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EAU Standardised Medical Terminology for Urologic Imaging: a Taxonomic Approach

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EAU Standardised Medical Terminology for Urologic Imaging: a Taxonomic Approach EUROPEAN UROLOGY 67 (2015) 965–971 available at www.sciencedirect.com journal homepage: www.europeanurology.com Education EAU Standardised Medical Terminology for Urologic Imaging: A Taxonomic Approach Tillmann Loch a,*, Brendan Carey b, Jochen Walz c, Pat Fox Fulgham d, for the European Association of Urology Guidelines Office Ad Hoc Working Group on Urological Imaging a Klinik fu¨r Urologie, Diakonissenkrankenhaus Flensburg, Lehrkrankenhaus der Christian-Albrechts-Universita¨t, Flensburg, Germany; b St. James Institute of Oncology, Leeds, UK; c Department of Urology, Institute Paoli-Calmettes Cancer Centre, Marseille, France; d Department of Urology, Texas Health Presbyterian Hospital Dallas, Dallas TX, USA Article info Abstract Article history: Background: The terminology and abbreviations used in urologic imaging have generally Accepted August 5, 2014 been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research. Objective: This work reviews the current nomenclature for urologic imaging used in Keywords: clinical practice and proposes a taxonomy and terminology for urologic imaging studies. Computed tomography Design, setting, and participants: A list of terms used in urologic imaging were compiled EAU guidelines from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Magnetic resonance imaging Criteria. Positron emission tomography Outcome measurements and statistical analysis: Terms searched were grouped into Radiographs broad categories based on technology, and imaging terms were further stratified based Taxonomy on the anatomic extent, contrast or phases, technique or modifiers, and combinations or Terminology fusions. Terms that had a high degree of utilisation were classified as accepted. Results and limitations: We propose a new taxonomy to define a more useful and Ultrasound acceptable nomenclature model acceptable to all health professionals involved in Urologic imaging urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature. Conclusions: This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement. Patient summary: In this paper we describe a classification system for urologic imaging terms with the aim of aiding health professionals and ensuring that the terms used are more consistent. # 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Klinik fu¨ r Urologie, Diakonissenkrankenhaus Flensburg, Knuthstrasse 1, 24939 Flensburg, Germany. Tel. +49 461 812 1401; Fax: +49 461 812 1402. E-mail address: [email protected] (T. Loch). http://dx.doi.org/10.1016/j.eururo.2014.08.014 0302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. 966 EUROPEAN UROLOGY 67 (2015) 965–971 1. Introduction published literature and to propose standardisation of terms using taxonomy. The continued development of new imaging techniques in urology has had considerable impact on both clinical 2. Methods practice and urologic research [1,2]. The clinical integration of these imaging techniques into urologic practice involves The list of terms used for urologic imaging was compiled from guidelines contributions from investigators and clinicians of varied published by the European Association of Urology (EAU) [7], the backgrounds including physics and engineering, informat- American Urological Association (AUA) [8], and the American College of ics, urology, and radiology. Each profession has its own Radiology (ACR) [9]. These guidelines are regularly updated and based on jargon, a specialised language that allows for rapid and extensive review of the current literature. efficient communication between members of the same A review of the different guideline texts, which included the profession while minimising the potential for misunder- terminology and abbreviations found in the reference listings for each guideline, showed that the same examination might have a variety of standings. Abbreviations are an extension of the jargon of names. As noted, IVU was also called KUB urogram or urography. each profession, and they enable health care professionals To investigate the terms used, the AUA and EAU guidelines and all of to document their work more easily and communicate the urology-related ACR Appropriateness Criteria were downloaded into quickly. single directories. Using the advanced search feature of Acrobat Pro (CTRL- Abbreviations have generally been adopted on an ad SHIFT-F; Adobe Systems Inc., San Jose, CA, USA), we searched for the terms, hoc basis to accommodate the often conflicting demands for example, CT or computed tomography (identical methodology for all of utilising brief context-sensitive phrases and combina- other terms) and identified all of the various terms, abbreviations, and tions of letters with the challenging requirements of more variants associated with them. Once the terms were identified, each term rigid, computer software–driven, clinical and research was then grouped by its operating characteristics. Specifically, terms were practice; however, this jargon might lead to the problem divided by the type of study (eg, computed tomography [CT]), anatomic of several terms for the same object. The differences in extent (eg, area researched such as abdomen or pelvis), the use of contrast and phases, the technique or type of detector (eg, multiphase, helical, low terminology and the lack of standardisation of the dose), and combined studies or fusions (eg, positron emission tomography terminology can lead to confounders, errors, and mis- [PET], CT). Based on the frequency of use and expert consensus, the terms understandings as well as to loss of information and were then placed in an accepted category or an equivalent or similar knowledge. category. The categories were ranked by frequency of use within the Most of this development and expansion of terminology documents. Imaging terms were grouped into broad categories based on has occurred in an unplanned and uncoordinated manner technology (eg, plain radiography, CT, ultrasound, magnetic resonance and has been adopted through common usage within imaging [MRI], and nuclear medicine). Within each broad category, the specialities rather than by consensus agreement [3]. imaging terms were further stratified based on the anatomic extent, Various lists of abbreviations and terminologies have been contrast or phases, technique or modifiers, and combinations or fusions. produced by different speciality groups [4,5]. During the Terms that had a high degree of utilisation were classified as accepted. Other terms were judged to be similar but were either infrequently used or review, it was found that a wide variety of terms were used contained modifiers requiring further explanation. for the same examination, for example, intravenous urogram To construct a general methodology for nomenclature adaptation in (IVU) was also termed kidney, ureter, bladder (KUB) urogram medical terminology, we propose that a taxonomy-based approach or urography. would help define a more useful model that would be acceptable to all Much of this usage has been driven by agreed common health professionals involved in urology. practice without reference to any unifying standard of methodology or taxonomy. Taxonomy is a general principle 2.1. Rationale for a taxonomic approach of scientific classification. Organisms are classified into a hierarchy of groupings. The order of ranking is usually from The major advantage of a taxonomic approach to the classification of the more general to the more specific to describe and reflect urologic imaging studies is that it provides a flexible framework for a morphologic relationship [6]. classifying the modifications of current imaging modalities and allows There has been a general lack of international for the incorporation of new imaging modalities. Adopting this cooperation among different specialities and among hierarchical classification model (ie, from the most general to the most different geographic locations for the same speciality. detailed descriptions) should facilitate hierarchical searches of the Confusion between the different requirements for digital medical literature using both general and very specific search terms. archive coding systems and research may cause a lack of support to integrate data produced by everyone involved 3. Results in urology imaging and further promote a diversity of interests. Tables 1–7 summarise the findings of the systematic search The benefits of a shared nomenclature for literature for all major types of urologic imaging studies: ultrasound research and communication among clinicians
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