We are creating our national value set with the positions in space and we have found in the qualifier values both 264217000 |Superior (qualifier value)| and 261183002 |Upper (qualifier value)| as children of 272425003 |General site descriptor (qualifier value)|. Same for lower and inferior. In French, both words translate the same as “supérieur”.
In Dutch, you can have “boven” or “bovenste” (the most at the top) to make a slight distinction. In anatomy, one would tend to say the correct word is superior, in reference to the descriptors of the position in the plan. But then in practice in breast you’ll say “upper left quadrant” in English.
None of those position qualifiers are (sadly) used currently in SNOMED CT concept model to fully define anatomical concepts (which I do find a pity).
My question is, what would you do? Use only “superior” in our transversal value set of relative position in space, or allow the use of both “upper” and “superior” concepts knowing that in one of the national languages it will be rendered as homonyms? Would you then add a business rule that in French only one of those concepts should be used to provide consistency of data?
In Swedish, superior would be used with latin phrases (anatomical), like superior vena cana, but “upper” (Swe: övre) would be used as a qualifier to position something. So this does not look correct. And they are homonyms in Swedish. Today, we have superior translated as superior, but that will not work.
Conversely, for lateral/external and medial/internal while I’ve found some example concepts where the terms are used interchangeably, I’ve also found counterexamples that would justify the existence of separate qualifier values.
Before submitting tickets for these two pairs of terms, we would need scientific literature references that confirm that these pairs are indeed synonymous, despite the counterexamples. @mlambot would it be possible to gather a list of appropriate references for these requests?
Examples:
Medial-Internal: all concepts about “medial/internal rotation”
Medial malleolar region structure (body structure) with AS “Internal malleolar region”
Lateral-External: all concepts about “lateral/external rotation”
Lateral malleolar region structure (body structure) with AS “External malleolar region’
Counterexamples:
Foreign body on external eye (disorder): “external” refers to the outermost layer of the eye (not lateral)
Combination of terms in one term: “Lateral internal anal sphincterotomy” ; “Lateral external iliac lymph node group”; “ ligament latéral externe du genou gauche (FR)”…