RSNA Annual Meeting 2017 | Chicago, IL USA

The LOINC/RSNA Radiology Playbook

A unified terminology for radiology procedures

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

Regenstrief-McDonald Scholar in Data Standards
Indiana University School of Medicine

Director, LOINC and Health Data Standards

@djvreeman Regenstrief Center for Biomedical Informatics

2017
Acknowledgements
Kenneth C. Wang, MD, PhD3,4
Chris Carr5
Beverly Collins, PhD5
Swapna Abhyankar, MD1
Jamalynne Deckard, MS1
Clement J. McDonald, MD6
Daniel Rubin, MD, MS7,8
Curtis P. Langlotz, MD, PhD7

1. Regenstrief Institute, Inc, Indianapolis, IN

2. Indiana University School of Medicine, Indianapolis, IN;
3. VA Maryland Health Care System, Baltimore, MD;
4. University of Maryland School of Medicine, Baltimore, MD;
5. Radiological Society of North America, Chicago, Illinois;
6. National Library of Medicine, National Institutes of Health, Bethesda, Maryland;
7. Department of Radiology Stanford University, Stanford, California
8. Department of Biomedical Data Science Stanford University, Stanford, California

Funding sources
National Institutes of Health (HHSN268201500247A, HHSN276201400239P), U.S. Department of
Defense, and the Regenstrief Foundation for funding support.
 An uncommon
standards story
Two SDOs joining paths to unify their
terminologies and produce a single standard
 Variation Abounds
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)
Problems
Idiosyncratic local procedure MO DATA MO PROBLEMS

terms hinder many goals:

data sharing, aggregation, decision

support, registry reporting, quality
initiatives, etc.

Can overcome these problems with data standards

Global standard for measurements, observations and documents

Published in twice-yearly releases (June and December)

Used in more than 170 countries

Radiology content since 2000, now with 5,000+ procedure codes

Terms are assigned a code and structured, pre-coordinated name

based on attributes called Parts
Developed by RSNA as a component of RadLex

Launched in 2011 as standard for radiology

procedures

Contained ~1,000 codes in Core Playbook

Grammar and set of pre-coordinated codes (RPIDs)

with attributes from RadLex (RIDs)
 LOINC/RSNA
Radiology Playbook
Initiated in 2013 as a jointly developed,
unified source of names and codes for
radiology procedures
 Main Ideas
Regenstriefs terminology experience + RSNAs
preeminent domain expertise

Unify, dont just do mappings (eternal work)

LOINC codes as the primary identifiers for

procedures in the unified terminology, attribute
values linked to RadLex

Distribute the standard at no cost worldwide

photo via didmyself | cc-by-nc-sa
 Main Deliverables
A Unified Model for Radiology Procedure Names

Transform existing LOINC terms into the unified model

Mapping between RadLex RPIDs and LOINC codes

Creating new LOINC codes where needed to fill in any gaps

Mapping of attribute-values between each terminology

(i.e. LOINC Parts to RadLex RIDs)

Develop a single integrated governance process

 Approach
Slightly less harrowing than landing on a glacier
Long term collaboration
Dedicated project from 2013 to 2017

Created the unified model through consensus

Agreed on collaborative governance approach

Designed the release artifacts

Iteratively applied the model and mappings for all terms

The road ahead
Transitioning into an ongoing, sustained activity jointly
maintained and governed by the two organizations,
with oversight by the new LOINC/RadLex Committee
 Unified Model
Complete Attribute Set

Modality
Modality.Modality Type
Modality.Modality Subtype
Anatomy
Radiology Procedure
Anatomic Location.Region Imaged
Maneuver
Maneuver.Maneuver Type
Pharmaceutical
Pharmaceutical.Substance Given
Pharmaceutical.Route

Naming Model
Anatomic Location.Imaging Focus Reason for Exam
Anatomic Guidance
Location.Laterality.Presence Guidance for.Presence
Anatomic Location.Laterality Guidance for.Approach
View Guidance for.Action
View.Aggregation Guidance for.Object
View.View type Subject
Timing
 Unified Model
Complete Attribute Set

Modality Maneuver
Modality.Modality Type Maneuver.Maneuver Type
Modality.Modality Subtype Pharmaceutical
Anatomy Pharmaceutical.Substance Given
Anatomic Location.Region Imaged Pharmaceutical.Route
Anatomic Location.Imaging Focus Reason for Exam
Anatomic Guidance
Location.Laterality.Presence Guidance for.Presence
Anatomic Location.Laterality Guidance for.Approach
View Guidance for.Action
View.Aggregation Guidance for.Object
View.View type Subject
Timing
Definitive documentation
published as User Guide
https://loinc.org/downloads
Procedure Names
Julius Winfield Erving II
The Doctor
Dr. J
 Concept Names
LOINC fully-specified name
LOINC long common name
LOINC short name
Radlex Playbook short name*
Radlex Playbook long name *
* only available for RadLex Playbook terms

