2015 08 - LOINC - Radiology Studies

Clinical LOINC Meeting
Radiology Studies
Daniel J. Vreeman, PT, DPT, MSc

Associate Research Professor, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
2015 08 13
2015
Overview
1. Overview of Radiology content in LOINC
2. LOINC Radiology Model (How we name
imaging studies)
3. Future evolution via collaboration with
RSNA
photo via Vernio77
LOINC Diagnostic
Imaging (Radiology)
photo via Karen Roe
In diagnostic imaging,
LOINC provides codes for:
Ordered (and returned) imaging study
Sections within a report
Measurements or observations made
Diagnostic Imaging Report

Structure from things like:
Document Level Codes

Abdomen CT
Brain MRI W & WO Contrast IV
Orbit X-ray for foreign body
This is our
bread and butter
Radiology Report Terms

> 5100 active terms in v2.52
Modality
# LOINC Terms
CT
700
Mammography
145
MRI
853
Nuclear Medicine
455
Ultrasound
443
XR
1858
Fluoroscopy
653
Sections within a Report

18785-6
55108-5
55111-9
11329-0
18782-3
55107-7
55109-3
55114-3
55113-5
19005-8
18834-2
18783-1
55115-0
55112-7
55110-1
Reason for study

Clinical presentation
Current imaging procedure descriptions
History general
Study observation (Findings)
Addendum
Complications
Prior imaging procedure descriptions
Key images
Impressions
Comparison study
Recommendation
Requested imaging studies information
Document summary
Conclusions
Measurements / Observations
38261-4
38264-8
53626-8
8294-1
Hip DXA Bone density

Hip DXA [T-score] Bone density
CT Cerebral atrophic index
Chest XR Diameter.anterior-posterior
In other domains, this is

LOINCs main content
Radiology Naming Model

First some general principles
Multiple Levels of Specificity

Views
named, counted, no specification
Laterality
right, left, bilateral, unilateral, unspecified
Contrast
W, WO, WO&W, unspecified
Anatomy of a LOINC Term

37842-2:View AP:Find:Pt:Shoulder:Doc:XR

37842-2
View AP
Find
LOINC Code
Component
Property Measured
Pt
Timing
Shoulder
System
Doc
Scale
XR
Method

37842-2
View AP
Find
LOINC Code
Component
Property Measured
Pt
Timing
Shoulder
System
Doc
Scale
XR
Method
There are six major LOINC axes
NOT part of a LOINC Name

Reason for the test (disease it diagnoses)
Testing instrument
Specific details about the testing
Priority (e.g. STAT)
Where testing was done
Who did the test
Test interpretation
Anything not part of naming the test
Stuff carried in other parts of HL7 message
Radiology Naming Model

Radiology-specific conventions
Component Structure
1st Subpart - View
<view descriptor> [<number of views>]

[<projection beam orientation>] [<body position>]
Views descriptor
# of views
Views, Multisection,
Views for leg length
,
3, greater than 3
Beam orientation
AP, lateral
Body position
Prone
Component Structure
1st Subpart - Interventional
Guidance for <indication>
Examples
Guidance for biopsy:Find:Pt:Breast:Doc:Mam
Guidance for anesthetic block injection:Find:Pt:Celiac plexus:Doc:CT
Guidance for drainage:Find:Pt:Extremity:Doc:US
Component Structure
2nd Subpart - Challenge/Precondition
<timing/existence><substance given><route>
Timing/existence
W, WO&W, 48H post
Substance given
contrast, adenosine,
Tc-99m Sestamibi
Route
IV, PO
System
The anatomic area being visualized
Not necessarily the anatomic area of interest

Examples
24627-2
Chest CT
24590-2
Brain MRI
25011-8
Tibia and Fibula X-ray
System Structure
System^Super System
Super System
Patient is the default
Used to indicate:
blood product unit, bone marrow donor, fetus
11670-7:Blood ow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler
Method
Modality
<modality><submodality>
Modality
CT, MRI, XR
Submodality
angio, fluor, SPECT
Side note: we handle ographies as synonyms.

(e.g. arthrogram is linked to W contrast intraarticular)
A few special cases

There are always some.
Portable studies
General rule: only create when the
image produced by a portable study
is different than the normal study.
Classic example:
Portable chest x-ray studies are typically taken at a
shorter distance than those taken in the radiology
department. We have separate codes for these.
Eponyms and colloquial expressions

All over in radiology
Meaning often spans multiple attributes
We use only when their meaning is
unambiguous and confined to within one axis
Example:
24801-3 View Merchants:Find:Pt:Knee:Doc:XR
Decubitus is a body position

Not a projection
We explicitly use lateral-decubitus
and name the projection
(e.g. AP or PA)
Nice essay in the Users Guide
Angiography Abbreviations
LOINC uses these methods: XR.fluor.angio,
MRI.angio, and CT.angio
MRA and CTA can refer to studies of arteries,
veins, or both. Included as synonyms of
MRI.angio and CT.angio.
MRV and CTV are synonyms where the
method is MRI.angio or CT.angio and the
system contains Vein or Veins.
Future evolution
Collaboration with RSNA to
develop a unified LOINC + RadLex
Playbook terminology
Initial Funding Support

Contract from National Institute of Biomedical
Imaging and Bioengineering
Started Oct 2013, Ending September 2015
Hopeful, but no guaranteed funding beyond that
Content focus for this is computed tomography
Overall Goal:
Produce a single unified source of
names and codes for radiology
procedures with a cooperative
governance process.
Developing the Unified

