RSNA Annual Meeting 2019 | Chicago, IL USA

The LOINC/RSNA Radiology Playbook

A unified terminology for radiology procedures

Daniel J. Vreeman, PT, DPT, MS, FACMI

Senior Clinical Data Standards Lead
RTI International
@djvreeman
!
© 2019
 Session Objectives

1. Purpose and scope of LOINC

2. Key implementation tools
3. Development process for the LOINC/
RSNA Radiology Playbook

📷 Vernio77 © cc-by-sa
Disclosure

I’m President of Blue Sky Premise, LLC which published the book
LOINC Essentials.

This material contains content from LOINC® (http://loinc.org). The LOINC Table, LOINC Table Core, LOINC
Panels and Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology
File, LOINC Hierarchies, LOINC Linguistic Variants File, LOINC/RSNA Radiology Playbook, and LOINC/IEEE
Medical Device Code Mapping Table are copyright © 1995-2018, Regenstrief Institute, Inc. and the
Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the
license at http://loinc.org/license.
 Slides available at:
https://danielvreeman.com/rsna2019
 Interoperability is about
people who want (their health
IT systems) to work together
and understand each other
📷 scarlatti2004_images © cc-by-sa
 Life without LOINC…
CODE NAME
HEADW CT HEAD W/CONTRAST
11884 Head CT with Contrast
CT1005 CT Brain W
OCT003 CT BRAIN/HEAD W/C
CTHEAD CT HEAD WITH
25284D CT Head with IV Contrast
CTHW Head W Contrast
3332251 CT HEAD W/Contrast
CTH2203 CT HEAD W/C
99234 HEAD CT W/Contr
A114 CT Brain/Head W Cont IV
ZCT9992 Head CT WC IV
CTHC332 CT Head W C
POBPD CT Head w Cont (70460)
Interoperability requires different
kinds of data standards for different Syntax Standards
purposes. Messages, Documents, APIs, CDMs
HL7v2, C-CDA, FHIR, OHDSI

Typically, syntax and semantic Semantic Standards

standards are used together Vocabulary/code systems
LOINC, RxNorm, HPO, ICD,
MONDO, UCUM

No single vocabulary covers it all

A freely available global standard for health measurements,
observations, and documents.

delivered with a rich set of implementation tools…

used by a diverse global community…

who propel its continuous development.

 LOINC is a rich trove of 91,000+ standardized variables
Genetics Lifestyle

21654-9 CFTR gene targeted mutation analysis

41950-7 Number of steps in 24 hour Measured
24475-6 F2 gene c.20210G>A [Presence]
75296-4 Carbohydrate intake 24 hour Estimated
75547-0 Noninvasive prenatal fetal aneuploidy
and microdeletion panel based on Plasma cell- 82289-0 Rating of perceived exertion [Score]
free+WBC DNA by Dosage of chromosome-specific
circulating cell free (ccf) DNA 72166-2 Tobacco smoking status NHIS

82245-2 Chromosome region 22q11.2 deletion in 64098-7 Distance walked in 6 minutes

Amniotic fluid or CVS by FISH

Lab and clinical Environmental

82464-9 Mosquito count [#] in Environmental specimen

4548-4 Hgb A1c MFr Bld 67784-9 Individuals below poverty line Neighborhood

8462-4 Diastolic blood pressure 63736-3 Materials to which you were exposed in your
work or daily life
24725-4 Head CT
63805-6 How long did you handle paints or solvents
57021-8 CBC W Auto Differential panel - Blood yourself?

8633-0 QRS duration 67640-3 My teachers believe that I can do well in my

school work

📷 glasgowamateur © cc-by-sa
📷 unamid-photo © cc-by-nd
Regenstrief + RSNA
An uncommon standards story

Two SDOs joining paths to unify their terminologies

LOINC
International standard used widely
25 years mature, published in twice-yearly releases
5,000+ radiology procedure terms

RadLex Playbook
Developed by RSNA as a component of RadLex
Launched in 2011 as standard for radiology procedures
Contained ~1,000 codes in Core Playbook
Guiding Ideas
Jointly developed, unified standard terminology

Regenstrief’s terminology experience + RSNA’s domain expertise

Unify, don’t just do mappings (eternal work)

