200.0 is not > 200 → exceeds_200 false ## Also searched as - risk of malignancy index - RMI-I - Jacobs RMI - CA125 ultrasound menopausal - ovarian malignancy index - RMI score - Jacobs 1990 RMI ## Parameters - `ca125_u_ml` (number, required): Serum CA125 in U/ml (0-50000). Enters the product unrounded. Jacobs 1990 uses U/ml. magent does not assay CA125. - `ultrasound_score` (integer, required): Caller-assigned Jacobs 1990 ultrasound score: 0 if no features, 1 if one feature, 3 if two or more of multilocular cyst, solid areas, bilateral lesions, ascites, or intra-abdominal metastases. Never 2. magent does not read ultrasound. - `postmenopausal` (boolean, required): true if postmenopausal (M=3), false if premenopausal (M=1). Jacobs 1990: more than one year since final period, or age >50 after hysterectomy. Caller sets the flag; magent does not date menses. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/rmi` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "ca125_u_ml": "50", "postmenopausal": "true", "ultrasound_score": "3" }, { "ca125_u_ml": "50", "postmenopausal": "true", "ultrasound_score": "3" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rmi Example 200: ```json { "count": 2, "path": "/api/calc/rmi", "items": [ { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG", "doi": "10.1111/j.1471-0528.1990.tb02448.x", "id": "jacobs-1990-rmi", "pmid": "2223684", "source": "Br J Obstet Gynaecol. 1990;97(10):922-929", "title": "A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer" }, "formula": "rmi", "formula_expression": "RMI = U × M × CA125 (U/ml); U is ultrasound_score 0, 1, or 3 (never 2); M is 1 if premenopausal, 3 if postmenopausal; exceeds_200 if RMI > 200 (Jacobs 1990)", "ca125_u_ml": 50.0, "exceeds_200": true, "postmenopausal": true, "rmi": 450.0, "ultrasound_score": 3 }, { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG", "doi": "10.1111/j.1471-0528.1990.tb02448.x", "id": "jacobs-1990-rmi", "pmid": "2223684", "source": "Br J Obstet Gynaecol. 1990;97(10):922-929", "title": "A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer" }, "formula": "rmi", "formula_expression": "RMI = U × M × CA125 (U/ml); U is ultrasound_score 0, 1, or 3 (never 2); M is 1 if premenopausal, 3 if postmenopausal; exceeds_200 if RMI > 200 (Jacobs 1990)", "ca125_u_ml": 50.0, "exceeds_200": true, "postmenopausal": true, "rmi": 450.0, "ultrasound_score": 3 } ] } ``` ## Response fields - `formula` (string): rmi - `formula_expression` (string): Exact Jacobs 1990 expression - `ca125_u_ml` (number): CA125 used in U/ml, unrounded in the product - `ultrasound_score` (integer): U used: 0, 1, or 3 (never 2) - `postmenopausal` (boolean): Menopausal flag used (true → M=3, false → M=1) - `rmi` (number): U × M × CA125, 1 decimal (Jacobs 1990). Not a diagnosis. - `exceeds_200` (boolean): true if RMI > 200 (Jacobs 1990 published cutoff). Exactly 200 is false. - `citation` (object): Jacobs 1990 BJOG citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG", "doi": "10.1111/j.1471-0528.1990.tb02448.x", "id": "jacobs-1990-rmi", "pmid": "2223684", "source": "Br J Obstet Gynaecol. 1990;97(10):922-929", "title": "A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer" }, "formula": "rmi", "formula_expression": "RMI = U × M × CA125 (U/ml); U is ultrasound_score 0, 1, or 3 (never 2); M is 1 if premenopausal, 3 if postmenopausal; exceeds_200 if RMI > 200 (Jacobs 1990)", "ca125_u_ml": 50.0, "exceeds_200": true, "postmenopausal": true, "rmi": 450.0, "ultrasound_score": 3 } ``` ## Errors - HTTP 400 `invalid_ca125`: ca125_u_ml must be a number from 0 to 50000. Returned before settlement; you are not charged. - HTTP 400 `invalid_ultrasound_score`: ultrasound_score must be 0, 1, or 3 (Jacobs 1990; never 2). Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_rmi`: RMI needs CA125 (U/ml), ultrasound_score 0, 1, or 3, and postmenopausal as used in Jacobs 1990. Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [GPS](https://magentlab.com/docs/gps) — Apply the Forrest 2003 original Glasgow Prognostic Score (GPS) from caller-supplied CRP in mg/L and albumin. - [mGPS](https://magentlab.com/docs/mgps) — Apply the McMillan 2007 modified Glasgow Prognostic Score (mGPS) from caller-supplied CRP in mg/L and albumin. - [MAPS](https://magentlab.com/docs/maps) — Sum the Pardanani 2018 MAPS hybrid clinical-molecular (Figure 3) points for systemic mastocytosis and return low (≤2), intermediate_1 (3), intermediate_2 (4), or high (≥5). ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.