The RadLex Playbook

Describing Imaging Devices, Procedures, and Protocols

Curtis P. Langlotz, MD, PhDDavid Channin, MDBeverly Collins, PhDCharles Kahn, Jr, MDJohn PaulettDaniel 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

4%9%

14%9%

42%

71%

50%50%

52%

87%

63%63%

0%

25%

50%

75%

100%

ICD9 SNOMED UMLS

 FSG:

eDict:

 LSVT:

Mean

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.Smoothb.Lobulatedc.Irregulard.Spiculatede.Obscured

Data Collection CDE Example

1. Please describe the margins of the mass:

a.Smoothb.Lobulatedc.Irregulard.Spiculatede.Obscured

Vocabulary Concepts

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

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)

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

Procedure Step

www.radlex.org - radlexfeedback@rsna.org

Term Viewer

NCI Thesaurus

Iterative LexiconDevelopment Process

SNOMED-CT

RadLex Lexicon Development Committees

XMLRadLex base

content

OWL

OWL

RadLexProtégé

Database

SNOMED-CT

RadLexwebsite

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)

Standardizedprocedure name

Mapped to CPT or other procedure code

*required elementCPT 71275 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 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 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”)