The RadLex Playbook Describing Imaging Devices, Procedures, and Protocols Curtis P. Langlotz, MD, PhD David Channin, MD Beverly Collins, PhD Charles Kahn, Jr, MD John Paulett Daniel Rubin, MD, MS November 25, 2007

Acknowledgments and Disclosure Supported in part by: Radiological Society of North America (RSNA) RSNA-National Institute for Biomedical Imaging and Bioengineering (NIBIB): “RadLex Ontology Pilot Project” National Cancer Institute (NCI) through the cancer Biomedical Informatics Grid (caBIG) initiative: “The RadLex Research Playbook” Society for Imaging Informatics in Medicine (SIIM) Grant: “Systematic Nomenclature for Imaging Procedures” (Sistrom) American College of Radiology, through its grant of a license to the ACR Index for Radiological Diagnoses Disclosure: Consultant, Elsevier, Inc. Radiology Advisory Board, GE Healthcare

Tower of Babel

Medical Vocabularies: Completeness for Radiology Langlotz & Caldwell, J Digit Imaging 15(1S):201, 2002

What is RadLex? A lexicon for uniform indexing and retrieval of radiology information resources A consistent vocabulary to improve clinical communication Common data elements to improve clinical imaging research

Data Collection CDE Example 1.Please describe the margins of the mass: a.Smooth b.Lobulated c.Irregular d.Spiculated e.Obscured

Data Collection CDE Example 1.Please describe the margins of the mass: a.Smooth b.Lobulated c.Irregular d.Spiculated e.Obscured Vocabulary Concepts

Identifying Studies of Interest Problems with CPT Key information is not explicit : Thorax and chest are synonyms MRI chest w/o dye and CT chest w/o dye use different modalities to image the same anatomic region CT thorax w/o dye and CT thorax w/dye are the same procedure, except for administration of IV contrast CT angiography, chest is similar to CT thorax w/dye, except the former is designed to visualize the vascular system CT thorax w/o&w dye is a combination of CT thorax w/o dye and CT thorax w/dye 71250CT thorax w/o dye 71260CT thorax w/dye 71270CT thorax w/o&w dye 71275CT angiography, chest 71550MRI chest w/o dye 71551MRI chest w/dye 71552MRI chest w/o&w/dye 71555MRI angio chest w or w/o dye Chest imaging CPT codes

What is RadLex? ~12,000 terms 15 committees 150+ expert participants 30+ participating organizations

RadLex Committee Structure RadLex Steering Committee (Curt Langlotz) RadLex Organ System Committees (each met twice in anatomy and pathology) Abdominal (Isaac Francis) Thoracic (Theresa McLoud) Musculoskeletal (David Rubin) Neuro (Adam Flanders) Cardiovascular (Kent Yucel) Pediatric (James Meyer) RadLex Modality Commitees (each met once in 2007) Computed Tomography (Isaac Francis) Ultrasound (Steve Horii) Interventional (Sanjoy Kundu) Magnetic Resonance Imaging (Don Mitchell) Nuclear Medicine (Bennett Greenspan) Radiography and Fluoroscopy (Dave Channin)

Cooperating Organizations American College of Radiology American Society of Functional Neuroradiology (ASFNR) American Society of Head and Neck Radiology (ASHNR) American Society of Neuroradiology (ASNR) American Society of Pediatric Neuroradiology (ASPNR) American Society of Spine Radiology (ASSR) Cardiovascular Radiology Council of the American Heart Association (AHA) College of American Pathologists DICOM/IHE Fleischner Society International Skeletal Society (ISS) International Society of Magnetic Resonance in Medicine (ISMRM) North American Society for Cardiac Imaging (NASCI) North American Spine Society (NASS) Society of Body Computed Tomography and Magnetic Resonance (SCBTMR) Society for Cardiovascular Computed Tomography (SCCT) Society for Cardiovascular Magnetic Resonance (SCMR) Society of Gastrointestinal Radiology (SGR) Society for Pediatric Radiology (SPR) Society of Radiologists in Ultrasound (SRU) Society of Skeletal Radiology (SSR) Society of Thoracic Radiology (STR) Society of Uroradiology (SUR)

The Plight of the Lexicographer …the writer of dictionaries [is] doomed only to remove rubbish and clear obstructions from the paths through which Learning and Genius press forward to conquest and glory, without bestowing a smile on the humble drudge that facilitates their progress. --Samuel Johnson, 1747

Procedure Step

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Term Viewer

NCI Thesaurus Iterative Lexicon Development Process SNOMED- CT RadLex Lexicon Development Committees XML RadLex base content OWL RadLex Protégé Database SNOMED- CT RadLex web site UMLS Meta- Thesaurus Lexicon Development Process OWL

The RadLex Playbook: An Indexed Charge Master Modality* (e.g., CT) Body region* (e.g., chest) Modality modifier (e.g., angiography) Imaging target (e.g., pulmonary artery) Anatomy modifier (e.g., left, right, bilateral) Technique (e.g., dynamic) Contrast (e.g., IV) Patient maneuver (e.g., inspiration) Standardized procedure name Mapped to CPT or other procedure code *required element CPT CT angiography, chest RadLex: CT-CHEST-ANGIO-PULMONARY-ARTERY Attributes of an orderable

Adoption of RadLex Teaching file software RSNA MIRC, RadPix, myPACS.net, ACR Index, Decision support software iVirtuoso YottaLook TM, Goldminer TM, Elsevier RadConsult TM, Clinical reporting (planned) Commissure RadWhere TM, StructuRad ReportNow TM Research projects caBIG, NCIA, Ontology of Biomedical Investigations, BIRN, FMA Standards DICOM, IHE, SNOMED, HL7 Scientific publications 33 abstracts at RSNA last 3 years Translations German, Spanish, Portuguese

RadLex Research Playbook Phase II Harmonization with EVS, caDSR, and DICOM Other RadLex activities: Integration of remaining anatomy and finding terms Ob/gyn, congenital/develomental, visual features, normal variants Linkage with other terminology systems ACR Index, SNOMED, CPT, FMA Formalize licensing terms for RadLex Move to curation/editorial phase Likely to become a de facto standard for imaging terminology

RadLex Playbook Summary Likely to become a de facto standard for imaging terminology Next step is harmonization for caBIG silver compatibility Related RSNA project: A repository of radiology reports based on RadLex (“imaging CRFs”)