jaymeemurdoch
commented
3 years ago Proposed Solution
- A new ValueSet for Imaging Anatomic Region of Interest composed of SNOMED CT concepts that are representative of the set of values proposed by the Australian Government Department of Health after consultation with the Royal Australian and New Zealand College of Radiologists
- Two new ConceptMaps describing relationships between the new Imaging Anatomic Region of Interest value set and NCTIS Anatomical Region value set to provide clarity on code equivalence and provide a path forwards for the transition of affected legacy materials
| . | Proposed ValueSet |
|---|---|
| Proposed Title | Imaging Anatomic Region of Interest (alternative: Imaging Anatomic Area of Interest) |
| Proposed Description | The Imaging Anatomic Region of Interest value set contains values that may be used to represent the anatomic region of interest for an imaging procedure or The Imaging Anatomic Region of Interest value set contains values that may be used to represent the anatomic area of interest for a diagnostic imaging procedure. |
| Proposed URL | https://healthterminologies.gov.au/fhir/ValueSet/imaging-anatomic-region-of-interest-1 |
ValueSet Requirement: To describe the general area or region where a diagnostic image is taken, to enable categorisation by common area/region. This value set will contain the equivalent SNOMED CT concepts representing the NCTIS Anatomical Region values suggested by DoH, after consultation with the Royal Australian and New Zealand College of Radiologists, that are currently in use. The suggested values are not indicative of all defined body regions and represents only the common regions identified for categorisation of diagnostic imaging.
| SCT ID | Preferred Term |
|---|---|
| 69536005 | Head structure |
| 45048000 | Neck structure |
| 51185008 | Thoracic structure (syn of Chest) |
| 80891009 | Heart structure |
| 76752008 | Breast structure |
| 818983003 | Abdomen |
| 12921003 | Structure of pelvis |
| 53120007 | Upper limb structure |
| 61685007 | Lower limb structure |
| 122494005 | Structure of cervical vertebral column |
| 122495006 | Structure of thoracic vertebral column |
| 122496007 | Structure of lumbar vertebral column |
| 38266002 | Entire body as a whole - Note the addition of a new concept representing 'whole body' was considered, however given the concept is representing the entire body, the existing 'entire' concept was chosen. This is supported by DICOM. |
ValueSet proposed in FTR-1223.
dtr-agency
davidmckillop
Prerequisites
The issue
Change description
Grouping of sites based on anatomical region is a consistent means of finding, classifying or discovering the results of imaging intensive diagnostic investigations, and therefore it is valuable to categorise a diagnostic report based on anatomical region.
A ValueSet is required to support anatomical region imaged to enable categorisation. SNOMED CT concepts should be utilised moving forward as it is the Agency's preferred national clinical terminology. Additionally, SNOMED CT is the preferred national solution for clinical terminology endorsed by the Australian Health Ministers' Advisory Council (AHMAC). In recent workshops with RANZCR, SNOMED CT was identified as the preferred terminology to support diagnostic imaging.
The ValueSet must be consistent with the following list of anatomical regions produced as a result of consultation by Australian Government Department of Health with RANZCR in 2014, which formed the basis of the Information Requirements for eHealth Diagnostic Imaging Report:
What it actually enables people to do
Categorisation based on anatomical region enables a consistent method of finding or aggregating imaging intensive diagnostic reports. It may be utilised for indexing, reporting, searching or discovering diagnostic reports that are focused on a particular anatomical region, and therefore contains imaging based on relevant anatomical sites or locations. For example, a potential use case may involve a clinician being notified of reports detailing prior similar or proximate imaging that is relevant for clinical decision making. It may prevent duplicate or unnecessary imaging, and assist in discoverability of reports that aid patient management.
How awesome would it be?
Anatomical region is a widely adopted means of categorisation supported by the Agency, which the Australian Government Department of Health and Royal Australian and New Zealand College of Radiologists both continue to endorse. Categorisation based on anatomical region is also supported by the RANZCR's Clinical Radiology Written Report Guidelines, which states "relevant imaging findings should be characterised as specifically as possible including a description of; precise anatomical location using accepted anatomical terminology and modality; size or extent; other anatomical imaging characteristics relevant to diagnosis or treatment."
