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Moghadam N, Lecomte R, Mercure S, Rehani MM, Nassiri MA. Simplified size adjusted dose reference levels for adult CT examinations: A regional study. Eur J Radiol 2021; 142:109861. [PMID: 34280596 DOI: 10.1016/j.ejrad.2021.109861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate retrospective classification of adult patients into small, average, and large based on effective diameter (EDia) from localizer image of computed tomography (CT) scans and to develop regional diagnostic reference levels (DRLs) and achievable doses (AD). METHOD The patients falling within the mean ± standard deviation (SD) of EDia were classified as average; those below this range as small and above as large. The CTDIvol,dose-length-product (DLP) and size-specific dose estimates (SSDE) of all adult patients undergoing CT examinations in 8 CT facilities for 11 months (Dec. 2019 - Oct. 2020) were evaluated. The 75th and 50th percentile values were compared with national and international values. RESULTS Of the total of 69,434 CT examinations, nearly 80% fell within average size. The 75th percentile values of CTDIvol and DLP for small patients for abdomen-pelvic exams were nearly half of average sized patients. Similarly, the 75th percentile values for large patients were nearly double. Similar findings were not found for chest exams. Analysis of image quality and dose factors such as noise, mean axial length, slice thickness, mean number of sequences, use of iterative reconstruction and tube current modulation (TCM) resulted in identification of opportunities for improvement and optimization of different CT facilities. CONCLUSIONS DRLs for adult patients were found to vary widely with patient size and thus establishing DRLs only for standard sized patient is not adequate. Simplified and intuitive methods for size classification was shown to provide meaningful information for optimization for patients outside the standard size adult.
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Affiliation(s)
- Narjes Moghadam
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada.
| | - Roger Lecomte
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Stéphane Mercure
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Moulay Ali Nassiri
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
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Vreeman DJ, Abhyankar S, Wang KC, Carr C, Collins B, Rubin DL, Langlotz CP. The LOINC RSNA radiology playbook - a unified terminology for radiology procedures. J Am Med Inform Assoc 2019; 25:885-893. [PMID: 29850823 PMCID: PMC6016707 DOI: 10.1093/jamia/ocy053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Abstract
Objective This paper describes the unified LOINC/RSNA Radiology Playbook and the process by which it was produced. Methods The Regenstrief Institute and the Radiological Society of North America (RSNA) developed a unification plan consisting of six objectives 1) develop a unified model for radiology procedure names that represents the attributes with an extensible set of values, 2) transform existing LOINC procedure codes into the unified model representation, 3) create a mapping between all the attribute values used in the unified model as coded in LOINC (ie, LOINC Parts) and their equivalent concepts in RadLex, 4) create a mapping between the existing procedure codes in the RadLex Core Playbook and the corresponding codes in LOINC, 5) develop a single integrated governance process for managing the unified terminology, and 6) publicly distribute the terminology artifacts. Results We developed a unified model and instantiated it in a new LOINC release artifact that contains the LOINC codes and display name (ie LONG_COMMON_NAME) for each procedure, mappings between LOINC and the RSNA Playbook at the procedure code level, and connections between procedure terms and their attribute values that are expressed as LOINC Parts and RadLex IDs. We transformed all the existing LOINC content into the new model and publicly distributed it in standard releases. The organizations have also developed a joint governance process for ongoing maintenance of the terminology. Conclusions The LOINC/RSNA Radiology Playbook provides a universal terminology standard for radiology orders and results.
