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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 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) A B D E I J M O P R S T X 1 2 3 4 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) 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 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
