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

2. 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

3. Outline RadLex background RadLex status report Key design decisions
RadLex 2.0 overview
Early adoption
Future plans
Key design decisions

4. 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

5. RadLex 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)

6. What is RadLex? ~12,000 terms 15 committees 150+ expert participants
30+ participating organizations

7. RadLex Committee Structure
RadLex Steering Committee (Curt Langlotz)
RadLex Organ System Committees (each met twice in 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)

8. 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)

9. Promotion of RadLex Few direct benefits to promote at present
Make stakeholders aware of process
Focus on developers
Once lexicon is complete, focus on users and RFPs

10. RadLex 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

11. Pre- vs. Post-Coordination
Superficial flexor muscle of 2nd finger
Tendon of superficial flexor muscle of 2nd finger
Sheath of tendon of superficial flexor muscle of 2nd finger
What about the other 4 fingers?
What about synonyms (e.g., index finger)?

12. 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

17. Adoption of RadLex Teaching file software Decision support 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

18. RadLex Resources www.radlex.org Documentation & Downloads link
Protégé files (v3.3.1)
SQL files
XML files
radlexwiki.rsna.org
RadLex API
RadLex SQL database schema
RadLex on SourceForge.net
RadLex plugins: upload text files, assign new IDs
RadLex Google group (groups.google.com)
All MSWord files from which lexicon is derived
Previous versions of Protégé files

19. RadLex 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 RadLex
Leadership transition--move to curation/editorial phase
Repository of best-practices radiology reports based on RadLex

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

21. The End

22. Why Not Google? Pertinent negatives Synonyms
“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: , 2001