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guidance inference 与发现推理有关（请参阅发现推理）。ACR（美国放射学学院）确定做出 guidance 发现的准则。
guidance 可以包含抑制器，它们是在文本中找到一个或多个值的发现的方面，例如大小。 这些抑制器值通常与查找中的信息重叠。 但是，生成指南的代码有时会标识查找中不存在的抑制器。
- 字段
kind为guidance. - 字段
finding是一个查找结论推理。 （请参阅 查找推理。 - 字段
identifier是包含 SNOMED 代码或 RadLex 代码的 CodeableConcept。 此概念表示指南的类型。 有关可能的代码，请参阅identifier。 - 字段
ranking具有值“high”或“low”。它表明该指导与文档中具有相同guidances的其他identifier相比的重要性。 - 字段
recommendationProposals（如果已填充）包含建议推理。 请参阅 建议推理。 这些建议基于finding和presentGuidanceInformation中的信息（见下文）。对于此字段中的建议，图像过程的形式可以是 SNOMED 代码 266750002（“未安排跟进（发现）”），这意味着不需要跟进过程。 （此代码不适用于指南之外的正常建议推理。 - 字段
presentGuidanceInformation（如果已填充），则包含 PresentGuidanceInformation 的一个或多个实例，每个实例对应于一个抑制器。 请参阅下一部分。 - 字段
missingGuidanceInformation（如果已填充），则包含抑制器字符串（与 PresentGuidanceInformation.presentGuidanceItem 中相同的字符串类型，请参阅下一节。它们是未找到任何值的抑制器字符串，文本需要提供一个值以使代码能够提出建议。
字段kind、finding、identifier和ranking是必填项。
示例：guidance，不带扩展且不包含finding字段的实际内容。
{
"kind": "guidance",
"finding": "<finding inference not shown>",
"identifier": {
"coding": [
{
"system": "http://radlex.org",
"code": "RID50503",
"display": "TI-RADS ASSESSMENT"
}
]
},
"presentGuidanceInformation": [
{
"presentGuidanceItem": "MAX DIAMETER",
"sizes": [
{
"resourceType": "Observation",
"component": [
{
"code": {
"coding": [
{
"system": "http://radlex.org",
"code": "246115007",
"display": "SIZE (ATTRIBUTE)"
}
]
},
"valueQuantity": {
"value": 5.0,
"unit": "MILLIMETER"
},
"interpretation": [
{
"coding": [
{
"code": "15240007",
"display": "CURRENT"
}
]
}
]
}
]
}
],
"presentGuidanceValues": [
"MAX DIAMETER"
]
},
{
"presentGuidanceItem": "SIZE",
"sizes": [
{
"resourceType": "Observation",
"component": [
{
"code": {
"coding": [
{
"system": "http://radlex.org",
"code": "246115007",
"display": "SIZE (ATTRIBUTE)"
}
]
},
"valueQuantity": {
"value": 5.0,
"unit": "MILLIMETER"
},
"interpretation": [
{
"coding": [
{
"code": "15240007",
"display": "CURRENT"
}
]
}
]
}
]
}
],
"presentGuidanceValues": [
"SIZE"
]
},
{
"presentGuidanceItem": "COMPOSITION",
"presentGuidanceValues": [
"CYSTIC OR ALMOST COMPLETELY CYSTIC"
]
},
{
"presentGuidanceItem": "SOLITARY OR MULTIPLE",
"presentGuidanceValues": [
"MULTIPLE"
]
}
],
"ranking": "high",
"missingGuidanceInformation": [
"ECHOGENICITY",
"SHAPE",
"MARGIN",
"ECHOGENIC FOCI"
]
}
PresentGuidanceInformation
字段 presentGuidanceItem 是一个字符串，表示一种信息，例如“SIDE”或“SIZE”。
字段 presentGuidanceValues（如果已填充）包含一个或多个值字符串。 例如，对于 presentGuidanceItem“SIDE”，它可以是“LEFT”或“RIGHT”。
如果 presentGuidanceItem 引用的是大小，字段 sizes 会被填充。 它包含一个 FHIR.R4 数组。 注意，但此数组最多具有一个元素。 然后，此观察元素在其组件中具有大小信息，格式与发现格式相同。 请参阅 查找推理。
如果 presentGuidanceItem 引用最大直径，则填充字段 maximumDiameterAsInText 。 字段 value 和 unit 应该被设置。
只有字段 presentGuidanceItem 是必需的，但另外三个字段之一也应填充。
