IHTSDO-1247 SURGICAL AND NON-SURGICAL DIATHERMY

JIRA Link: 

1. IHTSDO-1247

Amendment History

Review Timetable

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Introduction

Revision of concepts under 128422009 |Destruction using electrical energy (procedure)| as part of the QI Project for standardization of Surgical procedures revealed the lack of standardization of procedure concepts using the term "Diathermy" in descriptions and the value 428381003 |Diathermy - action (qualifier value)| in modeling.

The term and action value are both used to describe surgical and non-surgical procedures and to define procedures performed using different kinds of 78621006 |Physical force (physical force)| values and to describe different outcomes of the usage of electrical current and other Physical forces in biological tissues.

There is a need to review the hierarchy and related concepts and to create a template applicable both to surgical and non-surgical procedures considered "Diathermy procedures".

Purpose

Standardize the patterns for naming, defining and modeling the procedures related with Diathermy in the terminology. 

Related issues 

Statement of the problem

The term "Diathermy" is widely used to refer to many different types of procedures, from therapeutic non-invasive procedures to ablative/destructive procedures.  The term diathermy was originally applied to the therapeutic (non ablative) heating effect of passing high-frequency electrical current through deeper parts of the body. This term was later used to describe destruction or cutting of tissue. While the term diathermy is still used today, the term electrosurgery is preferred when referring to cutting or coagulation. https://www.sciencedirect.com/science/article/abs/pii/S0190962213010529. The term "Diathermy" is often used interchangeably when referring to electrosurgical procedures like electrocauterization or electrocoagulation. Different resources use the terms Diathermy and Electrocauterization as synonyms, leading to confusion.

Heat therapy is commonly used. It can be divided into superficial and deep treatment. Superficial heat therapy, which includes hot packs and thermal water, acts through skin contact.  Deep heat therapy is generated by the interaction of electromagnetic waves with biological tissues. Different types of waves can be used in diathermy. Long-wave diathermy (LWD), short-wave diathermy (SWD), and microwave diathermy (MWD) are the most common. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266838/.

Diathermy is considered a synonym of electrocautery by some resources, but this is erroneous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467049/, https://pubmed.ncbi.nlm.nih.gov/18080583/.

In SCT, the term Diathermy used in descriptions is linked to 428381003 |Diathermy - action (qualifier value)|, which is subsumed by 129398008 |Electrocautery - action (qualifier value)|, 129399000 |Electrodestruction - action (qualifier value)|, 129392009 |Cauterization - action (qualifier value)| and 129382001 |Destruction - action (qualifier value)|, and finally by 129284003 |Surgical action (qualifier value)|. So, concepts modeled with 428381003 |Diathermy - action (qualifier value)| are by definition, Surgical procedures.

The term Diathermy is used interchangeably in descriptions as a synonym to name different kinds of actions and procedures, leading to inconsistencies in classification. For example:

• 28443006 |Chiropractic diathermy (procedure)|. Classified erroneously as a Surgical procedure.

• 234313006 |Diathermy to cystic hygroma (procedure)|. Referring to the destruction of a lesion.

• 57103007 |Reattachment of retina by diathermy (procedure)|. Referring to the repair of a lesion by means of application of heat.

• 274071003 |Diathermy - surgical (procedure)|. Modeled with Method = Destruction and Using device = Diathermy device.

• 236851004 |Diathermy cauterization of lesion of vagina (procedure)|. = Conflation of diathermy and cauterization.

• 57103007 |Reattachment of retina by diathermy (procedure)|. Modeled with two Method (attribute) values: Reattachment and Diathermy, but also incorrectly classifies as a destructive procedure.

• 233160000 |Diathermy ablation operation for arrhythmia (procedure)|. Modeled with Method = Ablation and Using device = Diathermy device.

• 300020002 |Tubal diathermy (procedure)|. Ambiguity about the kind of energy used and the outcome of the action.

