Langlotz RadLex Presentation

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Langlotz RadLex Presentation

  1. 1. A Lexicon for Uniform Indexing and Retrieval of Radiology Information Resources January 29, 2015 Curtis P. Langlotz, MD, PhD
  2. 2. Motivations for a Unifying Medical Imaging Lexicon  Tower of Babel  Fragmented educational resources for imaging  Irreconcilable research results  Suboptimal clinical communication  Existing lexicons incomplete or outdated
  3. 3. Benefits of a Unified Imaging Lexicon:  Automatic indexing and retrieval of teaching files  Comparison or unification of disparate research databases  Point and click “structured” reporting systems  Literature searches tailored to specific imaging examinations or patients
  4. 4. Content and Clarity of Radiologists’ Reports  822 Medicare inpatients from 297 hospitals  Admission diagnoses: pneumonia, CHF, MI  14 different terms for interstitial edema/infiltrate  23 terms suggesting presence of an abnormality  30 terms for expressing uncertainty Sobel et al, Acad Radiol 3:709, 1996
  5. 5. Alternative Terms for Interstitial Edema/Infiltrate  acute interstitial change  edema along markings  horizontal linear stranding  increase in interstitial markings  Kerley B lines  linear parenchymal change  septal fluid  interstitial disease  interstitial process  interstitial changes  interstitial prominence  fluid  congestion  peribronchial cuffing  perivascular edema  vessel type infiltrate Sobel et al, Acad Radiol 3:709, 1996
  6. 6. Alternative Terms for Presence of an Abnormality  appears to be  are a bit  believe to be  compatible with  consistent with  definite  due to  evidence for  first consideration given to  indicating  most likely  presumably representing  representing  seems to be  significant  somewhat  suspect  thought to be Sobel et al, Acad Radiol 3:709, 1996
  7. 7. NY Cartoon
  8. 8. Why Are Lexicons Important? Donald Harrington, M.D. Professor and Chair, Department of Radiology, State University of New York-Stony Brook
  9. 9. The Goals of the RadLex Project January 29, 2015 Curtis P. Langlotz, MD, PhD
  10. 10. RadLex  RadLex hypothetical use cases  Origins: MIRC and the ACR Index  Motivations: incomplete existing lexicons  RadLex organizational structure
  11. 11. RSNA’s Medical Image Resource Center (MIRC)  Sharing of images and information for education, research and clinical practice  Originally conceived as a central point of storage (teaching file archive)  Now a community of teaching files linked through a common index  Searchable via the Internet
  12. 12. Use Case: Teaching File Creator  Radiologist is reading an interesting case  Radiologist selects case for teaching file  Radiologist assigns RadLex terms to the case  Radiologist makes the case publicly available  All radiologists can now search for the case on the Internet using MIRC and RadLex
  13. 13. Use Case: Information Seeker  Radiologist seeks optimal follow up interval for nodule on hi-res chest CT  Enters RadLex terms describing nodule and clinical history  Receives web page listing links to relevant information
  14. 14. Use Case: Information Seeker  Web page listing relevant:  MedLine citations  RSNA meeting content (refresher courses, scientific abstracts)  RSNA full-text journal articles  MIRC teaching files  Professional standards  Relevant billing codes
  15. 15. Use Case: Reporting Advisor  Radiologist is using an automated reporting system to report a case  Decision support system is running in the background  Decision support system has been tracking RadLex term co-occurrence over time  Radiologist describes a lung cancer on chest X-ray using RadLex terms
  16. 16. Use Case: Reporting Advisor  DSS suggests features to look for in the image  DSS lists ranked differential diagnosis
  17. 17. Medical Lexicons for Radiology  UMLS (National Library of Medicine)  SNOMED-RT (College of American Pathology)  Index for Radiological Diagnoses (ACR)  NCI Common Data Elements (CDEs)  Subspecialty lexicons: ACR BI-RADSTM , ASSR-intervertebral disks, Fleischner, ...  Coding schemes: ICD, CPT, LOINC
  18. 18. Medical Lexicons: Completeness for Radiology 0% 20% 40% 60% 80% 100% SNOMED UMLS ACR Index LSVT Percent of imaging terms in lexicon: Bell & Greenes, AMIA Proceedings:216, 1994 Humphreys et al, JAMIA 4:484, 1997.
