The Radiology Playbook:A Missing Component of RadLex™

Nasya Mendoza-Elias and Lizhou Huang

Pat Mongkolwat, Ph.D. and David S. Channin, M.D.Northwestern University Feinberg School of Medicine

DePaul University College of Computing and Digital MediaNational Science Foundation Research Experience for UndergraduatesIn Medical Informatics ProgramAugust 21, 2008

Overview

Introduction Progress Future Work

What is RadLex™?

Funded by the Radiological Society of North America (RSNA)

Purpose Capturing Indexing Retrieving

Will unify other lexicons

What is the RadLex™Playbook?

Orders, procedures, and procedure steps Powered by an ontology Dynamic

Why do we need a Playbook?

Consistency Interoperability Inadequacy of other lexicons

What about

Common Procedural Terminology CPT™?Not an adequate description

71010 Radiologic examination, chest; single view, frontal 71015 Radiologic examination, chest; stereo, frontal 71020 Radiologic examination, chest, two views, frontal and lateral 71021 Radiologic examination, chest, two views, frontal and lateral; with apical lordotic 71022 Radiologic examination, chest, two views, frontal and lateral; with oblique 71023 Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy 71030 Radiologic examination, chest, complete, minimum of four views 71034 Radiologic examination, chest, complete, minimum of four views; with fluoroscopy 71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky

studies)

Whereas Merrill’s Atlas of Radiographic Positioning and Radiologic Procedures says:

The IHE Model

Order Placer System: orderable Order Filler: orderable procedures Order Filler: procedure steps via modality

worklist

So… Orderable Referring physician Requested Procedure(s) Radiologist

Reportable, codifiable, billable unit of work Procedure Step Technologist (modality)

Scheduled procedure steps Performed procedure steps

The Challenge

Treading the fine line of granularity between the needs of the referring physician and the detail of radiology operations

What will the RadLex™ Playbook deliver initially? Knowledge model Grammar

Set of orderable names Grammar for imaging and non-imaging

procedure steps A set of procedure step names Can be used in DICOM

What can you do with the Playbook? Build a chargemaster Protocol studies Tailor studies Build software applications with

“knowledge”

What’s been keeping us busy

Ontology structure GUI Query

Filtering of choices

Ontologies

What is an ontology? Concepts and relationships For example

Wine: An alcoholic beverage fermented from grapes Red Wine: Wine fermented from whole grapes

is_a wine color: red

White wine: Wine fermented from skinless grapes is_a wine color: white

Chardonnay is_a white wine Bordeaux is_a red wine

Allows for knowledge based computation: “Is Chardonnay a wine?”

For example…Paranasal Sinus1. Survey2. SAG T1 SE3. COR SE T14. COR T2 TSE5. AX SE T16. AX T2 TSE7. INJECT8. AX SHARP FS9. COR SHARP FS10. SAG SHARP FS

NMH-HEAD_47

1. MR FACE MP SCOUT

2. MR FACE SAG T1R-2D(SE_1)_N

3. MR FACE COR T1R-2D(SE_1)_N

4. MR FACE COR T2P-2D(SE_N)_N/M

5. MR FACE AX T1R-2D(SE_1)_N

6. MR FACE AX T2P-2D(SE_N)_N/M

7. MR FACE INJ GAD

8. MR FACE AX 2D(GRE_1)_N

9. MR FACE COR 2D(GRE_1)_N

10. MR FACE SAG 2D(GRE_1)_N

Translation –CT, DEXA, Fluoro, Mammo, X-Ray Use RadLex Categorize procedure steps by attributes

Knowledge Model Example

XRAY CHEST is_a Imaging Orderable XRAY CHEST has_steps

1. XRAY CHEST PA XRAY CHEST PA is_a XRAY Procedure Step XRAY CHEST PA has_projection CORONAL XRAY CHEST PA produces DICOM DX Object

2. XRAY CHEST LATERAL LEFT XRAY CHEST LATERAL LEFT is_a XRAY Procedure

Step XRAY CHEST LATERAL LEFT has_projection SAGGITAL XRAY CHEST LATERAL LEFT produces DICOM DX

Object

1

2

45

3

6

7

8 9

10

11

12

NameRest. 1 Rest. 2 Rest. 3 Rest. 4 Rest. 5

Procedure Step

Radiologist TechnicianPhysician

Web Interface Protégé

Ontology(Orderables/Procedure Steps)

Technician

Builds,populates and editsDrives

User Interface

Query based on a series of restrictions Restriction filters are mutually linked Restrictors can be applied in any order

GUI (July 18)

1

2

3

4

5

Querying the Ontology

Code by Kaustubh Supekar, Stanford, created for a different project

Surprisingly roundabout codea.txtDeletes everything that is not a result

Problems with the query

SlowRequires vast amounts of codeLoads ontology for every query

Future Work

Connecting all parts of the GUI with the query

Optimizing the queryStrip unnecessary codeLoad ontology once

Future Work

Realtime web interface Modifying ontology Authorization and administration Integration into RadLex Other features

Such as…

Exporting protocols Printing Searching for similar protocols

Radiologist TechnicianPhysician

Web Interface Protégé

Ontology(Orderables/Procedure Steps)

Technician

Builds,populates and editsDrives

Radiologist TechnicianPhysician

Web Interface Protégé

Ontology(Orderables/Procedure Steps)

Technician

Builds,populates and edits

Drives Edits

Thank you

Questions?