• 232597008 |Bronchoscopic destruction of lesion - cautery (procedure)|. Subsumed by Diathermy - surgical but modeled with Method = Cauterization - action.

• 84093003 |Electrocoagulation of fallopian tube (procedure)|. Subsumed by Diathermy - surgical.

• 47902005 |Microwave diathermy (procedure)|. Under this concept we can find procedures with possible different outcomes:

  • 306883005 |Microwave therapy to pelvis (procedure)|. May refer to superficial therapy or tumor ablation procedures

Statement of problem as understood

This issue is due to the usage of the term Diathermy when referring to different types of procedures. Standardization of the use of the term "Diathermy" in procedures is needed to thoroughly define the term "Diathermy" and its application in the hierarchy. 

1. The term is used interchangeably for surgical and non-surgical procedures

2. The term is used interchangeably to define procedures with different specific outcomes of applying different types of energy to biological tissue.

3. There are two hierarchies for surgical procedures using diathermy:

   1. 21825005 |Diathermy (procedure)|. Defined concept with only defining attribute: Method = Diathermy - action.

   2. Subsumed by 128422009 |Destruction using electrical energy (procedure)|, with 25 direct children and sibling of destructive procedures like: Electrocautery operation, Electrocoagulation, Electrodesiccation, Electrolysis operation, and Fulguration. This means that in this hierarchy, 21825005 |Diathermy (procedure)| is defined as a destructive procedure using electrical current.

   3. There are 25 children under 21825005 |Diathermy (procedure)|. Here, we can find a number of Diathermy procedures referring to procedures for repair, ablation, reattachment, destruction, excision, etc.

   4. 274071003 |Diathermy - surgical (procedure)|. This is a defined concept modeled with two attributes: Method = Destruction - action and Using device = Diathermy device. 

      1.  274071003 |Diathermy - surgical (procedure)| is subsumed by 64597002 |Destructive procedure (procedure)| which makes it a sibling of 128422009 |Destruction using electrical energy (procedure)|.

      2. This concept has 11 direct children, some of which are also children of 21825005 |Diathermy (procedure)|. This is redundant.

4. Currently the energy used for these procedures is not necessarily stated, neither in descriptions nor in RGs

5. Both Diathermy (procedure) and Diathermy - surgical (procedure) are classified as Surgical procedures. This is redundant.  

6. Modeling of both types of procedures is inconsistent, some concepts using Diathermy - action are modeled with Using device (attribute) = << 281817001 |Diathermy device (physical object)|, which leads to be subsumed both by Diathermy (procedure) and Diathermy - surgical (procedure), which is redundant.

7. Non-destructive Diathermy procedures can't be sufficiently defined because 428381003 |Diathermy - action (qualifier value)| is a surgical action.

8. Proximal primitive parent rule: Many concepts reviewed are modeled with an |Is a| relationship with Defined concepts.

Solution Development

The proposal for solution is based on definitions from literature for the different ways the term Diathermy is used in clinical practice.

• A treatment that provides deep heat to the tissues. Without destructive action. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266838/

  • Therapeutical application of conductive heat using heated pads, water or other materials to promote healing.

  • Employment of physical agents that convert high-frequency electric current or electromagnetic waves to deep heat to promote healing. https://www.sciencedirect.com/topics/medicine-and-dentistry/diathermy

    • Long-wave diathermy

    • Short-wave diathermy

    • Microwave diathermy

    • Example: 

• The use of energy to destruct tissue for different purposes. 

  • A procedure in which tissue is heated to destroy abnormal cells. The heat may come from electric currents, microwaves, radio waves, or ultrasound. Used to destroy malignant cells. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/diathermy

  • The term diathermy was originally applied to the therapeutic (non ablative) heating effect of passing high-frequency electrical current through deeper parts of the body. This term was later used to describe cutting tissue. While the term diathermy is still used today, the term electrosurgery is preferred when referring to cutting or coagulation. https://www.sciencedirect.com/science/article/abs/pii/S0190962213010529

    • Example: 307999008 |Diathermy of skin lesion (procedure)|

• The use of Diathermy as a destructive procedure to perform a "secondary" action. e.g. Reattachment, repair.

