Материал: part17

Preparation

Note

The procedure details contain information expected by the infusion informer / infusion action informer may use procedure code, procedure name or explicit contrast reference. The mechanism that steers this information into the Infusion Manager is not addressed.

Patient and Study context

Patient / Study selection

Create explict

Contrast Usage plan

Administration

Note

As many or as few details as possible - since it’s manual, only limited information is expected. (e.g., total volume, average flow rate, etc.)

Register contrast usage details

Contrast Report Use

Imaging Agent Administration SR

Figure LLLL.2-1. Use Case 1 - Manual Bolus Injection​

LLLL.2.2 Use Case 2 - Automatic Infusion Pump - Contrast Reporting​

The use case shown in Figure LLLL.2-2 is an example of how a performed object could be used for capturing an automatic infusion.​ The technologist selects a patient at the infusion manager from the work list available from the scheduling system and then performs​ anautomatedadministrationofcontrastfortheselectedpatient.Theinfusionmanagerrecordsvariouseventsduringtheadministration.​ The data from the injector events and from the adverse events that occurred during the administration are captured and obtained by​ the infusion manager.​

Upon completion of the administration procedure, the infusion manager generates a Performed Imaging Agent Administration SR​ objectusingtheinjectiondataobtainedfromtheinjectionsystemandincludingtheeventsandupdatedparametersthatwerecaptured​ during the administration. The generated report is then sent to the PACS and other contrast usage consumers.​

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Figure LLLL.2-2. Use Case 2 - Automatic Infusion Pump - Contrast Reporting​

LLLL.2.3 Use Case 3 - Protocoling​

The use case shown in Figure LLLL.2-3 is an example of how a planned object could be used. The radiologist uses the protocoling​ application in order to plan the contrast administration protocol for a patient. The protocoling application outputs the planned object​ into the infusion manager for immediate use or to the RIS or PACS. The planned object is used by the technologist during the study.​

Worklist Query

Procedure Steps

Radiologist starts new case

Requests prior performed SR

Return prior performed SR

Radiologist reviews orders

Radiologist customizes injection protocol for patient

Alternative 1

Register contrast usage details

Query contrast usage details

Provide contrast usage details

Alternative 2

Register contrast usage details

Figure LLLL.2-3. Use Case 3 - Protocoling​

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LLLL.2.4 Use Case 4 - Consumption of the Contrast Information by Reporting Systems for​ Automated Documentation​

This use case gives an example of how a Performed Imaging Agent Administration SR object could be used for capturing summary​ valuesofcontrastintoaradiologyreportingsystem.Inthiscase,theradiologyreportingsystemwouldbeaContrastUsageConsumer​ (Figure LLLL.2-2).​

The most straightforward and ubiquitous need for the contrast administration record is in the radiologist reporting workflow. Inclusion​ of delivered contrast data into templates or sections of the report is mandated in some regions of the world as evidence for billing​ reconciliation. More generally, the radiologist can include this data for completeness of study documentation. Ostensibly, contrast​ data included in reports may be used to construct a longitudinal record of contrast exposure for a patient undergoing multiple imaging​ studies.​

Data of primary importance in this workflow are the summary values of contrast administered to the patient (total volume of contrast,​ saline, flow rate and concentration/type of contrast used). Often, information describing the vascular access device used (e.g., cath-​ eter gauge) is clinically relevant and/or mandated.​

The guidance from ACR [ACR Communication] about the procedures and materials description in the report body states, “The report​ shouldincludeadescriptionofthestudiesand/orproceduresperformedandanycontrastmediaand/orradiopharmaceuticals(including​ specificadministeredactivities,concentration,volume,androuteofadministrationwhenapplicable),medications,catheters,ordevices​ used, if not recorded elsewhere”.​

LLLL.3 Informative References​

[ACR Communication] American College of Radiology. 2014. Resolution 11. ACR Practice Parameters and Technical Standards -​ Practice Guideline for Communication of Diagnostic Imaging Findings. http://www.acr.org/-/media/ACR/Files/​ Practice-Parameters/CommunicationDiag.pdf .​

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MMMM Performed Imaging Agent​ Administration Structured Report​ (Informative)​

This Annex describes the use of Imaging Agent Administration Structured Report objects.​

MMMM.1 Performed Imaging Agent Administration Structured Report​

This Section contains examples for use cases involving contrast imaging of a single patient in CT system.​

In the basic use case:​

•​Patient was scheduled by RIS system with a study UID and accession number.​

•​An Injection procedure for the study was described by an IAASR plan object.​

•​Patient suffers from insufficient renal function, so intravenous (i.v.) contrast agents were dissolved to achieve necessary volumes.​

•​Before i.v. contrast was administered a 10 mg Prednisone injection was given to the patient.​

•​Afterconnectingthepatienttotheinjectionsystem,apatencytestinjectionwasdone.(Theinjectionsystemdoesnotrecorddetailed​ graph information of this.)​

•​"Keep vein open" was activated at a rate of 1 ml per minute.​

•​The Requested Procedure was a CT abdominal study with both i.v. and oral contrast administration.​

•​Oral contrast media OralContrastofin was diluted to 25:1000 as given in the drug usage description. 1000 ml of oral contrast​ mediawasgiven2hoursinadvanceoftheprocedure.(Preparationof1000mlsolutionuses24.4mlcontrastand975.6mlwater)​

•​Test bolus and Imaging injection phase was done at 3 ml/s and were followed by a 30 ml flush at the same flow rate.​

•​Before the diagnostic injection, a test bolus of 10 ml undiluted ContrastStuff 370 contrast was given, in order to determine scan​ delay time for the diagnostic injection.​

•​Finally 88 ml i.v. contrast media ContrastStuff 370 (corresponding to 0.5 g iodine / kg body weight for a 65 kg person) was given​ during imaging. Due to the high viscosity of the contrast and renal insufficiency of the patient, ContrastStuff 370 was diluted 1:1​ with 88 ml flush on the fly during injection.​

The content tree structure would resemble:​

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