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Every builder returns one uniform shape the frontend renders as a node-edge tree:
{available, kind, title, subtitle,
nodes: [{id, label, sub, tier, current}], edges: [[parentId, childId], ...],
note}
Graph relations use CIPHER, VA CDW, RxNorm, and LOINC data:
- Diagnosis (ICD-9/10) & ICD-9-Proc: dotted-code family (category stem -> the
codes sharing it), descriptions from the VA dictionary that backs code search.
ICD diagnosis graphs also carry the code's phecode assignments (v1.2 and
phecodeX) as annotation.
- Procedures (ICD-10-PCS): 7-char positional codes -> the 3-char "table" family.
- Procedures (CPT/HCPCS): CMS RBCS group (family, else subcategory) -> the
index codes sharing it.
- Medication: RxNorm ingredient(s) -> the drug -> sibling products.
- Lab (LOINC): COMPONENT -> active LOINC terms sharing it (loinc_terms).
VA-local LabChemTestSIDs enter that graph through the tiered lab mapping.
Mapping lookups go through the shared MappingStore, which owns the usability
rules. Routing resolves the clicked code to a CodeSystem once, then dispatches;
the resolution order is load-bearing (PCS and ICD-9-Proc types also contain
"ICD"/"CPT" substrings) and is pinned by tests. Codes without supported
relations return ``available: false``.
"""
from __future__ import annotations
import json
from collections import defaultdict
from enum import Enum
from pathlib import Path
from . import paths
from . import provenance
from .mappings import MappingStore, get_store
from .rxnav import RxNavClient
MEMBER_CAP = 26 # sibling codes shown per family (windowed around the clicked code; rest -> "+N more")
NDC_NODE_CAP = 4 # NDC package codes drawn on a medication graph; rest -> "+N more"
class CodeSystem(Enum):
PCS = "pcs"
ICD9_PROC = "icd9_proc"
CPT = "cpt"
ICD = "icd"
LOINC = "loinc"
VA_LAB = "va_lab"
MEDICATION = "medication"
def _dotted_cat(code: str) -> str:
"""Category stem for a dotted code (E11.9 -> E11, 345.01 -> 345)."""
return code.split(".")[0].strip()
def _pcs_cat(code: str) -> str:
"""ICD-10-PCS 'table' = first 3 positional chars (0SGK44Z -> 0SG)."""
return code[:3]
def _load_jsonl(path: Path):
if path.exists():
with path.open(encoding="utf-8") as handle:
for line in handle:
if line.strip():
yield json.loads(line)
class KnowledgeGraph:
def __init__(self, diagnosis_records=None, procedure_records=None,
rxnav_client: RxNavClient | None = None, lab_loinc_records=None,
loinc_records=None, store: MappingStore | None = None):
if store is None:
store = (MappingStore(lab_loinc_records=lab_loinc_records)
if lab_loinc_records is not None else get_store())
self.store = store
self.rxnav = rxnav_client or RxNavClient()
# -- lab (LOINC): term table + analyte(component) -> codes -------
self.loinc: dict[str, dict] = {}
self.loinc_by_comp: dict[str, list[str]] = defaultdict(list)
for r in (loinc_records if loinc_records is not None else _load_jsonl(paths.LOINC_TERMS)):
self.loinc[r["loinc"]] = r
self.loinc_by_comp[r["component"].lower()].append(r["loinc"])
# -- ICD diagnosis (dotted) --------------------------------------
self.icd, self.icd_cat = self._index_codes(
diagnosis_records,
keep="ICD", cat_fn=_dotted_cat)
# -- procedures: ICD-10-PCS (3-char) + ICD-9-Proc (dotted) -------
self.pcs, self.pcs_cat = {}, defaultdict(list)
self.icd9p, self.icd9p_cat = {}, defaultdict(list)
# -- procedures: CPT/HCPCS grouped by CMS RBCS -------------------
self.cpt, self.cpt_group = {}, defaultdict(list)
for r in procedure_records:
ct = str(r.get("code_type", ""))
desc = r.get("description", "")
for code in str(r.get("code", "")).split(","):
code = code.strip()
if not code:
continue
if "PCS" in ct and code not in self.pcs:
self.pcs[code] = {"code_type": "ICD-10-PCS", "description": desc}
self.pcs_cat[_pcs_cat(code)].append(code)
elif "ICD-9" in ct and "." in code and code not in self.icd9p:
self.icd9p[code] = {"code_type": "ICD-9-Proc", "description": desc}
self.icd9p_cat[_dotted_cat(code)].append(code)
elif "CPT" in ct and code not in self.cpt:
group = self._rbcs_group(code)
if group:
self.cpt[code] = {"code_type": "CPT", "description": desc,
"group": group}
self.cpt_group[group].append(code)
self._routes = {
CodeSystem.PCS: self._route_pcs,
CodeSystem.ICD9_PROC: self._route_icd9_proc,
CodeSystem.CPT: self._route_cpt,
CodeSystem.ICD: self._route_icd,
CodeSystem.LOINC: self._route_loinc,
CodeSystem.VA_LAB: self._route_va_lab,
CodeSystem.MEDICATION: self._route_medication,
}
def _rbcs_group(self, code: str) -> str | None:
"""Grouping label for a CPT/HCPCS code: RBCS family, else subcategory."""
