Post on 24-Jun-2020
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 onUrological Imaging
a Klinik fur Urologie, Diakonissenkrankenhaus Flensburg, Lehrkrankenhaus der Christian-Albrechts-Universitat, 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
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1
ava i lable at www.sciencedirect .com
journal homepage: www.europeanurology.com
Article info
Article history:
Accepted August 5, 2014
Keywords:
Computed tomography
EAU guidelines
Magnetic resonance imaging
Positron emission tomography
Radiographs
Taxonomy
Terminology
Ultrasound
Urologic imaging
Abstract
Background: The terminology and abbreviations used in urologic imaging have generallybeen adopted on an ad hoc basis by different speciality groups; however, there is a need forshared nomenclature to facilitate clinical communication and collaborative research.Objective: This work reviews the current nomenclature for urologic imaging used inclinical practice and proposes a taxonomy and terminology for urologic imaging studies.Design, setting, and participants: A list of terms used in urologic imaging were compiledfrom guidelines published by the European Association of Urology and the AmericanUrological Association and from the American College of Radiology AppropriatenessCriteria.Outcome measurements and statistical analysis: Terms searched were grouped intobroad categories based on technology, and imaging terms were further stratified basedon the anatomic extent, contrast or phases, technique or modifiers, and combinations orfusions. 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 andacceptable nomenclature model acceptable to all health professionals involved inurology. The major advantage of a taxonomic approach to the classification of urologicimaging studies is that it provides a flexible framework for classifying the modificationsof current imaging modalities and allows the incorporation of new imaging modalities.The adoption of this hierarchical classification model ranging from the most general tothe most detailed descriptions should facilitate hierarchical searches of the medicalliterature using both general and specific terms. This work is limited in its scope, as it isnot currently all-inclusive. This will hopefully be addressed by future modification asothers embrace the concept and work towards uniformity in nomenclature.Conclusions: This paper provides a noncomprehensive list of the most widely usedterms 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 imagingterms with the aim of aiding health professionals and ensuring that the terms used aremore consistent.
# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Klinik fur Urologie, Diakonissenkrankenhaus Flensburg, Knuthstrasse 1,24939 Flensburg, Germany. Tel. +49 461 812 1401; Fax: +49 461 812 1402.E-mail address: lochti@diako.de (T. Loch).
http://dx.doi.org/10.1016/j.eururo.2014.08.0140302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
1. Introduction
The continued development of new imaging techniques in
urology has had considerable impact on both clinical
practice and urologic research [1,2]. The clinical integration
of these imaging techniques into urologic practice involves
contributions from investigators and clinicians of varied
backgrounds including physics and engineering, informat-
ics, urology, and radiology. Each profession has its own
jargon, a specialised language that allows for rapid and
efficient communication between members of the same
profession while minimising the potential for misunder-
standings. Abbreviations are an extension of the jargon of
each profession, and they enable health care professionals
to document their work more easily and communicate
quickly.
Abbreviations have generally been adopted on an ad
hoc basis to accommodate the often conflicting demands
of utilising brief context-sensitive phrases and combina-
tions of letters with the challenging requirements of more
rigid, computer software–driven, clinical and research
practice; however, this jargon might lead to the problem
of several terms for the same object. The differences in
terminology and the lack of standardisation of the
terminology can lead to confounders, errors, and mis-
understandings as well as to loss of information and
knowledge.
Most of this development and expansion of terminology
has occurred in an unplanned and uncoordinated manner
and has been adopted through common usage within
specialities rather than by consensus agreement [3].
Various lists of abbreviations and terminologies have been
produced by different speciality groups [4,5]. During the
review, it was found that a wide variety of terms were used
for the same examination, for example, intravenous urogram
(IVU) was also termed kidney, ureter, bladder (KUB) urogram
or urography.
Much of this usage has been driven by agreed common
practice without reference to any unifying standard of
methodology or taxonomy. Taxonomy is a general principle
of scientific classification. Organisms are classified into a
hierarchy of groupings. The order of ranking is usually from
the more general to the more specific to describe and reflect
a morphologic relationship [6].
There has been a general lack of international
cooperation among different specialities and among
different geographic locations for the same speciality.
