• Informatics
  • RadLex Playbook

  • RadLex® Playbook is a special component of the RadLex ontology. Playbook provides a standard system for naming radiology procedures, based on the elements that define an imaging exam such as modality and body part. By providing standard names and codes for radiologic studies, Playbook can facilitate a variety of operational and quality improvements, including workflow optimization, chargemaster management, radiation dose tracking, enterprise integration and image exchange.


    Up to now, radiology sites have used idiosyncratic codes and names for radiology exams that they created themselves or acquired from vendors of radiology systems. This approach has limited interoperability in applications for data analysis and exchange that need standardized information on radiology procedures in order to work effectively. Playbook is a set of standardized codes and names that can replace or complement legacy procedure codes and names in systems that track imaging procedures, including  PACSes, RISes, reporting applications, physician order entry systems and electronic medical records.


    The Playbook project began in 2011 and initially produced a set of several thousand Playbook codes, based on contributions from a number of institutions. In 2014, the RadLex Playbook committee launched an effort to streamline Playbook in order to simplify adoption and enhance its clinical utility. A subset of just over 1,000 Playbook codes was created, which is designated in the new release of Playbook version 2.0 as the Core Playbook. It represents a tractable starting point for adopting Playbook that can be supplemented with additional codes to meet local practice needs.

    RSNA has also begun collaborating with the Regenstrief Institute, publisher of Logical Observation Identifiers Names and Codes (LOINC) to harmonize Playbook with the radiology codes in that medical terminology. This effort, funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), has already produced an information model to unify Playbook with LOINC and, by the fall of 2015, harmonized CT codes based on Core Playbook will be completed. The harmonization will bring Playbook content into a widely used and broadly recognized terminology standard. It will be achieved without causing disruption for sites using the current release of Playbook.


    Playbook addresses imaging exams as radiology “orderables,” that is studies a referring physician can request through an order entry system. Depending on institutional practice, orderables may be more general than the full description of the exam actually performed. For example, the orderable “CT abdomen/pelvis with contrast” is more general than the exam actually performed, “CT abdomen/pelvis with contrast, liver protocol.”

    In Playbook each procedure is identified with a unique numerical code (the RadLex Playbook identifier, or “RPID”), and described with a set of procedure names of varying length and “readability” for use in different applications. Each name is composed of a set of elements, or attribute values, each describing one aspect  of the exam. Each attribute value is a term from the general RadLex ontology, with its own corresponding RadLex identifier (or “RID”).  For a detailed description of the structure of Playbook, please refer to our newly published RadLex Playbook User Guide.

    How to Use Playbook

    RadLex Playbook is an ideal resource for radiology sites undertaking information system upgrades that offer an opportunity to update the procedure names in departmental chargemasters or map them to standard Playbook procedure names. The method of implementing Playbook in departmental systems will vary depending on local configurations and practice needs. Implementing a new set of procedure names is likely to require collaboration between site staff with knowledge of local needs and practices and vendors or consultants with knowledge of systems capabilities. RSNA is working with the vendor community to increase awareness of Playbook and to encourage implementation as a default foundation for radiology ordering systems and related applications.

    You can get a feel for Playbook by using the term browser at http://playbook.radlex.org/. That site also offers a download of Playbook in spreadsheet format (.csv) and access to the User Guide, licensing terms and other information resources.  RSNA is the copyright holder of RadLex and RadLex Playbook, and makes them freely available for use and redistribution to the radiology community.

    We welcome your questions and comments about RadLex and RadLex Playbook.  Visit the RadLex Discussion Forum—we want to hear from you!