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Clinical LOINC Meeting - Salt Lake City, UT USA

Radiology Studies
Daniel J. Vreeman, PT, DPT, MSc
Associate Research Professor, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
@djvreeman

2016

Overview
1. Overview of Radiology content in LOINC
2. LOINC Radiology Model (How we name
imaging studies)
3. Future evolution via collaboration with
RSNA

photo via Vernio77

LOINC Diagnostic
Imaging (Radiology)

photo via Karen Roe

In diagnostic imaging,
LOINC provides codes for:
Ordered (and returned) imaging study
Sections within a report
Measurements or observations made

Diagnostic Imaging Report


Structure from things like:

Document Level Codes


Abdomen CT
Brain MRI W & WO Contrast IV
Orbit X-ray for foreign body

This is our

bread and butter

Radiology Report Terms


> 5100 active terms in v2.54

Modality

# LOINC Terms

CT

739

Mammography

145

MRI

856

Nuclear Medicine

455

Ultrasound

445

XR

1892

Fluoroscopy

662

Sections within a Report


18785-6
55108-5
55111-9
11329-0
18782-3
55107-7
55109-3
55114-3
55113-5
19005-8
18834-2
18783-1
55115-0
55112-7
55110-1

Reason for study


Clinical presentation
Current imaging procedure descriptions
History general
Study observation (Findings)
Addendum
Complications
Prior imaging procedure descriptions
Key images
Impressions
Comparison study
Recommendation
Requested imaging studies information
Document summary
Conclusions

Measurements / Observations
38261-4
38264-8
53626-8
8294-1

Hip DXA Bone density


Hip DXA [T-score] Bone density
CT Cerebral atrophic index
Chest XR Diameter.anterior-posterior

In other domains, this is


LOINCs main content

Radiology Naming Model


First some general principles

Multiple Levels of Specificity


Views
named, counted, no specification
Laterality
right, left, bilateral, unilateral, unspecified
Contrast
W, WO, WO&W, unspecified

Anatomy of a LOINC Term


37842-2:View AP:Find:Pt:Shoulder:Doc:XR

Anatomy of a LOINC Term


37842-2:View AP:Find:Pt:Shoulder:Doc:XR
37842-2
View AP
Find

LOINC Code
Component
Property Measured

Pt

Timing

Shoulder

System

Doc

Scale

XR

Method

Anatomy of a LOINC Term


37842-2:View AP:Find:Pt:Shoulder:Doc:XR
37842-2
View AP
Find

LOINC Code
Component
Property Measured

Pt

Timing

Shoulder

System

Doc

Scale

XR

Method

There are six major LOINC axes

NOT part of a LOINC Name


Reason for the test (disease it diagnoses)
Testing instrument
Specific details about the testing
Priority (e.g. STAT)
Where testing was done
Who did the test
Test interpretation
Anything not part of naming the test
Stuff carried in other parts of HL7 message

Radiology Naming Model


Radiology-specific conventions

Component Structure
1st Subpart - View

<view descriptor> [<number of views>]


[<projection beam orientation>] [<body position>]

Views descriptor
# of views

Views, Multisection,
Views for leg length
,
3, greater than 3

Beam orientation

AP, lateral

Body position

Prone

Component Structure
1st Subpart - Interventional

Guidance for <indication>

Examples
Guidance for biopsy:Find:Pt:Breast:Doc:Mam
Guidance for anesthetic block injection:Find:Pt:Celiac plexus:Doc:CT
Guidance for drainage:Find:Pt:Extremity:Doc:US

Component Structure
2nd Subpart - Challenge/Precondition

<timing/existence><substance given><route>

Timing/existence

W, WO&W, 48H post

Substance given

contrast, adenosine,
Tc-99m Sestamibi

Route

IV, PO

System
The anatomic area being visualized

Not necessarily the anatomic area of interest


Examples
24627-2

Chest CT

24590-2

Brain MRI

25011-8

Tibia and Fibula X-ray

System Structure
System^Super System

Super System
Patient is the default
Used to indicate:
blood product unit, bone marrow donor, fetus

11670-7:Blood ow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler

Method
Modality

<modality><submodality>

Modality

CT, MRI, XR

Submodality

angio, fluor, SPECT

Side note: we handle ographies as synonyms.


