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)
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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)
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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
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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)
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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 :
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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
– 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
– “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