sct semantic

Semantic similarity search over a SNOMED CT Arrow IPC embeddings file.

Embeds your query text via Ollama and performs cosine similarity against all concept embeddings in the .arrow file produced by sct embed. Returns the concepts whose meaning is closest to your query text, including some concepts that don't share any keywords with it.

Experimental - read this before trusting a result

sct semantic runs a small, general-purpose text-embedding model (nomic-embed-text by default) - not a language model, and not one trained on medical text. It is genuinely useful as an adjunct to keyword search, surfacing paraphrase-level matches that sct lexical structurally cannot find. It is not reliable enough to trust unreviewed, and it has no real clinical or world knowledge: it does well when a query shares some vocabulary root with a concept's own text, and it can fail outright on idiomatic phrases that don't ("sugar sickness" for diabetes, "sticky blood" for hypercoagulable state - see Known limitations below for real, verified examples).

If you need deterministic, exact results, use sct lexical. If you need genuine meaning-level bridging - recognising that "sugar sickness" means diabetes - hand the terminology to an LLM instead: over sct mcp it can combine snomed_search and snomed_semantic_search judiciously and bring real-world knowledge that this embedding model doesn't have, while still grounding its answer in real SNOMED concepts.

Usage

sct semantic <QUERY> [--embeddings <FILE>] [--model <MODEL>] [--ollama-url <URL>] [--limit <N>] [--format text|json|yaml]

Options

Flag	Default	Description
`<QUERY>`	(required)	Natural-language search query.
`--embeddings <FILE>`	discovered (see Path resolution)	Arrow IPC file produced by `sct embed`.
`--model <MODEL>`	`nomic-embed-text`	Ollama model - must match the model used when building the embeddings.
`--ollama-url <URL>`	`http://localhost:11434`	Ollama base URL.
`--limit <N>`	`10`	Maximum number of results.
`-f, --format <FORMAT>`	`text`	Output format: `text`, `json`, or `yaml`.
`--ids`	off	Emit only matching SCTIDs (newline-delimited) for piping into other commands.
`--template <TEMPLATE>`	`{score} \\| {id} \\| {pt}`	Override the per-result line template (text output only). See `sct refset` for the variable list.
`--provenance` / `--no-provenance`	on for TTY, off otherwise	Show/hide release provenance (edition, release date) on this query's output.

Prerequisites

Ollama must be running with the same model that was used to build the embeddings:

ollama serve
ollama pull nomic-embed-text  # if not already pulled

Examples

# Paraphrase queries that share no SNOMED vocabulary at all - sct lexical
# returns nothing for any of these; sct semantic finds real candidates
sct semantic "can't stop peeing"          # → urinary urgency/incontinence concepts
sct semantic "chest pain climbing stairs" # → chest pain disorder concepts

# Return more results
sct semantic "difficulty breathing" --limit 20

# Pipe matching SCTIDs into a code list (review the file before trusting it -
# see the warning above)
sct semantic "urinary urgency" --ids --limit 30 | sct codelist add urgency.codelist -

# Use embeddings built with a different model
sct semantic "fracture" \
  --embeddings snomed-embeddings-small.arrow \
  --model mxbai-embed-large

# Use embeddings on a remote host
sct semantic "epilepsy" --ollama-url http://192.168.1.100:11434

Output

$ sct semantic "can't stop peeing"

0.6815 | 87557004 | Urge incontinence of urine
0.6762 | 249296002 | Sudden stoppage of urine flow
0.6757 | 299271000000100 | Urge to pass urine again shortly after finishing voiding
0.6710 | 249289004 | Must urinate repeatedly to empty urinary bladder
0.6562 | 5972002 | Delay when starting to pass urine

(Real output, UK Monolith 42.3.0, nomic-embed-text. The columns are {score} | {id} | {preferred_term}.)

The first column is the cosine similarity between the query vector and the concept embedding - a value between 0 and 1, where 1 means identical direction in vector space and 0 means completely unrelated.

There is no reliable score threshold that separates a good match from noise. With nomic-embed-text, real scores across a wide range of queries cluster in roughly 0.60-0.80 whether the top result is exactly right or completely wrong - a score of 0.66 might be a solid clinical match, or it might be latching onto an unrelated word (see Known limitations). Judge the returned concept, not the number. What the number is reliable for is relative ranking within one query's results - rank 1 is the model's best guess, and results usually degrade in relevance as you go down the list, even if the score gap between them is small.

How it works

Your query text is sent to Ollama, which returns a 768-dimensional float32 vector.
The .arrow file is scanned; cosine similarity is computed between the query vector and each concept's embedding.
The top-N concepts by score are printed.

The query is embedded using the same text template as sct embed, so the query vector lives in the same embedding space as the concept vectors. The search is entirely local - no network call beyond the Ollama process running on your machine.

Comparison with `sct lexical`

	`sct lexical`	`sct semantic`
Basis	Keyword matching (FTS5)	Meaning / vector similarity
Input	SQLite `.db`	Arrow `.arrow` + Ollama
Speed	Instant	A few seconds (Ollama round-trip + scanning the full `.arrow` file - observed 2-7 s on an 838k-concept UK Monolith)
Finds synonyms	Only if indexed	Yes
Finds related concepts without shared words	No	Yes
Works offline	Yes	Requires local Ollama
Deterministic / reliable	Yes	No - review results before trusting them

Use sct lexical when you know the SNOMED term, or need a dependable, repeatable result. Use sct semantic for exploring plain-language descriptions, but check what it returns.

Known limitations

Real, verified failures from testing against the UK Monolith with nomic-embed-text - kept here so expectations stay calibrated as the model or embedding scheme change.

Idiomatic phrases the model has no medical grounding for. A colloquial phrase that doesn't share a vocabulary root with its clinical concept can fail outright, with no signal in the score that anything went wrong:

$ sct semantic "sticky blood" --limit 3
0.6286 | 276403006 | Neonatal cord sticky
0.6222 | 104051000119105 | Exposure to body fluid due to accidental needle stick injury
0.6195 | 77262006 | Heel stick

The intended target - hypercoagulable state - never appears. The model has latched onto "sticky" and "stick" as tokens, not the medical idiom.

Synonym dilution. A concept whose preferred term is technical/Latin, but whose colloquial synonym is one of several in a list, can rank behind concepts that merely repeat the query phrase. sct semantic "heart attack" puts Myocardial infarction (22298006) at rank 11 (score 0.6998) - one place outside the default --limit 10 - behind several concepts that just happen to contain the word "heart" (Fear of having a heart attack, Contusion to heart).

Category drift. A query can land in the right clinical neighbourhood but the wrong part of SNOMED's hierarchy. sct semantic "water on the lungs" top-scores Measurement of extravascular lung water (a procedure) rather than the disorder a clinician means by that phrase (pulmonary oedema).

None of this is a bug in sct - the scores are exactly what the embedding model produces for the given text, reproducibly. It reflects nomic-embed-text being a general-purpose model with no medical fine-tuning. A future improvement path (per-synonym embeddings with max-pooling, or a clinically-trained model) is tracked in spec/roadmap.md; until then, treat every result as a candidate to review, not an answer.