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Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants

A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023.

Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback.

This Informational Briefing Note summarizes the changes that will be implemented.

Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete.

Substance Abuse/Use

There has been a shift from the term "substance abuse" to a more nuanced understanding of substance use disorders in this domain which is reflected in both ICD-11 and DSM-5 indicating a greater emphasis on the spectrum of substance-related problems.  Several members have expressed the need for content updates to incorporate this change and to simplify the translation process.  Consequently, efforts to revise the content associated with 66214007 |Substance abuse (disorder)| will begin and is expected to be completed by the end of Q2. 

An example of the content structure and terming using opioid use is shown. Specifically, descriptions will be added with “harmful pattern of X substance use” replacing the term “abuse” in the FSN and PT however the “abuse” descriptions are persisted as synonyms to facilitate searching.  In most cases there is no change in meaning, therefore the concepts will not be inactivated.

Approximately 100 existing concepts relating to “abuse” will be affected together with the addition of new concepts to represent “harmful episode” and the higher level “X substance use disorder 

Inactivation of Complication Disorder Concepts (371 concepts)

The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. 

The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype.

The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. 

For further information please see this briefing note. 

Update Role Grouping for Observable Entity and Evaluation Procedure Concepts

Currently, Observable Entity concepts’ attributes are self-grouped  in the international edition. Based on recommendation by the Modeling Advisory Group (MAG), the policy has changed to group these attributes together in order to support modeling concepts with multiple observations and address inconsistent modeling between evaluation procedures and observable entities.

The same changes will be applied to the concepts in the evaluation procedure hierarchy that are modeled with applicable self-grouped attributes. Please see this briefing note for details. 

Please note that the scope of this change is limited to implementation of the updated role grouping MRCM rules for the observable entity and evaluation procedure hierarchies. There are areas in these subhierarchies that require content improvements , including but not limited to the following areas: complement assays, autoantibody measurements, concepts that refer to more than one Component (examples: ratios and concepts with “And”), Components including “Free” and “Total," concepts with fully defined parents, and procedure concepts modeled with a combination of evaluation procedure attributes and general procedure attributes.

Some of the issues were already known and some were identified during this work. These improvements are not in the scope of this work and will be undertaken in future work including the QI project and improvements in other hierarchies including substance and specimen. Some of the issues require feedback from SMEs and/or communication with the Members. If required, editorial guidelines will be updated accordingly.

Angioplasty procedures

In response to several enquiries from members about the apparent duplication of concepts and descriptions for procedures representing 'Percutaneous transluminal angioplasty' an analysis of the content in this area is underway. It is expected to result in inactivation of duplicates, updates to the descriptions of published concepts and remodeling to represent the imaging guidance aspect where appropriate.

After the analysis of the impact has been completed, a Briefing Note will be dispatched to provide details of the changes. Examples of potential duplication:

• 3261007| Angioplasty of subclavian artery (procedure)
• 418738003 | Fluoroscopic angioplasty of subclavian artery (procedure)
• 175454003| Percutaneous angioplasty of subclavian artery (procedure)
• 431485005 Percutaneous transluminal angioplasty of subclavian artery using fluoroscopic guidance (procedure) - correct term.
  

Review 1263452006 |Anesthesia and/or sedation procedure (procedure)|

A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:

• Inactivation of Classification derived components.
• Review of the current model and possible addition of 363703001 |Has intent (attribute)| to the model.
• Review of current classification of groupers.

Review 48537004 |Bypass graft (procedure)| 

A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:

• Improving consistency of descriptions.
• Improving definitions for different types of concepts in the hierarchy (bypass vs shunt)
• Correct use of the term “graft” within the descriptions.
• Correct modeling of 260686004 |Method (attribute)| in the hierarchy.
• Review of the need for 360021005 |Bypass - action (qualifier value)| and 424208002 |Shunt - action (qualifier value)|in the model and testing of 245854003 |Proximal anastomosis (qualifier value)| and 245855002 |Distal anastomosis (qualifier value)| as new 260686004 |Method (attribute)| values in the hierarchy.
• Review for a consistent and appropriate usage of 425362007 |Surgical insertion - action (qualifier value)|and 129407005 |Grafting - action (qualifier value) in the model.
• Review for re-classification of 129376004 |Construction - action (qualifier value)| as a direct subtype of 129284003 |Surgical action (qualifier value)|.
• Given the complexity of some concepts in the hierarchy, potential duplicate, erroneous, or outdated concepts will be identified.

Review Use of 424876005 |Surgical approach (attribute)| 

A review to generalize 424876005 |Surgical approach (attribute)| to allow non-surgical procedures to be modeled with a subtype of <<103379005 |Procedural approach (qualifier value)| is in progress. 

• This issue is under review by the Editorial Advisory Group.
• Currently, 424876005 |Surgical approach (attribute)| is restricted to subtypes of 387713003 |Surgical procedure (procedure)|.  However, the values represented by the 103379005 |Procedural approach (qualifier value)| subhierarchy are applicable to concepts that are not subtypes of Surgical procedure and could potentially be used to define "non-surgical" procedure concepts.
• The impact of MRCM rule for using 116688005 |Procedure approach (attribute)| with domain constraint:  << 71388002 |Procedure (procedure)| and range constraint:  << 103379005 |Procedural approach (qualifier value) is under review. This change would allow Non-surgical procedures to be modeled with a generic Procedure approach attribute.