LOINC codes as the primary identifiers for procedures in the unified

terminology, attribute values linked to RadLex
Corollary: new RPID assignment would cease

Corollary: new RID assignment would expand to fill need

Distribute the standard at no cost worldwide

Vreeman DJ, Abhyankar S, Wang KC, et al. The LOINC RSNA radiology playbook - a unified terminology for radiology procedures. J Am Med Inform Assoc. 2018 Jul 1;25(7):885-893. doi:10.1093/jamia/ocy053. PubMed PMID: 29850823.
 Radiology Procedure Naming Model
Modality Maneuver
Modality.Modality Type Maneuver.Maneuver Type
Modality.Modality Subtype
Pharmaceutical
Anatomic Location Pharmaceutical.Substance Given
Anatomic Location.Region Imaged Pharmaceutical.Route
Anatomic Location.Imaging Focus
Anatomic Location.Laterality.Presence Reason for Exam
Anatomic Location.Laterality
Guidance
View Guidance for.Presence
View.Aggregation Guidance for.Approach
View.View Type Guidance for.Action

 Guidance for.Object
Timing

Subject
LOINC/RSNA Radiology Playbook
Version 2.66 | June 2019

6,000+ Radiology procedure terms

Over 42,000 attribute value relationships linking more than 1,000

LOINC Parts to RadLex clinical terms.

995 LOINC terms are mapped to unique RPID concepts

New requests welcome!
A quick taste from the collection…
36813-4 CT Abdomen and Pelvis W contrast IV

Part Type Part Name

Rad.Modality.Modality type CT

Rad.Anatomic Location.Region Imaged Abdomen

Rad.Anatomic Location.Region Imaged Pelvis

Rad.Timing W

Rad.Pharmaceutical.Substance Given Contrast

Rad.Pharmaceutical.Route IV
 LOINC/RSNA Radiology Playbook File
LOINC LOINCLongCommonName PartNumber PartType PartName PartSeqOrder RID PreferredName RPID LongName

CT Abdomen and Pelvis W CT Abdomen/Pelvis w IV

36813-4 LP200067-9 Rad.Modality.Modality type CT A RID10321 computed tomography RPID145
contrast IV Contrast

Rad.Pharmaceutical.Substanc
36813-4 … LP200085-1 Contrast A RID11582 Contrast agent RPID145 …
e Given

36813-4 … LP200088-5 Rad.Timing W A RID49853 W RPID145 …

36813-4 … LP200078-6 Rad.Pharmaceutical.Route IV A RID11160 intravenous RPID145 …

Rad.Anatomic
36813-4 … LP199956-6 Abdomen A.A RID56 Abdomen RPID145 …
Location.Region Imaged

Rad.Anatomic
36813-4 … LP199998-8 Pelvis A.B RID2507 Pelvis RPID145 …
Location.Region Imaged
Key Resources
From Regenstrief
“Raw” release artifacts
Online and desktop browser (RELMA)
API (via FHIR)
Documentation
Community resources
LOINC Users Guide

From RSNA
API for (retired) RPID-format terms: includes a mapping to CPT (see documentation)

All free. Some require a loinc.org account

 https://search.loinc.org
search.loinc.org
https://loinc.org/fhir
Get info about your favorite
LOINC term
[base]/CodeSystem/$lookup?system=http://
loinc.org&code=36813-4

Includes all the radiology-specific attributes

Other API Features
ValueSets
LOINC/RSNA Radiology Playbook
LOINC/RSNA Radiology Playbook Core

ConceptMap
LOINC Terms to RPID mappings
LOINC Parts to RID mappings
 Ready to Go
The LOINC/RSNA Radiology Playbook is ready for deployment
Use it!

Good coverage

Smooth process for requesting

new terms

Enables advanced applications

e.g. HIE-wide prior CT alerting

Peng P, Beitia AO, Vreeman DJ, et al. Mapping of HIE CT terms to LOINC®: analysis of content-dependent coverage and coverage improvement through new term creation. J Am Med Inform Assoc. 2018 Nov 16. PMID: 30445562
 Happy LOINCing!

https://danielvreeman.com/rsna2019