Confusion between the different requirements for digital
archive coding systems and research may cause a lack of
support to integrate data produced by everyone involved
in urology imaging and further promote a diversity of
interests.
The benefits of a shared nomenclature for literature
research and communication among clinicians are obvi-
ous. The absence of agreed-on operational nomenclature
will inevitably undermine the yield from literature
review if different search terms are used. The aim of
this work is to review the current nomenclature used for
imaging in urology in clinical practice and in the
published literature and to propose standardisation of
terms using taxonomy.
2. Methods
The list of terms used for urologic imaging was compiled from guidelines
published by the European Association of Urology (EAU) [7], the
American Urological Association (AUA) [8], and the American College of
Radiology (ACR) [9]. These guidelines are regularly updated and based on
extensive review of the current literature.
A review of the different guideline texts, which included the
terminology and abbreviations found in the reference listings for each
guideline, showed that the same examination might have a variety of
names. As noted, IVU was also called KUB urogram or urography.
To investigate the terms used, the AUA and EAU guidelines and all of
the urology-related ACR Appropriateness Criteria were downloaded into
single directories. Using the advanced search feature of Acrobat Pro (CTRL-
SHIFT-F; Adobe Systems Inc., San Jose, CA, USA), we searched for the terms,
for example, CT or computed tomography (identical methodology for all
other terms) and identified all of the various terms, abbreviations, and
variants associated with them. Once the terms were identified, each term
was then grouped by its operating characteristics. Specifically, terms were
divided by the type of study (eg, computed tomography [CT]), anatomic
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
dose), and combined studies or fusions (eg, positron emission tomography
[PET], CT). Based on the frequency of use and expert consensus, the terms
were then placed in an accepted category or an equivalent or similar
category. The categories were ranked by frequency of use within the
documents. Imaging terms were grouped into broad categories based on
technology (eg, plain radiography, CT, ultrasound, magnetic resonance
imaging [MRI], and nuclear medicine). Within each broad category, the
imaging terms were further stratified based on the anatomic extent,
contrast or phases, technique or modifiers, and combinations or fusions.
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
contained modifiers requiring further explanation.
To construct a general methodology for nomenclature adaptation in
medical terminology, we propose that a taxonomy-based approach
would help define a more useful model that would be acceptable to all
health professionals involved in urology.
2.1. Rationale for a taxonomic approach
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
for the incorporation of new imaging modalities. Adopting this
hierarchical classification model (ie, from the most general to the most
detailed descriptions) should facilitate hierarchical searches of the
medical literature using both general and very specific search terms.
3. Results
Tables 1–7 summarise the findings of the systematic search
for all major types of urologic imaging studies: ultrasound
(US); CT; MRI; fluoroscopy; radiographs; PET, in combina-
tion with either CT (PET-CT) or MRI (PET MRI); and
scintigraphy. In the tables, the most commonly used term
is listed as the accepted standard, and less frequently used
terms are listed under glossary of other terms, which should
be replaced by the accepted standard.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1966
Table 1 – Taxonomic classification of ultrasound
Root name Anatomicextent
Contrast/phases
Technique modifiers/postprocessing methods
Combinations/fusions
Accepted standard Ultrasound
US
Abdomen
Kidney
Ureter
Bladder
Penis
Testis
Scrotum
Prostate
Pelvis
Vas
Vessels
Noncontrast
Contrast
TRUS
Transvaginal
Transurethral
Transvesical
Intra-abdominal
Transabdominal
Elastography
C-TRUS/ANNA
Histoscanning
Doppler
Colour Doppler
Power Doppler
Spectral Doppler
Compound imaging
Harmonic
MRI
CT
Glossary of terms less widely acceptable
(descending order based on use in
current guidelines)
Ultrasonography
Sonography
Endosonography
Percutaneous
ANNA = artificial neural network analysis; CT = computed tomography; C-TRUS = computerised transrectal ultrasound; MRI = magnetic resonance imaging;
TRUS = transrectal ultrasound; US = ultrasound.
Example: ‘‘US, prostate, TRUS, C-TRUS/ANNA fused with MRI’’.