  19. 19. ACR Index Demo
  20. 20. ACR Index Limitations  Two “fields”: Anatomy, Pathology  Semantics embedded in identifiers  Designed for “off-line” teaching files  Coarse hierarchy  Static categories for findings
  21. 21. What is RadLex ?  Joint effort with professional organizations and standards bodies ACR, Fleischner, STR, DICOM, NLM  Harmonize lexicon development efforts Unifying framework for concepts and terms Common development process Harmonize/collaborate  Result: a freely-available resource
  22. 22. RSNA Organizational Structure RadLex Steering Committee RadLex Thoracic Lexicon Devel. Committee Other RadLex Lexicon Devel. Committees …
  23. 23. Collaborative Process Task RSNA Partner Common lexicon framework X Common development process X Select committee members X X Create draft lexicons X Provide informatics tools X Support meetings, conf. calls X Review and refine lexicons X X Establish on-line availability X Disseminate new lexicon X X Liaison to standards, govt. orgs. X
  24. 24. Desirable Properties of a Lexicon Donald Harrington, M.D. Professor and Chair, Department of Radiology, State University of New York-Stony Brook
  25. 25. Organization of the RadLex System January 29, 2015 Curtis P. Langlotz, MD, PhD
  26. 26. Lexicon Terminology Vocabulary Dictionary Glossary
  27. 27. The Lexicon Development Process
  28. 28. Lexicon Development Process (1) Texts Journal Articles Existing Lexicons And DBs Informatics Imaging Standards Lexicon Steering Committee Primary Data Sources Draft Lexicon
  29. 29. Lexicon Development Process (2) Final Lexicon Lexicon Devel. Committee Web-based resource You are here.
  30. 30. What is a RadLex Term?  Unique concept  Unique numeric ID  Name  Definition  Sample image(s)  Source(s)  Links to related terms/lexicons
  31. 31. Term Hierarchies Is-a (e.g., Finding)  pneumonia  bacterial pneumonia  aerobic bacterial pneumonia  gram-positive aerobic bacterial pneumonia  gram-negative aerobic bacterial pneumonia  anaerobic bacterial pneumonia  mycobacterial pneumonia  tuberculosis  primary tuberculosis  post-primary tuberculosis  non-tuberculous mycobacterial pneumonia  … Part-of (e.g., Anatomy)  lungs  left lung  left upper lobe of lung  superior division of the left upper lobe  anterior segment of the left upper lobe  apicoposterior segment of the left upper lobe  lingula  inferior segment of the lingula  superior segment of the lingula  left lower lobe of the lung  …
  32. 32. Term Categories 1. Examination type 2. Patient identifiers 3. Clinical history 4. Technique 5. Observer context 6. Level of difficulty 7. Exam quality 8. Image location 9. Anatomic location 10. Findings 11. Uncertainty 12. Conclusions 13. Recommendations 14. Relationships
  33. 33. Lexicon Development Approach Solution  Synonymous terms  Common terms  Standard descriptors  Adopt and link  Publicly available Pitfall  Competitive terms  Required terms  Clinical standards  Reinvent  Proprietary
  34. 34. Relationship to Other Lexicons ACR Index SNOMED CPT4 ICD-9-CM RadLex UMLS Thesaurus
  35. 35. Thoracic Lexicon Efforts  Fleischner Society Glossaries  NCI Common Data Elements (CDEs)  NCI Lung Image Database Consortium (LIDC)  DICOM Chest CAD supplement
  36. 36. Fleischner Glossaries  Imaging features unique to radiology  Excellent definitions  No categories, hierarchies or other framework  No unique identifiers  Not available in electronic form for indexing
  37. 37. RadLex-Fleischner Process  Use Fleischner glossary terms and definitions when possible  Note when the Fleischner glossary is a source of a RadLex term  Assign a RadLex unique identifier to each term  Place each Term in a RadLex category
  38. 38. Points for Discussion  Inaccuracies  Gaps  Duplication  Need for definition  Helpful sources
  39. 39. Lexicographer. A writer of dictionaries; a harmless drudge. -Samuel Johnson A Dictionary of the English Language (1755)
  40. 40. The Augean Stables For the fifth labor, Eurystheus ordered Hercules to clean up King Augeas' stables. Now King Augeas owned more cattle than anyone in Greece. Some say that he was a son of one of the great gods, and others that he was a son of a mortal; whosever son he was, Augeas was very rich, and he had many herds of cows, bulls, goats, sheep and horses. Hercules knew this job would mean getting dirty and smelly, but sometimes even a hero has to do these things. -The Perseus Project; www.perseus.tufts.edu
  41. 41. Let’s Get Started!
