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RIS-PACS
Descriptors and
Coding
Dr Keith Foord
Consultant Radiologist, East Sussex Hospitals
A national system of RIS coding
and descriptors ? Why?
Must be as intuitive and easy to use as possible
Should have national acceptance
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Relates to needs of request/entry systems within NCRS – preRIS - SNOMED match to record request to Spine
Consistency and uniqueness in requesting terminology – preRIS and within RIS
Consistency in activity measurement - RIS
Consistency in clinical coding of events – RIS - SNOMED match
For accurate communication of results data between hospitals –
post RIS results reporting, cluster stores and national spine SNOMED match to ‘performed examination code’ to Spine
For ‘Payment by results’ – accurate records of same patient
activity – national tariffs - SNOMED match / accurate HRGs
DICOM Structured Reporting
NHS Costings Code Book
Descriptors
Descriptors need to be UNIQUE in NCRS
FOOT LEFT not unique
When a user searches all of the examinations available for ‘Foot Left’
the search may return:
FOOT LEFT, FOOT LEFT Swab, FOOT LEFT Physiotherapy,
FOOT LEFT Dressing,
etc., etc.
But XR FOOT LEFT is unique
Radiology Short Codes
Used in RIS as shortcuts
For bookings
For internal communications within Radiology
To help group procedures
For internal management / audit / activity
For common use need a structure, ideally
short (max. 6 letters/digits) and logical
Radiological Short Codes
1 2 3 4 5 6
Modality
X – X-ray
F – Fluoro
I – Interventional/
Fluoro
C – CT
M – MRI
U – U’sound
N – Radionuclide
Imaging
P – PET
E- Endoscopy
Z- Image
analysis or
review
Three or four letter body part
/ function code
4th letter reserved
for R, L, B or W
if procedure R or L lateralisable,
Both or Whole body,
otherwise can be used for any
letter or number
Postqualifier
(Extra or subdescriptor)
Format for a midline or non lateralising structure, no
post qualifier
ABCDE
Format for a lateralisable or whole body structure, no
post qualifier
ABCDF
Format for a midline or non lateralising structure,
with a post qualifier
ABCDEG
Format for a lateralisable or whole body structure,
with a post qualifier
ABCDF G
Extra qualifiers (6th letter/number = G)
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A
B
D
E
I
J
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M
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O
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P
R
S
T
X
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1
 2
 3
 4
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Ablation
Biopsy (Core or FNA)
Drainage or Aspiration of fluid
Embolisation
Insertion of device
inJection - as an objective of the procedure, not as part of the preliminary to this
objective
Mobile - for any modality, but particularly for 'portable' plain films and use of mobile
image intensifiers
tOmography in its wider sense. O may be added to any plain film examination to
define planar tomography - or postcoordinated
Plasty - as in angioPlasty or dacrocystoPlasty - ie balloon dilatation
for Radiotherapy planning
Stent
Use of intraThecal contrast
eXtraction - eg in retrieval of intravascular foreign bodies or removal of temporary IVC
filter
First part of study
Second part of study
Third part of study
Fourth visit etc. – 5,6,7,8,9 – 10th = 0
Eg CT guided PELVic Biopsy
CPEL VB
Eg Interventional (Fluoroscopic) Right SFA Angioplasty
I ASF RP
Pre and Post Co-ordination (1)
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In order to group procedures many old RIS systems
lack the ability to post co-ordinate procedures together
under one accession number.
Particular examples are for 'both' plain film exams eg
'both ankles' and in CT where examinations often
combine e.g. CT Chest, Abdomen, Pelvis.
Pre co-ordination or grouping of these procedures is
therefore required in advance.
Pre co-ordination should not be used in RIS-PACS
systems capable of full post co-ordination as within
these individual procedure codes will be automatically
or manually grouped prior to archiving and reporting
Eg CT guided PELVic Biopsy
CPEL VB
This is pre-coordinated with the whole
process described in the code
Pre and Post Co-ordination (2)
In modern RIS systems post co-ordination can be
applied to group related procedures together. All RIS
systems supplied via LSPs should do this.
 Some procedure codes such as 'U/S biopsy' by
themselves do not define precisely what has
happened although it would define the activity of
“Performing a biopsy under ultrasound control and the
consumables/activity associated with this.”
