CP-2438 Update DICOM to reflect changes in IHTSDO SNOMED CT-DICOM Subset for JUL 2024 INT Release Status Jan 2025 Voting Packet Date of Last Update 2024/11/11 Person Assigned David Clunie Submitter Name David Clunie Submission Date 2024/08/09 Correction Number CP-2438 Log Summary: Update DICOM to reflect changes in IHTSDO SNOMED CT-DICOM Subset for JUL 2024 INT Release Name of Standard PS3.16 Rationale for Correction: [Ed.Note: Increasingly SNOMED just seems to be removing concepts somewhat gratuitously without replacement (e.g., due to "editorial policy" or incomplete remodelling efforts) - we need to reconsider our policy of routinely removing codes from DICOM that have been inactivated by SNOMED and replacing them, e.g., with DCM codes or codes from other coding schemes, or just removing them, since this is unnecessarily disruptive for the installed base and there is little evidence anyone is using the SNOMED ontology anyway. Instead we might just want to leave them in active use in DICOM, and flag that they have been inactivated in SNOMED (e.g., a different table than Annex J, e.g., "Inactivated by SNOMED but still actively used in DICOM" or similar). For the sake of argument, some (but not all) of these are shown as removed in this version of the CP to demonstrate the impact. Perhaps only if there is a genuine and meaningful replacement should we apply SNOMED inactivations (e.g., for genuinely duplicate or incorrect or ambiguous concepts).] [Ed.Note; Need WG1 review of inactivation/replacement of 33272004, 72542009.] The following concepts have been inactivated in the July 2024 INT release: 108290001 Radiation oncology AND/OR radiotherapy (procedure) 314122007 Maintenance therapy (procedure) - we requested reconsideration of this inactivation CRS#964190 - may be replaced be cancer-specific concept that is less vague wrt. application 413581001 Asian or Pacific islander (racial group) - we will continue to use since disagree w. SNOMED 414481008 Indian (racial group) - we will continue to use since disagree w. SNOMED 413490006 American Indian or Alaska native (racial group) - we will continue to use since disagree w. SNOMED 413600007 Australian aborigine (racial group) - we will continue to use since disagree w. SNOMED 284355001 Structure of left ventricle anterior segment (body structure) 284357009 Structure of left ventricle inferior segment (body structure) 284358004 Structure of left ventricle lateral segment (body structure) 284356000 Structure of left ventricle septal segment (body structure)| 103716009 Placement of stent (procedure) 307279007 Prosthetic replacement of heart valve (procedure) - replacement omits "prosthetic" aspect - reconsideration approved and will be reactivated - CRS#964191 33272004 Structure of myocardium of posterolateral region (body structure) - we requested reconsideration of this inactivation CRS#964192; SNOMED's suggested replacements do not seem equivalent: 264846001 Structure of basal inferior segment of left cardiac ventricle (body structure) 16239001 Structure of myocardium of inferolateral region of left ventricle (body structure)| See also "https://confluence.ihtsdotools.org/display/cmag/Revision+of+segmental+models+of+the+cardiac+wall" See also "https://confluence.ihtsdotools.org/display/IAP/Cardiac+wall+and+segment+models" SNOMED commented: "I could not find references for the posterolateral region apart from the segment model of the left ventricle. Because of the potential ambiguity of the word "posterior" for the anatomy of the heart, it is not clear about the specific region. From a gross anatomy aspect, posterior (base) surface of the heart, the true cardiac base, is somewhat quadrilateral, with curved lateral extensions…formed mainly by the left atrium, and only partly by the posterior part of the right atrium. This description of the anatomical base reflects the usual position of the heart in the thorax. Would a new concept posterior (base) surface of heart be suitable for the requirement? Note, currently posterior surface is an incorrect synonym of 60383004 |Structure of diaphragmatic surface of heart (body structure)|" Should we define DCM code? 