It is an online repository of teaching files. Of course variations in terminology have existed for decades but how do they affect practicing radiologists? Consider the Radiological Society of North America’s (RSNA) online teaching file called MIRC (Medical Imaging Resource Center). We need a standardized terminology that encapsulates the common meaning in order to reduce confusion. The problem with the richness of language and the numerous terms that we can pick from is that our understandings of the terms, both for radiologists and for referring clinicians, can be different. Part of the problem is that multiple terms exist to describe nearly any radiological finding. Having more report structure will vastly improve communication with our referring clinicians, which is a critical component of what we do. Certainly, being expressive is good, but it can also be problematic, because radiologists don’t always use clear and unambiguous terms.

So there is great variability amongst radiologists when they are creating reports. There are currently no standards for how a report is structured. But there are no standards for the terms we use when we create a report. The focal point of radiology is the report. These are important initiatives, because they will be incorporated into vendor products and systems, and will greatly enable future applications for radiologists. I will focus on two elements: A control terminology called RadLex and new, emerging standards for describing what images show, an initiative called Annotation and Image Mark-up (AIM). Standards would also enable some important applications, like data mining or correlations with genomics. That information is an integral part of the work product of a radiologist, and standards would allow that information to move seamlessly throughout the enterprise. How do we communicate the descriptions of the findings or the anatomy? The missing link in interoperability is a standard for the content that goes into a report in terms of what a radiologist says and what the image shows.

While these are important standards for interoperability, what is missing are standards for dealing with what is in the actual content of the reports themselves. The current standards are DICOM, which allows systems to move the actual images between each other HL-7, which allows health information systems to move clinical data and the Integrating the Healthcare Enterprise (IHE) standards, which provide a framework that allows systems to use the above standards to pass information. There are communications standards that allow these systems to interoperate with each other using the raw data they generate. And this is the critical informatics issue: How do these systems interoperate and how important is it, as radiologists, to be aware of the efforts that are being made to enable this interoperation to happen more seamlessly? These different systems need to communicate with each other and interoperate with the information. The imaging modality itself, where the patient actually has the imaging performed, communicates with the picture archiving and communications systems (PACS), and this is where the images are stored and interpreted. That system should communicate with the radiology information system (RIS),where the orders are placed and the results of radiology imaging ultimately are sent. For instance, the health information system (HIS), is where patients are first registered. It is critical that our systems talk to each other, because radiologists, on a daily basis, work with many systems. The term is defined as the ability for two or more systems to exchange information and to use the information that has been exchanged.

Radiologists may not be familiar with the term interoperability, or how it can have a significant impact on their daily workflow. Rubin is Assistant Professor of Radiology and of Medicine, Department of Radiology, Stanford University, Stanford, CA.

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