entry = self.store.rbcs_validated_for(code.upper())
if not entry:
return None
return entry.get("family") or entry.get("subcategory") or None
@staticmethod
def _index_codes(records, keep: str, cat_fn):
table: dict[str, dict] = {}
buckets: dict[str, list[str]] = defaultdict(list)
for r in records:
ct = str(r.get("code_type", ""))
if keep not in ct:
continue
desc = r.get("description", "")
for code in str(r.get("code", "")).split(","): # split merged rows
code = code.strip()
if code and code not in table:
table[code] = {"code_type": ct, "description": desc}
buckets[cat_fn(code)].append(code)
return table, buckets
# -- routing -----------------------------------------------------------
def code_system(self, code: str, code_type: str | None = None) -> CodeSystem:
"""Which family a clicked code belongs to. Order is load-bearing:
PCS and ICD-9-Proc must resolve before the bare "CPT"/"ICD" substring
tests, and an embedding-matched CPT code wins regardless of the
declared type (it has no other graph). MEDICATION is also the terminal
bucket for unknowns; its handler ends with the no-hierarchy answer."""
ct = (code_type or "").upper()
first = code.split(",")[0].strip()
if "PCS" in ct or (not ct and code in self.pcs):
return CodeSystem.PCS
if ("ICD" in ct and "PROC" in ct) or ("ICD-9" in ct and code in self.icd9p):
return CodeSystem.ICD9_PROC
if "CPT" in ct or (not ct and first.upper() in self.cpt) \
or self.store.has_cpt_embedding(first.upper()):
return CodeSystem.CPT
if "ICD" in ct or (not ct and (code in self.icd or _dotted_cat(code) in self.icd_cat)):
return CodeSystem.ICD
if "LOINC" in ct or first in self.loinc:
return CodeSystem.LOINC
if "LABCHEM" in ct or "VA LAB" in ct or (
not ct and self.store.has_lab_sid(code.split(","))):
return CodeSystem.VA_LAB
return CodeSystem.MEDICATION
def neighbors(self, code: str, code_type: str | None = None,
drug_name: str | None = None, cap: int | None = None) -> dict:
"""cap: sibling window size per family; None = MEMBER_CAP, 0 = no cap."""
code = (code or "").strip()
if not code:
return self._none(code, "No code given.")
cap = MEMBER_CAP if cap is None else max(0, cap)
return self._routes[self.code_system(code, code_type)](code, code_type, drug_name, cap)
def _route_pcs(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
return self._family(code.split(",")[0].strip(), self.pcs, self.pcs_cat, _pcs_cat,
"procedure", "ICD-10-PCS procedure table — codes sharing this 3-character root.", cap)
def _route_icd9_proc(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
return self._family(code.split(",")[0].strip(), self.icd9p, self.icd9p_cat, _dotted_cat,
"procedure", "ICD-9 procedure family — codes in this category.", cap)
def _route_cpt(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
return self._rbcs_family(code.split(",")[0].strip().upper(), cap)
def _route_icd(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
graph = self._family(code.split(",")[0].strip(), self.icd, self.icd_cat, _dotted_cat,
"icd", "Diagnosis code family — the codes in this ICD category.", cap)
self._attach_phecodes(graph, code.split(",")[0].strip(), (code_type or "").upper())
return graph
def _route_loinc(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
return self._loinc(code.split(",")[0].strip(), cap)
def _route_va_lab(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
return self._local_lab(code, drug_name, cap)
def _route_medication(self, code: str, code_type: str | None, drug_name: str | None, cap: int) -> dict:
# The NDC and VA drug indexes pack every package/local code of a product
# into one comma-joined field (the longest is 52,506 characters), so the
# first entry is the one to resolve — the rest are the same product.
first = code.split(",")[0].strip()
mapping = self.store.ingredients_for(first)
if mapping:
return self._med(first, mapping, cap=cap)
if self.store.ingredients_by_name(code) or self.store.ingredients_by_rxcui(code):
return self._med(code, cap=cap)
if self.store.ingredients_by_name(first) or self.store.ingredients_by_rxcui(first):
return self._med(first, cap=cap)
if self.rxnav.supports(code, code_type):
mapping = self.rxnav.resolve(code, code_type, drug_name)
if mapping:
# Display the code that actually resolved, never the whole
# packed field, and record what it is so the drug node names
# its own vocabulary.
up = (code_type or "").upper()
kind = ("ndc" if mapping.get("matched_ndc")
else "rxcui" if "RXNORM" in up else None)
return self._med(mapping.get("matched_ndc") or first,
{**mapping, "kind": kind}, cap=cap)
return self._none(
code,
f"No unique RxNorm match found for {drug_name or code}.",
"medication",
)
return self._none(code, "No hierarchy is available for this code.")
# -- dotted / positional code family (nodes + edges) -------------------
def _family(self, code, table, buckets, cat_fn, kind, subtitle, cap: int = MEMBER_CAP) -> dict:
cat = cat_fn(code)
members = sorted(buckets.get(cat, []))
if not members:
return self._none(code, f"No {kind} family found for {code}.", kind)
sel = self._window(members, code, cap) # siblings around the clicked code
root_desc = (table.get(cat) or {}).get("description")
nodes = [{"id": cat, "label": cat, "tier": 0, "current": cat == code, "path": True,
"sub": root_desc or f"{table.get(code, {}).get('code_type', 'ICD')} category {cat}"}]
edges, path = [], [cat]
for c in sel:
if c == cat:
continue
is_cur = c == code
nodes.append({"id": c, "label": c, "sub": table[c]["description"], "tier": 1,
"current": is_cur, "path": is_cur,
"nav": {"code": c, "code_type": table[c]["code_type"]}})
edges.append([cat, c])
if is_cur:
path.append(c)
if len(members) > len(sel):
nodes.append({"id": f"more:{cat}", "label": f"+{len(members) - len(sel)} more",
"sub": "", "tier": 1, "more": True})
edges.append([cat, f"more:{cat}"])
return {"available": True, "kind": kind, "code": code, "title": code, "subtitle": subtitle,
"nodes": nodes, "edges": edges, "path": path, "note": None}
@staticmethod
def _window(items: list[str], focus: str, cap: int) -> list[str]:
"""Up to `cap` items centred on `focus`; cap 0 = no windowing."""
if cap <= 0 or len(items) <= cap:
return items
if focus in items:
idx = items.index(focus)
start = max(0, min(idx - cap // 2, len(items) - cap))
return items[start:start + cap]
return items[:cap]
def _attach_phecodes(self, graph: dict, code: str, code_type: str) -> None:
"""Annotate an ICD family graph with the code's phecode assignments."""
if not graph.get("available"):
return
versions = [v.strip().upper() for v in code_type.split("|") if v.strip()]
entry = self.store.phecodes_for(code, versions or ["ICD10", "ICD9"])
if entry:
graph["phecodes"] = {**entry, "provenance": provenance.phecode_line(entry)}
# -- CPT/HCPCS: CMS RBCS group -> index codes sharing it ---------------
def _rbcs_family(self, code: str, cap: int = MEMBER_CAP) -> dict:
entry = self.cpt.get(code)
derived_entry = None if entry else self.store.cpt_embedding_for(code)
if entry:
rbcs = self.store.rbcs_validated_for(code) or {}
group = entry["group"]
sub = " · ".join(x for x in ["RBCS " + rbcs.get("category", ""),
rbcs.get("subcategory", "")] if x.strip())
mapping = rbcs
elif derived_entry:
group = derived_entry["group"]
sub = ("RBCS " + derived_entry.get("category", "")).strip()
mapping = derived_entry
else:
return self._none(code, f"No RBCS group is available for {code}.", "procedure")
members = sorted(self.cpt_group.get(group, []) or [code])
sel = self._window(members, code, cap)
group_id = "rbcs:" + group
nodes = [{"id": group_id, "label": group, "tier": 0, "current": False,
"path": True, "sub": sub}]
edges, path = [], [group_id]
if derived_entry and code not in sel:
# The clicked code inherited this group by embedding match; it is
# not a validated member, so it joins the display explicitly.
sel = [code] + (sel[:max(0, cap - 1)] if cap > 0 else sel)
for c in sel:
is_cur = c == code
desc = (self.cpt.get(c) or derived_entry or {}).get("description", "")
nodes.append({"id": c, "label": c, "sub": desc,
"tier": 1, "current": is_cur, "path": is_cur,
"nav": {"code": c, "code_type": "CPT"}})
edges.append([group_id, c])
if is_cur:
path.append(c)
if len(members) > len(sel):
nodes.append({"id": "more:" + group_id, "label": f"+{len(members) - len(sel)} more",
"sub": "", "tier": 1, "more": True})
edges.append([group_id, "more:" + group_id])
# Say how much of the family is on screen. The window is centred on the
# clicked code, so two codes in one family legitimately show different
# neighbours; without the count that looks like the group is unstable.
shown = (f"Showing {len(sel)} of {len(members)}. "
if len(members) > len(sel) else "")
return {"available": True, "kind": "procedure", "code": code, "title": code,
"subtitle": f"CPT/HCPCS codes sharing the RBCS group: {group}. "
f"{shown}Codes in one family share this name.",
"nodes": nodes, "edges": edges, "path": path,
"derived": bool(derived_entry),
"match_tier": "embedding_match" if derived_entry else None,
"note": "Grouped by the CMS Restructured BETOS Classification System.",
"source": provenance.line(mapping.get("source", "cms_rbcs_ry2025"),
derived=bool(derived_entry),
match=mapping.get("match"))}
def _local_lab(self, code: str, display_name: str | None = None, cap: int = MEMBER_CAP) -> dict:
"""Resolve VA LabChemTestSID mappings before drawing the LOINC graph."""
entries = self.store.loinc_for(code.split(","))
if not entries:
return self._none(
code,
"No LOINC mapping found for this VA lab code.",
"lab",
)
targets = {entry["loinc"] for entry in entries}
if len(targets) != 1:
return self._none(
code,
"These VA lab codes map to multiple LOINC terms.",
"lab",
)
entry = entries[0]
loinc = entry["loinc"]
graph = self._loinc(loinc, cap)
if not graph.get("available"):
return graph
local_label = display_name or entry.get("lab_name") or code
graph.update({
"title": f"{local_label} → LOINC {loinc}",
"derived": bool(entry.get("derived")),
"match_tier": entry.get("match"),
"source": provenance.line(entry.get("source"),
derived=bool(entry.get("derived")),
match=entry.get("match"),
target=entry.get("loinc_version", "LOINC")),
"mapped_from": {
"system": "VA Lab List (LabChemTestSID)",
"code": code,
"name": local_label,
},
"mapped_loinc": loinc,
"note": (
f"VA Lab List {code} → LOINC {loinc}. "
"Related terms share its LOINC COMPONENT."
),
})
return graph
# -- LOINC lab: COMPONENT -> active terms sharing that component -------
def _loinc(self, code, cap: int = MEMBER_CAP) -> dict:
term = self.loinc.get(code)
if not term:
return self._none(code, f"{code} is not in the LOINC table.", "lab")
comp = term["component"]
members = sorted(self.loinc_by_comp.get(comp.lower(), [code]))
sel = self._window(members, code, cap)
comp_id = "comp:" + comp
nodes = [{"id": comp_id, "label": comp, "tier": 0, "current": False, "path": True,
"sub": ("LOINC component · " + term.get("class", "")).strip(" ·")}]
edges, path = [], [comp_id]
for c in sel:
t = self.loinc.get(c, {})
sub = " · ".join(x for x in [t.get("system"), t.get("name")] if x)
is_cur = c == code
nodes.append({"id": c, "label": c, "sub": sub, "tier": 1, "current": is_cur,
"path": is_cur, "nav": {"code": c, "code_type": "LOINC"}})
edges.append([comp_id, c])
if is_cur:
path.append(c)
if len(members) > len(sel):
nodes.append({"id": "more:" + comp_id, "label": f"+{len(members) - len(sel)} more",
"sub": "", "tier": 1, "more": True})
edges.append([comp_id, "more:" + comp_id])
return {"available": True, "kind": "lab", "code": code, "title": code,
"subtitle": f"Active LOINC terms sharing COMPONENT: {comp}.",
"nodes": nodes, "edges": edges, "path": path,
"note": "Grouped by LOINC COMPONENT.",
"source": provenance.line("loinc_2_82")}
# -- medication: ingredient(s) -> drug -> sibling products ------------
def _med(self, code, mapping=None, cap: int | None = None) -> dict:
e = (mapping or self.store.ingredients_by_name(code)
or self.store.ingredients_by_rxcui(code))
if not e:
return self._none(code, f"No RxNorm ingredient mapping for {code}.", "medication")
label = e.get("name") or code
ings = e.get("ingredients", [])
if not ings:
return self._none(code, f"No RxNorm ingredient is mapped for {code}.", "medication")
nodes, edges, seen = [], [], set()
drug_id = "drug:" + str(code)
path = [drug_id]
for ing in ings:
iid = "ing:" + str(ing.get("rxcui") or ing["name"])