72542009 Structure of myocardium of diaphragmatic region (body structure) - we requested reconsideration of this inactivation CRS#964193; SNOMED's suggested replacements do not seem equivalent: 1335800009 Structure of myocardium of inferior region of left and right ventricles (body structure) 367598003 Structure of myocardium of inferior region of left ventricle (body structure) 60383004 Structure of diaphragmatic surface of heart (body structure)| See also "https://confluence.ihtsdotools.org/display/cmag/Revision+of+segmental+models+of+the+cardiac+wall" See also "https://confluence.ihtsdotools.org/display/IAP/Cardiac+wall+and+segment+models" SNOMED commented: "the diaphragmatic region could be interpreted from two aspects. From the gross anatomy aspect, the inferior (diaphragmatic) surface of the heart is largely horizontal. The inferior surface of the heart gently slopes anteroinferiorly towards the cardiac apex. It is formed by the ventricles (primarily the left) and rests mainly on the central tendon but also, apically, on a small area of the left muscular part of the diaphragm. It is represented by the new concept myocardium of inferior region of left and right ventricles to be explict. This is different from the inferior region in the segment model of the cardiac wall that comprises the apical, mid and basal inferior segments of the left ventricle only. If the usage in DICOM is not about segment, the new concept should be the replacement. Otherwise, it could be confused with the inferior region in the segment model that only involves the left ventricle." Should we define DCM code? 27483000 Diagnostic radiography with contrast media (procedure) - handled in seperate CP with other procedure code changes 128953001 Catheterization of both left and right heart without graft (procedure) - we requested reconsideration of this inactivation - reactivated CRS#964194 133874006 Selective fetal reduction (procedure) 64318009 Diagnostic radiography, stereotactic localization (procedure) 19776001 Decreased size (finding) - we requested reconsideration of this inactivation - reactivated CRS#964195 4563007 Hospital admission, transfer from other hospital or health care facility (procedure) 15415002 Injection of amnion (procedure) 255046005 Neuroendocrine tumor (disorder) 12169001 Granular cell tumor (morphologic abnormality) 92652009 Carcinoma in situ of male breast (disorder) - Japanese translation of original and replacement lacks "in situ" concept (added to French) 92248004 Benign neoplasm of nipple of female breast (disorder) 248536006 Finding of functional performance and activity (finding) 373270004 Substance with penicillin structure and antibacterial mechanism of action (substance) 421921003 Cannabinoid (substance) - not actually used in DICOM, but add its replacement anyway Correction Wording: <informaltable rules="all" frame="box"> <tr> <td> <para><emphasis role="italic">Amend DICOM PS3.16 as follows (changes to existing text are bold and <emphasis role="bold"><emphasis role="underline" >underlined</emphasis></emphasis> for additions and <emphasis role="bold" ><emphasis role="strikethrough">struckthrough</emphasis></emphasis> for removals):</emphasis></para> </td> </tr> </informaltable> <section label="TID 3802" status="3" xml:id="sect_TID_3802"> <title>Cardiovascular Patient History
Cardiovascular Patient History
NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
4 >> CONTAINS TEXT D 1-n U
Pediatric, Fetal and Congenital Cardiac Ultrasound Section
Pediatric, Fetal and Congenital Cardiac Ultrasound Section
NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
3 >> HAS CONCEPT MOD CODE EV (307279007, SCT, "Prosthetic replacement of heart valve") 1 U D
Image Guided Therapeutic Procedure Version: 20240611yyyymmdd
Image Guided Therapeutic Procedure
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 103716009 1296925008 Stent placement P1-05550 C0522776 C2348535
SCT 15415002 1269276008 Amnioinfusion [injection of amnion] P1-86520 C0521272
SCT 133874006 265633004 Fetocide (selective reduction)Selective destruction of fetus P1-86C50 P0-00843 C1297889 C0410890
