European Radiology

, Volume 20, Issue 9, pp 2153–2165 | Cite as

APPC—A new standardised coding system for trans-organisational PACS retrieval

  • F. Fruehwald
  • A. Lindner
  • G. Mostbeck
  • W. Hruby
  • J. Fruehwald-PallamarEmail author
Computer Applications



As part of a general strategy to integrate the health care enterprise, Austria plans to connect the Picture Archiving and Communication Systems (PACS) of all radiological institutions into a nationwide network. To facilitate the search for relevant correlative imaging data in the PACS of different organisations, a coding system was compiled for all radiological procedures and necessary anatomical details.


This code, called the Austrian PACS Procedure Code (APPC), was granted the status of a standard under HL7. Examples are provided of effective coding and filtering when searching for relevant imaging material using the APPC, as well as the planned process for future adjustments of the APPC.


The implementation and how the APPC will fit into the future electronic environment, which will include an electronic health act for all citizens in Austria, are discussed. A comparison to other nationwide electronic health record projects and coding systems is given. Limitations and possible use in physical storage media are contemplated.


Medical coding PACS Data retrival Automated search DICOM 



We thank Mrs. Mary McAllister for proof reading and editing the manuscript.


  1. 1.
    Mosser H, Urban M, Durr M, Ruger W, Hruby W (1992) Integration of radiology and hospital information systems (RIS, HIS) with PACS: requirements of the radiologist. Eur J Radiol 16:69–73CrossRefPubMedGoogle Scholar
  2. 2.
    Oosterwijk H (1998) DICOM versus HL7 for modality interfacing. J Digit Imaging 11:39–41CrossRefPubMedGoogle Scholar
  3. 3.
    Pelikan E, Kotter E, Jager D, Langer M, Timmermann U (1999) Modern network technologies for data communication in the hospital. Radiologe 39:292–297CrossRefPubMedGoogle Scholar
  4. 4.
    Pelikan E, Kotter E, Timmermann U (2001) Networks in the radiology department and the hospital. Eur Radiol 11:337–345CrossRefPubMedGoogle Scholar
  5. 5.
    Schrader U, Kotter E, Pelikan E, Zaiss A, Timmermann U, Klar R (1997) Critical success factors for a hospital-wide PACS. Proc AMIA Annu Fall Symp 439–443Google Scholar
  6. 6.
    Blazona B, Koncar M (2007) HL7 and DICOM based integration of radiology departments with healthcare enterprise information systems. Int J Med Inform 76:S425–S432CrossRefPubMedGoogle Scholar
  7. 7.
    Hruby W, Mosser H, Urban M et al (1994) Clinical experiences with PACS: digital radiology. Radiologe 34:291–299PubMedGoogle Scholar
  8. 8.
    Developement OfEC-Oa (2009) OECD Health DataGoogle Scholar
  9. 9.
    ARGE AEG (2009) ARGE ELGA-Arbeitsgemeinschaft Elektronische Gesundheitsakte. Available via Accessed 3 Sept 2009
  10. 10.
    Board H (2008) Store-Health Level Seven. Available via HL7 Home. Accessed 22 Aug 2009
  11. 11.
    Committee CaS (2007) NEMA-2007-DICOM-FULLSET. Available via NEMA-National Electrical Manufacturers Association. Accessed 3 Sept 2009
  12. 12.
    Langlotz CP (2006) RadLex: a new method for indexing online educational materials. Radiographics 26:1595–1597CrossRefPubMedGoogle Scholar
  13. 13.
    Marwede D, Daumke P, Marko K, Lobsien D, Schulz S, Kahn T (2009) RadLex-German version: a radiological lexicon for indexing image and report information. Rofo 181:38–44. doi: 10.1055/s-2008-1027895 PubMedGoogle Scholar
  14. 14.
    Partan G, Kainberger F, Fruhwald F (2008) Referral guidelines in diagnostic imaging. Radiologe 48:268–271. doi: 10.1007/s00117-008-1618-9 CrossRefPubMedGoogle Scholar
  15. 15.
    Frühwald F, Imhof H, Kletter K, Stiskal M (2006) Orientierungshilfe Radiologie-Anleitung zum optimalen Einsatz der klinischen Radiologie. Verlagshaus der Ärzte, ViennaGoogle Scholar
  16. 16.
    Sabutsch S (2009) Health-IT Standardisierungsorganisationen in Österreich vereinbaren Kooperation. HL7-Mitteilungen 25:21–23Google Scholar
  17. 17.
    ACR ((2004–2009)) The ACR Radiology Coding Source™. Available via The official Web Site of the American College of Radiology. Accessed 22 Aug 2009
  18. 18.
    Committee L (2009) LOINC 2.27. Available via Logical Observation Identifiers Names and Codes. Accessed 22 Aug 2009
