Application of Standardized Biomedical Terminologies in Radiology Reporting Templates

1. Application of Standardized Biomedical Terminologies in Radiology Reporting Templates • Yi Hong 1, Marcia Lei Zeng2, Jin Zhang 3, Alexandra Dimitroff3 and Charles E. Kahn, Jr. 4 • 1 Department of Architecture and Integration, Harris Corporation, Melbourne, Florida, USA • 2 School of Library and Information Science, Kent State University, Kent, Ohio, USA • 3 School of Information Studies, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, USA • 4 Medical College of Wisconsin, Milwaukee, • Wisconsin, USA • ISKO UK 2013 • London, July 8 - 9, 2013

2. Background • Conventional free-text radiology reports vs. structured reports • The Radiological Society of North America (RSNA) radiology reporting initiative and Reporting Template Library

3. Conventional Free-text Reports CT chest, abdomen, and pelvis were obtained to evaluate this 60-year-old male with renal cell carcinoma and are compared with CT chest, abdomen, and pelvis of 04/12/07. Technique: Helical acquisition was performed following the oral administration of contrast material and the intravenous administration of 140 cc of Omnipaque-300 and 2.5 mm axial images are reviewed. Findings: The visualized portions of the thyroid are unremarkable in appearance. There is no supraclavicular or axillaryadenopathy. No hilar or mediastinaladenopathy. Patient is status post right lower lobectomy. The cavitary nodule in the right lower lung appears slightly smaller but otherwise unchanged. The more solid nodule in the left lower lobe now measures 7 mm, and previously measured 5 mm, suggesting interval enlargement. The calcified nodule in the left upper lobe is unchanged. Focal areas of scarring in the lungs is unchanged as well. No pleural or pericardial effusion. The heart size is normal. The left nephrectomy bed is unremarkable in appearance. There is no evidence of recurrent mass. No free fluid in the abdomen or pelvis. No mass or adenopathy in the abdomen or pelvis. The liver, spleen, pancreas, adrenals, and right kidney are unchanged. The cyst in the right lobe of the liver is stable in appearance. Bowel loops are normal in caliber. There is no bowel wall thickening. The gallbladder is present. There is no mesenteric stranding. Prostate, seminal vesicles, and urinary bladder are unremarkable in appearance. No bone abnormalities to suggest metastatic disease. Right rib resection for thoracotomy appears unchanged. … The more solid nodule in the left lower lobe now measures 17 mm, and previously measured 12 mm, suggesting interval enlargement. … Information is difficult to extract from “free-text” reports

4. Structured Reports • Consistent ordering of report sections • Standardized set of concepts in predefined format • Improved report quality with • Greater completeness • Ease of use

5. Structured Reports with Standard Terminologies Tumor Location: [ Left upper lobe ] Size: [ 17 mm ] Pleural effusion: [ None ] Upper lobe of left lung(RID1327) None (RID28454) Pleural effusion(RID34539) Coded reporting elements can be linked to biomedical terminologies to improve retrieval of radiology reporting information. .