附录 A：字段“identifier”的可能代码
| 系统 | 代码 | 显示 |
|---|---|---|
| SNOMED | 445039006 | 子宫附件肿块（发现） |
| SNOMED | 237783006 | 肾上腺肿块（发现） |
| SNOMED | 39400004 | 肝损伤（疾病） |
| SNOMED | 300331000 | 肝脏病变（发现） |
| SNOMED | 363358000 | 肺恶性肿瘤（疾病） |
| SNOMED | 61823004 | 胰腺损伤（病症） |
| SNOMED | 79131000119100 | 肾脏病变（发现） |
| SNOMED | 23589004 | 脾损伤（疾病） |
| SNOMED | 40095003 | 肾损伤（疾病） |
| SNOMED | 237495005 | 甲状腺结节（病变） |
| SNOMED | 233985008 | 腹主动脉瘤（疾病） |
| SNOMED | 858901000000108 | 不明部位妊娠（疾病） |
| SNOMED | 289208006 | 妊娠可行性发现（发现） |
| SNOMED | 363351006 | 直肠恶性肿瘤（疾病） |
| SNOMED | 364327007 | 妊娠可行性（可观察实体） |
| SNOMED | 97171000119100 | 子宫附件囊肿（疾病） |
| SNOMED | 31258000 | 胰腺囊肿（疾病） |
| SNOMED | 276650005 | 围产期室管膜下出血（疾病） |
| SNOMED | 300346007 | 胆囊病变（发现） |
| SNOMED | 399244003 | 脑垂体疾病（疾病） |
| SNOMED | 289840004 | 卵巢病变（发现） |
| RADLEX | RID50149 | 肺 NODULE |
| RADLEX | RID50503 | TI-RADS 评估 |
| RADLEX | RID50134 | LUNG-RADS 评估 |
附录 B：按指南分组的受支持指南推理概述
ACR 适当性条件
这些指南可帮助医疗保健提供商针对特定临床条件做出最合适的成像或治疗决策：
https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria
| 指南 | SNOMED/RADLEX | 代码 | 白皮书参考 |
|---|---|---|---|
| 腹部动脉动脉瘤* | SNOMED | 233985008 | 霍萨，F.，克林斯基，G.，马卡里，M.，尤塞尔，E.K.，和伯兰，L.L.（2013年）。 管理腹部和盆腔 CT 和 MRI 的偶然发现，第 2 部分：ACR 偶然发现委员会关于血管发现的白皮书 II。 美国放射学院杂志，10（10），789-794。 doi：10.1016/j.jacr.2013.05.021 |
| 胆囊和比利亚路* | SNOMED | 300346007 | 塞巴斯蒂安，S.，阿劳霍，C.，尼特利希，J.D.，和伯兰，L.L.（2013年）。 管理腹部和盆腔 CT 和 MRI 的偶然发现，第 4 部分：ACR 偶然发现委员会关于胆囊和胆道发现的白皮书 II。 美国放射学院杂志，10（12），953-956。 doi：10.1016/j.jacr.2013.05.022 |
| 胚芽基质出血* | SNOMED | 276650005 | 鲍尔曼RA，顿恩SM，西尔弗TM，贾菲MH。 新生儿脑膜/心内出血及其并发症的自然史：声科观察。 AJNR Am J 美国神经放射学杂志。 1984;5(5):527-538;Brouwer AJ、Groenendaal F、Benders MJNL、de Vries LS。 早产婴儿中发芽矩阵出血-脑内出血的早期和后期并发症：什么是新的？ 新生儿学。 2014;106(4):296-303. doi：10.1159/000365127 |
| 肺癌分期 | SNOMED | 363358000 | Amin MB、Edge SB、Greene FL 等.AJCC 癌症暂存手册，第 8 版。 瑞士：斯普林格;2017:431-455 |
| 怀孕位置* | SNOMED | 858901000000108 | 杜比莱特 PM，本森 CB，伯恩 T，布莱瓦斯 M. 关于妊娠第一个三个月早期非可生存妊娠的诊断标准。 《新英格兰医学杂志》(N Engl J Med.) 2013;369(15):1443-1451. doi：10.1056/NEJMra1302417 |
| 妊娠可行性初始* | SNOMED | 289208006 | 杜比莱特 PM，本森 CB，伯恩 T，布莱瓦斯 M. 关于妊娠第一个三个月早期非可生存妊娠的诊断标准。 《新英格兰医学杂志》(N Engl J Med.) 2013;369(15):1443-1451. doi：10.1056/NEJMra1302417 |
| 妊娠可行性跟进* | SNOMED | 364327007 | 杜比莱特 PM，本森 CB，伯恩 T，布莱瓦斯 M. 关于妊娠第一个三个月早期非可生存妊娠的诊断标准。 《新英格兰医学杂志》(N Engl J Med.) 2013;369(15):1443-1451. doi：10.1056/NEJMra1302417 |
| 直肠癌分期 | SNOMED | 363351006 | Al-Sukhni E、Milot L、Fruitman M、Brown G、Schmocker S、Kennedy E. 直肠癌术前分期的综合MRI报告用户指南。 安大略省癌症护理：2015. |
ACR 偶然发现
这些指南为管理因无关原因执行的影像学检查期间发现的偶然发现提供建议：
https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Incidental-Findings
| 指南 | SNOMED/RADLEX | 代码 | 白皮书参考 |
|---|---|---|---|
