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# SNOMED Clinical Terms^®^ (SNOMED CT^®^) International Release -- July 2008

The SNOMED CT core terminology provides a common language that enables a
consistent way of indexing, storing, retrieving, and aggregating
clinical data across specialties and sites of care. The International
Health Terminology Standards Development Organisation (IHTSDO**^®^**)
maintains the SNOMED CT technical design, the core content architecture,
the SNOMED CT core content (includes the concepts table, the
descriptions table, the relationships table, a history table, and ICD
mappings), and related technical documentation.

## **Concepts**

The July 2008 International Release includes more than 315,000 active
concepts with formal logic-based definitions, organized into top-level
hierarchies:

+----------------------+---------------------+-------------------------+
| Body structure       | Linkage concept     | Procedure (*Biopsy of   |
| (*Structure of       |                     | lung*)                  |
| thyroid*)            | -   Link assertion  |                         |
|                      |     (*Has           | Qualifier value         |
| -   Morphologically  |     etiology*)      | (*Right*)               |
|     abnormal         |                     |                         |
|     structure        | -   Attributes      | Record artifact (*Death |
|     *(Granuloma)*    |     (*Finding       | certificate*)           |
|                      |     site*)          |                         |
| Clinical finding     |                     | Situation with explicit |
|                      | Observable entity   | content (*No nausea*)   |
| -   Finding          | (*Tumor stage*)     |                         |
|     (*Swelling of    |                     | Social context (*Organ  |
|     arm*)            | Organism            | donor*)                 |
|                      | (*Mycobacterium     |                         |
| -   Disease          | tuberculosis*)      | Special concept         |
|     *(Pneumonia)*    |                     | (*Inactive concept*)    |
|                      | Phar                |                         |
| Envir                | maceutical/biologic | Specimen (*Urine        |
| onments/geographical | product             | specimen*)              |
| locations            | (*Tamoxifen*)       |                         |
| (*Intensive care     |                     | Staging and scales      |
| unit*)               | Physical force      | (*Barthel index*)       |
|                      | (*Friction*)        |                         |
| Event (*Flash        |                     | Substance (*Gastric*    |
| flood*)              | Physical object     | *acid*)                 |
|                      | (*Suture needle*)   |                         |
+----------------------+---------------------+-------------------------+

## **Descriptions**

Contains more than 806,000 active English-language descriptions for
flexibility in expressing clinical concepts.

### **Relationships**

Provides more than 945,000 logically-defining relationships enable
consistency of data retrieval and analysis.

### **Attributes**

+-----------------+-----------------+-----------------+-----------------+
| **Body          | > **Events**    | > **Procedure** | > Revision      |
| Structure**     | >               | >               | > Status        |
|                 | > Associated    | > Access        | >               |
| > Laterality    | > With          | >               | > Route of      |
|                 |                 | > Direct        | >               |
| **Clinical      | -   After       | > Substance     |  Administration |
| Finding**       |                 | >               | >               |
|                 | -   Causative   | > Has Focus     | > Surgical      |
| > Associated    |     Agent       | >               | > Approach      |
| > With          |                 | > Has Intent    | >               |
|                 | -   Due To      | >               | > Using Energy  |
| -   After       |                 | > Method        | >               |
|                 | > Occurrence    | >               | > Using         |
| -   Causative   |                 | > Priority      | > Substance     |
|     Agent       | ##### Measur    | >               | >               |
|                 | ement Procedure | > Procedure     | > Situation     |
| -   Due To      |                 | > Device        | > with Explicit |
|                 | > Component     |                 | > Context       |
| > Associated    | >               | -   Direct      | >               |
| > Morphology    | > Has Specimen  |     Device      | > Associated    |
| >               | >               |                 | > Finding       |
| > Clinical      | > Measurement   | -   Indirect    | >               |
| > Course        | > Method        |     Device      | > Associated    |
| >               | >               |                 | > Procedure     |
| > Episodicity   | > Property      | -   Using       | >               |
| >               | >               |     Access      | > Finding       |
| > Finding       | > Scale Type    |     Device      | > Context       |
| > Informer      | >               |                 | >               |
| >               | > Time Aspect   | -   Using       | > Procedure     |
| > Finding       | >               |     Device      | > Context       |
| > Method        | > **Pharmace    |                 | >               |
| >               | utical/Biologic | > Procedure     | > Subject       |
| > Finding Site  | > Product**     | > Morphology    | > Relationship  |
| >               | >               |                 | > Context       |
| > Has           | > Has Active    | -   Direct      | >               |
| > Definitional  | > Ingredient    |     Morphology  | > Temporal      |
| > Manifestation | >               |                 | > Context       |
| >               | > Has Dose Form | -   Indirect    |                 |
| > Has           | >               |     Morphology  | **Specimen**    |
| >               | > **Physical    |                 |                 |
|  Interpretation | > Object**      | > Procedure     | Specimen        |
| >               | >               | > Site          | Procedure       |
| > Interprets    | > Has Active    |                 |                 |
| >               | > Ingredient    | -   Procedure   | Specimen Source |
| > Occurrence    |                 |     Site --     | Identity        |
| >               |                 |     Direct      |                 |
| > Pathological  |                 |                 | Specimen Source |
| > Process       |                 | -   Procedure   | Morphology      |
| >               |                 |     Site --     |                 |
| > Severity      |                 |     Indirect    | Specimen Source |
|                 |                 |                 | Topography      |
|                 |                 | > Recipient     |                 |
|                 |                 | > Category      | Specimen        |
|                 |                 |                 | Substance       |
+-----------------+-----------------+-----------------+-----------------+

## **Additional Release File -- References Table**

A new file has been included with the July 2008 International Release:
the References Table. This table is an existing, documented element of
the SNOMED CT history mechanism that has not previously been released.

### **References Table Overview**

The purpose of the References Table is to provide a reference from an
inactive SNOMED CT component (Description, Subset or Cross Map Set) to a
component that is current for the Release in which the first component
is made inactive. The type of reference indicates the nature of the
relationship between the two components. This is similar to the
information that historical relationships provide for inactive Concepts.

  --------------- -------------------------------------------------------
  Key Fields      

  ComponentId     The unique SNOMED CT Identifier for the inactive
                  Component

  ReferenceType   An indication of the nature of the relationship between
                  the inactive Component and the referenced Component.

  ReferencedId    The unique SNOMED CT Identifier for the referenced
                  Component.
  --------------- -------------------------------------------------------

*This release of the References Table makes use of a new ReferenceType
value: "7" (Refers to Concept).*

This new value provides a reference from an inactive Description to a
current Concept that can be correctly described by the Term of the
inactive Description. All rows in the References Table released for July
2008 have this ReferenceType value of "7". This use of the References
Table permits a Description to be made inactive without having to retire
its Concept.

## 

### **Use of the References Table**

*NOTE: the References Table is not required to continue using SNOMED
CT.*

While the References Table can provide useful information about inactive
Descriptions that has not previously been available to SNOMED CT
implementers and users, no information has been removed from the other
SNOMED CT release files, nor has the structure of those other files been
changed.

## 

### **References Table Specifications**

*NOTE: the References Table specifications have been updated for the
July 2008 International Release.*

The July 2008 SNOMED CT Technical Reference Guide, which is included in
this release, contains the current, updated specifications for the
References Table. The References Table is described in section 6.2.3,
and detailed specifications for the table in Appendix B.6.2. Please
refer to this document for a full description of the References Table.