Radiology Model
Main Deliverables
Developing a Unified Model for Radiology
Procedure Names
Mapping the attribute-values between each
terminology (i.e. LOINC Parts to RadLex RIDs)
Mapping between RadLex RPIDs and LOINC codes
Process
Mapping focus is on CT (per the contract)
Model unification reviewing all modalities
Attributes can employ a syntax
Have made excellent progress on resolving issues
(always a few remaining edge cases)
Developed aUser Guide covering all attributes:
definitions, usage notes, and identifying weird stuff
Unified Model Attribute Groupings

Modality
LOINC-speak
Method
Anatomy
System
View
Component
Reason for Exam
Component
Guidance
Component
Pharmaceutical
Challenge*
Subject
Super System
* Currently no differentiation between chemical (contrast) and physical challenges

All part of the syntax used in creating the Component part name, but not labeled differently
Complete Attribute Set

Modality
Modality
Modality.Subtype
Anatomy
Anatomic Location.Region Imaged
Anatomic Location.Imaging Focus
Anatomic Location.Laterality.Presence
Anatomic Location.Laterality
View
View.Maneuver
View.Aggregation
View.Modifiers
Pharmaceutical
Pharmaceutical.Substance Given
Pharmaceutical.Route
Pharmaceutical.Timing
Guidance
Guidance for.Presence
Guidance for.Approach
Guidance for.Action
Guidance for.Object
Reason for Exam
Subject
Having a nearly complete document

of all attribute Users Guides
Wrapping up the interventional portion (Guidance)
Solicit Review and Feedback from

interested LOINC Committee
Members
sign up at https://loinc.org/mailing-lists
CT Names Changed in LOINC 2.52
Many changes to CT terms in the

latest LOINC release
Example of new style anatomy:
24814-6 Abdomen>Liver CT
Planned Accessory File Format

LOINC
LOINCLongCom
PartNumber PartName PartType
monName
PartSeq
RID
Order
RadLexName
30612-6
Abdomen>Liver CT
WO and W contrast IV
LPTBD1
Abdomen
Anatomic Location.Region Imaged 1
RID56
Abdomen
30612-6
Abdomen>Liver CT
LPTBD2
Liver
Anatomic Location.Imaging Focus 1
RID58
Liver
30612-6
Abdomen>Liver CT
LPTBD3
CT
Modality
RID10321 CT
30612-6
Abdomen>Liver CT
LPTBD4
WO & W
Pharmaceutical.Timing
RIDTBD1
30612-6
Abdomen>Liver CT
LPTBD5
Contrast
Pharmaceutical.Substance given
RID11582 Contrast agent
30612-6
Abdomen>Liver CT
LPTBD6
IV
Pharmaceutical.Route
RID11160 IV
WO & W
Governance
Main Deliverables
Devising collaborative integrated governance process
for new terms
Creating single point-of-contact and governance structure
for the unified terminology
New joint LOINC/RadLex Committee to be advisory body
(Approved at Clinical LOINC Meeting 02/2014)
LOINC codes as the primary identifier for radiology
procedures (e.g. the universal codes) while linking to the
RadLex attribute/values for each term so that they can be
used as meta-data
Terms sheet with sketch of IP

issues, non-duplication, etc
was agreed by project team.
Full agreement drafted and
to be agreed by contract end.
Distribution Artifacts
Distribution Artifacts
LOINC Table, RELMA (Regenstrief)
As is today
LOINC RSNA Playbook Table (Regenstrief)

December 2015 LOINC release
Draft format as shown earlier
RadlLex Playbook Table (RSNA)

Format determined by RSNA
New format for Version 2 (learned a lot from LOINC)
Includes EXPORTED_TO_LOINC attribute that points people to
LOINC as we complete our work

2015 08 - LOINC - Radiology Studies

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2015 08 - LOINC - Radiology Studies

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Clinical LOINC Meeting

Daniel J. Vreeman, PT, DPT, MSc

photo via Vernio77

photo via Karen Roe

Diagnostic Imaging Report

Document Level Codes

bread and butter

Radiology Report Terms

Sections within a Report

Reason for study

Hip DXA Bone density

In other domains, this is

Radiology Naming Model

Multiple Levels of Specificity

Anatomy of a LOINC Term

Anatomy of a LOINC Term

Anatomy of a LOINC Term

There are six major LOINC axes

NOT part of a LOINC Name

Radiology Naming Model

<view descriptor> [<number of views>]

Guidance for <indication>

W, WO&W, 48H post

Not necessarily the anatomic area of interest

Tibia and Fibula X-ray

11670-7:Blood ow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler

angio, fluor, SPECT

Side note: we handle ographies as synonyms.

A few special cases

Eponyms and colloquial expressions

Decubitus is a body position

Initial Funding Support

Content focus for this is computed tomography

Developing the Unified

Unified Model Attribute Groupings

Reason for Exam

* Currently no differentiation between chemical (contrast) and physical challenges

Complete Attribute Set

Having a nearly complete document

Solicit Review and Feedback from

CT Names Changed in LOINC 2.52

Many changes to CT terms in the

Planned Accessory File Format

Anatomic Location.Region Imaged 1

Anatomic Location.Imaging Focus 1

RID11582 Contrast agent

Terms sheet with sketch of IP

LOINC RSNA Playbook Table (Regenstrief)

RadlLex Playbook Table (RSNA)

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