# The RXCUI is the portable half of this graph and the only part a
# reader can take elsewhere, so it travels as its own field rather
# than staying encoded in the node id. Absent when the ingredient
# was matched by name and carries no RXCUI of its own.
nodes.append({"id": iid, "label": ing["name"], "sub": "RxNorm ingredient",
"code": ing.get("rxcui"), "code_label": "RXCUI",
"tier": 0, "current": False, "path": True})
edges.append([iid, drug_id])
path.append(iid)
# The drug node names the vocabulary of the code it displays. NDC and
# RXCUI keyed mappings were labelled VA Drug List ID before, which
# asserted a vocabulary the code is not in. A name-keyed mapping has
# no code to show, so the chip is left off entirely.
kind = e.get("kind")
code_label = {"ndc": "NDC", "rxcui": "RXCUI",
"drug_name": None}.get(kind, "VA Drug List ID")
nodes.append({"id": drug_id, "label": label, "sub": "this medication",
"code": str(code) if code_label else None,
"code_label": code_label,
"tier": 1, "current": True, "path": True})
n_prod = 0
for ing in ings:
iid = "ing:" + str(ing.get("rxcui") or ing["name"])
for prod in (e.get("child_drugs", {}) or {}).get(ing["name"], []):
if prod.upper() == label.upper() or prod in seen:
continue
seen.add(prod)
pid = "prod:" + prod
nodes.append({"id": pid, "label": prod, "sub": "", "tier": 2, "current": False})
edges.append([iid, pid])
n_prod += 1
# NDC package codes of this product. The mapping's own packages win;
# a mapping that carries none falls back to the NDCs RxNorm lists for
# the matched concept. The displayed code is excluded by digit
# comparison, since keys are dashed and stored packages are 11 digit
# strings. cap follows the family convention: 0 draws them all.
digits = lambda s: "".join(ch for ch in str(s) if ch.isdigit())
shown_digits = digits(code)
ndcs = [n for n in (e.get("ndcs") or []) if digits(n) != shown_digits]
if not ndcs:
rxcuis = e.get("matched_rxcuis") or []
if rxcuis:
ndcs = [n for n in self.rxnav.ndcs_for_rxcui(str(rxcuis[0]))
if digits(n) != shown_digits]
# One NDC hub in the middle tier, package codes hanging off it: bare
# 11-digit strings interleaved with product names read as noise, and
# the hub also gives the codes a labelled parent the way ingredients
# have. No `code` on the hub, so Select all never collects it.
limit = len(ndcs) if cap == 0 else NDC_NODE_CAP
if ndcs:
n_pkg = len(ndcs)
nodes.append({"id": "ndcgrp", "label": "NDC",
"sub": f"{n_pkg} package code{'' if n_pkg == 1 else 's'}",
"vocab": "NDC", "tier": 1, "current": False})
edges.append([drug_id, "ndcgrp"])
for n in ndcs[:limit]:
nid = f"ndc:{n}"
nodes.append({"id": nid, "label": n, "sub": "NDC package code",
"code": n, "code_label": "NDC",
"vocab": "NDC", "tier": 2, "current": False})
edges.append(["ndcgrp", nid])
if len(ndcs) > limit:
nodes.append({"id": "more:ndc", "label": f"+{len(ndcs) - limit} more",
"sub": "", "tier": 2, "more": True})
edges.append(["ndcgrp", "more:ndc"])
source = provenance.line(e.get("source"), derived=bool(e.get("derived")),
match=e.get("match"))
total_products = e.get("related_product_count", n_prod)
shown_products = e.get("related_products_shown", n_prod)
note = f"{total_products} related products."
if total_products > shown_products:
note += f" Showing the first {shown_products}."
return {"available": True, "kind": "medication", "code": code,
"title": label, "subtitle": "RxNorm ingredient(s) → this drug → related products and NDC packages.",
"nodes": nodes, "edges": edges, "path": path,
"derived": bool(e.get("derived")),
"match_tier": e.get("match") if e.get("derived") else None,
"note": (note if n_prod else None), "source": source,
"mapped_rxcuis": e.get("matched_rxcuis", [])}
@staticmethod
def _none(code, reason, kind=None) -> dict:
return {"available": False, "code": code, "kind": kind, "reason": reason}
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