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Affiliation(s)
- Daniel J Vreeman
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Swapna Abhyankar
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Kenneth C Wang
- Imaging Service, VA Maryland Health Care System, Baltimore, Maryland, USA.,Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher Carr
- Informatics Department, Radiological Society of North America, Oak Brook, Illinois, USA
| | - Beverly Collins
- Department of Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA and.,Department of Radiology, Stanford University, Stanford, California, USA
| | - Curtis P Langlotz
- Department of Radiology, Stanford University, Stanford, California, USA
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Kohli MD, Summers RM, Geis JR. Medical Image Data and Datasets in the Era of Machine Learning-Whitepaper from the 2016 C-MIMI Meeting Dataset Session. J Digit Imaging 2018; 30:392-399. [PMID: 28516233 PMCID: PMC5537092 DOI: 10.1007/s10278-017-9976-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At the first annual Conference on Machine Intelligence in Medical Imaging (C-MIMI), held in September 2016, a conference session on medical image data and datasets for machine learning identified multiple issues. The common theme from attendees was that everyone participating in medical image evaluation with machine learning is data starved. There is an urgent need to find better ways to collect, annotate, and reuse medical imaging data. Unique domain issues with medical image datasets require further study, development, and dissemination of best practices and standards, and a coordinated effort among medical imaging domain experts, medical imaging informaticists, government and industry data scientists, and interested commercial, academic, and government entities. High-level attributes of reusable medical image datasets suitable to train, test, validate, verify, and regulate ML products should be better described. NIH and other government agencies should promote and, where applicable, enforce, access to medical image datasets. We should improve communication among medical imaging domain experts, medical imaging informaticists, academic clinical and basic science researchers, government and industry data scientists, and interested commercial entities.
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Affiliation(s)
- Marc D Kohli
- Radiology and Biomedical Imaging, 505 Parnassus Ave, Moffit-391, San Francisco, CA, 94117, USA.
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892-1182, USA
| | - J Raymond Geis
- University of Colorado School of Medicine, 3401 Shore Rd, Fort Collins, CO, 80524, USA
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Wang KC, Patel JB, Vyas B, Toland M, Collins B, Vreeman DJ, Abhyankar S, Siegel EL, Rubin DL, Langlotz CP. Use of Radiology Procedure Codes in Health Care: The Need for Standardization and Structure. Radiographics 2017; 37:1099-1110. [PMID: 28696857 DOI: 10.1148/rg.2017160188] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiology procedure codes are a fundamental part of most radiology workflows, such as ordering, scheduling, billing, and image interpretation. Nonstandardized unstructured procedure codes have typically been used in radiology departments. Such codes may be sufficient for specific purposes, but they offer limited support for interoperability. As radiology workflows and the various forms of clinical data exchange have become more sophisticated, the need for more advanced interoperability with use of standardized structured codes has increased. For example, structured codes facilitate the automated identification of relevant prior imaging studies and the collection of data for radiation dose tracking. The authors review the role of imaging procedure codes in radiology departments and across the health care enterprise. Standards for radiology procedure coding are described, and the mechanisms of structured coding systems are reviewed. In particular, the structure of the RadLex™ Playbook coding system and examples of the use of this system are described. Harmonization of the RadLex Playbook system with the Logical Observation Identifiers Names and Codes standard, which is currently in progress, also is described. The benefits and challenges of adopting standardized codes-especially the difficulties in mapping local codes to standardized codes-are reviewed. Tools and strategies for mitigating these challenges, including the use of billing codes as an intermediate step in mapping, also are reviewed. In addition, the authors describe how to use the RadLex Playbook Web service application programming interface for partial automation of code mapping. © RSNA, 2017.
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Affiliation(s)
- Kenneth C Wang
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Jigar B Patel
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Bimal Vyas
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Michael Toland
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Beverly Collins
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Daniel J Vreeman
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Swapna Abhyankar
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Eliot L Siegel
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Daniel L Rubin
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
| | - Curtis P Langlotz
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., J.B.P., E.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (K.C.W., J.B.P., B.V., M.T., E.L.S.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (B.C.); Indiana University School of Medicine, Indianapolis, Ind (D.J.V.); Regenstrief Institute, Indianapolis, Ind (D.J.V., S.A.); and Department of Radiology, Stanford University, Stanford, Calif (D.L.R., C.P.L.)
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