Digital Imaging and Communications in Medicine (DICOM) Supplement 26: Ultrasound...

Digital Imaging and Communications in Medicine (DICOM)4

Supplement 26: Ultrasound Procedure Reports

8

12

16

20

Status: InitialEarly Draft May 31, 2001,VERSION: 4 June, 2001

D. Sluis

24

DICOM Standards Committee

1300 N. 17th Street

Rosslyn, Virginia 22209 USA28


Table of Contents

Table of Contents...........................................................................................................................................2

Version History...............................................................................................................................................4

Foreword 432

Scope and Field of Application......................................................................................................................5

Disclaimer 5

Open Issues...................................................................................................................................................5

Resolved Issues.............................................................................................................................................536

Code Status...................................................................................................................................................7

Part 3, Annex A Addendum...........................................................................................................................8

1. Part 3, Annex X Addendum.....................................................................................................................9

ANNEX X (INFORMATIVE) ....................................................................................................................940

X.1 SR Content Tree Structure.........................................................................................................9X.2 Vascular Observation Patterns................................................................................................10X.3 OB-GYN Observation Patterns................................................................................................10X.4 Echo Observation Patterns......................................................................................................1344

X.5 Selected Value.........................................................................................................................13X.6 Explicitly Specifying Calculation Dependencies.......................................................................14X.7 Linking Observations to Images and Image Coordinates........................................................15X.8 Observation Context with Multiple Fetuses..............................................................................1548

X.8 Procedure Summary................................................................................................................16Figure X.9-1 Procedure Summary...............................................................................................................17

Part 4 Addendum.........................................................................................................................................18

B.5 STANDARD SOP CLASSES..........................................................................................................1852

Part 6 Addendum.........................................................................................................................................19

ANNEX A (NORMATIVE): REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID).............................19

Part 16 Addendum.......................................................................................................................................20

Annex A DCMR Templates (Normative).................................................................................................2056

A.T: ULTRASOUND SR TEMPLATES.................................................................................................20

A.1: VASCULAR ULTRASOUND SR TEMPLATES.............................................................................22TID nnn1 Vascular Ultrasound Procedure Document Root Template........................................22TID nnn11 Vascular Ultrasound Observation Group Template...................................................2360

A.U: OB-GYN ULTRASOUND SR TEMPLATES..................................................................................24TID nnn2 OB-GYN Ultrasound Procedure Document Root Template........................................24TID nnn12 OB-GYN Observation Group Template......................................................................25

A.V: ECHOCARDIOGRAPHY SR TEMPLATES..................................................................................2664

TID nnn3 Echocardiography Procedure Document Root Template............................................26TID nnn13 Echocardiography Observation Group Template......................................................27

A.W: COMMON ULTRASOUND SR TEMPLATES..............................................................................29TID nnn25 Ultrasound Observation Supplemental Template......................................................2968

TID nnn29 Image Reference Template.......................................................................................29TID nnn30 Patient Characteristics Template................................................................................30

Annex B DCMR Context Groups (Normative)........................................................................................31

B.U: VASCULAR ULTRASOUND CONCEPT GROUPS.....................................................................3172

B.V: ECHOCARDIOGRAPHY CONCEPT GROUPS...........................................................................35


B.W: OB-GYN ULTRASOUND CONCEPT GROUPS..........................................................................37

B.X: COMMON ULTRASOUND CONCEPT GROUPS........................................................................42CONTEXT GROUP xxx20 – Patient Characteristics......................................................................4276

Annex C Acquisition Context Templates (Normative).............................................................................42

Annex D DICOM Controlled Terminology Definitions (Normative).........................................................43

Appendix (Relevant DICOM Templates).....................................................................................................46

TID 1001 OBSERVATION CONTEXT........................................................................................4680

TID 1002 OBSERVER CONTEXT..............................................................................................46

TID 1003 PERSON OBSERVER IDENTIFYING ATTRIBUTES................................................47

TID 1004 DEVICE OBSERVER IDENTIFYING ATTRIBUTES..................................................47

TID 1005 PROCEDURE CONTEXT...........................................................................................4884

TID 1006 SUBJECT CONTEXT..................................................................................................48

TID 1007 SUBJECT CONTEXT, PATIENT................................................................................49

TID 1008 SUBJECT CONTEXT, FETUS....................................................................................50

TID 1200 LANGUAGE DESIGNATION......................................................................................5088

TID 1204 LANGUAGE OF CONTENT ITEM AND DESCENDANTS.........................................50

Appendix (Relevant DICOM Concept Groups)............................................................................................51CID 617 Measurement Type..........................................................................................................51CID 5 Transducer Approach...........................................................................................................5192

CID 7 Ultrasound Beam Pat...........................................................................................................53CID 7456 Units of Measure for Age................................................................................................54CID 7460 Units of Linear Measurement.........................................................................................54CID 7461 Units of Area Measurement............................................................................................5496

CID 7462 Units of Volume Measurement.......................................................................................55CID 7470 Linear Measurements.....................................................................................................55CID 7471 Area Measurements.......................................................................................................56CID 7472 Volume Measurements..................................................................................................56100


Version History

Version Date Notes

1 April, 2000 Initial draft

2 May16, 2000 Initial draft

3 May 2131 Revisions of WG12 May 20 meeting

4

Foreword

This supplement to the DICOM standard introduces the DICOM format for the results of numeric104

ultrasound procedure reports.