Medication Type Code Type from Anesthesia Quality Initiative Version: 20220922yyyymmdd
Medication Type Code Type from Anesthesia Quality Initiative
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 373270004 764146007 Penicillin antibiotic C-0021D C0030842
Tumor Graft Histologic Type Version: 20230630yyyymmdd
Tumor Graft Histologic Type
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 255046005 1290125003 NMalignant neuroendocrine tumor DF-004BC C0206754
ST Segment Location Version: 20091021yyyymmdd
ST Segment Location
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 284355001 1335839000 Left ventricle anterior segment T-3260A C0562222
SCT 284357009 367598003 Left ventricle inferior segment T-3260C T-32638 C0562224 C1288324
SCT 284358004 1335824001 Left ventricle lateral segment T-3260D C0562225
SCT 284356000 1335840003 Left ventricle septal segment T-3260B C0562223
SCT 128564006 Left ventricle apical segment T-32602 C0580781
Catheterization Procedure Phase Version: 20160314
Catheterization Procedure Phase
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 128952006 Catheterization of both left and right heart with graft P1-3160A C1293383
SCT 128953001 Catheterization of both left and right heart without graft P1-3160B C1293384
SCT 67629009 Catheterization of left heart P1-31604 C0189897
SCT 40403005 Catheterization of right heart P1-31602 C0189896
Procedure Action Value Version: 20190817yyyymmdd
Procedure Action Value
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 103716009 1296925008 Stent placement P1-05550 C0522776 C2348535
Myocardial Wall Segments in Projection This Context Group specifies the left ventricular myocardial wall segments as seen in typical right anterior oblique (RAO) and left anterior oblique (LAO) angiographic projections. Version: 20210328
Myocardial Wall Segments in Projection
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 264850008 left ventricle basal anterior segment T-32619 C0555926
SCT 73050001 myocardium of anterolateral region T-32634 C0225907
SCT 47962008 myocardium of apex of heart T-32636 C0225909
SCT 72542009 myocardium of diaphragmatic region T-32632 C0225905
SCT 264846001 left ventricle basal inferior segment T-32615 C0555929
SCT 33272004 myocardium of posterolateral region T-32633 C0225906
SCT 16239001 myocardium of inferolateral region T-32637 C0225910
SCT 264845002 left ventricle apical septal segment T-32614 C0555923
Admission Status Version: 20070827yyyymmdd
Admission Status
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID NCDR [2.0b] Equivalent
SCT 4563007 308292007 Transfer P0-10210 P0-004F6 C0184681 C1531390 17-3
Concern Type Version: 20240611yyyymmss
Concern Type
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 1269496002 Complaint C0277786
SCT 64572001 Disease DF-00000 C0012634
SCT 404684003 Finding R-005AE C0037088
SCT 418799008 Finding reported by patient/informant R-005E0 C1689949
SCT 248536006 423690003 Functional performance and activityPhysical performance F-03E55 F-04E56 C0424866 C1827056
SCT 55607006 Problem F-01000 C0033213
Change Since Last Mammogram or Prior Surgery from BI-RADS® From BI-RADS® Third Edition (National Mammography Database, E79) Version: 20020904
Change Since Last Mammogram or Prior Surgery from BI-RADS®
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 129721008 New finding F-01721 C1268649
SCT 129722001 Finding partially removed F-01722 C1268650
SCT 129723006 No significant changes in the finding F-01723 C1268651
SCT 15454001 Increase in size M-02520 C0332509
SCT 19776001 Decrease in size M-02530 C0332511
SCT 129726003 Increase in number of calcifications F-01726 C1268654
SCT 129727007 Decrease in number of calcifications F-01727 C1268655
SCT 129728002 Less defined F-01728 C1268656
SCT 129729005 More defined F-01729 C1268657
SCT 129730000 Removal of implant since previous mammogram F-0172A C1268658
SCT 129731001 Implant revised since previous mammogram F-0172B C1268659
Benign Pathology Code from BI-RADS® Version: 20230630yyyymmdd
Benign Pathology Code from BI-RADS®
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 12169001 404035005 Granular cell tumor M-95800 DF-006C7 C0085167