 Such codes need post co-ordinating with the relevant
body part to fully inform activity statistics
 Similarly separate CT body part examinations can be
post co-ordinated together to enable the multiple
examinations to be reported together as one report.
 The advantage is a more sophisticated approach to
audit, activity measurement and stocktaking

Eg CT guided PELVis Biopsy
CPEL VB
CPEL V
PLUS
CB I OP B
Are POST coordinated and describe both processes which are
then reported as one. CT biopsy cost structures do not need to be
built into multiple codes
Eg PET/CT for Chest
CCHES
PLUS
P GE NW
Are POST coordinated and describe both processes which are
then reported as one.
SNOMED code Local Code (code used by
the Radiology System s)
Carecast request display nam e (Data field lim it - 40)
Carecast request SHORT display name (Data field limit-20)
Requestable procedures
CCA/FJA have not yet
For FJA RIS these MUST be used as the prime descriptors
announced which RIS will
be offered as part of the
CRS. Local codes are
specific to Site/RIS in
use. For CCA or FJA RIS
These codes MUST be
used.
IACLY
FADVS
FAAAA
FALLL
FALLR
FALLB
FAAGM
FABRN
FACAL
FACAR
FACEG
FACOE
FAGUT
FAHEP
FAHIO
FALIP
FAIMA
FAGEN
FAOVA
FAPEV
FAPUG
FAPUP
FAREN
FARTK
FASPN
FASPN
FASCL
FASCR
FASMA
FATES
FAULL
FAULR
FAVTL
FAVTR
FAABDM
FACHEM
FAGENM
FASKUM
FALLLM
FALLRM
FAULLM
FAULRM
IAORAP
IAAFMP
IABRLP
IABRRP
IACEGP
IACOEP
IAHEPP
Acolysis
Adrenal Vein Sampling
Angio Abdominal Aortogram
Angio Antegrade Femoral Lt
Angio Antegrade Femoral Rt
Angio Aorto-Femoral Lower Limbs Both
Angio Arch Aortogram
Angio Bronchial
Angio Carotid Lt
Angio Carotid Rt
Angio Cerebral
Angio Coeliac
Angio Coeliac/SMA/Hepatic/IMA
Angio Hepatic
Angio Hepatic & Iodine 131
Angio Hepatic With Lipiodol
Angio Inferior Mesenteric Artery
Angio Other
Angio Ovarian
Angio Pelvic
Angio Pulmonary
Angio Pulmonary with Pressures
Angio Renal
Angio Renal Transplant
Angio Spinal
Angio Splenic
Angio Subclavian Lt
Angio Subclavian Rt
Angio Superior Mesenteric Artery
Angio Testicular
Angio Upper Limb Lt
Angio Upper Limb Rt
Angio Vertebral Lt
Angio Vertebral Rt
Angio In Theatre Abdomen
Angio In Theatre Chest
Angio In Theatre General
Angio In Theatre Head
Angio In Theatre Limbs Lower Lt
Angio In Theatre Limbs Lower Rt
Angio In Theatre Limbs Upper Lt
Angio In Theatre Limbs Upper Rt
Angioplasty Aorta
Angioplasty Aorto-Femoral
Angioplasty Brachial Lt
Angioplasty Brachial Rt
Angioplasty Cerebral
Angioplasty Coeliac
Angioplasty Hepatic
Vein Sample Adrenal
SNOMED codeAbdominal
Local CodeAortogram
(code used by Carecast request display nam e (Data field lim it - 40)
the Radiology
System
s) Lt
Femoral
Antegrade
Angio
Carecast request SHORT display name (Data field limit-20)
Femoral Antegrade Angio Rt
Aorto-Femoral Angio Lower Limbs Both
Aortic Arch Angio
Bronchial Angio
Carotid
Angio
Lt not yet
CCA/FJA
have
For FJA RIS these MUST be used as the prime descriptors
Carotid
Angiowhich
Rt RIS will
