Материал: part17

the left side and in the right eye the nasal subfields are on the right side (nasal as determined by the location of the subfield closest​ to the nose).​

The OPT macula thickness report consists of the thickness at the center point of the grid, and the mean retinal thickness calculated​ for each of the 9 subfields of the grid. In the context of the macular disease considered for the diagnosis, and qualitative interpretation​ of morphology from examination and OPT and/or other modalities, the clinician uses the macula thickness report to determine if the​ center and the grid subfield averages fall outside the normative range. Monitoring of macular disease by serial grid measurements​ allows assessment of disease progression and response to intervention. Serial measurements are assessed by comparing OPT​ thickness or volume reports, provided that the grids are appropriately centered upon the same location in the macula for each visit.​

Figure UU.5-1. Macular Grid Thickness Report Display Example​

The center point of the grid should be aligned with the anatomic center of the macula, the fovea. This can be approximated by having​ thepatientfixateuponatargetcoincidentwiththecenterofthegrid.However,erroneousretinalthicknessmeasurementsareobtained​ when the center of the grid is not aligned with the center of the macula. This may occur in patients with low vision that cannot fixate​ upon the target, or in patients that blink or move fixation during the study. To determine the expected accuracy of inter-visit compar-​ isons, clinicians would benefit from knowing the alignment accuracy of the OPT data from the two visits. Ophthalmologists may also​ want to customize locations on the fundus to be monitored at each visit.​

The following figure illustrates how the content items of the Macular Grid Thickness and Volume Report are related to the ETDRS​ Grid. Figure shown is not drawn to scale.​

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Figure UU.5-2. - ETDRS GRID Layout​

UU.6 Interpretation of OPT​

The process of evaluation of diabetic macular edema will help illustrate the role of the OPT macula thickness report. In diabetic​ macular edema there is a breakdown in the blood retina barrier, which can lead to focal and/or diffuse edema (or thickening) of the​ macula. The report of the thickness of each subfield area of the macula grid will help direct treatment. For instance, laser treatment​ to a specific thickened quadrant would be expected to reduce the thickness of retina in the treated zone. Serial comparisons of OPT​ thicknesses should demonstrate a reduction in thickness in the successfully treated zone. A zone that subsequently became thicker​ on follow-up scans may warrant further treatment. In addition to an expected local response to specific zonal treatment such as laser,​ there are treatments with drugs and biologics that are less localized. For instance, the injection of intravitreal drugs in a successfully​ treated eye would be expected to have a global reduction of thickness in all zones with DME. Patients with severe retinal disease​ may lose the ability to fixate making the acquisition of OPT images to represent a specific zone less reliable.​

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VV Pediatric, Fetal and Congenital Cardiac​

Ultrasound Reports (Informative)​

VV.1 Content Structure​

Figure VV.1-1 is an outline of the Pediatric, Fetal and Congenital Cardiac Ultrasound Reports.​

ROOT

Document Title (CONTAINER)

Target Site

(CODE)

Figure VV.1-1. Top Level Structure of Content​

VV.2 Pediatric, Fetal and Congenital Cardiac Ultrasound Patterns​

The common Pediatric, Fetal and Congenital Cardiac Ultrasound measurement pattern is a group of measurements obtained in the​ context of a protocol. Figure VV.2-1 shows the pattern.​

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Figure VV.2-1. Pediatric, Fetal and Congenital Cardiac Ultrasound Measurement Group Example​

VV.3 Measurement Terminology Composition​

Because of the wide variety of congenital issues in fetal and pediatric cardiology, DICOM identifies these findings primarily with post-​ coordination. The concept name of the base content item typically specifies a property, which then requires an anatomic site concept​ modifier.​

Further qualification specifies the image mode and the image plane using HAS ACQ CONTEXT with the value sets shown below.​

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WW Audit Messages (Informative)​

This annex holds examples of audit messaging, as described by the Audit Trail Message Format Secure Use Profile in PS3.15.​

WW.1 Message Example​

An example of one of the DICOM Instances Transferred messages is shown in Example WW.1-1.​

Example WW.1-1. Sample Audit Event Report​

<?xml version="1.0" encoding="UTF-8"?> <AuditMessage

xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="D:\data\DICOM\security\audit-message.rnc"> <EventIdentification

EventActionCode="C" EventDateTime="2001-12-17T09:30:47" EventOutcomeIndicator="0">

<EventID code="110104" codeSystemName="DCM"

displayName="DICOM Instances Transferred"/> </EventIdentification>

<ActiveParticipant

UserID="123"

AlternativeUserID="AETITLE=AEFOO"

UserIsRequestor="false"

NetworkAccessPointID="192.168.1.2"

NetworkAccessPointTypeCode="2">

<RoleIDCode

code="110153"

codeSystemName="DCM" displayName="Source Role ID"/>

</ActiveParticipant>

<ActiveParticipant

UserID="67562"

AlternativeUserID="AETITLE=AEPACS"

UserIsRequestor="false"

NetworkAccessPointID="192.168.1.5"

NetworkAccessPointTypeCode="2">

<RoleIDCode

code="110152"

codeSystemName="DCM" displayName="Destination Role ID"/>

</ActiveParticipant>

<ActiveParticipant

UserID="smitty@readingroom.hospital.org"

AlternativeUserID="smith@nema" UserName="Dr. Smith" UserIsRequestor="true" NetworkAccessPointID="192.168.1.2" NetworkAccessPointTypeCode="2"> <RoleIDCode

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