Version 2.78

Term Description

Radiology study observation (or Findings) contains the main narrative body of a radiology report. While not an absolute requirement for transformed DICOM SR reports, it is suggested that Diagnostic Imaging Reports authored in CDA follow Term Info guidelines for the codes in the various observations and procedures recorded in this section.
Source: Regenstrief LOINC

Fully-Specified Name

Component
Study observation
Property
Find
Time
Pt
System
XXX
Scale
Nar
Method
Radiology

Basic Attributes

Class
ATTACH.CLINRPT
Type
Claims Attachments
First Released
Version 1.0l
Last Updated
Version 2.63

Member of these Panels

LOINC Long Common Name
26443-2 Clinical reports.non lab claims attachment
55168-9 Data Elements for Emergency Department Systems (DEEDS) Release 1.1
85430-7 Diagnostic imaging report - example sections and entries
72230-6 Diagnostic imaging report - recommended C-CDA R1.1 sections
81220-6 Diagnostic imaging report - recommended C-CDA R2.0 and R2.1 sections

Language Variants Get Info

Tag Language Translation
de-AT German (Austria) Untersuchung:Ergebnis:Zeitpunkt:XXX:Freitext:Radiologie
Synonyms: Befund
es-AR Spanish (Argentina) STUDY OBSERVATION:hallazgo:punto en el tiempo:XXX:Narrativo:radiografía
it-IT Italian (Italy) Rilievo:Osservazione:Pt:XXX:Nar:Radiologia
Synonyms: Allegato Allegato referto clinico Osservazione Osservazione di studio Punto nel tempo (episodio)
nl-NL Dutch (Netherlands) observatieonderzoek:bevinding:moment:XXX:tekstueel:radiologie
pt-BR Portuguese (Brazil) Observação:Achado:Pt:XXX:Nar:RX
Synonyms: Finding; Findings; Point in time; Random; Misc; Miscellaneous; Unspecified; Other; Narrative; Report
zh-CN Chinese (China) 检查观察结果:发现:时间点:XXX:叙述型:放射医学
Synonyms: 不明的;其他;将在相应消息内其他部分之中加以详细说明;未作详细说明的;未作说明的;未做说明的标本;未加规定的;未加说明的标本;杂项 临床报告信息附件;健康保险便携与责任法案信息附件.临床报告 信息附件;健康保险便携与责任法案信息附件;附件 发现是一个原子型临床观察指标，并不是作为印象的概括陈述。体格检查、病史、系统检查及其他此类观察指标的属性均为发现。它们的标尺对于编码型发现可能是名义型，而对于叙述型文本之中所报告的发现，则可能是叙述型。;发现物;所见;结果;结论 叙述;叙述性文字;报告;报告型;文字叙述;文本叙述型;文本描述;文本描述型 放射学;放射科;放射线学;X射线学;影像诊断学;放射;X光线学;X光线科;应用辐射学;辐射学 时刻;随机;随意;瞬间 检查;检查观察 检查分析 研究;检查项目;调查;考察;研究项目;学习 考察 调查

LOINC Terminology Service (API) using HL7® FHIR® Get Info

CodeSystem lookup
https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=18782-3