SCT 92248004 1306316005 Benign neoplasm of nipple of female breast (Nipple adenoma) D7-F0810 C0686290
Malignant Pathology Code from BI-RADS® Version: 20230630yyyymmdd
Malignant Pathology Code from BI-RADS®
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 92652009 189336000 Carcinoma in situ of male breast D7-F0902 D1-F3507 C0686328 C0154084
Breast Biopsy Technique Version: 20160314yyyymmdd
Breast Biopsy Technique
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 392021009 Lumpectomy P1-030C4 C0851238
UMLS C0024881 Mastectomy C0024881
SCT 172049005 Quadrantectomy of breast P1-4834A C0337354
SCT 64318009 428907005 Diagnostic radiography, stereotactic localizationPlain X-ray guided wire localization of breast lesion P5-00032 P0-00C4B C0202577 C1997063
SCT 61593002 Ultrasonic guidance procedure P5-B0700 C0442973
SCT 71651007 Mammography P5-40010 C0024671
DCM 111487 Mammographic (crosshair)
DCM 111488 Mammographic (grid)
SCT 277592004 Magnetic resonance imaging guided biopsy P1-03107 C0456854
SCT 277591006 Computed tomography guided biopsy P1-03106 C0456853
DCM 111489 Palpation guided
DCM 111490 Vacuum assisted
Therapies for Breast Version: 20230630yyyymmdd
Therapies for Breast
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 108290001 1287742003 Radiation therapy P5-C00F8 C1522449
Substance Version: 20160314yyyymmdd
Substance
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 398705004 Marijuana F-61D6F C0678449
SCT 771355003 Cannabinoid C2927148
Racial Group This Context Group is intended to be a set of values that is the union of concepts used in various jurisdictions. It does not distinguish race from ethnic group. Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Keyword: RacialGroup FHIR Keyword: dicom-cid-6099-RacialGroup Type: Extensible Version: 20240611 UID: 1.2.840.10008.6.1.1278
Racial Group
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 413464008 African race S-0004E C0027567
SCT 413582008 Asian race S-00051 C0078988
SCT 413773004 Caucasian race S-0003D C0007457
SCT 413490006 American Indian or Alaska native S-0004B C1515945
NCIt C41219 Native Hawaiian or other Pacific Islander C1513907
SCT 413581001 Asian or Pacific Islander race S-0004C C1531604
SCT 413600007 Australian aborigine race S-00052 C0337948
SCT 414481008 Indian race S-0003E C1524069
SCT 414408004 Hispanic S-00045 C0086409
UMLS C5690844 Middle Eastern or North African C5690844
SCT 414752008 Mixed racial group S-00043 C0682081
Chest Qualitative Temporal Difference Type Version: 20090717
Chest Qualitative Temporal Difference Type
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 442755000 Difference in border shape F-0517E C2711283
SCT 442688001 Difference in border definition F-05166 C2711343
SCT 442704007 Difference in distribution F-0516C C2711851
SCT 442711006 Difference in site involvement F-05170 C2711937
SCT 442691001 Difference in substance F-05167 C2711644
SCT 442700003 Difference in Texture F-0516A C2711323
SCT 129722001 Finding partially removed F-01722 C1268650
SCT 129723006 No significant changes in the finding F-01723 C1268651
SCT 15454001 Increase in size M-02520 C0332509
SCT 19776001 Decrease in size M-02530 C0332511
SCT 129728002 Less defined F-01728 C1268656
SCT 129729005 More defined F-01729 C1268657
Time Point Type Version: 20221002yyyymmdd
Time Point Type
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
UMLS C1442488 Baseline
UMLS C3539075 Pretreatment
DCM 126074 Posttreatment
DCM 126075 Eligibility
UMLS C1699701 Unscheduled
UMLS C1708760 Nadir
SCT 262068006 Pre-operative R-413C5 C0445204
SCT 262061000 Post-operative R-413B7 C0032790
SCT 264908009 Post-radiation R-424A6 C0445177
SCT 262502001 Post-chemotherapy R-41AEA C0439577
SCT 314122007 Maintenance therapy P0-006F0 C0677908
SCT 25173007 Recurrence of tumor G-F517 C0521158
(C1442488, UMLS, "Baseline") is (C25213, NCIt, "Baseline"). The undefined (121079, DCM, "Baseline") that is used in is not used in this context. (C3539075, UMLS, "Pretreatment") is (C103341, NCIt, "Pretreatment"). (C1708760, UMLS, "Nadir") is (C43517, NCIt, "Nadir"), and is a synonymn for "lowest", though "nadir" is more commnly used in the context of therapeutic response criteria.
