Материал: part17

In the case of measurements from the Core Set, it is a well-known pre-coordinated code (i.e., the code is in CID 12300 “Core Echo​ Measurements”), the full semantics are well-known and the measurement will be recorded in TID 5301 “Pre-coordinated Echo​ Measurement” . Likely most, if not all, of the Core Set measurements come pre-configured on the Ultrasound System.​

In the case of vendor-specific or site-specific measurements, it is a pre-coordinated code managed by the site or the vendor which​ is entered and persisted on the Ultrasound System. Since the code is not well-known, the measurement will be recorded in TID 5302​ “Post-coordinated Echo Measurement” along with the modifiers describing its semantics.​

The receiver (i.e., the PACS display package or the reporting package) is configured to associate the specific pre-coordinated code​ with a location on the overlay or a slot in the report.​

The form of the user interface for these capabilities is up to the implementer.​

CCCC.2.1.2 Operation​

The user takes measurements on the Ultrasound System, including measurement ABC. All these measurements are recorded in the​ SimplifiedAdultEchoSRobject.IfmultipleinstancesofmeasurementABCareincluded,oneofthemmaybeflaggedbytheUltrasound​ System by setting the Selection Status for that instance to the reason it was selected as the preferred value.​

The Ultrasound System stores the SR object to the PACS.​

ThePACSorthereportingpackageretrievestheSRobjectandscansthecontentslookingformeasurementswiththepre-coordinated​ code for measurement ABC. If multiple instances are found, the receiver takes the one for which the Selection Status has been set.​

The receiver renders the measurement value to the display or report, annotating it with the recorded Units, Code Meaning, and/or​ Short Label as appropriate.​

Note that in this use case the receiver handles the measurement in a mechanical way. As long as the measurement can be unam-​ biguously identified, the semantics do not need to be understood by the receiver.​

CCCC.2.2 Use Case 2: Store and Process Measurements​

The user wishes to perform measurements on the Ultrasound System, store them to the PACS and later perform processing of some​ or all of the measurements on a CVIS (Cardiovascular Information System) or other system. Processing may include incorporating​ measurements into a database, performing trend analysis, plotting graphs, driving decision support, etc. One measurement taken at​ end systole may be compared to the "same" measurement that is taken at end diastole, etc. Measurements at the same Finding Site​ might be collected together.​

CCCC.2.2.1 Configuration​

As in Use Case 1, the Ultrasound System is configured to encode each measurement using a specific pre-coordinated code (and​ code meaning).​

Again, measurements from the Core Set use a well-known pre-coordinated code and are recorded in TID 5301 “Pre-coordinated​ Echo Measurement” while vendor-specific or site-specific measurements use locally managed codes and are recorded in TID 5302​ “Post-coordinated Echo Measurement” along with the modifiers describing their semantics.​

CCCC.2.2.2 Operation​

The user again takes measurements on the Ultrasound System which are recorded in the Simplified Adult Echo SR object and if​ multiple instances of a measurement are included, one of them may be flagged by the Ultrasound System by setting the Selection​ Status for that instance to the reason it was selected as the preferred value.​

The Ultrasound System stores the SR object to the PACS.​

ThereceivingdatabaseorprocessingsystemretrievestheSRobjectandparsesthecontents.ThecontentsofTID5301“Pre-coordin-​ ated Echo Measurement” have known semantics and are processed accordingly.​

On first encounter, measurements in TID 5302 “Post-coordinated Echo Measurement” will likely have unfamiliar pre-coordinated​ codes (since the pre-coordinated code in Row 1 of TID 5302 is not taken from CID 12300 “Core Echo Measurements”, but rather was​ likely produced by the vendor of the Ultrasound System). Depending on the sophistication of the receiver, parsing the modifiers may​

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provide sufficient information for the receiver to automatically handle the new measurement. If not, the measurement can be put in​ an exception queue for a human operator to review the values of the modifiers and decide how the measurement should be handled.​ In between those two possibilities, the receiver may be able to compare the modifier values of known measurements and provide the​ operator with a partially categorized measurement.​

In any case, once the semantics of the measurement are understood by the receiver, the corresponding pre-coordinated code can​ be logged so that future encounters with that measurement can be handled in an automated fashion.​

The receiver may also make use of the Selection Status values or may database all the provided measurement values or allow the​ human to select from the provided set.​

Note that in this use case the receiver handles the measurements based on the semantics associated with the measurement.​

