# Presentation: 571259

## 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

## Slide 3

## Medical Vocabularies: Completeness for Radiology

**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

**Please describe the margins of the mass:**
- Smooth
- Lobulated
- Irregular
- Spiculated
- Obscured

## Data Collection CDE Example

**Please describe the ****margins**** of the ****mass****:**
- Smooth
- Lobulated
- Irregular
- Spiculated
- Obscured

## 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

| 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**

## Slide 14

## www.radlex.org

## Slide 16

## Lexicon Development Process

_**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)**

***required element**

_**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”)**