<emphasis role="underline">CT </emphasis>Contrast Imaging Technique Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Keyword: CTContrastImagingTechnique FHIR Keyword: dicom-cid-10014-CTContrastImagingTechnique Type: Extensible Version: 20071031yyyymmdd UID: 1.2.840.10008.6.1.546
Contrast Imaging Technique
Coding Scheme Designator Code Value Code Meaning SNOMED-RT ID UMLS Concept Unique ID
SCT 27483000 1331946003 Diagnostic radiography with contrast mediaCT with contrast P5-00100 C0542435 C0742919
SCT 399331006 CT without contrast P5-0808E C1275400
French Language Meanings of Selected Codes Used in the DCMR (Normative)
French Language Meanings of Selected Codes
Coding Scheme Designator Coding Scheme Version Code Value Code Meaning English Language Code Meaning French Language
SCT 19776001 Decrease in size Diminution de taille
SCT 12169001 404035005 Granular cell tumor Tumeur à cellules granuleuses
SCT 92652009 189336000 Carcinoma in situ of male breast Carcinome de l'hommein situ
SCT 92248004 1306316005 Benign neoplasm of nipple of female breast (Nipple adenoma) Adénomatose (papillomatose) érosive du mamelon
Mapping of Pathology Codes used in DICOM to ADICAP
Coding Scheme Designator Coding Scheme Version Code Value Code Meaning French Language Equivalent ADICAP Code
SCT 12169001404035005 Tumeur à cellules granuleuses X0H4
Japanese Language Meanings of Selected Codes Used in The DCMR (Normative)
Japanese Language Meanings of Selected Codes
Coding Scheme Designator Coding Scheme Version Code Value Code Meaning English Language Code Meaning Japanese Language
SCT 19776001 Decrease in size サイズの縮小
SCT 12169001 404035005 Granular cell tumor 顆粒細胞腫
SCT 92652009 189336000 Carcinoma in situ of male breast 男性乳癌
SNOMED Retired Codes
SNOMED Codes Retired from DICOM Use
Retired Code Value Code Meaning Replacement Code Notes
53438000 Radiation therapy 108290001 1287742003 Replacement code has meaning of "Radiation oncology AND/OR radiotherapy (procedure)". Retired code is inactive in SNOMED CT.
Add new retired concepts to DICOM PS3.16:
SNOMED Retired Codes
SNOMED Codes Retired from DICOM Use
Retired Code Value Code Meaning Replacement Code Notes
108290001 Radiation therapy 1287742003 Replacement code has meaning of "Radiotherapy (procedure)". Retired code is inactive in SNOMED CT.
284355001 Left ventricle anterior segment 1335839000 Replacement code has meaning of "Structure of myocardium of anterior region of left ventricle (body structure)". Retired code is inactive in SNOMED CT.
284357009 Left ventricle inferior segment 367598003 Replacement code has meaning of "Structure of myocardium of inferior region of left ventricle (body structure)". Retired code is inactive in SNOMED CT.
284358004 Left ventricle lateral segment 1335824001 Replacement code has meaning of "Structure of myocardium of lateral region of left ventricle (body structure)". Retired code is inactive in SNOMED CT.
284356000 Left ventricle septal segment 1335840003 Replacement code has meaning of "Structure of myocardium of septal region of left ventricle (body structure)". Retired code is inactive in SNOMED CT.
103716009 Stent placement 1296925008 Replacement code has meaning of "Insertion of stent (procedure)". Retired code is inactive in SNOMED CT.
33272004 myocardium of posterolateral region No replacement. Retired code is inactive in SNOMED CT.
72542009 myocardium of diaphragmatic region No replacement. Retired code is inactive in SNOMED CT.
133874006 Fetocide (selective reduction) 265633004 Replacement code has meaning of "Selective destruction of fetus (procedure)". Retired code is inactive in SNOMED CT.
64318009 Diagnostic radiography, stereotactic localization 428907005 Replacement code has meaning of "Wire localization of lesion of breast using plain X-ray guidance (procedure)". Retired code is inactive in SNOMED CT.
4563007 Transfer 308292007 Replacement code has meaning of "Transfer of care (procedure)". Retired code is inactive in SNOMED CT.
15415002 Amnioinfusion [injection of amnion] 1269276008 Replacement code has meaning of "Injection of substance into amniotic cavity (procedure)". Retired code is inactive in SNOMED CT.
255046005 Neuroendocrine tumor 1290125003 Replacement code has meaning of "Neuroendocrine neoplasm, malignant (disorder)". Retired code is inactive in SNOMED CT.
12169001 Granular cell tumor 404035005 Replacement code has meaning of "Granular cell tumor (disorder)". Retired code is inactive in SNOMED CT.
92652009 Carcinoma in situ of male breast 189336000 Replacement code has meaning of "Carcinoma in situ of breast (disorder)". Retired code is inactive in SNOMED CT.
92248004 Benign neoplasm of nipple of female breast (Nipple adenoma) 1306316005 Replacement code has meaning of "Benign neoplasm of nipple (disorder)". Retired code is inactive in SNOMED CT.
248536006 Functional performance and activity 423690003 Replacement code has meaning of "General physical performance status (observable entity)". Retired code is inactive in SNOMED CT.
373270004 Penicillin antibiotic 764146007 Replacement code has meaning of "Substance with penicillin structure (substance)". Retired code is inactive in SNOMED CT.
314122007 Maintenance therapy No replacement. Retired code is inactive in SNOMED CT.