RSNA Annual Meeting 2018 | 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

© 2018 © 2018
 Session Objectives

1. Purpose and scope of LOINC

2. Key implementation tools
3. Development process for the LOINC/
RSNA Radiology Playbook

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Disclosure
I’m President of Blue Sky Premise, LLC which published the book LOINC
Essentials.

I’m PI on a contract from bioMérieux for LOINC content development

(and many federal and non-profit funding sources for LOINC).

This material contains content from LOINC® (http://loinc.org). The LOINC Table, LOINC Table Core, LOINC Panels and
Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology File, LOINC Hierarchies,
LOINC Linguistic Variants File, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are
copyright © 1995-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC)
Committee and is available at no cost under the license at http://loinc.org/license.
Financial Support for LOINC
Regenstrief Institute AHIMA Foundation
Regenstrief Foundation Contract FORE-ASPE-2007-5
U.S. National Library of Medicine RTI International
Contracts NO1-LM-4-3510, N01-LM-6-3546, N01- Contract 0-312-0209853
LM-9-3517, and HHSN276200800006C,
John A. Hartford Foundation
HHSN276201400138P, HHSN276201400239P
Agency for Health Care Policy and Research
Office of the National Coordinator for Health Information
Technology (ONC) Grants HS 08750 and HS 07719-03
Contract 90AX0021 Centers for Disease Control and Prevention
U.S. Food and Drug Administration Grant and Contracts R13/CCR517099 and H75/CCH520501
Contract HHSF223201710178P, HHS223201810268P Centers for Medicare and Medicaid Services
American Physical Therapy Association Contract HHSM-500-2016-00040C
bioMérieux National Center for Advancing Translational Sciences
Indiana Clinical and Translational Sciences Institute Grant 3UL1TR001108-04S1
California Healthcare Foundation National Institute of Diabetes and Digestive and Kidney Diseases
Radiological Society of North America through the National Contract HHSN275201600752P
Institute of Biomedical Imaging and Bioengineering Members of the LOINC Community who have made donations or
Contract HHSN268201500247A became Premium Members
Interoperability
Why it matters
 Interoperability is ultimately
about people who want (their
health IT systems) to work
together and understand
each other
📷 scarlatti2004_images | cc-by-sa
Connecting Many Data Sources

Social and community determinants

Lifestyle and behavioral
Health history
Patient-generated
EHR/clinical
Genetics
Basic science
Reality:
patients move faster and further
than their health information
Life without LOINC…
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)
 The universal standard for identifying health
measurements, observations, and documents.

LOINC terms have the specificity to distinguish

between clinically important differences.
📷 puuikibeach | cc-by
 LOINC is a rich trove of 87,000+ standardized variables
Genetics Lifestyle

21654-9 CFTR gene targeted mutation analysis

41950-7 Number of steps in 24 hour Measured
24475-6 F2 gene c.20210G>A [Presence]
75296-4 Carbohydrate intake 24 hour Estimated
75547-0 Noninvasive prenatal fetal aneuploidy
and microdeletion panel based on Plasma cell- 82289-0 Rating of perceived exertion [Score]
free+WBC DNA by Dosage of chromosome-specific
circulating cell free (ccf) DNA 72166-2 Tobacco smoking status NHIS

82245-2 Chromosome region 22q11.2 deletion in 64098-7 Distance walked in 6 minutes

Amniotic fluid or CVS by FISH

Lab and clinical Environmental

82464-9 Mosquito count [#] in Environmental specimen

4548-4 Hgb A1c MFr Bld 67784-9 Individuals below poverty line Neighborhood

8462-4 Diastolic blood pressure 63736-3 Materials to which you were exposed in your
work or daily life
24725-4 Head CT
63805-6 How long did you handle paints or solvents
57021-8 CBC W Auto Differential panel - Blood yourself?

8633-0 QRS duration 67640-3 My teachers believe that I can do well in my

school work

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📷 unamid-photo | cc-by-nd
A freely available global standard

delivered with a rich set of implementation tools…

used by a diverse global community…

who propel its continuous development.