Review 1287742003 |Radiotherapy (procedure)| 

A review of 1287742003 |Radiotherapy (procedure)| hierarchy is in progress, the focus is on:

• Review of the devices and systems used in the hierarchy for update and to correct subsumption.
• Review of the impact of changing the Method (attribute) value from 129445006 |Administration - action (qualifier value)| to 129382001 |Destruction - action (qualifier value)| within the hierarchy.
• The correct type of energy used for these procedures should be 125576007 |Ionizing radiation (physical force)|.
• Addition of 424832003 |Surgical introduction - action (qualifier value)|or subtypes and 410675002 |Route of administration (attribute)| role group as needed for proper classification.

Review 424226004 |Using device (attribute)| vs. 363699004 |Direct device (attribute)| for Modeling of Repair Procedures

424226004 |Using device (attribute)| and 363699004 |Direct device (attribute)| are used interchangeably for modeling of repair procedures within the Repair group of relationships.

• 363699004 |Direct device (attribute)| should be used when grouped with 260686004 |Method (attribute)| = << 257903006 |Repair - action (qualifier value)|.
• Exceptions were found where the device is used to perform the procedures but are not involved directly in the Repair action itself. e.g. 82830000 |Robotic arm, device (physical object)|
• New model is being tested.

Update for Cardiac Wall and Cardiac Segment

A proposed new model for this area of content is available here.

Further information is available in this briefing note.

Update 'Head and Neck' and 'Head and/or Neck'

A small number of concepts have been identified with FSN of “head and neck” but modeled with 774007 |Structure of head and/or neck (body structure)|.  For some concepts the intention had always been disjunctive “and/or” so to minimise disruption the FSN’s will be changed to reflect this intended meaning with therefore no change in descendants.

Procedures such as 430215009 |Biopsy of head and neck structure (procedure)| will be inactivated and replaced with distinct concepts for each body site as a disjunctive in this instance would be a grouper of no clinical significance and non-conformance to editorial policy.  This will impact descendants who will become children of the distinct concepts.

Examples of concepts to be inactivated and replaced with two distinct concepts:

• 430215009 |Biopsy of head and neck structure (procedure)| 
• 431056007 |Fine needle aspiration biopsy of head and neck structure (procedure)| 
• 430220009 |Specimen from head and neck structure (specimen)|

Examples of concepts with model change to two role groups (finding/disorder can occur in both structures at the same time):

• 255057000 |Benign tumor of head and neck (disorder)| 
• 716659002 |Squamous cell carcinoma of head and neck (disorder)|
• 274755005 |Head and neck swelling (finding)|

Examples of concepts with FSN change to 'and/or':

• 301871007|Lipoma of head and neck (disorder)|
• 441535001|Adenocarcinoma of head and neck (disorder)|
• 1197313009|Metastatic adenocarcinoma to lymph node of head and neck (disorder)|

Review of <<75506009 |Construction of stoma (procedure)|

A review of the 75506009 |Construction of stoma (procedure)| hierarchy is in progress. The focus is on updating concept modeling, but there will be a small number of inactivations (<20 concepts) and description changes, where appropriate.

Update 42687005|Lymphangiogram (procedure)| and Subtypes

42687005|Lymphangiogram (procedure)| and subtypes have been reviewed as part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details).

Based on user feedback and review, ‘lymphangiography’ uses fluoroscopy and contrast unless an alternative imaging method such as MRI is specified. The content in this hierarchy that currently states ‘lymphangiography’ or 'lymphangiogram' with method 278110001|Radiographic imaging - action (qualifier value)| will be inactivated and replaced with a new concept which specifies the imaging modality and the use of contrast.

For example: 48858003 |Lymphangiography of lower extremity (procedure)| will be inactivated and replaced by a new concept: Fluoroscopic lymphangiography of lower limb with contrast (procedure)|

A new supertype concept will be added: 1336147007 |Imaging of lymphatic system (procedure)|

Update to 55670007 |Endodontic procedure (procedure)| and Subtypes

In consultation with the Dentistry Clinical Reference Group, updates will be made to the hierarchy 55670007 |Endodontic procedure (procedure)|. This will result in approximately 25 concepts being inactivated or remodeled. Where appropriate, replacement concepts will be added.

Update << 385420005 |Contrast media (substance)|

The 95 subtypes of 385420005 |Contrast media (substance) will be updated. Concepts will be remodeled based on discussion with stakeholders. New substance concepts including groupers will be required. 

Proposed New Model for Solid Organ and Tissue Transplant Procedures

Feedback is requested for a proposed new model for solid organ and tissue transplant procedures.

Please see briefing note here. Deadline to submit feedback is 15 June 2024.

Please see the follow up briefing note for further information about the inactivation of therapeutic role groupers in the Medicinal Product hierarchy.