From: Richard Webb [rwebb@radiology.ucsf.edu]
Sent: Monday, April 21, 2003 3:46 PM
To: Curtis P. Langlotz
Subject: Re: RadLex Thoracic Lexicon meeting Wed 4/23

A few very general comments, as I will not be in attendance.

The ACR system has several significant drawbacks from the point of 
view of a thoracic radiologist, which should be kept in mind.

Although the anatomical field is important, it is often not relevant 
for pulmonary disease, emphasizing the lung lobe involved, when the 
process is generalized or multilobar.

It also provides short shrift to detailed location in the 
mediastinum, etc. For example, other than listing mediastinal lymph 
nodes, the trachea, and great vessels, nothing in the mediastinum 
(e.g. thymus) is indicated, nor is there a way to indicate the 
presence of abnormalities in a specific mediastinal compartment (e.g. 
prevascular space, aortopulmonary window). Mediastinal lymph nodes 
should be listed with names and numbers corresponding to the new AJCC 
classification.

Also, although hilar abnormalities are common, the hila are not 
listed as separate structures, other than as bronchi or "hilar lymph 
nodes", which incidentally are not in the mediastinum as they are 
listed.

Further, among the anatomic terms provided, a number of structures, 
although in the thoracic, do not fall in the category of chest 
diseases. Examples include the thoracic disks, thoracic spine, and 
esophagus.

Although disease entities are not in the list you provide, I would 
recommend a significant break from the ACR system. It is virtually 
impossible to find the disease you wish using the ACR system by 
looking at the major categories listed.

The categories listed in the ACR system were chosen (I think) to be 
the same for each anatomic region (e.g. brain, GI, etc), while 
diseases affecting these different systems are more appropriately 
divided into very different groups. For example, inhalational disease 
(pneumoconiosis) is an important category of chest disease, but is 
clearly not appropriate for other systems.

Have fun.

>Dear RadLex Thoracic Committee member,
>
>We have been working at a feverish pitch in preparation for our meeting in
>Oak Brook next week.  Attached are an agenda for our meeting, a brief
>overview of RadLex that explains the basic organization of the lexicon, and
>a spreadsheet containing a sample of RadLex terms.  (You will receive paper
>copies of these documents by the end of the week.)  If you have any comments
>or questions about the attached documents, please feel free to email or call
>me (langlotz@rad.upenn.edu; 856-722-5666).
>
>Don Harrington, Chair of Radiology at the State University of New York in
>Stony Brook, who many of you met at our RSNA breakfast meeting, will help me
>guide our discussion, and will share the task of introducing you to the
>world of lexicons.  Don, Theresa McLoud, and I are excited about the
>prospect of a new thoracic imaging lexicon, and are looking forward to
>seeing you next week in Chicago.  Even if you will not be joining us in
>Chicago, we would appreciate your review of the draft lexicon, and any
>comments and feedback you can provide over the phone or by email.
>
>Thank you again for your participation in this important effort.
>
>Best regards,
>Curt Langlotz
>
>cc: Electronic Communications Committee, RadLex Steering Committee
>
>=============================================================
>Curtis P. Langlotz, MD, PhD
>Adjunct Associate Professor of Radiology and Epidemiology
>    University of Pennsylvania
>address: 719 Iron Post Road
>          Moorestown, NJ 08057-1861
>voice:   856-722-5666
>fax:     856-722-5659
>email:   langlotz@rad.upenn.edu
>
>
>Attachment converted: Macintosh HD:RadLexThoracicAgenda.doc 
>(WDBN/MSWD) (0003F71C)
>Attachment converted: Macintosh HD:RadLexIntro.doc (WDBN/MSWD) (0003F71D)
>Attachment converted: Macintosh HD:ThoracicAnatomyTerms.xls 
>(XLS4/XCEL) (0003F71E)
>Attachment converted: Macintosh HD:RadLexThoracicCommittee.doc 
>(WDBN/MSWD) (0003F71F)


-- 
Best regards, Rick