Table 2 – Taxonomic classification for computed tomography
Root name Anatomicextent
Contrast/phases Techniquemodifiers
Combinations/fusions
Accepted standard Computed tomography
CT
Chest
Abdomen
Pelvis
Abdomen and
pelvis
Contrast
Noncontrast
urography
Multiphasic
Multidetector
PET/CT
Glossary of terms less widely
acceptable
(descending order based on use
in current guidelines)
Computer tomography
Computer-aided
tomography scan
CAT scan
CT scan
Scan
Contrast-enhanced CT
Noncontrast CT
Nonenhanced CT
Unenhanced CT
Unenhanced spiral CT
CT cystography
CT angiography
CT scout
Intravenous CT angiography
Three-phase helical CT
Multidetector row CT
Single detector CT
Multiphase CT
Multiphasic CT
Multiphasic CT urography
Multiphasic CTU
Low-dose CT
Standard-dose CT
Ultra-low-dose CT
CAT = computer-aided tomography; CT = computed tomography; CTU = computed tomography urography; PET = positron emission tomography.
Example: ‘‘CT, renal arteries, contrast, multiphasic’’.
Table 3 – Taxonomic classification for magnetic resonance imaging
Root name Anatomicextent
Contrast/phases Techniquemodifiers
Combinations/fusions
Accepted standard Magnetic resonance
imaging
MRI
Whole body
Abdomen
Pelvis
Genitals
Prostate
Kidney
Testis
Penis
Urinary tract
T1 weighted (T1)
T2 weighted (T2)
Dynamic contrast enhanced
Diffusion weighted imaging
Spectroscopy
Multiparametric
1.5 tesla (1.5T)
3 tesla (3T)
7 tesla (7T)
Body array coil
Rectal coil
Surface coil
PET/MRI
Glossary of terms less
widely acceptable
(descending order based
on use in current
guidelines)
Magnetic resonance
MR
Nuclear magnetic
resonance
NMR
MRI urography
Contrast-enhanced MRI
Nonenhanced MRI
Unenhanced MRI
MRI cystography
MRI angiography
Functional MRI
Molecular MRI
Molecular imaging
Open-gantry MRI
Regular-gantry MRI
Interventional MRI
Thermometrie
DCE = dynamic contrast enhanced; DWI = diffusion weighted imaging; MP = multiparametric; MR = magnetic resonance; MRI = magnetic resonance imaging;
NMR = nuclear magnetic resonance; PET = positron emission tomography.
Example: ‘‘MRI, prostate, T2, DCE, DWI, MP, 1.5T, surface coil’’.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1 967
Table 4 – Taxonomic classification of fluoroscopy
Root name Anatomicextent
Contrast/phases
Techniquemodifiers
Combinations/fusions
Accepted standard Fluoroscopy Chest
Abdomen
Pelvis
Renal tracts
Noncontrast
Contrast
CT fluoroscopy
Intraoperative
Glossary of terms less widely acceptable
(descending order based on use in current guidelines)
Fluorography
CT = computed tomography.
Example: ‘‘Fluoroscopy, renal tract, contrast, intraoperative’’.
Table 5 – Taxonomic classification of radiographs
Root name Anatomicextent
Contrast/phases
Techniquemodifiers
Combinations/fusions
Accepted standard Radiographs
Plain x-rays
Intravenous urogram
Chest
Abdomen
Pelvis
Spine
Extremities
Renal tract
Conventional
Digital
Antegrade
Retrograde
CT-urogram
Glossary of terms less widely acceptable
(descending order based on use in
current guidelines)
Plain films
Radiography
KUB
Intravenous
Pyelogram
Excretion Urography
Nephrostogram
Kidneys, ureters,
bladder
Urethra
Vas
Plain Radiography
CT
Ascending
Descending
CT-KUB
CT-nephrostogram
CT-urethrogram
CT = computed tomography; IVU = intravenous urogram; KUB = kidney, ureter, and bladder.
Example: ‘‘IVU, renal tract, digital’’.
