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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 “Disorder caused by X substance”.

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. 

Changes to MRCM

There are planned changes to MRCM for the attribute in group cardinality to four attributes:

• "characterizes"
• "precondition"
• "technique"
• "component"

These changes are being made to support the implementation of role group changes to observables and evaluation procedures. 

The domain "administration via specific route (procedure)" will be removed and the attribute "route for administration" will be optional for the domain of procedure.

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. 

Inactivation of 248536006 |Finding of functional performance and activity (finding)

This concept will be inactivated:

248536006 |Finding of functional performance and activity (finding).

The concept is an intermediate primitive grouper for 2000+ concepts and this inactivation will improve subsumption for content in the hierarchy.

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.
  

Antibody to X Organism

The descriptions for the children of 312301006 |Infective organism antibody (substance)| (antibody to X or X antibody) will be updated as per editorial guidelines where applicable.

Update 71651007|Mammography (procedure)| and Descendants

As part of the content update being undertaken forUpdate Hierarchy : 363680008|Radiographic imaging Procedure (procedure)|and Descendants (please see item 2 above for details)

Content content changes will be undertaken for 71651007|Mammography (procedure)| and subtypes.

A new concept will be added as the supertype - Imaging of breast (procedure).

New imaging actions will be added:

• Mammographic imaging - action (qualifier value)
• Mammographic digital tomosynthesis - action (qualifier value)

These new actions will distinguish mammography from the less specific supertype 278110001 |Radiographic imaging - action (qualifier value)|.

71651007|Mammography (procedure)| and subtypes will be modeled with the new imaging action Mammographic imaging - action (qualifier value)

450566007|Digital tomosynthesis of breast (procedure)| will be sufficiently defined by the new imaging action Mammographic digital tomosynthesis - action (qualifier value) and remain a subtype of 71651007|Mammography (procedure)|.