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The following sections outline the main features of the structure of SNOMED CT and particular aspects of interest to translators. More detailed information on the structure of SNOMED CT can be found in the SNOMED CT Guides (https://confluence.ihtsdotools.org/display/DOC/Guides).

Concept systems and ontologies

Conceptual relationships can be coded in formal structures or so-called ontologies. The construction of ontologies is based on conceptual networks derived from expert knowledge. The aim is to represent domain-specific knowledge (i.e. the conceptualization of a particular domain) in a formal, computer-readable and consensus-based way in accordance with criteria agreed upon by a community of experts. The elements of knowledge are defined according to a set of properties and linked via explicit relationships of different kinds (both hierarchical and non-hierarchical such as partitive, cause-effect, etc.). Since the concepts and relations are represented formally, the information can be processed electronically, allowing different kinds of operations such as data retrieval and standardized data exchange.

SNOMED CT is a terminological ontology that combines the terminological approach of concept system creation described in Section 2.2 with knowledge-based ontology design. It is developed by domain experts for domain experts as knowledge resource for information exchange for use in various applications. The system uses a relationship-based representation of concepts (Concept 1 <relation> Concept 2) by means of the formal ontology language Description Logic (e.g. Common Cold <causative agent> Virus).

SNOMED CT definitions

In SNOMED CT concepts are defined in three different ways.

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Figure 5 – Illustration of the three SNOMED CT Description types in the US English language refset of concept 609328004 |Allergic disposition (finding)| (International Edition 2021-07-31) F - Fully Specified Name; S - Synonym; D - Definition

The hierarchical and multi-axial structure of SNOMED CT

SNOMED CT contains more than 350,000 concepts from clinical and non-clinical concept fields or domains (e.g. Body Structure, Clinical Finding, Procedure, Substance, Event, Environment or geographical location, Physical object, etc.). These concepts are arranged in 19 top-level hierarchies according to the domain to which they belong (Figure 6).

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Figure 8 – Polyhierarchical structure of concepts (as shown in SNOMED International Starter Guide)

Figure 9 – Full polyhierarchical view of concept 788951001 |Hemorrhage of digestive system (disorder)| (International Edition 2021-07-31) using Ontoserver Shrimp browser (https://ontoserver.csiro.au/shrimp)

Description types

Each concept is represented at least by two types of Descriptions: one Fully Specified Name (FSN) and Synonyms (SYN), one of which is marked as the Preferred Term (PT) (Figure 10). The presence of a Description of type definition is optional.

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Text definitions can, but do not have to be translated.  SNOMED International intends to introduce more Description types in the future and make them configurable. For example, a Description type could be configured for search terms that include Descriptions (i.e. terms) that are inappropriate for display and data exchange but useful for clinicians to quickly retrieve them at the data collection interface. Examples are Descriptions containing spelling errors, Descriptions that are not correct but commonly used in clinical practice (e.g. “uterine fibroma" for “uterine leiomyoma”) or polysemous acronyms (e.g. “IRA” which stands both for “acute renal insufficiency” and “acute respiratory insufficiency”.

Table 1 – SNOMED CT description types for the concept 22649008 |photodermatitis (disease)| in the Great Britain English language reference set

For translation purposes the three types of Definitions can be useful (see Section 4). Professional translators without medical expertise will have greater difficulty understanding all SNOMED CT by their formal relationships. Therefore, natural language definitions and textual sources that provide information on the contextual use of a concept are important additional tools.

SNOMED CT logical definitions, attributes and relationships

There are two types of defined concepts: fully defined and primitive concepts.

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              363698007 |finding site|  =  66754008 |appendix structure|

SNOMED International Editorial Guide and Confluence Templates

SNOMED International has numerous resources to promote the understanding and use of SNOMED CT.  These documents are available in the Document Library, which is a collection of SNOMED CT documents, including introductory material, practical guides, technical specifications and reference material (https://confluence.ihtsdotools.org/display/DOC/SNOMED+CT+Document+Library).

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