Clinical LOINC Meeting | Salt Lake City, UT USA

Radiology Studies

Daniel J. Vreeman, PT, DPT, MS

Regenstrief-McDonald Scholar in Data Standards
Indiana University School of Medicine

Director, LOINC and Health Data Standards

@djvreeman Regenstrief Center for Biomedical Informatics

2017
 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
CT Abdomen
MR Brain WO and W contrast IV
XR Orbit for foreign body
This is our
bread and
butter
 Radiology Report Terms
> 5500 active terms in v2.61

Modality # LOINC Terms

CT 807
Mammography 158
MRI 871
Nuclear Medicine 529
Ultrasound 505
XR 1953
Fluoroscopy 681
 Sections within a Report
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
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 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
Radiology Naming Model
Radiology-specific conventions
 LOINC/RSNA
Radiology Playbook
A collaboration produce a single unified source
of names and codes for radiology procedures
with a cooperative governance process
 Main Deliverables
A Unified Model for Radiology Procedure Names

Mapping of 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

To date, all of the modality-specific terms have

been converted to the new model
 Complete Attribute Set
Modality
Modality.Modality Type
Modality.Modality Subtype
Anatomy
Anatomic Location.Region Imaged
Anatomic Location.Imaging Focus
Anatomic
Location.Laterality.Presence
Anatomic Location.Laterality
View
View.Aggregation
View.View type
Timing
Maneuver
Maneuver.Maneuver Type
Pharmaceutical
Pharmaceutical.Substance Given
Pharmaceutical.Route
Reason for Exam
Guidance
Guidance for.Presence
Guidance for.Approach
Guidance for.Action
Guidance for.Object
Subject
 Anatomy of a LOINC Term
37842-2:View AP:Find:Pt:Upper extremity>Shoulder:Doc:XR

37842-2 LOINC Code

View AP Component
Find Property Measured
Pt Timing

Upper extremity>Shoulder System

Doc Scale

XR Method

Six major LOINC axes

 View
Component 1st Subpart

<view descriptor> [<view aggregation>] [<view type>]

Views descriptor Views, Multisection,

View aggregation 3, greater than 3
View type AP, lateral
 Reason for Exam
Component 1st Subpart
A clinical indication or a purpose for the study. This
may refer to a patient diagnosis, a clinical indication,
a clinical status (e.g., post op), an intended
measurement, altered anatomy (e.g. endograft), or
some other indicator of the purpose of the exam
(e.g. screening). Only used where necessary.

Examples
79086-5 CT Chest for screening WO contrast
39032-8 US for transplanted kidney
 Guidance
Component 1st Subpart (for Interventional)

Guidance for <approach> <action> <object>

Approach percutaneous

Action aspiration, biopsy,

placement, etc
Object abscess, foreign body,
nephrostomy tube, etc
 Timing/Existence
Component 2nd Subpart

Used in conjunction with both the

Pharmaceutical and Maneuver
attributes (stay tuned)

Example values
W, WO & W, WO
 Pharmaceutical
Component 2nd Subpart

<timing/existence> <substance given> <route>

Substance given contrast, adenosine,

Tc-99m Sestamibi

Route IV, PO, etc

 Maneuver
Component 2nd Subpart

<timing/existence> <maneuver>

Maneuvers relate to a challenge presented to a patient, often with

the goal of elucidating or testing some dynamic aspect of anatomy
or physiology. Maneuvers often carry an implication of patient
exertion (e.g. Valsalva maneuver), although some maneuvers do
not involve patient exertion (e.g. pharmacologic cardiac stress).

Example values
flexion, extension, standing, inspiration, etc
 Anatomic Location
System

<region imaged> > <imaging focus>

Region imaged is used in two ways. First, as a coarse-

grained descriptor of the area imaged and a grouper for
finding related imaging exams; or, it is used just as a grouper.
Values drawn from a constrained list.

Imaging focus is defined as a more fine grained descriptor of

the specific target structure of an imaging exam. In many
areas, the focus should be a specific organ.
 Region Imaged
allowed axis values
Head
Neck
Chest
Breast
Abdomen
Pelvis
Extremity
Upper extremity
Lower extremity
Whole body (used when the Imaging focus exists throughout the body
and is being imaged in its entirety, such as bones or bone marrow)
Unspecified (represented in LOINC as XXX)
 Subject
Super System

Same usage as super system in other

parts of LOINC.

Example values
fetus, surgical specimen
(mammography)
 Modality
Method

<modality>.<modality subtype>

Modality CT, MR, XR, etc

Modality subtype angio, densitometry,

spectroscopy, tomography
Allowed combinations are enumerated in Users Guide
 A few special cases
There are always some.

photo via JD Hancock | cc-by

 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

still specify anatomy separately)

We use when the name is evocative

Example:
24801-3 View Merchants:Find:Pt:Lower extremity>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: 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.
LOINC/RSNA Radiology
Playbook File
The main distribution of this joint work
 Accessory File Format
LOINCLongC PartSeq
LOINC PartNumber PartName PartType RID PreferredName RPID LongName
ommonName Order

Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis CT W LP200067-9 Rad.Modality.Modality type CT A RID10321 computed tomography RPID145
w IV Contrast
contrast IV

Abdomen and
Rad.Pharmaceutical.Substanc CT Abdomen/Pelvis
36813-4 Pelvis CT W LP200085-1 Contrast A RID11582 Contrast agent RPID145
e Given w IV Contrast
contrast IV

Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis CT W LP200088-5 Rad.Timing W A RID49853 W RPID145
w IV Contrast
contrast IV

Abdomen and
CT Abdomen/Pelvis
36813-4 Pelvis CT W LP200078-6 Rad.Pharmaceutical.Route IV A RID11160 intravenous RPID145
w IV Contrast
contrast IV

Abdomen and
Rad.Anatomic CT Abdomen/Pelvis
36813-4 Pelvis CT W LP199956-6 Abdomen A.A RID56 Abdomen RPID145
Location.Region Imaged w IV Contrast
contrast IV

Abdomen and
Rad.Anatomic CT Abdomen/Pelvis
36813-4 Pelvis CT W LP199998-8 Pelvis A.B RID2507 Pelvis RPID145
Location.Region Imaged w IV Contrast
contrast IV