Transcript RIS Coding - UK Imaging Informatics Group

Terminology for
representation of
Diagnostic Imaging
Procedures
Dr Keith Foord
Consultant Radiologist, East Sussex Hospitals
National Programme for IT in the NHS
Wednesday 1st December 2004
A national system of RIS coding
and descriptors ?
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Relates to needs of request/entry systems within
ICRS – pre-RIS
 Consistency and uniqueness in requesting
terminology – pre-RIS and within RIS
 Consistency in activity measurement - RIS
 Consistency in clinical coding of events - RIS
 But must be as intuitive and easy to use as possible
 Should have national acceptance
 For accurate communication of results data between
hospitals – post RIS results reporting, cluster stores
and national spine
 For ‘Payment by results’ – accurate records of same
patient activity – national tariffs
NHS Costings Code Book
Other sources
RIS Descriptors and
Codings from:
Guildford
North Bristol
Hastings
Eastbourne
Calderdale
Bart’s
NWWM cluster
Descriptors
Descriptors need to be UNIQUE in ICRS
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
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
Eg X-ray SIJ
XSI J S
Eg Right Hand X-ray
XHANR
Eg MRI Abdomen
MA B DO
Eg Whole body Bone scan
NB ONW
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
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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
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 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 with
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
Examples of other pre coordinated studies
CT NECK/THORAX/ABDO/PELVIS
CT NECK/THORAX/ABDO/PELVIS WITH CONTRAST
CT PELVIS AND ASPIRATION/DRAINAGE
CT PELVIS AND BIOPSY
CT PELVIS WITH/WITHOUT CONTRAST
CT THORACIC AND LUMBAR SPINE
CT THORACIC AND LUMBAR SPINE WITH CONTRAST
CT TRAUMA HEAD AND C SPINE
ELBOWS BOTH
FEMORA (THIGH) BOTH
FOREARMS BOTH
HANDS BOTH
HIPS BOTH
HUMERI (UPPER ARMS) BOTH
KNEES BOTH
LEG LENGTH MEASUREMENT: BOTH
MAMMOGRAM BILATERAL
CNCAP
CNCPC
CPELVD
CPELVB
CPEWC
CTLSP
CTLSC
CSKTC
XELBB
XTHIB
XFARB
XHANB
XHIPB
XUPAB
XKNEB
XLEMB
XMAMB
CNCAP
CNCPC
CPELVD
CPELVB
CPEWC
CTLSP
CTLSC
CSKTC
XELBB
XTHIB
XFARB
XHANB
XHIPB
XUPAB
XKNEB
XLEMB
XMAMB
D
B
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Precoordinated
Pre and Post Co-ordination (2)
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In modern RIS systems post co-ordination can be
applied to group related procedures together.
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.
Codes for post co-ordination
ANGIOPLASTY AORTO-FEMORAL
ANGIOPLASTY CEREBRAL
BILIARY DRAINAGE
CT 3 D STUDY
CT 4 D STUDY
CT Guided ablation
CT guided aspiration/drainage
CT guided biopsy
CT MIP STUDY
Drainage catheter exchange
EMBOLISATION
EMBOLISATION CEREBRAL
Embolisation of AVM
FLUORO ASPIRATION/DRAINAGE
Internal metallic stent
Percutaneous ethanol injection
SIALOGRAPHY STONE REMOVAL
SIALOPLASTY
SPECT (any other additional)
THROMBOLYSIS: AORTO:FEMORAL
U/S ARTERIAL
U/S BIOPSY/FNA BIOPSY
U/S DOPPLER
U/S EXTREMITY
U/S GUIDED CORE or FNA BIOPSY
U/S GUIDED INJECTION
VENOUS SAMPLING
IAAFMP
IACEGP
IBILDD
C3DSY
C4DSY
CABLTA
CASPD
CBIOPB
CMIPY
IEXCHD
IEMBOE
IACEGE
IAVEME
FASDRD
IMETCS
IETHAJ
ISIACX
ISIAOP
NSPECO
IAATTJ
UARTE
UBIOPB
UDOPP
UEXTR
UBIOPB
USINJJ
FVSAM
IAAFMP
IACEGP
IBILDD
C3DSY
C4DSY
CABLTA
CASPD
CBIOPB
CMIPY
IEXCHD
IEMBOE
IACEGE
IAVEME
FASDRD
IMETCS
IETHAJ
ISIACX
ISIAOP
NSPECO
IAATTJ
UARTE
UBIOPB
UDOPP
UEXTR
UBIOPB
USINJJ
FVSAM
P
P
D
A
D
B
D
E
E
E
D
S
J
X
P
J
B
B
J
Associate (Postcoordinate with Angio)
Associate (Postcoordinate with Angio)
Select postcoordinators from biliray list
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Associate (Postcoordinate with Angio)
Associate (Postcoordinate with Angio)
Associate (Postcoordinate with Angio)
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Associate (Postcoordinate with Angio)
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Postcoordinate with body part study
Alphabetical list of all procedures
by DESCRIPTOR or CODE
(1037 codes)
Descriptors
Codes
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…
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IN RADIOLOGY Layer
(2nd order)
Supine
SU
Prone
PR
Decubitus
DE
Complex Oblique QC
Angled Oblique
22,30,45
Frog laterals
FR
May need to combine
with 1st order list eg
DELR
Total diagnostic
examinations/interventions
Pre-coordinated
full list
1037
PostPost-coordinated
coordinators only examinations
46
924
‘Both’ and
multi-CTs
67
Endoscopy
11
X-Ray
144
CT
166
MRI
149
IR Fluoro
157
US
131
PET
4
Diag Fluoro
190
Diag RNI
107
NPfIT and Descriptors/Codes
Southern Cluster – IDX – GE PACS- ? Cerner RIS
 London Cluster-IDX- Philips PACS-? Sectra RIS
 NE & EEM Clusters- iSOFT-? Agfa PACS-? RIS
 NWWM Cluster- iSOFT- ComMedica PACS –Kodak
RIS
 Has RCR endorsement
 SNOMED CT can be integrated-matched (Dr David
Nag)
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SNOMED CT
Carecast 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 Carecast via the Discharge
Summary / Encounter diagnosis and procedure codes.
The SNOMED codes recorded in Carecast 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 Carecast and will update,
not replace, the patient diagnosis and procedure codes.
A full audit trail is available.
SNOMED CT
Within Carecast P1R2, users will have the ability to manually
record SNOMED CT codes within the following areas:
§
Discharge Summary / Encounter
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Problems / Provisional Diagnoses
Within Carecast P1R2, SNOMED CT codes will be recorded
against the patients record, as a bi-product of clinical
processes, in the following clinical areas:
§
Assessments
§
Findings / Flowsheets
§
§
Orders
Results
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.
A provisional radiological diagnosis which may be a list of
differential diagnoses could be entered by a reporter (ie
manually). Unlikely to happen !
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