  • Diathermy is used to reach a secondary purpose stated on the descriptions. e.g. 33397002 |Reattachment of choroid and retina by diathermy (procedure)|

Proposal:  

1. General. 

   1. Although the term "Electrosurgery" seems to be the more appropriate to group the actions resulting from the application of electrical current and its passage through biological tissue and would be a substitute for 128422009 |Destruction using electrical energy (procedure)|, the overlapping in definitions for different destructive concepts using electrical current, the generalized use of the term “Diathermy” as a synonym for electrosurgery (although erroneous) and the number of concepts using it in descriptions, the proposal is to subsume 128422009 |Destruction using electrical energy (procedure)| under 274071003 |Diathermy - surgical (procedure)| to maintain the notion of the term and to not disrupt the paradigm.

   2. 274071003 |Diathermy - surgical (procedure)|  should be specifically used to define “destructive procedures” by means of applying a physical force (electricity) to heat the tissue with Method (attribute) = Surgical diathermy (new concept). 

   3. Groupers (e.g. 129399000 |Electrodestruction - action (qualifier value)| and 128422009 |Destruction using electrical energy (procedure)|) to subsume the different types of diathermy are no longer needed as the nature of the physical force used will be stated on the definition through 424244007 |Using energy (attribute)| = << 78621006 |Physical force (physical force)|.

   4. Non-surgical diathermy or 21825005 |Diathermy (procedure)| is a therapeutic procedure and should be modeled with Method (attribute) = Diathermy - action.

   5. The Semantic tag will differentiate the naming patterns between surgical and non-surgical diathermy given the similarity between such concepts.

2. Naming patterns. Non-surgical and surgical diathermy

   1. 21825005 |Diathermy (procedure)|. To avoid confusion between surgical and non-surgical diathermy procedures, non surgical diathermy procedures should be described including the energy used in the procedure.
      
      

      1. The type of energy used to perform the procedure must be stated on the FSN: use the name of the energy (e.g.  microwave, conductive heat, shortwave) followed by the term "diathermy", then "to"  and finally the "Anatomical or acquired body structure" where the procedure is applied. Semantic tag: regime/therapy.

         1. Example: 306882000 |Microwave diathermy to back (procedure)|.

   2. 274071003 |Diathermy - surgical (procedure)|. The term "Diathermy" us used to refer to different types of surgical actions performed using electricity (e.g. electrocauterization, electrocoagulation, electrodesiccation). The proposal to consistently name the different types of actions and to accurately differentiate them, is to base the descriptions primarily on the more specific action stated on the description and secondarily on the term diathermy.

      1. If a specific destructive action (cauterization, coagulation, disiccation) is stated in descriptions, use that action to name the concept and avoid the inclusion of the term "Diathermy". Finally, add "using electrical energy" and avoid using the prefix "electro" to describe a destructive action using electricity.

         1. Examples:

            1. Instead of using 232597008 |Bronchoscopic destruction of lesion - cautery (procedure)|, use 232597008 |Bronchoscopic cauterization of lesion using electrical energy (procedure)|

            2. Instead of using 236851004 |Diathermy cauterization of lesion of vagina (procedure)|, use 89245002 |Cauterization of lesion of vagina (procedure)|

      2. If a specific non-destructive action (e.g. repair, reattachment) is included in the FSN, locate that action first in the description followed by "of" the "Morphologically abnormal structure", then "of" the "Anatomical or acquired body structure" and finally add "by diathermy" if stated, or the specific surgical action ("by coagulation", "by cauterization") if stated as explained.

