Introduction

Background

SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

SNOMED International maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.

Purpose

This document provides a summarized description of the content changes included in the June 2025 release of SNOMED Clinical Terms^® (SCT) International Edition.

It also includes notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.

The SNOMED International release notes are available alongside the June 2025 International Edition.

Scope

This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made.

Audience

The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the June 2025 International Edition.

Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.

Content Development Activity

Summary

Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The June 2025 International Edition has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS). 

Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found here.

Quality Initiative

The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 Edition release, the next stage has been implemented for subsequent releases including June 2025. 

Quality improvement tasks are being deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships is being carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.

Revision of Enterocele Disorder and Procedure Concepts

398061002 |Vaginal enterocele (disorder)| and 302371001 |Repair of enterocele (procedure)| hierarchies have been reviewed to update the model for sex specific concepts.

“Enterocele” was a synonym of 398061002 |Vaginal enterocele (disorder)|.  Given that “Enterocele” may occur in both males and females this description has been inactivated.  Additionally, the concept was modeled with a 363698007 |Finding site (attribute)| of 30315005 |Structure of small intestine (body structure)|, this has been updated because “Enterocele” may involve different portions of the intestinal structure.

The site of occurrence for enterocele is different for males and females, the site in males is 85481009 |Structure of rectovesical pouch (body structure)| while for females the site is 53843000 |Structure of rectouterine pouch (body structure).

Following the same logic, the current model for 302371001 |Repair of enterocele (procedure)| with 263355003 |Structure of vaginal wall (body structure)| as the value for the 405813007 |Procedure site - Direct (attribute)| has been revised.

Both hierarchies have been updated to add sex specific enterocele disorder concepts and repair of enterocele procedure concepts, and to remodel the Finding site of the “Enterocele disorder” to a more generic 113276009 |Intestinal structure (body structure)|.

Description Update for Subdural

Concepts using 'subdural' in their descriptions have being assessed to ensure the meaning in the descriptions is clear and the site specified aligns with the FSN.

These changes have completed this content tracker.

Description Update for Ear Canal

New synonyms have been added for concepts referencing ear canal, (external) auditory canal, (external) acoustic meatus, and (external) auditory meatus.

These changes have completed this content tracker.

Body Structure 

Revision of Subtypes of 45048000|Neck structure (body structure)|

895519005 |Structure of nuchal region of neck (body structure)| has been inactivated as a duplicate of 304036007 |Cervical region back structure (body structure)|.

The material structures beneath the surface of the neck have been reassigned. Subdivisions of 182329002 |Structure of anterior triangle of neck (body structure)| have been amended, and a new concept 1366401004 |Structure of muscular triangle of neck (body structure)| has been added. The anterior, lateral, and posterior subdivisions of the neck have been restructured.

Number of concepts edited (approx): 50

SEP and Laterality Anatomy Reference Sets

The release file for the lateralizable body structure reference set has been updated and validated.

The release file for the SEP reference set has been updated and validated.

Clinical Finding

Update Post-Traumatic Urethral Stricture Concepts

Synonyms that specify 'post-traumatic' have been inactivated on 5 concepts:

• 86347007 |Traumatic urethral stricture (disorder)|
• 368981000119103 |Traumatic stricture of female urethra (disorder)|
• 367951000119106 |Traumatic anterior urethral stricture (disorder)|
• 367971000119102 |Traumatic membranous urethral stricture (disorder)|
• 367961000119108 |Traumatic bulbous urethral stricture (disorder)|

5 new concepts have been added for ‘post-traumatic urethral stricture'.

Number of concepts edited (approx): 10

Revision 17709002|Bleeding esophageal varices (disorder)|

17709002 |Bleeding esophageal varices (disorder)| has been remodeled with a new concept 1366412004 |Structure of esophageal vein within esophagus (body structure)| to address the missing parent 15238002 |Esophageal bleeding (disorder)|.

The concept 735499005 |Dilatation of gastrointestinal tract (disorder)| had incorrectly inferred subtypes. These subtypes included conditions such as angiodysplasia of stomach, esophagus, or intestine and varices of stomach, esophagus, or intestine. These conditions actually represent dilatation of blood vessel within organ, rather than dilatation of the organs themselves. To resolve this issue, 735499005 |Dilatation of gastrointestinal tract (disorder)| has been changed to a primitive concept, and the expected organ dilatation concepts have been remodeled by this primitive concept. This modification has resolved the incorrect inferences related to angiodysplasia and varices.

Number of concepts edited (approx): 44

Remodel of Absence of Pulmonary Artery and Absence of Pulmonary Trunk Concepts

The concept 448084009 |Absent pulmonary trunk (disorder)| has been inactivated due to ambiguity and replaced by:

• 1366733007 |Agenesis of pulmonary trunk (disorder)|
• 1366734001 |Congenital absence of pulmonary trunk (disorder)|
• 1366736004 |Acquired absence of pulmonary trunk (disorder)|

The synonym 'Pulmonary artery absent' on 86252004 |Agenesis of pulmonary artery (disorder)| has been inactivated due to ambiguity. 

In addition, descriptions on the following concepts have been updated to specify 'congenital' for clarity and consistency:

• 253627007 |Congenital absence of pulmonary trunk with confluent pulmonary arteries (disorder)|
• 253628002 |Congenital absence of pulmonary trunk with non-confluent pulmonary arteries (disorder)|

The following concepts have had descriptions updated to explicitly specify complete congenital absence:

• 253629005 |Complete congenital absence of pulmonary trunk with complete congenital absence of pulmonary artery (disorder)|
• 448059006 |Complete congenital absence of pulmonary trunk with complete congenital absence of left pulmonary artery (disorder)|
• 448060001 |Complete congenital absence of pulmonary trunk with complete congenital absence of right pulmonary artery (disorder)|

These changes improve semantic clarity, support more precise clinical use, and align with SNOMED CT editorial guidance on congenital absence modeling.

