2016 08 25 - LOINC - Radiology Studies

Clinical LOINC Meeting - Salt Lake City, UT USA
Radiology Studies
Daniel J. Vreeman, PT, DPT, MSc
Associate Research Professor, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
@djvreeman
2016
Overview
1. Overview of Radiology content in LOINC
2. LOINC Radiology Model (How we name
imaging studies)
3. 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 MR W & WO Contrast IV
Orbit X-ray for foreign body
This is our
bread and butter
Radiology Report Terms

> 5400 active terms in v2.56
Modality
# LOINC Terms
CT
725
Mammography
145
MRI
870
Nuclear Medicine
522
Ultrasound
509
XR
2000
Fluoroscopy
646
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
Caution: Work in Progress
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
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 specimen
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
Examples
24627-2
Chest CT
24590-2
Brain MRI
25011-8
Tibia and Fibula X-ray
Area under constructionchanges underway
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><modality subtype>
Modality
CT, MR, XR
Subtype
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 (soon to
be RF.angio), MR.angio, and CT.angio
MRA and CTA can refer to studies of arteries, veins, or
both. Included as synonyms of MR.angio and CT.angio.
MRV and CTV are synonyms where the method is
MR.angio or CT.angio and the system contains Vein
or Veins.
Side note: these are broken in current release
Evolving Conventions
Collaboration with RSNA to develop a
unified LOINC + RadLex Playbook
terminology
Overall Goal:
Produce a single unified source of
names and codes for radiology
procedures with a cooperative
governance process.
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
Creating new LOINC codes where needed
Process
Model unification reviewed all modalities
Attributes can employ a syntax
Have made excellent progress on resolving issues
(always a few remaining edge cases)
Developed a User Guide covering all attributes:
definitions, usage notes, and identifying weird stuff
Mapping focus progressing through modalities
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
Pharmaceutical
Modality
Pharmaceutical.Substance Given
Modality.Subtype
Pharmaceutical.Route
Anatomy
Anatomic Location.Region Imaged
Pharmaceutical.Timing
Guidance
Anatomic Location.Imaging Focus
Guidance for.Presence
Anatomic Location.Laterality.Presence
Guidance for.Approach
Anatomic Location.Laterality
Guidance for.Action
View
Guidance for.Object
View.Aggregation
Reason for Exam
View.View type
Subject
View.Maneuver
Annex in LOINC Users Guide
Feedback Welcome
Body Region
Lots of discussion!
Drawn from a short list:

head, neck, chest, breast, abdomen, pelvis, upper
extremity, lower
Both coarse descriptor & grouper:

Descriptor & Grouper: Abdomen>Liver
Grouper: Upper Extremity > Elbow
Syntax for parallelism also in progress
Content Changes
Changes underway in each release
CT, MR, US, NM and PT done!
Last release:
200 new terms
1500 terms edited
Accessory File Format

LOINC
LOINCLongC
PartNumber PartName
ommonName
PartType
24628-0
Chest CT W
contrast IV
LP200088-5
Rad.Pharmaceutical.Timing
24628-0
Chest CT W
contrast IV
LP200085-1
Rad.Pharmaceutical.Substanc
e Given
24628-0
Chest CT W
contrast IV
LP200078-6
24628-0
Chest CT W
contrast IV
24628-0
24628-0
PartSeq
RID
Order
PreferredName
RPID
LongName
1 RID49853 W
RPID18
CT Chest w IV
Contrast
Contrast
1 RID11582 Contrast agent
RPID18
CT Chest w IV
Contrast
Rad.Pharmaceutical.Route
IV
1 RID11160 intravenous
RPID18
CT Chest w IV
Contrast
LP199962-4
Rad.Anatomic
Location.Region Imaged
Chest
1 RID1243
Thorax
RPID18
CT Chest w IV
Contrast
Chest CT W
contrast IV
LP200067-9
Rad.Modality
CT
1 RID10321 computed tomography
RPID18
CT Chest w IV
Contrast
Chest CT W
contrast IV
LP200088-5
Rad.Pharmaceutical.Timing
1 RID49853 W
RPID18
CT Chest w IV
Contrast

2016 08 25 - LOINC - Radiology Studies

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2016 08 25 - LOINC - Radiology Studies

Enviado por

Direitos autorais:

Formatos disponíveis

Clinical LOINC Meeting - Salt Lake City, UT USA

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

Caution: Work in Progress

Multiple Levels of Specificity

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

Tibia and Fibula X-ray

Area under constructionchanges underway

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

Unified Model Attribute Groupings

Reason for Exam

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

Complete Attribute Set

Anatomic Location.Imaging Focus

Reason for Exam

Annex in LOINC Users Guide

Drawn from a short list:

Both coarse descriptor & grouper:

Syntax for parallelism also in progress

Accessory File Format

1 RID11582 Contrast agent

1 RID10321 computed tomography

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