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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

Acknowledgments and
• 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 – 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 .

g. SNOMED.g. ACR Index. courtesy of RSNA • Linked back to existing term sets (e. DICOM) • Fills gaps where radiology terms are absent • Freely available.. CPT.RadLex Key Features • Adopts existing concepts from widely accepted standards (e. 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) .

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

Vogt-Koyanagi-Harada syndrome • Use post-coordination to avoid combinatoric explosion . 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.RadLex Term Guidelines • No plurals except when intrinsic to term – meninges.

Pre.g.. 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 finger What about synonyms (e. index finger)? .vs.

except for administration of IV contrast • CT angiography. chest 7155 0 MRI chest w/o dye 7155 1 MRI chest w/dye 7155 2 MRI chest w/o&w/dye 7155 5 MRI angio chest w or w/o dye .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. 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 7125 0 CT thorax w/o dye 7126 0 CT thorax w/dye 7127 0 CT thorax w/o&w dye 7127 5 CT angiography.


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BIRN. • Decision support software – iVirtuoso YottaLookTM. FMA • Standards – DICOM. ACR Elsevier RadConsultTM. Spanish. Ontology of Biomedical Investigations. NCIA. GoldminerTM. Portuguese . StructuRad ReportNowTM • Research projects – caBIG.Adoption of RadLex • Teaching file software – RSNA MIRC. HL7 • Scientific publications – 33 abstracts at RSNA last 3 years • Translations – German. SNOMED. RadPix. myPACS. IHE. • Clinical reporting (planned) – Commissure RadWhereTM.

RadLex Resources • – RadLex API – RadLex SQL database schema • RadLex on Documentation & Downloads link – Protégé files (v3. assign new IDs • RadLex Google group ( – All MSWord files from which lexicon is derived – Previous versions of Protégé files .1) – SQL files – XML files • – RadLex plugins: upload text files.

RadLex Plans 2008 • Integration of remaining anatomy and finding terms – Ob/gyn. congenital/develomental. CPT. normal variants • Linkage with other terminology systems – ACR Index. visual features. FMA • Formalize licensing terms for RadLex • Leadership transition--move to curation/editorial phase • Repository of best-practices radiology reports based on RadLex . SNOMED.

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 .

adenocarcinoma AND lingula *Chapman et al.Why Not Google? • Pertinent negatives – “There is no evidence of ectopic pregancy” – Automatic detection: sens 82%. J Biomed Informatics 34: 301-310. urolithiasis • Hierarchical relationships – cancer AND lung vs. 2001 . spec 96%* • Synonyms – renal stone vs. kidney stone vs.