Rad Lex Status Report Curtis P Langlotz MD

Rad. Lex Status Report Curtis P. Langlotz, MD, Ph. D Chair, RSNA Rad. Lex Steering Committee Vice Chair for Informatics, Dept. of Radiology Associate Professor of Radiology and Epidemiology Medical Director, University of Pennsylvania Health System

Acknowledgments and Disclosure • Supported in part by: – Radiological Society of North America (RSNA) – RSNA-National Institute for Biomedical Imaging and Bioengineering (NIBIB): “Rad. Lex Ontology Pilot Project” – National Cancer Institute (NCI) through the cancer Biomedical Informatics Grid (ca. BIG) initiative: “The Rad. Lex 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 • Rad. Lex background • Rad. Lex status report – Rad. Lex 2. 0 overview – Early adoption – Future plans • Key design decisions

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

Rad. Lex 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 Rad. Lex? • ~12, 000 terms • 15 committees • 150+ expert participants • 30+ participating organizations

Rad. Lex Committee Structure • Rad. Lex Steering Committee (Curt Langlotz) • Rad. Lex Organ System Committees (each met twice in 2006 --anatomy and pathology) – – – Abdominal (Isaac Francis) Thoracic (Theresa Mc. Loud) Musculoskeletal (David Rubin) Neuro (Adam Flanders) Cardiovascular (Kent Yucel) Pediatric (James Meyer) • Rad. Lex 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 Rad. Lex • Few direct benefits to promote at present • Make stakeholders aware of process • Focus on developers • Once lexicon is complete, focus on users and RFPs

Rad. Lex 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 2 nd finger Tendon of superficial flexor muscle of 2 nd finger Sheath of tendon of superficial flexor muscle of 2 nd finger What about the other 4 fingers? What about synonyms (e. g. , index finger)?

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 Chest imaging CPT codes 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

www. radlex. org radlexfeedback@rsna. org

Adoption of Rad. Lex • Teaching file software – RSNA MIRC, Rad. Pix, my. PACS. net, ACR Index, • Decision support software – i. Virtuoso Yotta. Look. TM, Goldminer. TM, Elsevier Rad. Consult. TM, • Clinical reporting (planned) – Commissure Rad. Where. TM, Structu. Rad Report. Now. TM • Research projects – ca. BIG, NCIA, Ontology of Biomedical Investigations, BIRN, FMA • Standards – DICOM, IHE, SNOMED, HL 7 • Scientific publications – 33 abstracts at RSNA last 3 years • Translations – German, Spanish, Portuguese

Rad. Lex Resources • www. radlex. org Documentation & Downloads link – Protégé files (v 3. 3. 1) – SQL files – XML files • radlexwiki. rsna. org – Rad. Lex API – Rad. Lex SQL database schema • Rad. Lex on Source. Forge. net – Rad. Lex plugins: upload text files, assign new IDs • Rad. Lex Google group (groups. google. com) – All MSWord files from which lexicon is derived – Previous versions of Protégé files

Rad. Lex 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 Rad. Lex • Leadership transition--move to curation/editorial phase • Repository of best-practices radiology reports based on Rad. Lex

Rad. Lex Summary • Likely to become a de facto standard for imaging terminology • Transition to curation mode • Clinical radiologists will see concrete benefits as vendors adopt Rad. Lex

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