announced
Cerebral
Angio
be offered
as part of the
Coeliac
Angiocodes are
CRS. Local
Coeliac/SMA/Hep/IMA
specific to Site/RIS in Angio
Hepatic
Angio
use. For
CCA or FJA RIS
Hepatic
Angio +
Iodinebe131
These codes
MUST
Hepatic
used. Angio + Lipiodol
Inferior Mesenteric Artery Angio
Full list incl multis
Z3DST
3 D study
Ovarian
Z4DSTAngio
4 D study
Pelvic
Angio
ZABAN
Abandonned procedure
Pulmonary
Angio
IACLY
Acolysis
Pulmonary
ZWORK Pressure Angio Additional use of workstation
Renal
Angio
FADVS
Adrenal Vein Sampling
Renal
Transplant Angio
FAAAA
Angio Abdominal Aortogram
Spinal
Angio
FALLL
Angio Antegrade Femoral Lt
Splenic
FALLRAngio
Angio Antegrade Femoral Rt
Subclavian
FALLB Angio Lt
Angio Aorto-Femoral Lower Limbs Both
Subclavian
FAAGM Angio Rt
Angio Arch Aortogram
Superior
Mesenteric
Artery
Angio
FABRN
Angio Bronchial
Testicular
FACAL Angio
Angio Carotid Lt
Upper
Limb Angio Lt
FACAR
Angio Carotid Rt
Upper
Limb Angio Rt
FACEG
Angio Cerebral
Vertebral
Angio
Lt
FACOE
Angio Coeliac
Vertebral
FAGUT Angio Rt
Angio Coeliac/SMA/Hepatic/IMA
Abdominal
FAHEP Angio Theatre Angio Hepatic
Chest
Angio Theatre
FAHIO
Angio Hepatic & Iodine 131
FALIP
Angio
Head
Angio Theatre
FAIMA
Angio
Lower
Limb Angio Theatre LtAngio
FAGEN
Lower
Limb Angio Theatre RtAngio
FAOVA
Upper
Limb
Angio
Theatre
Lt
FAPEV
Angio
Upper
Limb Angio Theatre RtAngio
FAPUG
Aorta
Angioplasty
FAPUP
Angio
Aorto-Femoral
Angioplasty Angio
FAREN
Brachial
FARTK Angioplasty Lt
Angio
Brachial
Angioplasty
Rt
FASPN
Angio
Cerebral
FASPNAngioplasty
Angio
Coeliac
FASCLAngioplasty
Angio
Hepatic
Angioplasty
FASCR
Angio
FASMA
FATES
FAULL
FAULR
FAVTL
FAVTR
FAABDM
FACHEM
FAGENM
FASKUM
FALLLM
FALLRM
FAULLM
FAULRM
IAORAP
IAAFMP
IABRLP
Hepatic With Lipiodol
Inferior Mesenteric Artery
Other
Ovarian
Pelvic
Pulmonary
Pulmonary with Pressures
Renal
Renal Transplant
Spinal
Splenic
Subclavian Lt
Subclavian Rt
Angio Superior Mesenteric Artery
Angio Testicular
Angio Upper Limb Lt
Angio Upper Limb Rt
Angio Vertebral Lt
Angio Vertebral Rt
Angio In Theatre Abdomen
Angio In Theatre Chest
Angio In Theatre General
Angio In Theatre Head
Angio In Theatre Limbs Lower Lt
Angio In Theatre Limbs Lower Rt
Angio In Theatre Limbs Upper Lt
Angio In Theatre Limbs Upper Rt
Angioplasty Aorta
Angioplasty Aorto-Femoral
Angioplasty Brachial Lt
SNOMED code Local Code (code used by
the Radiology System s)
Carecast request display nam e (Data field lim it - 40)
Carecast request SHORT display nam e (Data field lim it-20)
Post co-ord list
Vein Sample Adrenal
Abdominal Aortogram
Femoral Antegrade Angio Lt
Femoral Antegrade Angio Rt
Aorto-Femoral Angio Lower Limbs Both
CCA/FJA
not yet
For FJA RIS these MUST be used as the prime descriptors
Aortic Archhave
Angio
announced
which RIS will
Bronchial Angio
be
offered
as part
Carotid
Angio
Lt of the
CRS.
Local
codes
Carotid
Angio
Rt are
specific
Site/RIS in
CerebraltoAngio
use.
For Angio
CCA or FJA RIS
Coeliac
These
codes MUST be Angio
Coeliac/SMA/Hep/IMA
used.
