Terminological resources in languages other than English are playing a critical role in all kinds of medical administrative solutions in countries where English is not an o cial language, or not the only o cial language. French bene ts from being among the top ve most covered languages in the UMLS in number of concepts. Herein, we review the extent of this coverage as well as the sources and methods for additional material available for French.
2.1
The UMLS R (Uni ed Medical Language System R ; Bodenreider 2004) is a major terminological resource for many languages, including French. The UMLS Metathesaurus R is the structured union of existing biomedical vocabularies, some of which include terms in languages other than English. The second row of
Table 1 provides an overview of the various sources in the UMLS Metathesaurus (version 2012AA) with an indication of size using the number of unique strings and Concept Unique Identi ers (CUIs) covered4. As far as French is concerned, the MeSH R thesaurus (Medical Subject Headings) and the Medical Dictionary for Regulatory Activities (MedDRA) make the bulk of the French terms available in the UMLS.
Rows 3 to 5 in Table 1 show some of the other terminologies available through the UMLS for English that are also available in French but not included in the UMLS release. It should be noted that some light processing is required to map the French terms (strings) from these resources to UMLS CUIs as the data is provided natively for each terminology, i.e. each term is mapped to a terminology unique identi er which is also present in the UMLS Metathesaurus. Using the English version of the UMLS, the mappings between these identi ers and UMLS CUIs can be recovered: for instance, the French term \bras robotique" in SNOMED v3.5 has code A-01100 which is found in the Metathesaurus with CUI C0336542 and preferred English term \Robotic arm". Therefore, it can be inferred that the French term \bras robotique" should be assigned to CUI C0336542.
Other resources in French have not been mapped to the UMLS. The European Health Terminology Ontology Portal (EHTOP5) provides an integrated access to four of them: CCAM, ATC, Orphanet, and CISMeF. CCAM (Classi cation 4 This number was obtained using the following SQL query: select LAT, count(distinct STR collate utf8 bin) from MRCONSO where LAT="FRE"; and similarly for the CUIs. 5 http://www.ehtop.eu/ Commune des Actes Medicaux) is a French counterpart of CPT (Current Procedural Terminology). The Anatomical Therapeutic Chemical (ATC) classi cation system is a drug classi cation system managed by the World Health Organization (WHO); its counterpart in the UMLS is RXNORM, which is developed by the US National Library of Medicine. Orphanet is a portal of information on rare diseases which has driven the development of a terminology which, in turn, led to the OntoOrpha ontology. CISMeF (Catalogue et Index des Sites Medicaux Francophone; Darmoni et al. 2000) is an online portal providing health information in French relying on MeSH indexing of online documents. The so-called CISMeF terminology comprises MeSH as well as additional resources in French: additional Entry Terms, additional resources types, and metaterms, which are broad categories corresponding to medical specialties. CISMeF metaterms comprise links to relevant MeSH terms, allowing for specialty-oriented document searches and specialty pro ling of corpora. Finally, we can also mention the case of the Foundational Model of Anatomy (FMA). The English version of this ontology is part of the UMLS and is also included in ETHOP. In addition to English, a handful of other languages are partially covered, including French: 4,452 concepts out of 82,083 (5.4%) have at least one term in French.
Then, the issue of string normalization and pre-processing for use in
Natural Language Processing applications remains to be addressed. Many of the
strategies used for English are also applicable for French [
Over the past decade, there has been a collaborative e ort to develop a French
\Specialist Lexicon" comprising linguistic information about in ected forms and
lemmas found in biomedical terms [
Contributions to the resources described above came from many researchers throughout Canada, France, and Switzerland. These e orts came from institutional initiatives or from the concerted work of individual researchers.
INSERM has been a partner of the National Library of Medicine since 1969.
They have been producing a version of MeSH translated into French every year
since 1986. While all main headings were available in French, only selected
Entry Terms are also translated. To address the need for additional Entry Terms
in French, INIST has helped INSERM with the manual translation of several
thousand terms. Meanwhile, the CISMeF team has been enhancing the MeSH
resources available in French by adding synonyms [
The French version of SNOMED is the results of the e orts of Dr. R.A. C^ote
[
Several nationally-funded projects contributed to the extension of these
resources. Beyond the already cited UMLF project, let us mention VUMeF [
We identify three important needs for enhancing the existing resources for French, in order of increasing di culty:
access and use: for instance, French versions of ICD10, FMA, SNOMED;
with the result of work that has been on-going for the past decade, e.g.
UMLF, MeSH terminological resources for indexing;
3. have the UMLS cover terminologies that are used in clinical
practice in countries where French is an o cial language used in hospitals
(France, Canada, Belgium, Switzerland, French-speaking African countries,
etc.). For instance, as mentioned above, terminologies such as CCAM are
not part of the UMLS. [
We consider that the main barriers to further progress are the following: 1. lack of a concerted e ort: while the NLM is prioritizing the development of resources in English, some resources for other languages are developed for a particular application and the means (time, funds) to produce a distributable version are not available. A roadmap for further developments is needed, listing aims and objectives, and methods to obtain appropriate support from relevant teams and organizations. A project such as MANTRA could provide a venue for preparing such a concerted e ort. Additionally, societies such as IMIA could provide a longer-term framework for such an initiative. For instance, its recently created Francophone SIG intends to address the promotion of work on French-language corpora and controlled vocabularies. Coordinated action in di erent languages could build on language-speci c actions. 2. licensing issues: the access to some terminologies is restricted (SNOMED CT, ATC, CISMeF, . . . ); terminologies underpin the development of science, standards and information systems and should be made widely available at no cost. 4
This overview of French resources for the biomedical domain shows that there is a real interest from the community for using these resources, as well as e orts to create quality resources. However, there is an on-going need for encouraging the sharing of the end-results under the umbrella of a standard framework such as the UMLS. Funded projects are a possible means for this type of activity (see, e.g., UMLF, VUMeF, InterSTIS, EHTOP, MANTRA); societies (e.g., IMIA) are another framework where it could be coordinated.
The authors acknowledge travel funding from the EU STREP project grant 296410 (\Mantra") under the 7th EU Framework Programme within Theme \Intelligent Content and Semantics", \Challenge 4: Technologies for Digital Content and Languages" (ICT 2011.4.1).