Table 6 – Taxonomic classification of positron emission tomography in combination with either computed tomography or magneticresonance imaging
Root name Anatomic extent Technique modifiers(isotope)
Accepted standard Positron emission tomography–
computed tomography
PET-CT
Whole body
Pelvis
Kidney
Bladder
Prostate
Abdomen Retroperitoneum
Fluorodeoxyglucose11C-choline18Fluorine
Methionine
Other (nonspecified)
Glossary of terms less widely acceptable
(descending order based on use in
current guidelines)
CT-PET
FDG-PET18FDG-PET
PET
FDG-PET CT
Accepted standard Positron emission tomography
magnetic resonance imaging
PET MRI
Whole body
Pelvis
Kidney
Bladder
Prostate
FDG
Choline
Acetate
Glossary of terms not to be used
(descending order based on use in
current guidelines)
PET/MRI
PET-MRI
fluoro deoxy glucose18F-choline11C-acetate18F-acetate
Other
18FDG-PET = 18fluorine-fluorodeoxyglucose positron emission tomography; CT = computed tomography; FDG = fluorodeoxyglucose; MRI = magnetic resonance
imaging; PET = positron emission tomography.
Example: ‘‘PET CT, Abdomen, 11C- choline’’.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1968
4. Discussion
4.1. Rationale for advocating the use of a unified nomenclature
In our review of the terminology used for imaging studies in
clinical urologic practice, research, and publication, we
found that terms used for the same studies were not
uniform (Supplementary Tables 1–3). We found that there
is no standardised or recommended terminology for these
imaging studies. There are more general, ongoing efforts to
standardise the different vocabularies used in health care.
The Unified Medical Language System (UMLS) [10]
developed by the US National Library of Medicine is a set
of files and software that link the major international
terminologies into a common structure, allowing for
efficient translation and interoperability. The UMLS cur-
rently includes vocabularies from about 140 different
sources that can be used for the exchange of information.
The Systematized Nomenclature of Medicine Clinical
Terms (SNOMED CT) [11] is a reference terminology
standard available through the UMLS consisting of concepts
and terms and the interrelationships between them. The
Health Terminology Standards Development Organisation
is responsible for promoting the international adoption of
SNOMED CT. It standardises the way health care terminol-
ogy and data are recorded and aims to facilitate the coding,
retrieval, analysis, aggregation, indexing, and exchange of
clinical information across different health care entities.
SNOMED CT was designed for use in software applications
to represent clinically relevant information in a reliable and
reproducible manner.
In a similar way, different professional groups have
adopted varying terminology for similar imaging investiga-
tions. Our ability to communicate effectively across medical
and scientific disciplines may be hindered by inconsistent
use or inadvertent misinterpretation of commonly used
abbreviations and acronyms. These terminology variations
are evident across different health care systems in different
countries and across individual disciplines of clinical and
scientific interest.
There are a variety of abbreviations and synonyms for
similar investigations, with overlapping definitions that can
potentially confuse or misdirect clinicians and researchers
(Supplementary Tables 1–3). The language of medicine is
complex, and there is a justifiable need to avoid undue
repetition and offer clarity to researchers and clinical
specialists. Many abbreviations and acronyms that are
readily understood within different professional disciplines
may not be easily extrapolated to other areas of medical,
and specifically urologic, practice.
The advent of the digital era in imaging has added a
further layer of complexity to the terminology used for
imaging procedures. The requirements of various digital
systems to code and file huge volumes of imaging data has
prompted the development of additional abbreviations and
synonyms to organise and search for data within and
between digital networks. Within these coding systems,
individual studies are represented by specific identifiers,
which are usually a combination of characters (letters and/
or numbers) that have no meaning in themselves. This
coded representation is then used in place of the natural
language description of the concept for further computer or
human processing. Standardised clinical vocabularies also
generally include a coding system. An example of a coded
system is Medline’s Medical Subject Headings [12].
Different professional groups (eg, radiologists, urolo-
gists, health care providers) have ad hoc lists that have been
adopted and incrementally amended in recent years. Large
international databases such as the Cochrane Library [13]
and Medline [14] have guidelines for the use of abbrevia-
tions and acronyms without being prescriptive or exclusive.
The Cochrane Library, for example, advises using abbrevia-
tions and acronyms only if they are widely known and
states that not using them ‘‘would make literature reading
tedious’’ [13].