         1. Examples:

            1. 57103007 |Reattachment of retina by diathermy (procedure)|

            2. Instead of using 61440000 |Repair of retina for retinal tear or defect by diathermy (procedure)|, use 61440000 |Repair of retinal tear or defect by diathermy (procedure)|

            3. 56121000 |Repair of arteriovenous fistula by coagulation (procedure)|

3. Definition. Non-surgical and surgical diathermy

   1. 21825005 |Diathermy (procedure)|: Diathermy referring to non-surgical/non-destructive procedures used in physical therapy and chiropraxy. Will be subsumed by: 91251008 |Physical therapy procedure (regime/therapy)|

      1. Use 428381003 |Diathermy - action (qualifier value)| as the value for 260686004 |Method (attribute)|

      2. Include the type of energy applied for 424244007 |Using energy (attribute)|

         1. 88999006 |Heat (physical force)|

         2. 64285002 |Electromagnetic radiation in the microwave region (physical force)|

         3. 285334005 |Long wave radiation (physical force)|

         4. 286633001 |Short wave radiation (physical force)|

      3. Link the objective of the procedure with non-surgical action values (diathermy)

      4. Include Using device (attribute) to definition as needed

      5. To specify the Clinical finding or Procedure which is the focus of a procedure if needed with Has focus (attribute)

   2. 274071003 |Diathermy - surgical (procedure)|: Diathermy referring to surgical/destructive procedures using a physical force. Subsumed by: 387713003 |Surgical procedure (procedure)|.

      1. Use the value for 260686004 |Method (attribute)| = Surgical diathermy - action (qualifier value)

      2. Include the type of energy applied for 424244007 |Using energy (attribute)|

         1. 18213006 |Electricity (physical force)|

         2. Electromagnetic radiation in the radiofrequency region (for radiofrequency ablation procedures)

         3. 88999006 |Heat (physical force)|

         4. 64285002 |Electromagnetic radiation in the microwave region (physical force)|

         5. 285334005 |Long wave radiation (physical force)|

         6. 286633001 |Short wave radiation (physical force)|

      3. State the final result of applying diathermy on tissues in the definition in a second RG with: 260686004 |Method (attribute)| = << 129264002 |Action (qualifier value)|

         1. Ablation

         2. Destruction

         3. Coagulation

         4. Desiccation

         5. Fulguration

         6. Cauterization

         7. Reattachment

         8. Repair

         9. Etc

      4. Include Using device (attribute) to definition as needed.

      5. Use Has focus (attribute) to specify the Clinical finding or Procedure which is the focus of a procedure if needed

Descriptions pattern for non-surgical Diathermy procedures:

21825005 |Diathermy (procedure)| 

To be used to describe non-Surgical procedures modeled with the term "Diathermy" in descriptions. This change will be applied to the Descriptions of inherited concepts which use "Diathermy of X" referring to a treatment that provides deep heat to the tissues. Without destructive action.

Examples: 

306882000 |Microwave diathermy to back (procedure)|

304408006 |Short wave diathermy to foot (regime/therapy)|

Concept model for non-surgical Diathermy procedures:

Descriptions pattern for Surgical Diathermy procedures:

274071003 |Diathermy - surgical (procedure)| 

To be used to define Surgical procedures modeled with the term "Diathermy" in descriptions. This change will be applied to change the Descriptions of inherited concepts which use "Diathermy of X" referring to the use of Electric current with a destructive purpose. It may be used to model procedures aimed to perform an action which is reached through the use of Surgical diathermy involving non destructive or destructive actions. 

Pattern 1.

Example:

232467003 |Correction of alar collapse by diathermy (procedure)|

90243001 |Destruction of lesion of retina by diathermy (procedure)|

Pattern 2.

Example:

234313006 |Diathermy of cystic hygroma (procedure)|

177064004 |Diathermy of lesion of uterosacral ligament (procedure)|

405323007 |Diathermy of vein (procedure)|

Concept model for surgical Diathermy procedures: