A State-of-the Art Review of SNOMED CT Terminology Binding and Recommendations for Practice and Research

BACKGROUND

Unambiguous sharing of data requires information models and terminology in combination, but there is a lack of knowledge as to how they should be combined, leading to impaired interoperability.

OBJECTIVES

To facilitate creation of guidelines for SNOMED CT terminology binding we have performed a literature review to find existing recommendations and expose knowledge gaps. The primary audience is practitioners and researchers working with terminology binding.

METHODS

PubMed, Scopus, and Web of Science were searched for papers containing "terminology binding," "subset," "map," "information model" or "implement" and the term "SNOMED."

RESULTS

The search yielded 616 unique papers published from 2004 to 2020, from which 55 papers were selected and analyzed inductively. Topics described in the papers include problems related to input material, SNOMED CT, information models, and lack of appropriate tools as well as recommendations regarding competence.

CONCLUSION

Recommendations are given for practitioners and researchers. Many of the stated problems can be solved by better co-operation between domain experts and informaticians and better knowledge of SNOMED CT. Settings where these competences either work together or where staff with knowledge of both act as brokers are well equipped for terminology binding. Tooling is not thoroughly researched and might be a possible way to facilitate terminology binding.

Computed Tomography and Conventional Radiography in Intrathoracic Metastases from Non-Seminomatous Testicular Tumor

Conventional chest radiographs and CT scans were studied retrospectively in 283 patients with untreated non-seminomatous testicular tumor. Intrathoracic metastases were found in 47 patients, and CT was the only positive examination in 20 of them. Lung metastases were seen in 39 patients and mediastinal lymph nodes were involved in 13. The additional yield of CT in detecting metastases was most marked for the lymph nodes (tumor detected only at CT in 9 out of 13 cases as compared with 14 out of 39 for the lung parenchyma). Posterior mediastinal and retrocrural lymph nodes were most often enlarged, and involvement of these was most difficult to detect at conventional radiography.

Absorbed Dose Resulting from a Specially Designed Computed Tomography Technique for Examination of the Urinary Bladder

The absorbed spatial dose distribution resulting from a specially designed CT protocol for examination of the urinary bladder has been investigated with TLD rods in a body phantom containing tissue equivalent material. The CT examination consisted of scout view and both pre- and postcontrast scan series with 5 mm slice thickness and 5 mm unscanned intervals between successive scans. Cross-sectional dose distribution for one scan in the plane of the ovaries was measured as well as the dose profile for one scan along a line through the ovary parallel to the axis of rotation. Based on these measurements, the dose resulting from the whole CT examination was calculated, both with contiguous and noncontiguous scans. The ovarian dose was calculated for different positions of the ovaries in relation to the scanned area. The absorbed dose varied between 8.3 mGy and 9.7 mGy with the actual technique used. When contiguous scans with the same thickness were taken, the ovarian dose increased with a factor from 1.7 to 1.9. The dose resulting from the CT protocol of the urinary bladder was of the same magnitude as absorbed dose resulting from urography. When the diagnostic gain from a precise definition of tumor extent was taken into account, the dose resulting from the CT protocol was judged acceptable.

Computed Tomography of Invasive Bladder Carcinoma after Diagnostic Transurethral Resection

Fourteen patients with known muscle invasive bladder carcinoma were examined with computed tomography (CT) before and five to seven days after diagnostic transurethral resection (TUR). The CT examinations included pre- and postcontrast series. In order to standardize the technique, we examined on a distended bladder. No significant changes occurred for the whole group after TUR. Individual changes were seen. In six patients the largest measured area of the bladder tumor increased after resection and in four the largest measured thickness increased, and this should be borne in mind when CT is used to evaluate tumor response to treatment. Perivesical changes occurred only after extensive diathermy or perforation. They did not show contrast enhancement and could therefore not be mistaken for tumor growth.

Shape of Retroperitoneal Lymph Nodes at Computed Tomography Does Not Correlate to Metastatic Disease in Early Stage Non-Seminomatous Testicular Tumors

Variety Range (difference between the maximum and minimum transverse diameters in percentage of the minimum diameter) was calculated for 86 lumbar lymph nodes with maximum diameter ranging between 5 mm and 19 mm at CT. The nodes were located within a group (pre- and paracaval, interaortico-caval, pre- and paraaortic) which was removed during primary lymphadenectomy for non-seminomatous testicular tumor. Most nodes were fairly rounded with a Variety Range less than 20%. There was no difference between the largest node in a metastasis group (Variety Range less than 20% in 29 out of 36) and tumor free nodes (Variety Range less than 20% in 39 out of 50). A rounded shape of lymph nodes measuring less than 20 mm on transverse CT sections was not a reliable sign of metastasis in patients with ***non-seminomatous testicular tumor.

