NucLexNuclear Medicine Lexicon and Theranostics Ontology
Stage W0: private living prototype12 of 30 manuscripts drafted, 0 reviewed; 50 lexicon entries in draftWhat each later stage would need to show

Ontology as economic infrastructure

Semantic interoperability

Two systems can exchange a message perfectly and still fail to mean the same thing by it.

MonographBriefNX-M11Proposed length 2,500 to 5,000 words

Writing brief. This monograph has been assigned but the manuscript is not yet written or approved. What follows is the commissioning brief: its question, outline, evidence instructions, and review requirements.

Central question

When do systems preserve intended meaning?

Reader promise

The reader will be able to say which layer an exchange failure belongs to, what "mapping quality" means as a measurable property, and why a shared code is necessary but not sufficient for shared meaning.

Required development

  1. Distinguish the layers. Define transport (the message arrives), syntax (it parses), semantics (codes mean what the sender meant), workflow (the receiver can act), and context (the conditions under which the content was true). Give one failure example per layer from a radiopharmaceutical administration record moving between a department system, an enterprise record, and a registry.
  2. Describe a synthetic exchange failure. Invent a case in which every layer below semantics succeeds and the receiver still records a different agent or procedure than was given. Trace the error to the mapping and show what the sender could not learn from the acknowledgement. Label it synthetic.
  3. Explain mapping quality: relationship type (equivalent, narrower, broader, related), coverage, currency against source versions, and review status. Connect to the ConceptMap relationship values in FHIR terminology resources and to Provenance and evidence.
  4. Explain maintenance. Show how a mapping correct against one release becomes wrong when either side changes, who notices, and what currency costs. Treat this as recurring stewardship.
  5. Locate the economic argument. State what an institution pays for at each layer and why the semantic layer is most often left unfunded; connect to The cost of disconnected knowledge without repeating it.

Evidence and review

Evidence to obtain: the HL7 FHIR R5 ConceptMap and terminology service pages for relationship semantics and version handling; published definitions of interoperability levels, cited as definitions, not as outcome evidence; primary studies measuring mapping accuracy or inter-mapper agreement between clinical terminologies, with sample, method, and reported uncertainty; documented accounts from a terminology maintainer of the effort to update mappings after a release. Any figure must carry numerator, denominator, setting, and uncertainty.

Review concern: the manuscript must not imply that adopting a standard terminology produced measured interoperability gains without a documented study.

Semantic interoperability, Concept map, Data quality, Identifier, Code system, Provenance, FHIR terminology resources, SNOMED CT and the NucLex niche, Provenance and evidence, The cost of disconnected knowledge.

Review requirements

Source check of every definition against the cited specification. Domain review by an informatician with mapping experience and a nuclear medicine physician. Editorial check that the review gate holds throughout.

Review gate for this monograph

Identifiers alone cannot promise lossless interoperability.

The assignment exists. The manuscript has not been written or approved.