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 - [email protected]
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”)