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Circular 59-7


DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
Public Health Service
Division of Indian Health Washington 25, D.C.

DIVISION OF INDIAN HEALTH CIRCULAR NO. 59-7


April 09, 1959

ROENTGEN DIAGNOSES INDEX

HEADQUARTERS IHS CIRCULAR FORMAT

  1. PURPOSE.  To prescribe the use of a basic record system for coding and indexing roentgen diagnoses.

  2. POLICY.  Form PHS-3039, "Roentgen Index A, is prescribed for use in Indian Health facilities and shall be used to record essential identifying data and applicable code according to the “Index for Roentgen Diagnoses" published by The American College of Radiology.

    Coding shall be done by the roentgenologist or the responsible physician.  Normal findings need not be indexed.

  3. INSTRUCTIONS FOR USE OF PHS-3039.

    1. Code Number and Anatomical Field.  The anatomical field heading and the specific anatomic code number should be entered at either the top or bottom of the card depending on whether the card is to be filed in a vertical or a visible file.

    2. Film Number.  Under film number post the patient’s unit record number.  This number identifies both his X-ray films and medical record.

    3. Pathological Field Number.  Enter the applicable code for the pathology noted on the X-ray film in this column.

    4. Special Notation.  This column makes it possible to enter any additional applicable code or special notations that would be particularly useful in providing further valuable information.

  4. "INDEX FOR ROENTGEN DIAGNOSES.”  Approximately eighty index cards will be required for the simplified version, “Index for Roentgen Diagnoses" published by The American College of Radiology.  The cards shall be divided into the eight atomically fields, each field into its respective eight, nine, or ten subdivisions.  A copy of the simplified version is attached for use until such time as copies of the "Index for Roentgen Diagnoses" and the single sheet "Index for Roentgen Diagnoses" can be ordered from The American College of Radiology, 20 N, Wacker Drive, Chicago 6, Illinois.

  5. SUPPLY OF FORMS.  An estimated annual supply of Form PHS-3039 will be distributed shortly.  Thereafter, stocks of that form will be furnished in accordance with the provisions of Administrative Services Circular No. 55, Supplement No. 1, revised September 20, 1957.
/James R. Shaw, M.D./
James R. Shaw, M.D.
Assistant Surgeon General
Chief, Division of Indian Health


Attachment to DIH
Circular 59-7
Copy of Simplified Version

"Index for Roentegen Diagnoses"

Anatomic Fields

I.  Skull and Contents

10. Skull and contents

10. Location not specified or known
11.  Frontal
12.  Parietal
13.  Occipital
14.  Temporal
15.  Base of Skull or brain, include: sella, carotid siphon, sphenoid ridge, Basal cisterns
16.  Subtentorial include:  internal auditory meatus, cerebellum, craniovertebral angle, posterior fossa, fourth ventricle, foramen magnum
17.  Deep seated lesions, include:  pineal, pons, basal ganglia, intra-ventricular lesions in the lateral and 3rd ventricles
18.  More than two of above areas, generalized, widespread
19.  Other

Pathologic Fields

.10  Normal, techiques, anomalies
.11  Normal routine plain films, exclude: normal variants (.14)
.12  Special techniques, procedures or views, include:  laminography, carotid angiography, etc.
.13  Congenital anomalies, include: hydrocephalous
.14  Normal variants, include:  metopic suture, normal calcifications, etc.
.19  Other

.20  Inflammation
.21  Osteomyelitis
.22  Syphilis, aneurysms, luetic or other
.29  Other, exclude:  abscess (.34)

.30  Neoplasm
.31  Benign neoplasm or cyst arising in bone or scalp
.32  Malignant, neoplasm primary in bone or scalp, include:
.33  Malignant neoplasm secondary in bone or scalp
.34  Intracranial space consuming lesion, include:  pincal shift, erosion of dorsum, exclude:  pituitary (.35)
.35  Pituitary tumors, include:  crainiopharyngioma, sellar enlargement, etiology undetermined
.39  Other

.40  Trauma
.41  Fracture
.44  Foreign body
.45  Post operative
.46  Cephalhematoma
.49  Other

.50  Miscellaneous
.51  Skull manifestations of aquired generalized bone disease, include:  Paget's
.52  Abnormal calcification, exclude: space consuming leasion (.34)
.55  Atrophic lesions of brain, include:  cortical atrophy and parencephaly
.59  Other, include:  thrombosis or spasm of vessal

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  phenomena related to technique of examination

Anatomic Fields

II.  Sinuses, mastoids and Face

2.  Face, sinus, mastoid, teeth, mandible, madibular joint, salivary glands, orbit, other facial, oral and naso-pharyngeal structures, exclude:  Larynx, neck (5.)