Ongoing work to further refine these

A tiny sample of
LOINC/RSNA
names and
attribute values
 CT Abdomen and Pelvis W contrast IV

PartType PartName
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
 XR Ankle - right AP and lateral

PartType PartName
Rad.Modality.Modality type XR
Rad.Anatomic Location.Region Imaged Lower extremity
Rad.Anatomic Location.Imaging Focus Ankle
Rad.Anatomic Location.Laterality.Presence TRUE
Rad.Anatomic Location.Laterality Right
Rad.View.Aggregation Views
Rad.View.View type AP
Rad.View.View type Lateral
LOINC/RSNA Radiology
Playbook File
The main distribution of this joint work
loinc.org/radiology
 Version 2.61 (June 2017)
5,500+ LOINC terms (all in main LOINC file, special
structure in the LOINC/RSNA Radiology Playbook File)

Over 37,000 attribute value relationships linking more

than 830 LOINC Parts to RadLex clinical terms.

766 LOINC terms are mapped to unique RPID concepts

For December 2017, last remaining content will be

included:
modality-agnostic interventional procedures
 CT Abdomen and Pelvis W contrast IV
LOINCLongC PartSeq
LOINC PartNumber PartType PartName RID PreferredName RPID LongName
ommonName Order

CT Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP200067-9 Rad.Modality.Modality type CT A RID10321 computed tomography RPID145
w IV Contrast
IV

CT Abdomen and
Rad.Pharmaceutical.Substanc CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP200085-1 Contrast A RID11582 Contrast agent RPID145
e Given w IV Contrast
IV

CT Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP200088-5 Rad.Timing W A RID49853 W RPID145
w IV Contrast
IV

CT Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP200078-6 Rad.Pharmaceutical.Route IV A RID11160 intravenous RPID145
w IV Contrast
IV

CT Abdomen and
Rad.Anatomic CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP199956-6 Abdomen A.A RID56 Abdomen RPID145
Location.Region Imaged w IV Contrast
IV

CT Abdomen and
Rad.Anatomic CT Abdomen/Pelvis
36813-4 Pelvis W contrast LP199998-8 Pelvis A.B RID2507 Pelvis RPID145
Location.Region Imaged w IV Contrast
IV
search.loinc.org
free online LOINC browser
Core Playbook

Good starter set

Find them in RSNA or

LOINC releases

As of next release, all will

have been exported to LOINC
RadLex Playbook User Guide
GET https://services.rsna.org/playbook/v1/playbook/complete/rpid/RPID17
 Ready to Go
The LOINC/RSNA Radiology Playbook File is
ready for deployment
In diagnostic imaging, LOINC
provides codes for:

Ordered (and returned) imaging study

The LOINC / RSNA Radiology Playbook

Sections within a report

As described by C-CDA, DICOM, MRRT

Measurements or observations made

 Diagnostic Imaging Report
Procedure codes from LOINC/RSNA Radiology Playbook

Additional structure from things like:

LOINC Codes for Report Sections
18785-6 Reason for study
55108-5 Clinical presentation
55111-9 Current imaging procedure descriptions
11329-0 History general
18782-3 Study observation (Findings)
55107-7 Addendum
55109-3 Complications
55114-3 Prior imaging procedure descriptions
55113-5 Key images
19005-8 Impressions
18834-2 Comparison study
18783-1 Recommendation
55115-0 Requested imaging studies information
55112-7 Document summary
55110-1 Conclusions
Measurements / Observations
a relatively nascent area in radiology

38261-4 DXA Hip [Mass/Area] Bone density

38264-8 DXA Hip [T-score] Bone density
53626-8 CT Cerebral atrophic index
8294-1 XR Chest Diameter.anterior-posterior

In other domains such as lab,

this is LOINCs main content
 Updating from RPIDs to the
new LOINC/RSNA Playbook
Enabling a smooth update process

photo via JD Hancock | cc-by-nd

Future updates will occur in LOINC format

Encourage transition from RPIDs to LOINC

Use tools and documentation from RSNA/

LOINC to find corresponding LOINC codes

Most are 1:1 mappings

 Wrap up

photo via National Museum of Health and Medicine | cc-by

The Regenstrief Institute and the RSNA have
created a unified terminology standard for
radiology procedures that builds on the
strengths of LOINC and the RadLex Playbook.

Use it!

Attributes can be exploited for many purposes

If you find gaps, request new content at:

https://loinc.org/submissions/new-terms/
Happy LOINCing!

photo via Karen Roe