| 附件囊肿 | SNOMED | 97171000119100 | Levine D、Brown DL、Andreotti RF 等根据超声放射学会 2009 年关于无症状卵巢和其他附件囊肿管理的共识声明，对附件囊肿进行跟进的建议。 放射学。 2010;256(3):943-954. doi： 10.1148/radiol.10100213 |
| 附件肿块 | SNOMED | 445039006 | 帕特尔 MD、阿舍尔 SM、帕斯普拉蒂 RM、山博格 AK、西格尔曼 ES、斯坦姆瓦、伯兰 LL。 管理腹部和盆腔 CT 和 MRI 的偶然发现，第 1 部分：ACR 偶然发现委员会关于附件发现的白皮书 II。 J Am Coll Radiol. 2013;10(9):675-681. doi：10.1016/j.jacr.2013.05.023 |
| 肾上腺结核* | SNOMED | 237783006 | Mayo-Smith WW、Song JH、Boland GL 等偶发性肾上腺肿块的管理：ACR 偶然发现委员会白皮书。 J Am Coll Radiol. 2017;14(8):1038-1044. doi：10.1016/j.jacr.2017.05.001 |
| 肝损伤* | SNOMED | 300331000 | Berland LL、Silverman SG、Gore RM 等管理腹部 CT 的偶然发现：ACR 偶然发现委员会白皮书。 J Am Coll Radiol. 2010;7(10):754-773. doi：10.1016/j.jacr.2010.06.013 |
| 胰腺囊肿* | SNOMED | 31258000 | Megibow AJ、Baker ME、Morgan DE 等偶发性胰腺囊肿的管理：ACR 偶然发现委员会白皮书。 J Am Coll Radiol. 2017;14(8):911-923. doi：10.1016/j.jacr.2017.05.001 |
| 脑垂体* | SNOMED | 399244003 | Hoang JK、Hoffman AR、González RG 等关于 CT、MRI 和 18F-氟脱氧葡萄糖 PET 的偶然脑垂体发现的管理：ACR 偶然发现委员会白皮书。 J Am Coll Radiol. 2018;15(7):966-972. doi：10.1016/j.jacr.2018.03.037 |
| 肾损伤* | SNOMED | 79131000119100 | Herts BR、Silverman SG、Hindman NM 等关于 CT 的偶发性肾肿块的管理：ACR 偶然发现委员会白皮书。 J Am Coll Radiol. 2018;15(2):264-273. doi：10.1016/j.jacr.2017.05.001 |
| 腺结核* | SNOMED | 237495005 | Hoang JK、Langer JE、Middleton WD 等管理影像学检查中检测到的甲状腺结节：ACR 偶然甲状腺发现委员会白皮书。 J Am Coll Radiol. 2015;12(2):143-150. doi：10.1016/j.jacr.2014.09.038 |
RADS （报告和数据系统）
报告和数据系统是标准化系统，用于在放射学中报告和数据管理，侧重于特定条件和成像形式：
https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems
| 指南 | SNOMED/RADLEX | 代码 | 白皮书参考 |
|---|---|---|---|
| Lung-RADS | RADLEX | RID50134 | Kazerooni EA、Austin JHM、Black WC 等肺癌筛查胸部计算机断层摄影的性能和报告的 ACR-STR 实践参数（决议 4）。 J Thorac Imaging 2014;29(5):310-316. doi：10.1097/RTI.0000000000000097 |
| TI-RADS* | RADLEX | RID50503 | 特斯勒 FN、米德尔顿 WD、格兰特 EG 等 ACR TI-RADS 委员会的白皮书。 J Am Coll Radiol. 2017;14(5):587-595. doi：10.1016/j.jacr.2017.01.046 |
创伤和伤害分级 （美国创伤手术协会 （AAST）
这些指南提供标准化的评分系统，用于评估伤害的严重性： https://www.aast.org/resources-detail/injury-scoring-scale
| 指南 | SNOMED/RADLEX | 代码 | 白皮书参考 |
|---|---|---|---|
| 肝外伤 | SNOMED | 39400004 | Tinkoff G、Esposito TJ、Reed J 等。美国创伤外科学会器官损伤评级标准 I：脾脏、肝脏和肾脏，基于国家创伤数据库的验证。 J 创伤。 2008;64(2):204-210. doi：10.1097/TA.0b013e31815b847a |
| 胰腺损伤分级 | SNOMED | 61823004 | Tinkoff G、Esposito TJ、Reed J 等。美国创伤外科学会器官损伤评级标准 I：脾脏、肝脏和肾脏，基于国家创伤数据库的验证。 J 创伤。 2008;64(2):204-210. doi：10.1097/TA.0b013e31815b847a |
| 肾损伤分级 | SNOMED | 40095003 | Tinkoff G、Esposito TJ、Reed J 等。美国创伤外科学会器官损伤评级标准 I：脾脏、肝脏和肾脏，基于国家创伤数据库的验证。 J 创伤。 2008;64(2):204-210. doi：10.1097/TA.0b013e31815b847a |
| 脾脏损伤分级 | SNOMED | 23589004 | Tinkoff G、Esposito TJ、Reed J 等。美国创伤外科学会器官损伤评级标准 I：脾脏、肝脏和肾脏，基于国家创伤数据库的验证。 J 创伤。 2008;64(2):204-210. doi：10.1097/TA.0b013e31815b847a |
弗莱施纳社会准则
| 指南 | SNOMED/RADLEX | 代码 | 白皮书参考 |
|---|---|---|---|
