SNOMED CT Editorial Guide

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It is essential to express when contrast is part of a procedure and that descriptions are constructed consistently.

For example, 

The descriptions for all procedure concepts that use contrast must explicitly state ‘with contrast.’  All procedures that use contrast, including 420040002 |Fluoroscopic angiography with contrast (procedure)|and all subtypes, must include the attribute 424361007 |Using substance (attribute)| and value 385420005 |Contrast media (substance)| in the role group. 

It is unnecessary to add the word media to contrast.

It is agreed that the linking word to associate the contrast use with the procedure is with not for, or, etc.

Contrast

There is a suggestion that additional concept detail is required when it is necessary to know the more precise nature of contrast (e.g. iodinated with various osmolalities, barium, or gas).

Imaging without contrast

Although considered a negation, this term is used in clinical records. Without contrast imaging procedures are acceptable.

For example, 

Without contrast

There is a case for explicitly adding a concept qualification when naming procedures that are explicitly performed without contrast.

In the UK and Australia, it was reported that there are no procedures that specify without contrast pre-coordinated in the national subset. With this information, implementation guidance may be provided.

Unacceptable concept qualification

With and without and With or without imaging concepts are not acceptable due to ambiguity.  Two concepts should be used to express these separately.

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