  19. 19.
    Dugas M, Thun S, Frankewitsch T, Heitmann KU (2009) LOINC codes for hospital information systems documents: a case study. J Am Med Inform Assoc 16:400–403CrossRefPubMedGoogle Scholar
  20. 20.
    Edelberg C (2004) Emergency department coding and billing. Emerg Med Clin North Am 22:131–151. doi: 10.1016/S0733-8627(03)00098-1 CrossRefPubMedGoogle Scholar
  21. 21.
    Miller J, Lineberry J (2004) Coding for effective denial management. Radiol Manage 26:18–21PubMedGoogle Scholar
  22. 22.
    NLM USNLoM (2008) SNOMED Clinical Terms® (SNOMED CT®). Available via United States Library of Medicine, National Institutes of Health. Accessed 3 Sept 2009
  23. 23.
    Phillips CD, Hillman BJ (2001) Coding and reimbursement issues for the radiologist. Radiology 220:7–11PubMedGoogle Scholar
  24. 24.
    Price P (2002) Fundamentals of coding and reimbursement. Radiol Technol 74:123–129 quiz 130–124PubMedGoogle Scholar
  25. 25.
    Renfrew DL, Bass SH, Albanese MA, Whitis BM (1992) Hypercard coding system for the ACR Index for Radiological Diagnoses. AJR Am J Roentgenol 158:669–672PubMedGoogle Scholar
  26. 26.
    Rosenbloom ST, Brown SH, Froehling D et al (2009) Using SNOMED CT to represent two interface terminologies. J Am Med Inform Assoc 16:81–88CrossRefPubMedGoogle Scholar
  27. 27.
    Yam CS, Kruskal J, Sitek A, Larson M (2004) A Web-based ACR index for radiological diagnoses. AJR Am J Roentgenol 183:1517–1521PubMedGoogle Scholar
  28. 28.
    Rosenbloom ST, Miller RA, Johnson KB, Elkin PL, Brown SH (2006) Interface terminologies: facilitating direct entry of clinical data into electronic health record systems. J Am Med Inform Assoc 13:277–288CrossRefPubMedGoogle Scholar
  29. 29.
    NLM USNLoM (2008) Unified Medical language System. Available via United States Library of Medicine, National Institutes of Health. Accessed 3 Sept 2009
  30. 30.
    Lindberg DA, Humphreys BL, McCray AT (1993) The unified medical language system. Methods Inf Med 32:281–291PubMedGoogle Scholar
  31. 31.
    CDC CfDCaP (2009) ICD-10-CM Classification of Diseases, Functioning, and Disability. Available via Classification of Diseases, Functioning, and Disability. Accessed 3 Sept 2009
  32. 32.
    Committee RS (2008) Radlex: A Lexicon for Uniform Indexing and Retrieval of Radiology Information Resources. In: Radiological Society of North America. Accessed 3 Sept 2009
  33. 33.
    Services USDoHaH (2009) Indian Health Service. Available via Accessed 15 Dec 2009
  34. 34.
    Affairs USDoV (2009) Profiles for the VistA Imaging and Commercial PACS DICOM Interface. Available via Accessed 15 Dec 2009
  35. 35.
    Department of Health and Ageing CG (2009) Health Connect. Available via Accessed 15 Dec 2009
  36. 36.
    Alberta Go (2009) Alberta Netcare. Available via Accessed 15 Dec 2009
  37. 37.
    Arrowsmith I, Braithwaite M (2009) National Interim Clinical Imaging Procedures to support PACS/RIS implementations. Available via Accessed 25 Dec 2009
  38. 38.
    Mildenberger P, Kotter E, Riesmeier J et al (2007) The DICOM-CD-Project of the German Radiology Association—an overview of the content and results of a pilot study in 2006. Rofo 179:676–682. doi: 10.1055/s-2007-963122 PubMedGoogle Scholar
  39. 39.
    van Ooijen PM, Guignot J, Mevel G, Oudkerk M (2005) Incorporating out-patient data from CD-R into the local PACS using DICOM worklist features. J Digit Imaging 18:196–202. doi: 10.1007/s10278-005-5158-9 CrossRefPubMedGoogle Scholar
  40. 40.
    van Ooijen PM, Roosjen R, de Blecourt MJ, van Dam R, Broekema A, Oudkerk M (2006) Evaluation of the use of CD-ROM upload into the PACS or institutional web server. J Digit Imaging 19(Suppl 1):72–77. doi: 10.1007/s10278-006-0932-x CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • F. Fruehwald
    • 1
  • A. Lindner
    • 1
  • G. Mostbeck
    • 2
  • W. Hruby
    • 3
  • J. Fruehwald-Pallamar
    • 4
    Email author
  1. 1.Diagnostic ImagingInstitut Frühwald/Steiner/ObermayerSt. PöltenAustria
  2. 2.Department of RadiologyWilhelminenspitalViennaAustria
  3. 3.Department of RadiologyDonauspitalViennaAustria
  4. 4.Department of RadiologyMedical University Vienna/ Vienna General HospitalViennaAustria

Personalised recommendations