| 肺结节 | RADLEX | RID50149 | MacMahon H、Naidich D、Goo J 等CT 图像上偶然发现的肺结节处理指南：2017 年 Fleischner 学会。 放射学。 2017;284(1):228-43. doi： 10.1148/radiol.2017161659 - PubMed |
* RecommendationProposal 适用
请求/响应 JSON 示例：
{
"jobData" : {
"configuration" : {
"inferenceOptions" : {
"followupRecommendationOptions" : {
"includeRecommendationsWithNoSpecifiedModality" : false,
"includeRecommendationsInReferences" : false,
"provideFocusedSentenceEvidence" : true
},
"findingOptions" : {
"provideFocusedSentenceEvidence" : true
},
"GuidanceOptions" : {
"showGuidanceInHistory" : true
}
},
"inferenceTypes" : ["guidance" ],
"locale" : "en-US",
"verbose" : false,
"includeEvidence" : false
},
"patients" : [ {
"id" : "11111",
"details" : {
"sex" : "female",
"birthDate" : "1939-05-25",
"clinicalInfo" : [ {
"resourceType" : "Observation",
"status" : "unknown",
"code" : {
"coding" : [ {
"system" : "http://www.nlm.nih.gov/research/umls",
"code" : "C0018802",
"display" : "MalignantNeoplasms"
} ]
},
"valueBoolean" : "true"
} ]
},
"encounters" : [ {
"id" : "encounterid1",
"period" : {
"start" : "2014-2-20T00:00:00",
"end" : "2014-2-20T00:00:00"
},
"class" : "inpatient"
} ],
"patientDocuments" : [ {
"type" : "note",
"clinicalType" : "radiologyReport",
"id" : "docid1",
"language" : "en",
"authors" : [ {
"id" : "authorid1",
"name" : "authorname1"
} ],
"specialtyType" : "radiology",
"createdAt" : "2014-2-20T00:00:00",
"administrativeMetadata" : {
"orderedProcedures" : [ {
"code" : {
"coding" : [ {
"system" : "http://loinc.org",
"code" : "CTCHWO",
"display" : "CT CHEST WO CONTRAST "
} ]
},
"description" : "CT CHEST WO CONTRAST "
} ],
"encounterId" : "encounterid1"
},
"content" : {
"sourceType" : "inline",
"value" : "\n\n\n\r\n\nEXAM: CT CHEST WO CONTRAST\n\nINDICATION: abnormal lung findings. History of emphysema.\n\nTECHNIQUE: Helical CT images through the chest, without contrast. This exam was performed using one or more of the following dose reduction techniques: Automated exposure control, adjustment of the mA and/or kV according to patient size, and/or use of iterative reconstruction technique. \n\nCOMPARISON: Chest CT dated 6/21/2022.\n\nNumber of previous CT examinations or cardiac nuclear medicine (myocardial perfusion) examinations performed in the preceding 12-months: 2\n\nFINDINGS: \n\nHeart size is normal. No pericardial effusion. Thoracic aorta as well as pulmonary arteries are normal in caliber. There are dense coronary artery calcifications. No enlarged axillary, mediastinal, or hilar lymph nodes by CT size criteria. Central airways are widely patent. No bronchial wall thickening. No pneumothorax, pleural effusion or pulmonary edema. The previously identified posterior right upper lobe nodules are no longer