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

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

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

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

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)

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)

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

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

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)?

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 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

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

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

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

The End

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: 301-310, 2001