  42. 42. Term Categories 1. Examination type 2. Patient identifiers 3. Clinical history 4. Technique 5. Observer context 6. Level of difficulty 7. Exam quality 8. Image location 9. Anatomic location 10. Findings 11. Uncertainty 12. Conclusions 13. Recommendations 14. Relationships
  43. 43. RadLex Term Category: Examination Type  Radiograph foot  CT chest  MRI abdomen  Ultrasound pelvis  Fluoro upper GI series
  44. 44. RadLex Term Category: Patient Identifiers  Name  Medical record number/Subject number  Age  Gender  Ethnicity  Sociodemographics (e.g., zip code)
  45. 45. RadLex Term Category: Clinical History  Reason for exam  Medical history  Symptoms  Medications  Family history  Surgical history  Physical exam findings  Laboratory values
  46. 46. RadLex Term Category: Technique  Equipment (e.g. 1.5T MRI)  Imaging parameters (e.g., image weighting)  Patient positioning  Date/time images created  Field of view  Contrast agent administered, if any
  47. 47. RadLex Term Category: Observer Context  Who viewed the images?  Display medium  Window/level information  Reconstruction algorithm (e.g., surface rendering)  Availability of CAD or decision support
  48. 48. RadLex Term Category: Degree of Difficulty  Layperson  Medical student  Junior resident  Senior resident  Radiologist  Sub-specialist
  49. 49. RadLex Term Category: Image Quality  Uninterpretable  Non-diagnostic  Limited  Diagnostic  Optimal
  50. 50. RadLex Term Category: Image Location  For example On the corner of the lateral view On series #1, image #5 On the post contrast images
  51. 51. RadLex Term Category: Anatomic Location  For example: The left upper lobe The trachea The right costophrenic angle
  52. 52. RadLex Term Category: Finding  Visual features  Anatomical derangements  Pathologic processes  Diseases  Syndromes
  53. 53. RadLex Term Category: Uncertainty  Definitely not  Probably not  Possibly not  Uncertain  Possibly  Probably  Definitely
  54. 54. RadLex Term Category: Conclusion  Normal  No clinically significant findings  Expected findings for patient demographics (e.g., normal for age)  Probably no clinically significant findings (confirmatory future follow-up needed)  Clinically significant findings (workup should continue)  Urgent clinically significant findings (definitive therapy required)
  55. 55. RadLex Term Category: Recommendation  Comparison to prior exams  Correlation with other patient information, such as laboratory tests, surgical and medical history  Follow up imaging, including the type of imaging examination and the time interval  Tissue sampling  Definitive therapy, such as surgical excision or medical therapy
  56. 56. RadLex Term Category: Relationships  Spatial (e.g., the tumor arises from the upper pole)  Logical (e.g., pneumonia and congestive heart failure)  Causal (e.g., the increased signal is due to a brain tumor)

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