Cross-organizational workflow in radiology: an empirical study of the quality of shared metadata elements in Region Västra Götaland, Sweden

BACKGROUND

Challenges related to the cross-organizational access of accurate and timely information about a patient's condition has become a critical issue in healthcare. Interoperability of different local sources is necessary.

PURPOSE

To identify and present missing and semantically incorrect data elements of metadata in the radiology enterprise service that supports cross-organizational sharing of dynamic information about patients' visits, in the Region Västra Götaland, Sweden.

MATERIAL AND METHODS

Quantitative data elements of metadata were collected yearly from the first Wednesday in March from 2006 to 2011 from the 24 in-house radiology departments in Region Västra Götaland. These radiology departments were organized into four hospital groups and three stand-alone hospitals. Included data elements of metadata were the patient name, patient ID, institutional department name, referring physician's name, and examination description.

RESULTS

The majority of missing data elements of metadata was related to the institutional department name for Hospital 2, from 87% in 2007 to 25% in 2011. All data elements of metadata except the patient ID contained semantic errors. For example, for the data element "patient name", only three names out of 3537 were semantically correct.

CONCLUSION

This study shows that the semantics of metadata elements are poorly structured and inconsistently used. Although a cross-organizational solution may technically be fully functional, semantic errors may prevent it from serving as an information infrastructure for collaboration between all departments and hospitals in the region. For interoperability, it is important that the agreed semantic models are implemented in vendor systems using the information infrastructure.

Simulation of radiology workflow and throughput

Emerging electronic health technologies create an unending transformation process. This calls for new ways to plan and prepare the radiology department for these changes. There is a lack of literature addressing ways to predict the effects of implementing and using new technologies in healthcare. Innovative services by means of simulation is a technique that could predict effects of changes beforehand. The aim of this study was to validate the use of discrete event simulation to plan future examination throughput changes in the radiology department of Alingsås Hospital in Sweden after both the investment in a new MRI suite and the closing down of two old rooms. The simulation scenario presented here was based on real life local examination throughput in combination with the total examination throughput from other radiology departments in the region already having MRI suites in use.

Better quality in healthcare through gamified simulation based skill training application

Although the screening of abdominal aortic diameter helps to identify men with abdominal aortic aneurysm and saves lives, there is need to coordinate and synchronize screening personnel's way to work. This article describes the design of a game based skill training application that could give the screening personnel an additional opportunity to refine measuring of abdominal aortic diameter in ultrasound images. The design work follows the steps of the Goal Directed design process. Consequently, the design activities are divided into six phases: the Research, Modelling, Requirements Definition, Framework Definition, Refinement and Development support. The design process described in this paper finishes with usability testing of an interactive prototype. The evaluation of the design was conducted with end users by studying their subjective ratings and performance on given tasks. The overall results of the usability testing show that the interactive prototype of the skill training application is not yet fully usable. Consequently, further improvement of the interface design is needed. The identified usability issues and collected qualitative and quantitative material about the interaction between test participants and the interface can guide the next design iteration and lead to more usable design.

The use of simulation in radiology

The aim of this study is to analyze how simulation has been used in healthcare (radiology, in particular) to predict the outcome of work practice changes. This is a literature study concerning different simulation models as a planning tool prior to changes in work practice. The radiology organization is in a transformation process. There is a lack of existing literature addressing ways to predict or imagine new technology in the context of its use in radiology work practice. Yet, studies also illustrate that data collection and mining is an excellent investment in understanding complex systems and how simulation models can be applied for change in radiology. If changes in work practices are a result of changing ourselves and the way we think about our work, simulation could be a technique to help the individual understand changes in the healthcare process.