4.2. Guidelines
Panels charged with writing clinical guidelines must
evaluate the existing literature regarding medical practice
and make judgments, first, about the quality of the data and,
next, about the clinical effectiveness of the procedure, the
risks and harms associated with the procedure, and the
costs of the procedure.
Table 7 – Taxonomic classification of scintigraphy
Root name Anatomic extent Contrast/phases Combinations/fusions
Accepted standard Scintigraphy Bone
Kidney
Testis
Bladder
99m Technetium
DMSA
MAG3
DTPA
SPECT
Glossary of terms less widely acceptable
(descending order based on use in
current guidelines)
Radionuclide scintigraphy
Nuclear scintigraphy
Radiographic scintigraphy
Isotope scintigraphy
Radioisotope scintigraphy
Bone scan
Bone scintigraphy
Renal scintigraphy
Renal cortical scintigraphy
Isotope renogram
Isotope renography
Scrotum scintigraphy
Scintigraphy of the testis
Radioisotope cystography
Dimercaptosuccinic acid
Mercaptuacetyltriglycine 3
Captopril scintigraphy
99mTc = 99m technetium; DMSA = dimercaptosuccinic acid; MAG3 = mercaptuacetyltriglycine 3; SPECT = single-photon emission computed tomography.
Example: ‘‘Scintigraphy, Bone, 99mTc’’.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1 969
Medical imaging is a complex technological procedure
with many variables that affect efficacy, risk, and cost. It is
difficult to evaluate the quality of the data when multiple
terms describe the same imaging procedure and imaging
procedures that share a common name but have vastly
different operating characteristics (eg, radiation dose,
number of exposures).
Evaluations of existing guidelines from the EAU, the AUA,
and the ACR have demonstrated wide variability in terms
associated with imaging. We have attempted to define the
range of terms within the existing guidelines and then
proposed a strategy for naming these imaging studies. The
proposed strategy should improve the ability to compare
outcome data using similar methodologies and ultimately
will encourage the use of consistent terminology when
constructing new guidelines [15].
In an effort to unify the terminology used in the imaging
of urologic conditions, this EAU imaging panel compiled a
list of terms commonly used in clinical and investigative
urology. The panel focused on terms most relevant to
urology. Not included within the scope of this document are
more general terms related to the details of imaging. These
were considered to be already well understood and
documented in the literature of their respective fields.
Finally, terms that were considered interchangeable with-
out being ambiguous or requiring further clarification were
not considered for this document.
5. Conclusions
The current list will form the basis for further discussion,
development, and enhancement. The expert panel would
like to stress that it has incorporated the most widely used
terms across different specialities, avoiding any subjective
selection of a term and aiming for objective selection of the
most commonly used term for an imaging technique.
Despite this, the proposed list (especially the glossary) is
probably not complete. Consequently, the resulting list is
not all-inclusive or comprehensive.
The proposed terminology is intended to promote unified
nomenclature in both clinical and research settings. It is not
intended to be used for administrative and billing purposes.
Different health care administrative systems already have
different agreed terminologies based on individual require-
ments, and our tables are not intended to replace these.
It is anticipated that by adopting such a standardised
terminology, all professional disciplines involved in the
field of urologic imaging will benefit from better commu-
nication across specialities.
In particular, for those involved in research, unified
terminology should enhance the yield of evidence from
literature searches and thus help promote the dissemina-
tion of findings as different professional groups publish
within their own literature bases using commonly agreed
terminology.
Author contributions: Tillmann Loch had full access to all the data in the
study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Loch, Carey, Walz, Fulgham.
Acquisition of data: Loch, Carey, Walz, Fulgham.
Analysis and interpretation of data: Loch, Carey, Walz, Fulgham.
Drafting of the manuscript: Loch, Carey, Walz, Fulgham.
Critical revision of the manuscript for important intellectual content: Loch,
Carey, Walz, Fulgham.
Statistical analysis: Loch, Carey, Walz, Fulgham.
Obtaining funding: Loch, Carey, Walz, Fulgham.
Administrative, technical, or material support: Loch, Carey, Walz, Fulgham.
Supervision: Loch, Carey, Walz, Fulgham.