seen. However, there are multiple new small pulmonary nodules. An 8 mm nodule in the right upper lobe, image #15 series 4. New posterior right upper lobe nodule measuring 6 mm, image #28 series 4. New 1.2 cm pulmonary nodule, right upper lobe, image #33 series 4. New 4 mm pulmonary nodule left upper lobe, image #22 series 4. New 8 mm pulmonary nodule in the left upper lobe adjacent to the fissure, image #42 series 4. A few new tiny 2 to 3 mm pulmonary nodules are also noted in the left lower lobe. As before there is a background of severe emphysema. No evidence of pneumonia.\n\nLimited evaluation of the upper abdomen shows no concerning abnormality.\n\nReview of bone windows shows no aggressive appearing osseous lesions.\n\n\nIMPRESSION:\n\n1. Previously identified small pulmonary nodules in the right upper lobe have resolved, but there are multiple new small nodules scattered throughout both lungs. Recommend short-term follow-up with noncontrast chest CT in 3 months as per current Current guidelines (2017 Fleischner Society).\n2. Severe emphysema.\n\nFindings communicated to Dr. Jane Smith.\n\n\r\n"
}
} ]
} ]
}
}
{
"result": {
"patientResults": [
{
"patientId": "11111",
"inferences": [
{
"kind": "guidance",
"finding": {
"kind": "finding",
"finding": {
"resourceType": "Observation",
"id": "3781",
"status": "unknown",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "404684003",
"display": "CLINICAL FINDING (FINDING)"
}
]
},
"interpretation": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "7147002",
"display": "NEW (QUALIFIER VALUE)"
}
]
}
],
"component": [
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "131195008",
"display": "SUBJECT OF INFORMATION (ATTRIBUTE)"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "27925004",
"display": "NODULE (MORPHOLOGIC ABNORMALITY)"
}
]
}
},
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "722871000000108",
"display": "ANATOMY (QUALIFIER VALUE)"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "39607008",
"display": "LUNG STRUCTURE (BODY STRUCTURE)"
}
]
}
},
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "722871000000108",
"display": "ANATOMY (QUALIFIER VALUE)"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://radlex.org",
"code": "RID1301",
"display": "LUNG"
}
]
}
},
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "722871000000108",
"display": "ANATOMY (QUALIFIER VALUE)"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://radlex.org",
"code": "RID13437",
"display": "LUNGS"
}
]
}
},
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "723851000000107",
"display": "GUIDANCE (QUALIFIER VALUE)"
}
]
},
"valueCodeableConcept": {
"coding": [
{
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