20.  Location not specified or unknown
21.  Frontal
22.  Maxillary
23.  Ethmoidal, Sphonidal
24.  Mastoids, ears, middle ear, external auditory meatus
25.  Teeth
26.  Mandible, mandibular joints
27.  Salivary glands
28.  More than two of above areas, generalized
29.  Other, include:  Tonsil, adenoids, tongue, orbit, nose lacrimal apparatus, exclude:  Soft tissues of neck (55.), hypo-pharynx (55.)

Pathological Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  Normal variants (.14)
.12  Special techniques, procedures or views, include:  Laminography, sialography
.13  Congenital anomalies, inlcude:  impaced teeth, facial manifestations of generalized congenital bone disease
.14  Normal variants
.19  Other

.20  Inflammation
.21  Osteomyelitis
.25  Sinusitis
.26  Mastoiditis
.27  Dental infection
.28  Enlarged tonsils, adenoids
.29  Other

.30  Neoplasm
.31  Benign neoplasm or cyst, include: mucous cyst of sinus, dentigerous cyst, multiple cementomas, exclude:  Radiular cyst (.27)
.32  Malignant neoplasm, primary, include:  myeloma
.33  Malignant neoplasm, secondary, include:  lymphoma
.39  Other

.40  Trauma
.41  Fracture
.42  Dislocation
.44  Foreign body
.45  Postoperative, include:  radium implantation
.49  Other

.50  Miscellaneous
.51  Facial manifestations of aquired generalized bone disease, include:  Paget's fibrous dysplasia, hyperpara-thyroidism, reticuloses, cortical hypera-ostosis, sicklemia
.52  Calculus or abnormal calcification
.57  Other temporomandibular abnormality
.58  Other dental abnormality, include:  retained root
.59  other

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  phenomena related to technique of examination

Anatomic Fields

III.  Spine and Contents

3.  Spine and contents - gacroiliac joint, exclude:  Pelvis, hip joint (44.)

30.  Location not specified or unknown
31.  Cervical
32.  Dorsal
33.  Lumbar
34.  Sacral, coccygeal
35.  Sacroiliac joint
38.  More than two of above areas, generalized
39.  Other

Pathologic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  normal variants (.14)
.12  Special techniques, procedures or views, include:  laminography, myelography
.13  Congenital anomalies, exclude:  scoliosis (.15)
.14  Normal variants, include:  cervical rib
.15  Abnormal alignment of spine, aquired or congenital (kyphoscoliosis)
.19  Other

.20  Inflammation .21  Osteomyelitis, include:  Fungus, brucella, etc.
.23  Tuberculosis
.24  Sinus tract, fistula
.29  Other, include:  arachnoiditis, myelitis, etc.

.30  Neoplasm
.31  Benign neoplasm primary in bone, include:  giant cell tumor, hemangioma
.32  Malignant neoplasm primary in bone, include:  Myeloma
.33  Malignant neoplasm secondary in bone
.34  Space consuming intraspinal lesion, include:  herniated disc, varices, neurofibroma, ependynoma
.39  Other

.40  Trauma
.41  Fracture
.42  Dislocation, subluxation
.44  Foreign body
.45  Postoperative
.49  Other

.50  Miscellaneous
.51  Spinal manifestations of acquired generalized bone disease, include:  Paget's, senile osteoporosis
.52  Abnormal calcification, include: calcified disc
.53  Osteochondritis, include:  Scheuermann, Calve, Kummell
.54  Rheumatoid arthritis
.55  Hypertrophic changes, spurring, bridging
.56  Neuropathic joint, Charcot type
.59  Other

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  Phenomena related to technique of examination

Anatomic Fields

IV.  Extremities

4.  Extremities
Scapula, acromioclavicular joint, pelvis, hip joint, multiple disseminated, generalized bone involvement, exclude:  Sacroiliac joint (35.), clavicle, sternoclavicular joint (56.)

40.  Location not specified or unknown
41.  Shoulder joint, acromioclavicular joint, scapula, upper arm, exclude Clavicle (56.)
42.  Elbow and forearm
43.  Wrist, and hand
44.  Pelvis, hip joint, buttock, thigh, pubis
45.  Knee and lower leg
46.  Ankle and foot
48.  More than two of above areas, generalized, (Cross index also under "skull" (10.) and "spine" (30.) if desired)
49.  Other

Pathologic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude: normal variants (.14)
.12  Special techniques, procedures or views, include:  laminography, peripheral angiography, arteriography
.13  Congenital anomalies, include:  manifestations of generalized congenital bone diseases, club foot, congenital dislocation of hip
.14  Normal variants, include:  supracondylar process, bipartite patella, sesamoids, bone islands, growth lines
.19  Other

.20  Inflammation
.21  Osteomyelitis
.22  Syphilis, exculde:  Charcot joint (.55)
.23  Tuberculosis, include:  tuberculosis arthritis
.24  Sinus tract
.25  Purulent or inflammatory arthritis
.29  Other, include:  osteitis pubis, cellulitis, pericatitis adjacent to soft tissue inflammation, sarcoid, etc.

