Curtis P. Langlotz, MD, PhDChair, RSNA RadLex Steering CommitteeVice Chair for Informatics, Dept. of RadiologyAssociate Professor of Radiology and EpidemiologyMedical Director, University of Pennsylvania Health System
RadLex Status Report
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
Outline
• RadLex background• RadLex status report
– RadLex 2.0 overview– Early adoption– Future plans
• Key design decisions
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
RadLex Key Features
• Adopts existing concepts from widely accepted standards (e.g., SNOMED, DICOM)
• Fills gaps where radiology terms are absent
• Freely available, courtesy of RSNA• Linked back to existing term sets (e.g.
CPT, ACR Index, UMLS)
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 2006--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)
Promotion of RadLex
• Few direct benefits to promote at present
• Make stakeholders aware of process
• Focus on developers• Once lexicon is
complete, focus on users and RFPs
RadLex Term Guidelines
• No plurals except when intrinsic to term– meninges, fused ribs OK
• Omit articles– proximal phalanx of finger
• Nominal form when possible– fundus of uterus rather than uterine fundus
• English form rather than Latin form– deep femoral artery rather than profunda femoris artery
• Omit possessives for eponyms– Alzheimer disease rather than Alzheimer’s disease
• Prefer descriptive terms over eponyms– uveomeningitic syndrome vs. Vogt-Koyanagi-Harada
syndrome• Use post-coordination to avoid combinatoric explosion
Pre- vs. Post-Coordination
Superficial flexor muscle of 2nd finger Tendon of superficial flexor muscle of 2nd finger
Sheath of tendon of superficial flexor muscle of 2nd finger
What about the other 4 fingers?
What about synonyms (e.g., index finger)?
Identifying Studies of InterestProblems 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
71250 CT thorax w/o dye
71260 CT thorax w/dye
71270 CT thorax w/o&w dye
71275 CT angiography, chest
71550 MRI chest w/o dye
71551 MRI chest w/dye
71552 MRI chest w/o&w/dye
71555
MRI angio chest w or w/o dye
Chest imaging CPT codes
Adoption of RadLex
• Teaching file software– RSNA MIRC, RadPix, myPACS.net, ACR Index,
• Decision support software– iVirtuoso YottaLookTM, GoldminerTM, Elsevier RadConsultTM,
• Clinical reporting (planned)– Commissure RadWhereTM, StructuRad ReportNowTM
• 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 Resources
• www.radlex.org Documentation & Downloads link– Protégé files (v3.3.1)– SQL files– XML files
• radlexwiki.rsna.org– RadLex API– RadLex SQL database schema
• RadLex on SourceForge.net– RadLex plugins: upload text files, assign new IDs
• RadLex Google group (groups.google.com)– All MSWord files from which lexicon is derived– Previous versions of Protégé files
RadLex Plans 2008
• 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• Leadership transition--move to
curation/editorial phase• Repository of best-practices radiology
reports based on RadLex
RadLex Summary
• Likely to become a de facto standard for imaging terminology
• Transition to curation mode• Clinical radiologists will see
concrete benefits as vendors adopt RadLex
The End
Why Not Google?
• Pertinent negatives– “There is no evidence of ectopic pregancy”– Automatic detection: sens 82%; spec 96%*
• Synonyms– renal stone vs. kidney stone vs. urolithiasis
• Hierarchical relationships– cancer AND lung vs.
adenocarcinoma AND lingula
*Chapman et al. J Biomed Informatics 34: 301-310, 2001