Hepatic Angio
Hepatic Angio + Iodine 131
Z3DST
Hepatic Angio + Lipiodol 3 D study
Z4DST
4 D study
Inferior Mesenteric Artery Angio
ZABAN
Abandonned procedure
IACLY
Acolysis
Ovarian Angio
ZWORK
Additional use of workstation
Pelvic Angio
FADVS
Adrenal Vein Sampling
Pulmonary Angio
FAAAA
Pulmonary Pressure AngioAngio Abdominal Aortogram
FALLL
Angio Antegrade Femoral Lt
Renal Angio
FALLR
Renal Transplant Angio Angio Antegrade Femoral Rt
FALLB
Angio Aorto-Femoral Lower Limbs Both
Spinal Angio
FAAGM
Angio Arch Aortogram
Splenic Angio
FABRN
Angio Bronchial
Subclavian Angio Lt
FACAL
Angio Carotid Lt
Subclavian Angio Rt
FACAR
Superior Mesenteric ArteryAngio
Angio Carotid Rt
FACEG
Angio Cerebral
Testicular Angio
FACOE
Angio Coeliac
Upper Limb Angio Lt
FAGUT
Angio
Coeliac/SMA/Hepatic/IMA
Upper Limb Angio Rt
FAHEP
Angio Hepatic
Vertebral Angio Lt
FAHIO
Angio Hepatic & Iodine 131
Vertebral Angio Rt
FALIP
Abdominal Angio Theatre Angio Hepatic With Lipiodol
FAIMA
Angio Inferior Mesenteric Artery
Chest Angio Theatre
FAGEN
Angio Other
FAOVA
Angio Ovarian
Head Angio Theatre
FAPEV
Pelvic
Lower Limb Angio Theatre Angio
Lt
FAPUG
Pulmonary
Lower Limb Angio Theatre Angio
Rt
FAPUP
Pulmonary with Pressures
Upper Limb Angio Theatre Angio
Lt
FAREN
Renal
Upper Limb Angio Theatre Angio
Rt
FARTK
Angio Renal Transplant
Aorta Angioplasty
FASPN
Aorto-Femoral AngioplastyAngio Spinal
FASPN
Brachial Angioplasty Lt Angio Splenic
FASCL
Angio Subclavian Lt
FASCR
Angio Subclavian Rt
FASMA
Angio Superior Mesenteric Artery
FATES
Angio Testicular
FAULL
Angio Upper Limb Lt
FAULR
Angio Upper Limb Rt
FAVTL
Angio Vertebral Lt
FAVTR
Angio Vertebral Rt
IAORAP
Angioplasty Aorta
IAAFMP
Angioplasty Aorto-Femoral
IABRLP
Angioplasty Brachial Lt
IABRRP
Angioplasty Brachial Rt
IACEGP
Angioplasty Cerebral
IACOEP
Angioplasty Coeliac
IAHEPP
Angioplasty Hepatic
IAILLP
Angioplasty Iliac Lt
IAILRP
Angioplasty Iliac Rt
IAIMAP
Angioplasty Inferior Mesenteric Artery
IAIPLP
Angioplasty Infrapopliteal Lt
Vein Sample Adrenal
Abdominal Aortogram
Femoral Antegrade Angio Lt
Femoral Antegrade Angio Rt
Aorto-Femoral Angio Lower Limbs Both
Aortic Arch Angio
Bronchial Angio
Carotid Angio Lt
Carotid Angio Rt
Cerebral Angio
Coeliac Angio
Coeliac/SMA/Hep/IMA Angio
Hepatic Angio
Hepatic Angio + Iodine 131
Hepatic Angio + Lipiodol
Inferior Mesenteric Artery Angio
Ovarian Angio
Pelvic Angio
Pulmonary Angio
Pulmonary Pressure Angio
Renal Angio
Renal Transplant Angio
Spinal Angio
Splenic Angio
Subclavian Angio Lt
Subclavian Angio Rt
Superior Mesenteric Artery Angio
Testicular Angio
Upper Limb Angio Lt
Upper Limb Angio Rt
Vertebral Angio Lt
Vertebral Angio Rt
Aorta Angioplasty
Aorto-Femoral Angioplasty
Brachial Angioplasty Lt
Brachial Angioplasty Rt
Cerebral Angioplasty
Coeliac Angioplasty
Hepatic Angioplasty
Iliac Angioplasty Lt
Iliac Angioplasty Rt
Inferior Mesenteric Artery Angioplasty
Infrapopliteal Angioplasty Lt
Unique codes for requestor, reporter, Trust,
ward and unique ‘Accession numbers’
related to examination modality.
