ACCEPTED FOR PUBLICATION IN THE INTERNATIONAL JOURNAL OF DIGITAL LIBRARIES. © 1997. ALL RIGHTS RESERVED BY THE AUTHORS. 1 Controlled Terminology for Clinically-Relevant Indexing and Selective Retrieval of Biomedical Images W. Dean Bidgood, Jr., M.D., M.S. 1 , Louis Y. Korman, M.D. 2 , Alan M. Golichowski, M.D., Ph.D. 3 , P. Lloyd Hildebrand, M.D. 4 , Angelo Rossi Mori 5 , Bruce Bray, M.D. 6 , Nicholas J.G. Brown, Ph.D. 7 , Kent A. Spackman, MD, Ph.D. 8 , S. Brent Dove, D.D.S., M.S. 9 , Katherine Schoeffler 10 ABSTRACT Existing clinical nomenclatures do not provide comprehensive, detailed coverage for multispecialty biomedical imaging. To address clinical needs in this area, the College of American Pathologists (CAP), secretariat of the Systematized Nomenclature of Human and Veterinary Medicine (SNOMED), has entered into partnership with the DICOM (Digital Imaging and Communications in Medicine) Standards Committee, the American College of Radiology, the American Dental Association, the American Academy of Ophthalmology, the American Society for Gastrointestinal Endoscopy, the American Academy of Neurology, the American Veterinary Medical Association, and other professional specialty organizations to develop the controlled terminology that is needed for diagnostic imaging applications. Terminology development is coordinated with ongoing development and maintenance of the DICOM Standard. SNOMED content is being enhanced in two general areas: 1) imaging procedure descriptions and 2) diagnostic observations. The SNOMED DICOM Microglossary (SDM) has been developed to provide context-dependent value sets (SDM Context Groups) for DICOM coded- entry data elements and semantic content specifications (SDM Templates) for reports and other structures composed of multiple data elements. The capability of storing explicitly- labeled coded descriptors from the SDM in DICOM images and reports improves the potential for selective retrieval of images and related information. A pilot test of distributed multispecialty terminology development using a World Wide Web (WWW) application was performed in 1997, demonstrating the feasibility of large-scale distributed development of SDM terminology. [Address reprint requests to: W. Dean Bidgood, Jr., MD, MS, Center for Healthcare Informatics, Box 2986 DUMC, Duke University Medical Center, Durham, NC 27710; E-Mail: bidgood@nlm.nih.gov. 1 Duke University Medical Center, Center for Healthcare Informatics, Durham, NC; Cognitive Science Branch, Lister Hill National Center for Biomedical Communication, the United States National Library of Medicine. 2 Department of Medicine, Division of Gastroenterology, Washington VA Medical Center, Washington, DC. 3 Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN. 4 Department of Ophthalmology. Associate Director of Telemedicine. University of Oklahoma Health Sciences Center, Oklahoma City, OK. 5 Istituto Tecnologie Biomediche, CNR, Rome, Italy. 6 Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City, UT. 7 Department of Nuclear Medicine, Kings College Hospital, London, England. 8 Department of Pathology, Oregon Health Sciences University, Portland, OR. 9 Division Chief of Diagnostic Sciences. School of Dentistry. University of Texas Health Science Center, Austin, TX. 10 Duke/UNC Program in Medical Informatics, Duke University, Durham, NC. INTRODUCTION Background: Biomedical Images, Image-Related Data, and DICOM Images (e.g. photographs, x-rays, sonograms, magnetic resonance imaging scans) are critical components of the medical, dental, or veterinary (i.e. biomedical) clinical record. It is becoming practical and cost-effective to view, exchange, and store biomedical images in digital (computerized) form. The most common types of clinical images utilized in biomedicine today can be stored as two-dimensional arrays of "pixels" that represent calculated x-ray attenuation values (as in computerized tomography), sound intensity (as in ultrasound), electron density (as in radiographs, i.e. x-rays), various properties of radio waves (as in magnetic resonance), or color (as in endoscopy, microscopy, and photography). These pixel arrays can be viewed with appropriate display software. Digitized images are stored as computer files.