.30  Neoplasm
.31  Benign neoplasm or cyst, include: exostosis, solitary bone cyst and giant cell tumor
.32  Malignant neoplasm, primary, include:  synovioma, myeloma, osteogenic sarcoma, chondrosarcoma, Ewing's
.33  Malignant neoplasm, secondary
.39  Other

.40  Trauma
.41  Fracture, exclude:  complication of fracture (.46)
.42  Dislocation, subluxation, exclude:  congenital dislocation (.13)
.43  Epiphyseal separation
.44  Foreign body
.45  Postoperative
.46  Complication of fracture
.47  A-V fistula, post traumatic aneurysm
.49  Other

.50  Miscellaneous
.51  Manifestations of acquired generalized bone disease, include:  Paget's, fibrous dysplasia and anemias, exclude:  arthritis (.54), joint manifestations of systemic disease (.56), osteoporosis, malacia (.57), and poisoning (.58)
.52  Calcification, include:  bursitis
.53  Osteochondritis, vascular disease of bone, joint mice, include:  Legg-Calve-Perthe's, Osgood Schlatter', juvenile slipped femoral epiphysis, octeochondromatosis
.54  Arthritis, noninfectious, include: rheumatoid and hypertrophic
.55  Neuropathic or neurotrophic bone or joint disease
.56  Joint manifestations of systemic disease, include: gout, hemophilia, etc.
.57  Osteoporosis and osteomalacia, include: rickets and scurvy
.58  Poisoning, include:  lead and hypervitaminosis A & D
.59  Other, include:  phlebothromobis, varicose veins, bone atrophy, flat feet, periostitis of unkown etiology, hallux valgus, protrusio acetabuli

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  Phenomena related to technique of examination

Anatomic Fields

V.  Heart, Mediastinum

5.  Heart, and mediastinum
Heart, pericardium, great vessels, mediastinum, hilar nodes, neck, larynx, thoracic cage, clavicle, sternoclavicular joint, breast, excludes:  trachea (69.), scapula, acromiclavicular joint (41.)

50.  Location not specified or unknown
51.  Heart
52.  Great vessels
53.  Pericardium
54.  Mediastinal soft tissues, thymus, lymph nodes, include:  Hilar nodes
55.  Soft tissues of neck, thyroid, larynx
56.  Thoracic cage, include:  Breast, rib, clavicle, sternum, sternoclavicular joint; exclude:  Scapula, acromioclavicular joint (.41)
58.  More than two of above areas, generalized
59.  Other

Pathologic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  normal variants (.14)
.12  Special techniques, procedure of views, include:  laminography, angiocardiography
.13  Congenital anomalies, include:  patent ductus, tetralogy of Falot, coarctation, etc.
.14  Normal variants, include:  Fat pad, normal thymus, etc.
.19  Other

.20  Inflammation
.21  Ostomyelitis (of rib cage)
.22  Syphilis, angurysm all types except cardiac (.55)
.23  Tuberculosis, exclude:  tuberculous pericarditis (.57)
.24  Sinus tract or fistula
.25  Mediastinal lymphadenitis, nontuberculous, include:  sarcoid (sarcoid of 60.22)
.27  Cervical or retropharyngeal abscess or adenitis, nontuberclous, include:  edema of larynx
.29  Other

.30  Neoplasm
.31  Benign neoplasm or cyst, include: goiter
.32  Malignant neoplasm, primary, include: larynx, hypopharynx, breast, myeloma, etc.
.33  Malignant tumor, secondary (in ribs, hilar nodes)
.39  Other, include:  mediastinal nodes or mass, etiology undetermined

.40  Trauma
.41  Fracture (rib, clavicle)
.44  Foriegn body
.45  Postoperative, include:  radium implantation, tracheotomy, etc.
.49  Other: exclude:  hemopericardium (.57)