Requestor and reporter NCRS National code related to
GMC/GDC/SR no. or cross match to this via look up table.
May not be a doctor.
Trust 3 character NCRS codes eg RPX
Ward 3 character prefix eg RPXBaird
Accession No. 3 character prefix RPX123456.
Needed as same model machines might generate
identical numbers and no process between manufacturers
to coordinate these.
Full list of
RIS Codes &
Descriptors
+ Synonyms
SNOMED CT
Descriptors
and Codes
NACS
Location &
People
codes
Post
Coordinating
RIS single
descriptors
HL7
RIS
SNOMED CT
Descriptors
and Codes
HL7
NCRS
‘Order’
Entry
List of
Orderable
Procedures
SNOMED CT
Descriptors
and Codes
NCRS
‘Reporting’
Module
SNOMED CT
SPINE
Sub-Descriptors / Codes
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REQUESTING Layer
(1st order)
Right Oblique
QR
Left Oblique
QL
Right Lateral
LR
Left Lateral
LL
Weight Bearing WB
Standing
ST
Axial
AX
AP20o
20
Judet’s
JU
Stryker’s
SY
Etc…

IN RADIOLOGY (RIS)
Layer
(2nd order)
 Same list +
 Supine
SU
 Prone
PR
 Decubitus
DE
 Complex Oblique QC
 Angled Oblique
22,30,45
 Frog laterals
FR
 May need to combine
together or with 1st
order list eg DELR
SNOMED CT
NCRS provides support for clinical coding using the
SNOMED CT nomenclature for diagnosis and procedure
codes.
SNOMED CT codes will be applied to the patients record
through manual selection by users, as well as an integrated
bi-product of clinical processes (i.e. orders, assessments).
SNOMED CT clinical coding is supported for inpatient and
outpatient encounters.
SNOMED CT
At the end of an episode / encounter of care, SNOMED CT
codes are recorded in NCRS via the Discharge Summary /
Encounter diagnosis and procedure codes.
The SNOMED codes recorded in NCRS are sent to the 3M
clinical encoder where clinical coding is completed in
SNOMED CT, ICD10, Read, and OPCS4.
Codes will be transferred back to NCRS and will update,
not replace, the patient diagnosis and procedure codes.
A full audit trail is available.
SNOMED CT
Within NCRS P1R2, users will have the ability to manually
record SNOMED CT codes within the following areas:
§
Discharge Summary / Encounter
§
Problems / Provisional Diagnoses
Within NCRS P1R2, SNOMED CT codes will be recorded
against the patients record, as a by-product of clinical
processes, in the following clinical areas:
§
Assessments
§
Findings / Flowsheets
§
§
Orders (viz. the code for the request)
Results (viz. the code for the procedure(s)
performed, not the radiological diagnosis or report which will
be transferred via HL7 messaging)
Orders and Results
in Radiology
SNOMED CT Order codes can be derived from Order/Entry
systems, but will be MUCH MORE ACCURATE if derived from
the accepted and if required modified final RIS procedure
entry with SNOMED CT matching.
SNOMED CT Results codes from Radiology are a dilemma.
This does not apply to ‘Procedure performed’ , but to a
provisional radiological diagnosis which may be a list of
differential diagnoses which could be entered by a reporter (ie
manually). Unlikely to happen given pressures of work!
The use of DICOM structured reporting may give the possibility
of automatically constructing radiological diagnosis codes from
the structured report
Structured reporting
DICOM SR – is an ‘envelope’, but within this useful structure is available.
User decides how much structure to use and controls with templates the type of
content, if it is mandatory or optional and modes of expression
Incorporated into the report are captured
images of key findings (which can be exploded
to full screen presentation), structured
diagnosis information, recorded audio, the
ability to sort findings by anatomy or priority, to
view prior findings associated with the
corresponding patient and hyperlinks to related
information.
Structured reporting
Link Features to Description
New nodule
superimposed
with right
fourth rib
10% Pneumothorax
Cavitation
Free air
David Clunie
Development Director, Imaging Products
ComView Corporation – Paper at SPIE, 2001
Structured reporting
David Clunie
Development Director, Imaging Products
ComView Corporation – Paper at SPIE, 2001
Structured reporting