CCCC.3 Differences of Note Between TID_5200 and TID 5300​

CCCC.3.1 Report Sections​

In TID 5200 “Echocardiography Procedure Report”, containers and headings were used to facilitate the layout of printed/displayed​ reports by collecting measurements into groups based on concepts like anatomical region. Further, TID 5200 permitted Ultrasound​ Systems to add new sections freely, TID 5300 “Simplified Echo Procedure Report” does not. Section usage was a source of problem-​ aticvariabilityforreceiversofTID5200.TID5300constrainsthis.Whensuchgroupingsareuseful,forexamplewhenprintingreports,​ it makes more sense to configure it in one place (in the receiving database/reporting system) rather than configuring such groupings​ independently(andpossiblyinconsistently)oneachultrasounddeviceinadepartment.Receiversmaychoosetogroupmeasurements​ based on Finding Site or some other logic as they see fit. This avoids the problem of trying to keep many Ultrasound Systems in sync.​ SRobjectsareconsideredacquisitiondata/evidence.IfthefindingsaretranscodedintoCDAreports,sectionswilllikelybeintroduced​ in the CDA as appropriate.​

CCCC.3.2 Finding Observation Type​

The Finding Site is the location at which the measurement was taken. While some measurements will be an observation of the​ structure of the finding site itself, other measurements will be an observation of something like flow, in which case the Finding Site is​ simplythelocation,nottheactualthingbeingobserved/measured.Toclarifythisdistinction,FindingObservationTypewasintroduced​ in TID 5302 “Post-coordinated Echo Measurement” . For example, when the measurement is a peak velocity and the Finding Site is​ a valve, to distinguish between a measurement of the velocity of the blood through the valve, and a measurement of the velocity of​ thevalvetissue,theFindingObservationTypewouldbesetto"HemodynamicMeasurement"or"BehaviorofFindingSite"respectively.​

CCCC.4 Usage Guidance​

CCCC.4.1 Finding Site​

Modifiers are not permitted on the Finding Site in TID 5302 “Post-coordinated Echo Measurement” since such modifiers resulted in​ different ways of encoding the same concept. TID 5302 requires the use of a single anatomical code that fully pre-coordinates the​ location details of the measurement. CID 12305 “Basic Echo Anatomic Sites” has proven to be sufficient to encode the ASE Core​ Set of measurements. Implementers are strongly recommended to using codes from that list. If there is a truly significant location​ detail that needs to be captured, e.g., to identify a specific segment of the atrial wall, or a specific leaf of a valve as the location of the​ measurement, then the implementer may introduce a new code (CID 12305 is extensible) or better yet, new codes can be added to​ CID 12305 through a DICOM Change Proposal.​

CCCC.4.2 Measured Property​

ThecodesinCID12304“EchoMeasuredProperties”havealsoproventobesufficienttoencodetheASECoreSetofmeasurements.​ It is expected that the majority of vendor-specific or site-specific measurements can also be encoded using these properties, but it is​ understandable that some additional codes may be needed. When introducing new codes, implementers should be careful not to in-​ troduce elements of the other modifiers, such as Finding Site or Cardiac Cycle Point, into the Measured Property. For example, do​ not introduce a property for Diastolic Atrial Length to be used for the left and right atria, rather for such a measurement, use Prop-​ erty=Length, Cardiac Cycle Point=End Diastole and Finding Site=Left Atrium or Right Atrium respectively.​

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CCCC.4.3 Image View​

Implementers may use codes for image views beyond those listed in DCID 12226 “Echocardiography Image View” as needed, but​ note that Image View is only recorded if it is significant to the interpretation of the measurement. Inclusion of the Image View will likely​ isolate the measurement from other measurements of the same feature taken in different views.​

CCCC.4.4 Cardiac Cycle Point​

Note that (111973004, SCT, "Systole") is used here to refer to the entire duration of ventricular systole, while (416430001, SCT, "End​ Systole") is used to refer to the point in time where the aortic valve closes (or in the case of the right ventricle, the pulmonary valve).​ Therefore, a Vmax measurement for systole would mean the maximum velocity over the period of systole, and a Vmax measurement​ for end systole would mean the maximum velocity at the time point of end systole.​

CCCC.4.5 Measurement Method​

This distinguishes between two measurements that convey the same concept, but are obtained or derived in a different way. As with​ the Image View, this is only recorded if it is significant to the interpretation of the measurement.​

CCCC.4.6 Selection Status​

This is used to flag the preferred value when multiple instances of the same measurement are recorded in the SR object. Using this​ to communicate the value preferred by the operator or the Ultrasound System is very useful for receivers that lack the logic to make​ a selection themselves. In cases where there is no need or value in sending multiple instances of the same measurement, the issue​ can be avoided by only sending a single instance of any given measurement in the SR object.​

CCCC.4.7 Additional Modifiers​

The concept modifiers in the template are sufficient to accurately encode all the best practice echo measurements recommended by​ the ASE. Although TID 5302 “Post-coordinated Echo Measurement” is extensible and adding new modifiers is not prohibited, the​ meaning and significance of such new modifiers will generally not be understood by receiving systems, delaying or preventing import​ of such measurements. Further, adding modifiers that replicate the meaning of an existing modifier is prohibited.​

CCCC.5 Example​

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