.50  Miscellaneous
.51  Manifestations of acquired generalized bone disease, include:  Paget', fibrous dysplasia, etc.
.52  Intracardiac calcification, exclude:  pericardial (.57)
.54  Rheumatic heart disease
.55  Arteriosclerosis and hypertension, include:  cardiac aneurysm
.56  Generalized cardiac enlargement, include:  thyrotoxic, anemia
.57  Pericardial disease, include:  pericardial effusion, adhesive pericarditis
.59  Other, include:  rib notching other than coarctation

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  phenomena related to technique of examination

Anatomic Fields

VI.  Lungs, Pleura

6.  Pulmonary
Pleura, trachea, superior aspect of diaphragms, exclude:  Hilar nodes (5.)

60.  Location not specified
61.  Right upper lobe
62.  Right, middle lobe
63.  Right lower lobe
64.  Left upper lobe, exclude: Lingula
65.  Lingula
66.  Left lower lobe
67.  Pleura
68.  More than two of above areas, widespread or generalized, include:  Miliary
69.  Other, include:  Superior aspect of diaphragm, trachea

Pathelogic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  normal variants (.14)
.12  Special techniques, procedures or views, include:  laminography, angiography
.13  Congenital anomalies, include:  Pulmonary A-V fistula, agenesis, etc.; exclude:  cystic disease (.31) and lung changes of cystic fibrosis of pancreas (.22)
.14  Normal variants, include:  azygos lobe
.19  Other

.20  Inflammation
.21  Acute inflammation, include:  lobar pneumonia, bronchopneumonia, virus pneumonia, etc.
.22  Subacute or chronic pneumonia, include:  sarcoid (see 50.25); exclude:  bronchiectasis (.26)
.23  Tuberculosis, pulmonary
.24  Fistutla or sinus tract, include:  bronchopleural, acquired tracheosophageal, etc.
.25  Lung abscess
.26  Bronchiectasis (see .56)
.29  Other

.30  Neoplasm
.31  Benign neoplasm or cyst, include:  "coin" or spheroid lesion, cystic disease of lung
.32  Malignant neoplasm, primary, bronchogenic carcinoma, etc.
.33  Malignant neoplasm, secondary (metastasis in lung fileds)
.39  Other

.40  Trauma
.44  Foreign body, exclude:  obstructive emphysema (.51) and collapse (.56)
.45  Postoperative
.46  Post traumatic pneumonitis, hemorrhage
.47  Radiation changes in lung
.49  Other, exclude:  traumatic pneumothorax (.53)

.50  Miscellaneous
.51  Pulmonary emphysema, include:  obstructive emphysema
.52  Calcification in lung, exclude:  broncholith (.56) and calcified pleura (.57)
.53  Pneumothorax, include:  hydropneumothorax
.54  Pulmonary infarct
.55  Pneumoconiosis
.56  Atelectasis, collapse
.57  Pleurisy, include:  pleural effusion, calcified pleura
.58  Pulmonary edema
.59  Other, include:  scleroderma

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  phenomena related to technique of examination.

Anatomic Fields

VII.  Gastrointestinal

7.  Gastrointestinal
Inferior aspect of diaphragms, pancreas, all intraperitoneal structures, exclude: pelvic organs and retroperitoneal structures (80.)

70.  Location not specified or unknown
71.  Esophagus
72.  Stomach
73.  Duodenum
74.  Small bowel
75.  Colon and appendix
76.  Gall bladder and biliary tract
77.  Liver and spleen, pancreas
78.  More than two of above organs, generalized, widespread
79.  Other, include:  Abdominal wall, inferior aspect of diaphragm, intraperitoneal vessels, peritoneum.

Pathologic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  normal variants (.14)
.12  Special techniques, procedures or views, include:  penumoperitoneum, eploroportography small bowel enema
.13  Congenital anomalies, include:  tracheoesophageal fistula, hypertrophic pyloric stenosis, megacolon, etc.
.14  Normal variants, include:  "corkscrew" esophagus, cascade stomach, Phrygian cap gall bladder, etc.
.15  Hernia, eventration, congenital or acquired, include:  traumatic
.19  Other, include:  diverticulum (.27)

.20  Inflammation
.21  Intra-abdominal abscess, inflammatory mass or hematoma
.23  Tuberculosis
.24  Sinus tract or fistula, include:  acquired tracheosophageal mass or hematoma; exclude:  biliary fistula (.28) and congenital tracheoesophageal fistula (.13)
.25  Peptic ulcer
.26  Enteritis, colitis, include:  regional enteritis, ulcerative colitis
.27  Diverticulum, diverticulitis
.28  Abnormal biliary tract, include:  gall stones, abnormally functioning gall bladder, milk of calcium bile, etc.
.29  Other, include:  esophagitis, gastritis, duodentis, appendicitits, pancreatitis, hepatitis, etc.

