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 Usound 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 Ablation B Biopsy (Core or FNA) D Drainage or Aspiration of fluid E Embolisation I Insertion of device J inJection - as an objective of the procedure, not as part of the preliminary to this objective M Mobile - for any modality, but particularly for 'portable' plain films and use of mobile image intensifiers O tOmography in its wider sense. O may be added to any plain film examination to define planar tomography or postcoordinated P Plasty - as in angioPlasty or dacrocystoPlasty - ie balloon dilatation R for Radiotherapy planning S Stent T
Use of intraThecal contrast X eXtraction - eg in retrieval of intravascular foreign bodies or removal of temporary IVC filter 1 First part of study 2 Second part of study 3 Third part of study 4 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 coordinated 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. S SNOMED code Local Code (code use d by N the Radiology System s) O M E D L o CCA/FJA have not yet Carecast request display name (Data field limit - 40) Carecast request SHORT display name (Data field limit-20) Requestable procedures
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
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 S SNOMED codeAbdominal Local CodeAortogram (code used by Carecast reque st display nam e (Data field limit - 40) N the Radiology Systems ) Lt Femoral Antegrade Angio O Femoral Antegrade Angio Rt M Aorto-Femoral Angio Lower Limbs Both E Aortic Arch Angio D Bronchial Angio L Carotid Angio Lt not yet o CCA/FJA have For FJA RIS these MUST be used as the prime descriptors Carecast request SHORT display name (Data field limit-20) Full list incl multis 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 Z3DST 3 D study Ovarian Z4DSTAngio 4 D study Pelvic Angio ZABAN Abandonned procedure Pulmonary Angio IACLY
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 S SNOMED code N O M E D L o Local Code (code used by the Radiology Syste ms) Care cast reques t display name (Data field limit - 40) Carecast request SHORT dis play nam e (Data fie ld 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
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. equestor and reporter NCRS National code related MC/GDC/SR no. or cross match to this via look up tab y not be a doctor. ust 3 character NCRS codes eg RPX ard 3 character prefix eg RPXBaird cession No. 3 character prefix RPX123456. eded as same model machines might generate ntical numbers and no process between manufacturers 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
SNOMED CT Module SPINE Sub-Descriptors / Codes REQUESTING Layer order) Right Oblique QR Left Oblique QL Right Lateral LR Left Lateral LL Weight Bearing WB Standing ST Axial AX AP20o 20 Judets JU
Strykers SY Etc (1st 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
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