Number of concepts edited (approx): 12

Procedure

Radiographic Imaging

Work is progressing for this content tracker for information please see the informational briefing note here.   

Collaboration/Harmonization Agreements

Convergent Medical Terminology (CMT)

48 new CMT concepts have been added with the main focus area being the musculoskeletal domain.

Orphanet

Working in collaboration with Orphanet efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps. In scope content has been annotated with attribution to Inserm Orphanet.

All of the concepts added for the Orphanet project have been mapped to ICD-10.

Cancer Synoptic Reporting

Cancer synoptic reports are used by many member countries to record pathology examination of cancer specimens including the College of American Pathologists (US and Canada), Royal College of Pathology (UK), Royal College of Pathology Australasia (Australia, New Zealand), PALGA (The Netherlands), Swedish Society of Pathology, and others.

For more information about this project, please see Cancer Synoptic Reporting Clinical Project Group 

International League Against Epilepsy (ILAE)

In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy  << 313307000 |Epileptic seizure (finding)|.

Further information about the project is available here

Internal Quality Improvement

Machine Readable Concept Model (MRCM) Changes

The following changes have been made for MRCM in the June 2025 International Edition.

• The following attribute used in modeling << 363787002 |Observable entity (observable entity) has had cardinality updated from 0..1 to 0..*. The change has been made to support modeling observable entity concepts where two (or more) types of observations are modeled in one concept and the result is reported in one value.

  • 370132008 |Scale type (attribute)| 

    
    

• Inactivation of surgical approach attribute and change to MRCM rules.

Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser

Please see Early Visibility Release Notifications for future planned changes to MRCM.

Annotation Reference Set

The addition of content for the Annotations refset was commenced in the July 2024 International Edition release and is ongoing for attribution of in scope content that is part of a collaboration agreement.

SNOMED CT derived products

ICD-10 map

The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2016 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International Edition as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of SNOMED International member countries and WHO Collaborating Centers.

The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_20200731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders. 

The SNOMED CT to ICD-10 Map is released as Refset 447562003 |SNOMED CT to ICD-10 extended map (foundation metadata concept).

The ICD-10 Mapping Technical Guide (including exemplars) is hosted here https://confluence.ihtsdotools.org/display/DOCICD10.

Content Development Activity Summary

The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes.  The SNOMED CT source domains for the map are constrained to subtypes of 404684003 |Clinical finding (finding)|, 272379006 |Event (event)|, and 243796009 |Situation with explicit context (situation)|. The target classification used is the ICD-10 WHO version 2016 (https://icd.who.int/browse10/2016/en#/).

Mapped content for June 2025 release

The map provided for this release has been updated and represents a complete map from the June 2025 release of the SNOMED CT International Edition to the ICD-10 WHO version 2016.

This includes:

• Addition of 167 new mapped concepts

• Reactivation of 2 previously published maps
• Updates to 152 existing mapped concepts
• Retirement of 32 mapped concepts

The SNOMED CT to ICD-O morphology map has zero (0) additions for this release.

We welcome feedback on any issues that users may detect when deploying the map. Issues can be reported to mapping@snomed.org.

SNOMED CT to OWL conversion and classification

The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit

Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.

Technical notes

Known Issues

Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented.  This can be due to a number of reasons, from lack of time within the new monthly editing cycles, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.  

For the current SNOMED CT International Edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:

Resolved Issues

Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release.  They can also be issues found during testing of the current release, which were resolved before the final deployment of the Production release.  Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.  

The Resolved Issues for the current SNOMED CT International Edition can be found here:

Technical updates

RF2 package format

The RF2 package convention dictates that all relevant files are included, regardless of whether or not there is content to be included in each release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and files that (intentionally) include only header records.  The reason that these "empty" files are included in the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in future releases 

2. ...files that happen to contain no data in this particular release (and are therefore included in the package with just a header record), but are still relevant to RF2, and could therefore contain content in future releases.

This allows users to easily distinguish between the two scenarios, as otherwise if files in option 2 were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

 Proposal to increase the maximum length of Description Types

Please find below the link to the recent announcement on the proposal to increase the limit of characters allowed in Descriptions:

• https://confluence.ihtsdotools.org/pages/viewpage.action?pageId=238158325

A community consultation was launched to solicit feedback on a proposal to increase the size limits of SNOMED CT concept descriptions to 4096 from the current limit of 255 characters. While this change does not represent a modification of the existing specification, it could be disruptive to implementers who have coded fixed length limits into their systems.  

Please read the full proposal, along with the latest Q&A blog post which details the proposed change, its potential benefits, the feedback process and timelines, and the issues that may need to be considered in such an update:

• https://confluence.ihtsdotools.org/mag/community-consultations/snomed-international-proposal-to-increase-description-length-limit
• https://www.snomed.org/news/blog%3A-snomed-international-seeks-community-feedback-on-proposed-description-character-limit-increase

As always, SNOMED International greatly appreciated all feedback provided before the deadline (which was Dec 31, 2024).  A summary of the feedback will be collated and disseminated in 2025, alongside a plan for the transition.

Early visibility of impending changes in the upcoming 2025 Monthly International Edition releases

Please see the Early Visibility Release Notifications Confluence page for details of forthcoming changes.