.30  Neoplasm
.31  Benign neoplasm or cyst, include:  polyps, and leiomyoma
.32  Malignant neoplasm, primary carcinoma, sarcoma and lymphoma
.33  Malignant neoplasm, secondary, include:  peritoneal carcinomatois
.34  Extra-alimentary mass affecting GI structure
.35  Splenomegaly, hepatomegaly
.39  Other

.40  Trauma
.44  Foreign body
.45  Postoperative
.46  Ruptured solid organ, include:  liver, spleen
.49  Other, exclude:  traumatic or induced penumoperitoneum (.53) and traumatic diaphragmatic hernia (.15)

.50  Miscellaneous
.52  Intra-abdominal calcification or calculus, exclude:  biliary calculi (.28)
.53  Perforated hollow viscus, include:  traumatic pneumoperitoneum and perforated peptic ulcer
.54  Ileus, include: mechanical obstruction, paralytic ileus; exclude:  congenital (.13)
.55  Miscellaneous espohageal abnormalities, include:  lye stricture, varices, achalasia, scheroderma; exclude:  congenital (.13), hernia (.15) and perforation (.53)
.57  Disordered motor function (of small bowel)
.58  Ascities, include: hemoperitoneum
.59  Other, include:  parasites, pneumatotis cystoides, acute gastric dilatation, fecal impaction, etc.; exclude:  diverticulum (.27) and hiatal hernia (.15)

90.  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.99  Other, include:  phenomena related to technique of examination

Anatomic Fields

VIII.  Genitourinary

8.  Genitourinary

All retroperitoneal structures including aorta, all pelvic structures, exclude:  Pancreas (7.)
80.  Location not specified or unknown
81.  Kidney
82.  Ureter
83.  Bladder, include:  Urachus
84.  Prostate
85.  Ovary and tube
86.  Uterus, fetus, placenta
88.  More than two of above organs, generalized
89.  Other, include:  Extra peritoneal vessels, adrenals, retroperitoneal soft tissues, urethra, seminal vesicle, abdominal aorta, vas deferens

Pathologic Fields

.10  Normal, techniques, anomalies
.11  Normal routine plain films, exclude:  normal variants (.14)
.12  Special techniques, procedures or viewss, include:  aortography and presacral air insufflation
.13  Anomalies, diverticulum, congenital or acquired, include:  duplication or pelvis, horseshoe kidney, ectopic kidney, ureterocele; exclude:  ureteropelvic obstruction (.55) and polycystic kidneys (.31)
.14  Normal variants, include:  renal backflow, ptosis, multiple pregnancy
.19  Other, exclude:  diverticulm (.13)

.20  Inflammation
.21  Abscess or hematoma, include:  perinephric, retroperitoneal, extraperitoneal abscess, prostatic abscess, tubo-ovarian abscess, etc.
.22  Syphilis, extraperitoneal aneurysm, luotic or other
.23  Tuberculosis
.24  Sinus tract or fistula
.25  Urinary tract infection without dilatation, include:  cystitis, ureteritis cystica, renal papillitis, pyelonephritis, etc.; exclude:  with dilatation (.55)
.29  Other, include:  urethral stricture

.30  Neoplasm
.31  Benign neoplasm or cyst, include:  polycystic kidney, fibroids and benign prostatic hypertrophy, dermoid cyst
.32  Malignant neoplasm, primary hypernephroma, etc.
.33  Malignant neoplasm, secondary, Krukenberg, etc.
.34  Extrinsic mass affecting genitourinary structure
.39  Other

.40  Trauma
.44  Foreign body
.45  Postoperative
.46  Effects of trauma, include:  rupture of kidney, perforation of bladder, etc.
.49  Other

.50  Miscellaneous
.52  Calculus or calcification, include:  seminal vesicles, neophrocalcinosis, urinary calcui, adrenal, calcified vessels, etc.
.53  Obstetrical abnormalties, include:  disproportion, placenta previa, fetal death, transverse lie, etc.
.54  Abnormalties of urinary bladder, include:  neurogenic bladder, cystocele; exclude:  diverticulm (.13)
.55  Urinary tract dilatation, hydronephrosis
.56  Nonfunctioning kidney, cause unknown, include: poor function
.57  Circulatory disease, include:  lariche syndrome; exclude: aneurysm (.22)
.59  Other, include:  blocked tubes, hydrocele, reflux from bladder into ureter, nephrosclerosis, etc.; exclude:  diverticulum(.13)

.90  Other
.91  Fundamental observations
.92  Anatomic details
.93  Artifacts
.94  Errors in diagnosis
.95  Others, include:  phenomena related to technique of examination


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