(e.g. arthrogram is linked to W contrast intraarticular)

A few special cases


There are always some.

Portable studies
General rule: only create when the
image produced by a portable study
is different than the normal study.
Classic example:
Portable chest x-ray studies are typically taken at a
shorter distance than those taken in the radiology
department. We have separate codes for these.

Eponyms and colloquial expressions


All over in radiology
Meaning often spans multiple attributes
We use only when their meaning is
unambiguous and confined to within one axis
Example:
24801-3 View Merchants:Find:Pt:Knee:Doc:XR

Decubitus is a body position


Not a projection
We explicitly use lateral-decubitus
and name the projection
(e.g. AP or PA)
Nice essay in the Users Guide

Angiography Abbreviations
LOINC uses these methods: XR.fluor.angio,
MRI.angio, and CT.angio
MRA and CTA can refer to studies of arteries,
veins, or both. Included as synonyms of
MRI.angio and CT.angio.
MRV and CTV are synonyms where the
method is MRI.angio or CT.angio and the
system contains Vein or Veins.

Evolving Conventions
Collaboration with RSNA to develop a
unified LOINC + RadLex Playbook
terminology

Overall Goal:
Produce a single unified source of
names and codes for radiology
procedures with a cooperative
governance process.

Main Deliverables
Developing a Unified Model for Radiology
Procedure Names
Mapping the attribute-values between each
terminology (i.e. LOINC Parts to RadLex RIDs)
Mapping between RadLex RPIDs and LOINC codes

Process
Model unification reviewed all modalities
Attributes can employ a syntax
Have made excellent progress on resolving issues
(always a few remaining edge cases)
Developed a User Guide covering all attributes:
definitions, usage notes, and identifying weird stuff
Mapping focus progressing through modalities

Unified Model Attribute Groupings


Modality

LOINC-speak
Method

Anatomy

System

View

Component

Reason for Exam

Component

Guidance

Component

Pharmaceutical

Challenge*

Subject

Super System

* Currently no differentiation between chemical (contrast) and physical challenges


All part of the syntax used in creating the Component part name, but not labeled differently

Complete Attribute Set


Modality
Modality
Modality.Subtype
Anatomy
Anatomic Location.Region Imaged
Anatomic Location.Imaging Focus
Anatomic Location.Laterality.Presence
Anatomic Location.Laterality
View
View.Maneuver
View.Aggregation
View.Modifiers
Pharmaceutical
Pharmaceutical.Substance Given
Pharmaceutical.Route
Pharmaceutical.Timing
Guidance
Guidance for.Presence
Guidance for.Approach
Guidance for.Action
Guidance for.Object
Reason for Exam
Subject

Annex in LOINC Users Guide

Feedback Welcome

Ongoing discussion
about use of Body
Region attribute
Entire area scanned
A broad roll-up category
Forget about it

Content Changes
Many changes to CT terms in the
latest LOINC release
Example of new style anatomy:
24814-6 Abdomen>Liver CT

MR done, US + Fluoro + NM coming

Accessory File Format


LOINC

LOINCLongC
PartNumber PartName
ommonName

PartType

24628-0

Chest CT W
contrast IV

LP200088-5

Rad.Pharmaceutical.Timing

24628-0

Chest CT W
contrast IV

LP200085-1

Rad.Pharmaceutical.Substanc
e Given

24628-0

Chest CT W
contrast IV

LP200078-6

24628-0

Chest CT W
contrast IV

24628-0

24628-0

PartSeq
RID
Order

PreferredName

RPID

LongName

1 RID49853 W

RPID18

CT Chest w IV
Contrast

Contrast

1 RID11582 Contrast agent

RPID18

CT Chest w IV
Contrast

Rad.Pharmaceutical.Route

IV

1 RID11160 intravenous

RPID18

CT Chest w IV
Contrast

LP199962-4

Rad.Anatomic
Location.Region Imaged

Chest

1 RID1243

Thorax

RPID18

CT Chest w IV
Contrast

Chest CT W
contrast IV

LP200067-9

Rad.Modality

CT

1 RID10321 computed tomography

RPID18

CT Chest w IV
Contrast

Chest CT W
contrast IV

LP200088-5

Rad.Pharmaceutical.Timing

1 RID49853 W

RPID18

CT Chest w IV
Contrast