6. PROCEDURE: MRI ABDOMEN WITHOUT AND WITH CONTRAST (DATE) • CLINICAL INDICATION: [Characterize liver mass]. • COMPARISON: [Specify modality: e.g CT, enhanced MRI <date> | None*]. • TECHNIQUE: Pre and dynamic post contrast evaluation of the abdomen was performed on a [field strength] Tesla scanner. The following sequences were obtained: [axial T1-weighted dual-echo gradient recalled-echo, axial fat suppressed respiratory triggered T2-weighted fast (turbo) spin-echo, and axial dynamic fat suppressed T1-weighted 3-D gradient recalled-echo prior to and following gadolinium contrast administration in the arterial, venous, delayed phases of enhancement. • [ ] ml of [name of contrast agent] was administered. [<MRCP was also performed>] [<using a 3-D respiratory triggered T2-weighted and axial thin slice breath-hold single shot FSE sequences.>] • Image quality is [satisfactory/degraded by motion/etc]. • FINDINGS: • Liver has [normal/decreased/increased] size, [normal/decreased/increased] signal intensity and [normal/abnormal] enhancement pattern. • Fatty liver [Yes/No]. {If yes} [focal: location, morphology: patchy, nodular, or diffuse, areas of sparing [location, morphology: patchy, nodular] • Iron deposition: [None; Diffuse, patchy] • Gall bladder is [normal/abnormal] and there is [Yes/No] intrahepatic or extrahepaticbiliaryductal dilatation. • Solid Liver Mass: [None] • Number • Margin [well defines, ill defined] • Morphology [round, elongated, lobulated] • Size: [# x # cm] • ……………… • Lymph nodes: [location, <Normal size>][<Enlarged; probably reactive>]. • IMPRESSION: • 1. [ ] • Recommendations: [ ] Reporting template - a list of reporting element placeholders to create best-practices reports with consistent format and components Integrate all of the information collected during the imaging procedure with standardized terminologies

7. RSNA Reporting Template Library • Available at: http://www.radreport.org

9. Purpose of the Study • Assess how well standardized biomedical terminologies represent radiological knowledge as reflected by the RSNA reporting templates • Obtain first-hand information to guide the enhancement of both the standard terminologies and the RSNA reporting templates from users’ perspective.

10. Research Questions • What role do standardized biomedical terminologies play in radiological knowledge representation and organization with structured reporting? • How well do RadLex® and SNOMED CT® represent radiological knowledge in RSNA reporting templates? • How would the first-hand information be used to guide the development of both RadLex® and the RSNA reporting templates from users’ perspective?

11. RadLex® • Radiology lexicon developed and maintained by RSNA • 58,000+ terms of anatomy, imaging observations, procedures, and medical conditions relevant to radiology • Online: www.radlex.org

12. radlex.org

13. SNOMED CT® • Systematized Nomenclature of Medicine Clinical Terms • Most comprehensive, multilingual clinical healthcare terminology • Used in more than fifty countries • 310,000+ terms • Owned, maintained and distributed by the International Health Terminology Standards Development Organisation (IHTSDO) • Online: http://www.ihtsdo.org/snomed-ct/

16. Synonym “Post-coordinated” term Exact or partial match

17. Selecting the best matching RadLex term No matching RadLex term

18. Mapped XML-encoded Reporting Templates

21. RadLex® Coverage in Sample Reporting Templates

22. Total annotations for each of sample reporting templates

23. Unique annotationsfor each of sample reporting templates

24. Limitations of the Study • Only limited number of sample templates of five exam types with two terminologies were chosen to do the study. • The BioPortal Annotator often identified multiple concepts for a specific term. For example, the reporting element "Pleural effusion" was mapped to annotations for "Pleural effusion", "Pleural", and "effusion". Such redundancy may artificially increase the number of annotations. • Only exactly matched terms were counted for the terminology coverage analyzed with the BioPortal Annotator, which might result in smaller percentage of the matching concepts due to missing of the partially matched terms.

25. Conclusion • Standardized biomedical terminologies offer an effective way to cope with various representations of radiological knowledge. • Incorporation of standardized terminologies into reporting templates improves the consistency and quality of radiology reports. • The RadLex® and SNOMED CT® have covered most of the terms (38% to 53% coverage) used in the radiology reporting templates. • The mapping results and analysis provide valuable insights for ongoing development of the RSNA reporting templates and RadLex®.

26. Acknowledgments • National Institute of Biomedical Imaging and Bioengineering (NIBIB) • RSNA Radiology Informatics Committee • Authors of RSNA reporting templates • Developers of RadMap and NCBO Annotator • For more information . . . • http://radreport.org • RSNA Reporting Wiki - reportingwiki.rsna.org • Email: yhong@harris.com