 Regenstrief + RSNA
An uncommon standards story
Two SDOs joining paths to unify their terminologies and
produce a single standard
LOINC
International standard used widely
25 years mature, published in twice-yearly releases
5,000+ radiology procedure terms

RadLex Playbook
Developed by RSNA as a component of RadLex
Launched in 2011 as standard for radiology procedures
Contained ~1,000 codes in Core Playbook

LOINC/RSNA Radiology Playbook

Jointly developed, unified standard terminology for radiology procedures
Recommended procedure terminology standard
 Main Ideas
Regenstrief’s terminology experience + RSNA’s domain expertise

Unify, don’t 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

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Approach
Created a unified model for procedure names

Transformed existing LOINC terms into the unified model

Mapped between RadLex RPIDs and LOINC codes

Created new LOINCs to fill in any gaps

Mapped of attribute-values between each terminology

Developed a single integrated governance process

Vreeman DJ, Abhyankar S, Wang KC, et al. The LOINC RSNA radiology playbook - a unified terminology for radiology procedures. J Am Med Inform Assoc. 2018 Jul 1;25(7):885-893. doi:10.1093/jamia/ocy053. PubMed
PMID: 29850823.
Key Resources
loinc.org/downloads

Documentation
“Raw” release artifacts
Online and desktop browser (RELMA)
API (via FHIR)
Community resources

Most require a free loinc.org account

Definitive documentation
published as User Guide
Radiology Procedure Naming Model
Modality Maneuver
Modality.Modality Type Maneuver.Maneuver Type
Modality.Modality Subtype
Pharmaceutical
Anatomic Location Pharmaceutical.Substance Given
Anatomic Location.Region Imaged Pharmaceutical.Route
Anatomic Location.Imaging Focus
Anatomic Location.Laterality.Presence Reason for Exam
Anatomic Location.Laterality
Guidance
View Guidance for.Presence
View.Aggregation Guidance for.Approach
View.View type Guidance for.Action

 Guidance for.Object
Timing

Subject
A small sample from the
collection…
 CT Abdomen and Pelvis W contrast IV
36813-4

Part Type Part Name

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
37667-3

Part Type Part Name

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 Version 2.64
June 2018

Current Status

5,800+ Radiology procedure terms

Over 41,000 attribute value relationships linking more than 1,000

LOINC Parts to RadLex clinical terms.

996 LOINC terms are mapped to unique RPID concepts

New requests welcome!

 LOINC/RSNA Radiology Playbook File
LOINC LOINCLongCommonName PartNumber PartType PartName PartSeqOrder RID PreferredName RPID LongName

CT Abdomen and Pelvis W RID103 CT Abdomen/Pelvis w IV

36813-4 LP200067-9 Rad.Modality.Modality type CT A computed tomography RPID145
contrast IV 21 Contrast

CT Abdomen and Pelvis W Rad.Pharmaceutical.Substanc RID115 CT Abdomen/Pelvis w IV

36813-4 LP200085-1 Contrast A Contrast agent RPID145
contrast IV e Given 82 Contrast

CT Abdomen and Pelvis W RID498 CT Abdomen/Pelvis w IV

36813-4 LP200088-5 Rad.Timing W A W RPID145
contrast IV 53 Contrast

CT Abdomen and Pelvis W RID111 CT Abdomen/Pelvis w IV

36813-4 LP200078-6 Rad.Pharmaceutical.Route IV A intravenous RPID145
contrast IV 60 Contrast

CT Abdomen and Pelvis W Rad.Anatomic CT Abdomen/Pelvis w IV

36813-4 LP199956-6 Abdomen A.A RID56 Abdomen RPID145
contrast IV Location.Region Imaged Contrast

CT Abdomen and Pelvis W Rad.Anatomic RID250 CT Abdomen/Pelvis w IV

36813-4 LP199998-8 Pelvis A.B Pelvis RPID145
contrast IV Location.Region Imaged 7 Contrast
https://search.loinc.org
Core Playbook
Good starter set

Find them in RSNA or

LOINC releases
https://loinc.org/fhir
Get info about your favorite
LOINC term
Including all the radiology-specific attributes

https://fhir.loinc.org/CodeSystem/$lookup?system=http://
loinc.org&code=36813-4
Get the LOINC/RSNA Radiology
Playbook as a ValueSet

https://fhir.loinc.org/ValueSet/?url=http://
loinc.org/vs/loinc-rsna-radiology-playbook
RSNA RadLex Playbook

Ongoing maintenance in LOINC

User Guide
API
https://services.rsna.org/playbook/v1/playbook/
complete/rpid/RPID17
 Ready to Go
The LOINC/RSNA Radiology Playbook is ready for deployment
Use it!

Good coverage

Smooth process for requesting

new terms

Enables advanced applications

e.g. HIE-wide prior CT alerting

Peng P, Beitia AO, Vreeman DJ, et al. Mapping of HIE CT terms to LOINC®: analysis of content-dependent coverage and coverage improvement through new term creation. J Am Med Inform Assoc. 2018 Nov 16. doi:
10.1093/jamia/ocy135. [Epub ahead of print] PubMed PMID: 30445562.
 !
Procedure codes, and beyond…

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, this is LOINC’s main content

 Happy LOINCing!

https://danielvreeman.com/rsna2018