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
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 Alzheimers 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 finger

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

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, 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

www.radlex.org

radlexfeedback@rsna.org

Adoption of RadLex
Teaching file 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
Protg 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 Protg 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
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