The impact of PACS on radiologists' work practice

This paper identifies and analyzes how the implementation and use of picture archiving and communication system impacts radiologists' work practice. The study is longitudinal from 1999 to 2005 and have a qualitative perspective were data were collected by structured interviews in a total of 46. The interviews were transcribed, analyzed, and coded using grounded theory as an organizing principle. In radiologists' work practice, three main categories were defined: professional role, diagnostic practice, and technology in use. The changing trends within the professional role indicated that radiologists moved from a more individual professional expertise to become more of an actor in a network. The diagnostic practice changed, as reading x-ray films was seen as an art form in 1999, requiring years of training. Once everyone could view digital images, including 3-dimensional technology, it was easier for other clinicians to see and interpret the images and the skills become accessible to everyone. The change in technology in use as a result of the shift to digital images led to an increased specialization of the radiologist.

Positioning of temperature measurement points using multiplanar computed tomography

A method is described for the use of computed tomography and multiplanar reconstruction to depict in single images the full course of obliquely running thermometry catheters. In 14 patients given thermoradiotherapy for locally advanced breast carcinoma, reformatted images of the full catheter course were obtained for all 98 catheters so far tested. The main clinical advantage of this time-consuming procedure was the ability to determine the localization within the catheters of individual temperature measurement points of multipoint thermistor probes. It was also possible to study the localization of the measurement points in relation to the tumour margins.

Absorbed dose resulting from a specially designed computed tomography technique for examination of the urinary bladder

The absorbed spatial dose distribution resulting from a specially designed CT protocol for examination of the urinary bladder has been investigated with TLD rods in a body phantom containing tissue equivalent material. The CT examination consisted of scout view and both pre- and postcontrast scan series with 5 mm slice thickness and 5 mm unscanned intervals between successive scans. Cross-sectional dose distribution for one scan in the plane of the ovaries was measured as well as the dose profile for one scan along a line through the ovary parallel to the axis of rotation. Based on these measurements, the dose resulting from the whole CT examination was calculated, both with contiguous and noncontiguous scans. The ovarian dose was calculated for different positions of the ovaries in relation to the scanned area. The absorbed dose varied between 8.3 mGy and 9.7 mGy with the actual technique used. When contiguous scans with the same thickness were taken, the ovarian dose increased with a factor from 1.7 to 1.9. The dose resulting from the CT protocol of the urinary bladder was of the same magnitude as absorbed dose resulting from urography. When the diagnostic gain from a precise definition of tumor extent was taken into account, the dose resulting from the CT protocol was judged acceptable.

Computed tomography and conventional radiography in intrathoracic metastases from non-seminomatous testicular tumor

Conventional chest radiographs and CT scans were studied retrospectively in 283 patients with untreated non-seminomatous testicular tumor. Intrathoracic metastases were found in 47 patients, and CT was the only positive examination in 20 of them. Lung metastases were seen in 39 patients and mediastinal lymph nodes were involved in 13. The additional yield of CT in detecting only at CT in 9 out of 13 cases as compared with 14 out of 39 for the lung parenchyma). Posterior mediastinal and retrocrural lymph nodes were most often enlarged, and involvement of these was most difficult to detect at conventional radiography.

Computed tomography of invasive bladder carcinoma after diagnostic transurethral resection

Fourteen patients with known muscle invasive bladder carcinoma were examined with computed tomography (CT) before and five to seven days after diagnostic transurethral resection (TUR). The CT examinations included pre- and postcontrast series. In order to standardize the technique, we examined on a distended bladder. No significant changes occurred for the whole group after TUR. Individual changes were seen. In six patients the largest measured area of the bladder tumor increased after resection and in four the largest measured thickness increased, and this should be borne in mind when CT is used to evaluate tumor response to treatment. Perivesical changes occurred only after extensive diathermy or perforation. They did not show contrast enhancement and could therefore not be mistaken for tumor growth.

Shape of retroperitoneal lymph nodes at computed tomography does not correlate to metastatic disease in early stage non-seminomatous testicular tumors

Variety Range (difference between the maximum and minimum transverse diameters in percentage of the minimum diameter) was calculated for 86 lumbar lymph nodes with maximum diameter ranging between 5 mm and 19 mm at CT. The nodes were located within a group (pre- and paracaval, interaortico-caval, pre- and paraaortic) which was removed during primary lymphadenectomy for non-seminomatous testicular tumor. Most nodes were fairly rounded with a Variety Range less than 20%. There was no difference between the largest node in a metastasis group (Variety Range less than 20% in 29 out of 36) and tumor free nodes (Variety Range less than 20% in 39 out of 50). A rounded shape of lymph nodes measuring less than 20 mm on transverse CT sections was not a reliable sign of metastasis in patients with non-seminomatous testicular tumor.