The potential benefits of categorisation based on anatomical region include reporting capability, and indexing to assist clinicians in finding relevant or related reports, and therefore assisting in reducing unnecessary repeat imaging. Categorisation by anatomical region would provide a means of searching and discovering imaging intensive diagnostic reports.
Workarounds
The NCTIS Anatomical Region ValueSet is currently published on the NCTS, and may be used until a SNOMED CT set is produced.
Additional context
The NCTIS Anatomical Region ValueSet is published on the National Clinical Terminology Service (NCTS) and is implemented in My Health Record system for eHealth Diagnostic Imaging Report CDA R2 documents. The ValueSet is also used to describe Anatomical Region in Imaging Examination Result DCM and Diagnostic Imaging SCS and CDA implementation guide. The use of SNOMED CT concepts to describe anatomical regions is preferred but was unable was unable to be developed at the time of implementation, hence the NCTIS set was produced as a workaround in order to deliver the product within the required timeframe.
Consideration for ValueSet to be bound to DiagnosticReport.Category (a slice of category to indicate categorisation based on anatomy, where binding strength may be preferred but cardinality optional). ValueSet could potentially be used in ImagingStudy or an imaging Observation, noting Observation.bodySite and ImagingStudy.bodySite currently enables indication of the observed body structure.
Comparable existing terminology
DICOM set ‘Common Anatomic Regions’ which utilises SNOMED CT body structure concepts (http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_4031.html). This set is used in the DICOM ‘Anatomic Region Sequence Attribute’ which identifies the general anatomic region imaged by the protocol (Attribute definition: Sequence that identifies the anatomic region of interest in this instance (ie external anatomy, surface anatomy, or general region of the body)). This is used in correlation with ‘Primary Anatomic Structure Sequence’ which identifies the specific organ or structure that is the focus of the procedure described by the protocol. For example, a protocol might identify the Primary Anatomic Structure as "liver" and the Anatomic Region as "abdomen". DICOM specifies that ‘structure’ rather than ‘entire’ SNOMED CT concepts are to be used as they are more inclusive and do not imply the imaging of the entire structure recorded. An exception to this rule is the use of |Entire body as a whole|, as this is explicitly referring to the entire body. DICOM also notes that the contents of the element Anatomic Region Sequence (0008,2218) is not necessarily a precise description of the full extent of the scan or the reconstructed slices. For example, where "Chest" is recorded it may refer to a scan that spans only part of the chest, the whole chest, or includes parts of regions beyond the chest.
LOINC 'Anatomic Location' attribute specifies the body part or body region that is imaged, and includes the sub-attributes 'Region Imaged' and 'Imaging Focus' (https://loinc.org/kb/users-guide/loinc-rsna-radiology-playbook-user-guide/#anatomic-location). 'Region Imaged' is used in two ways - as a general descriptor for the area imaged and as a grouper for finding related imaging exams, or it is just used as a grouper. It is constrained to the following set: Head, Neck, Chest, Breast, Abdomen, Pelvis, Extremity, Upper extremity, Lower extremity, Whole body, Unspecified. Where multiple regions are imaged without an imaging focus, such as CT of head and neck, two regions may be combined with a '+', eg Head+Neck.
RadLex attribute BODY_REGION (broad area of the body imaged; https://pubs.rsna.org/doi/pdf/10.1148/rg.2017160188) is described by the following values: Abdomen, Body, Bone, Breast, Cervical spine, Chest, Extremities, Extremity, Face, Head, Lower extremity, Lumbar spine, Lumbosacral spine, Neck, Pelvis, Skull, Skull base to mid-thigh, Spine, Thoracic Spine, Thoracolumbar spine, Upper extremity, Wholebody. It is used in combination with ANATOMIC_FOCUS, which indicates the specific site of interest, such as a particular organ or joint. Multiple regions can be specified by BODY_REGION, BODY_REGION_2 etc.