The Radiology Playbook: A Missing Component of RadLex

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The Radiology PlaybookA Missing Component of
RadLex

• Nasya Mendoza-Elias and Lizhou Huang
• Pat Mongkolwat, Ph.D. and David S. Channin, M.D.
• Northwestern University Feinberg School of
  Medicine
• DePaul University College of Computing and
  Digital Media
• National Science Foundation Research Experience
  for Undergraduates
• In Medical Informatics Program
• August 21, 2008

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Overview

• Introduction
• Progress
• Future Work

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What is RadLex?

• Funded by the Radiological Society of North
  America (RSNA)
• Purpose
• Capturing
• Indexing
• Retrieving
• Will unify other lexicons

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What is the RadLexPlaybook?

• Orders, procedures, and procedure steps
• Powered by an ontology
• Dynamic

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Why do we need a Playbook?

• Consistency
• Interoperability
• Inadequacy of other lexicons

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What aboutCommon Procedural Terminology CPT?

• Not an adequate description
• 71010 Radiologic examination, chest single view,
  frontal
• 71015 Radiologic examination, chest stereo,
  frontal
• 71020 Radiologic examination, chest, two views,
  frontal and lateral
• 71021 Radiologic examination, chest, two views,
  frontal and lateral with apical lordotic
• 71022 Radiologic examination, chest, two views,
  frontal and lateral with oblique
• 71023 Radiologic examination, chest, two views,
  frontal and lateral with fluoroscopy
• 71030 Radiologic examination, chest, complete,
  minimum of four views
• 71034 Radiologic examination, chest, complete,
  minimum of four views with fluoroscopy
• 71035 Radiologic examination, chest, special
  views (eg, lateral decubitus, Bucky studies)

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Whereas Merrills Atlas of Radiographic
Positioning and Radiologic Procedures says
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The IHE Model

• Order Placer System orderable
• Order Filler orderable ?procedures
• Order Filler procedure steps via modality
  worklist

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So

• Orderable ? Referring physician
• Requested Procedure(s) ? Radiologist
• Reportable, codifiable, billable unit of work
• Procedure Step ? Technologist (modality)
• Scheduled procedure steps
• Performed procedure steps

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The Challenge

• Treading the fine line of granularity between the
  needs of the referring physician and the detail
  of radiology operations

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What will the RadLex Playbook deliver initially?

• Knowledge model
• Grammar
• Set of orderable names
• Grammar for imaging and non-imaging procedure
  steps
• A set of procedure step names
• Can be used in DICOM

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What can you do with the Playbook?

• Build a chargemaster
• Protocol studies
• Tailor studies
• Build software applications with knowledge

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Whats been keeping us busy

• Ontology structure
• GUI
• Query
• Filtering of choices

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Ontologies

• What is an ontology?
• Concepts and relationships
• For example
• Wine An alcoholic beverage fermented from grapes
• Red Wine Wine fermented from whole grapes
• is_a wine
• color red
• White wine Wine fermented from skinless grapes
• is_a wine
• color white
• Chardonnay is_a white wine
• Bordeaux is_a red wine
• Allows for knowledge based computation
• Is Chardonnay a wine?

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For example

• NMH-HEAD_47
• MR FACE MP SCOUT
• MR FACE SAG T1R-2D(SE_1)_N
• MR FACE COR T1R-2D(SE_1)_N
• MR FACE COR T2P-2D(SE_N)_N/M
• MR FACE AX T1R-2D(SE_1)_N
• MR FACE AX T2P-2D(SE_N)_N/M
• MR FACE INJ GAD
• MR FACE AX 2D(GRE_1)_N
• MR FACE COR 2D(GRE_1)_N
• MR FACE SAG 2D(GRE_1)_N

• Paranasal Sinus
• Survey
• SAG T1 SE
• COR SE T1
• COR T2 TSE
• AX SE T1
• AX T2 TSE
• INJECT
• AX SHARP FS
• COR SHARP FS
• SAG SHARP FS

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Translation CT, DEXA, Fluoro, Mammo, X-Ray

• Use RadLex
• Categorize procedure steps by attributes

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Knowledge Model Example

• XRAY CHEST is_a Imaging Orderable
• XRAY CHEST has_steps
• XRAY CHEST PA
• XRAY CHEST PA is_a XRAY Procedure Step
• XRAY CHEST PA has_projection CORONAL
• XRAY CHEST PA produces DICOM DX Object
• XRAY CHEST LATERAL LEFT
• XRAY CHEST LATERAL LEFT is_a XRAY Procedure Step
• XRAY CHEST LATERAL LEFT has_projection SAGGITAL
• XRAY CHEST LATERAL LEFT produces DICOM DX Object

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User Interface

• Query based on a series of restrictions
• Restriction filters are mutually linked
• Restrictors can be applied in any order

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GUI (July 18)
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Querying the Ontology

• Code by Kaustubh Supekar, Stanford, created for a
  different project
• Surprisingly roundabout code
• a.txt
• Deletes everything that is not a result

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Problems with the query

• Slow
• Requires vast amounts of code
• Loads ontology for every query

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Future Work

• Connecting all parts of the GUI with the query
• Optimizing the query
• Strip unnecessary code
• Load ontology once

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Future Work

• Realtime web interface
• Modifying ontology
• Authorization and administration
• Integration into RadLex
• Other features

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Such as

• Exporting protocols
• Printing
• Searching for similar protocols

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Thank you

• Questions?