Other (specify): None.
Financial disclosures: Tillmann Loch certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: Loch holds
equity interests in ANNA/C-TRUS GmbH, and receives company speaker
honoraria from Takeda and GSK. Walz receives company speaker
honoraria from: Supersonic, Hitachi, Takeda. The other authors have
nothing to disclose.
Funding/Support and role of the sponsor: This guidelines document was
developed with the financial support of the EAU, which is a non-profit
organisation. No external sources of funding and support were used. EAU
funding was limited to administrative assistance and travel and meeting
expenses. No honoraria or other reimbursements were provided. The
Imaging Expert Panel has submitted potential conflict of interest
statements, which can be viewed on the EAU website: http://
www.uroweb.org/guidelines/.
Acknowledgment statement: This document was externally peer
reviewed by representatives from several organisations (National
Institute of Clinical Excellence, the European Society of Urologic Imaging,
ad hoc panel members of the American Urological Association and the
American College of Radiology) as well as the current chairmen of the
European Association of Urology (EAU) guideline panels. This publica-
tion is the first approach addressing the issue of imaging terminology by
the EAU Guidelines Office. The authors would like to thank the Guideline
Office Board, the Panel Chairman, and the Central Office of the EAU for
their constructive support during the process.
Appendix A. Practical points
Details should be carefully noted, for example, consis-
tency of punctuation is essential so that the term is IVU and
not I.V.U. Nonspecific terms such as plain films should not be
used.
It may generally be helpful to write the name of the
abbreviation or acronym in full, immediately followed by the
abbreviated version or acronym in brackets: computed
tomography (CT). A list of the most commonly used terms
and abbreviations can be found online (http://www.uroweb.
org/guidelines/eau-standardised-medical-terminology-for-
urologic-imaging/).
Appendix B. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at http://dx.doi.org/10.1016/
j.eururo.2014.08.014.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1970
References
[1] Marberger M, Barentsz J, Emberton M, et al. Novel approaches to
improve prostate cancer diagnosis and management in early-stage
disease. BJU Int 2012;109:1–7.
[2] Loch T. Novel strategies in imaging. World J Urol 2011;29:569–71.
[3] Mulla M, Schulte KM. Terminology inaccuracies in the interpreta-
tion of imaging results in detection of cervical lymph node
metastases in papillary thyroid cancer. Endocr Connect 2012;1:
78–86.
[4] Moon S, Pakhomov S, Liu N, et al. A sense inventory for clinical
abbreviations and acronyms created using clinical notes and
medical dictionary resources. J Am Med Inform Assoc 2014;21:
299–307.
[5] Komi M, Shiraishi J. Abbreviations of special terms for presentation/
paper titles in magnetic resonance study. Nihon Hoshasen Gijutsu
Gakkai Zasshi 2013;69:879–83.
[6] Taxonomy. Merriam-Webster Dictionary Web site. http://www.
merriam-webster.com/dictionary/taxonomy.
[7] EAU guidelines. European Association of Urology Web site. http://
www.uroweb.org/guidelines/.
[8] Guidelines and policies. American Urological Association Web site.
http://www.auanet.org/education/aua-guidelines.cfm.
[9] ACR Appropriateness Criteria. American College of Radiology Web
site. http://www.acr.org/Quality-Safety/Appropriateness-Criteria.
[10] Unified Medical Language System (UMLS). U.S. National Library of
Medicine Web site. http://www.nlm.nih.gov/research/umls/.
[11] SNOMED CT. International Health Terminology Standards Devel-
opment OrganisationWeb site. http://www.ihtsdo.org/snomed-ct/.
[12] Medical Subject Headings. U.S. National Library of Medicine Web
site. http://www.nlm.nih.gov/mesh.
[13] Home page. The Cochrane Library Web site. http://handbook.co-
chrane.org/.
[14] Welcome to NCBI. U.S. National Library of Medicine Web site.
http://www.ncbi.nlm.nih.gov/.
[15] Aus G, Chapple C, Hanus T, et al. The European Association of
Urology (EAU) guidelines methodology: a critical evaluation. Eur
Urol 2009;56:859–64.
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 9 6 5 – 9 7 1 971