This draft Supplement to the DICOM Standard was developed according to DICOM CommitteeProcedures. The DICOM Standard is developed in liaison with other Standards Organizations includingHL7, CEN/TC 251 in Europe and MEDIS-DC, JAMI, and JIRA in Japan, with review by other108

organizations.

The DICOM Standard is structured as a multi-part document using the guidelines established in thefollowing document:

- ISO/IEC Directives, 1989 Part 3 - Drafting and Presentation of International Standards.112

This document is a Supplement to the DICOM Standard. It is an extension to PS 3.3, PS 3.4 and 3.6 ofthe published DICOM Standard which consists of the following parts:

PS 3.1 - Introduction and Overview

PS 3.2 - Conformance116

PS 3.3 - Information Object Definitions

PS 3.4 - Service Class Specifications

PS 3.5 - Data Structures and Encoding

PS 3.6 - Data Dictionary120

PS 3.7 - Message Exchange

PS 3.8 - Network Communication Support for Message Exchange

PS 3.9 - Point-to-Point Communication Support for Message Exchange

PS 3.10 - Media Storage and File Format124

PS 3.11 - Media Storage Application Profiles

PS 3.12 - Media Formats and Physical Media

PS 3.13 - Print Management - Point-to-point Communication Support

PS 3.14 - Grayscale Standard Display Function128

PS 3.15 - Security Profiles

PS 3.16 - Content Mapping Resource

These Parts are independent but related documents.132


Scope and Field of Application

This supplement to the DICOM standard defines templates for ultrasound procedure reports. Ultrasoundprocedure reports provide evidence for diagnostic interpretation: not the output, which is the physicianreport. Physician reports is the subject of a future Supplement. This Supplement addresses the following136

clinical specialties:

a. OB-GYN

b. Vascular

c. Echocardiography140

This Supplement does not address:

a. Fetal echocardiography

b. Pediatrics144

c. Physician reports

Disclaimer

This Supplement is an initial draft intended to outline an approach for defining templates and conceptgroups for incorporation into DICOM. It is based on a an encoding approach outlined by WG12 that is not148

yet complete. At this time, the focus is template structure and context grop definition that can describethe encoding approach and the required terms. There are known typos and inconsistencies (hopefullyminor).

Open Issues152

1) Some observation types can be a member of a cluster that should be treated as unit for thepurpose of editing or deleting. Need to describe the usage, motivation and proposal to signify thatan observation is a member of such a group

2) We need a section on how to handle Method of Creation (section 4.8 from Proposal for the Use of156

Structured Reporting in Ultrasound). [Evaluate a new CG for use with “Measurement Tool”(see Row 6 of TID nnn25 Supplemental Template). ]

3) Code meanings need to be assigned. LOINC does not provide a code meaning the way DICOMintended its use. There needs to be a process to create one.160

4) Have not yet considered general comments and where they should go. I propose allowing “generalcomment” TEXT nodes under any section heading.

Resolved Issues

1) Data Precision (Nov. 2000)164


The NUM type uses the “DS” VR type for its value, which limits us to a 16 character text-basednumeric representation of data. Will this be sufficient to represent all data accurately? Will theinevitable rounding/truncation of data introduce artifact that a customer will perceive betweendifferent ends of the DICOM transfer pipe?168

It was decided that 16 characters will be accurate enough.

2) Comprehensive vs. Enhanced structured reports (Nov. 2000)

Do we want to advocate sticking to only Comprehensive structured reports for ultrasound?

It was overwhelmingly voted to only support Comprehensive structured reports.172

3) What is a good name for the Fetal Container? (Nov. 2000)

Fetal Biometry implies measurements. How about Fetus Information? Fetal Data? Does anyonehave better suggestions?

This became a non-issue when it was decided to use section headings for OB instead of Pete’s176

initial proposal.

4) How do we handle invalid numbers? (Nov. 2000)

Consider the following scenario: Dr. Titus is looking at his vascular report. He can see his deltatime and his delta velocity, but where the heck is his acceleration? (He neglects to notice that his180

acceleration was infinite due to infinite slope, but quite frankly, he doesn’t care. He wants to seesomething.) While a corner case, this does happen.

It was decided to introduce a property called “NumberError” to the number to indicate these states.

How do represent Invalid Numbers? (Feb. 2001)184

Numbers in measurements and calculations can have invalid states, such as NaN (not a number),-Infinity, +Infinity, etc. What do we store as the value for these numbers?

It was decided that invalid numbers should have an empty number field.

5) Is an observation encoded as a CONTAINER or CODE. What is the concept meaning or code188

value? At the May 2001 it was decided to use the CONTAINER with a concept meaning ofobservation group.

6) Should ranges have TEXT description? At May 2001 meeting it was decided to stay with numericas defined in the normality template. Reevaluate only if a specific case emerges to warrant it.192

7) Should there be TEXT representation of composite units such as the obstetric use of xxWxD? Atthe May 2000 meeting it was decided to use units of days, There was insufficient justifcation forthe additional complexity of an alternate TEXT representation.

8) Specification of units: At the May 2001 meeting, it was decided that it was not necessary to specify196

unit constraints. Report creators can be trusted not to choose units inconsistent with the propertyof the observation. Also, applications vary in their choice of unit for a property type (e.g. mm orcm), and since UCUM provides a formal grammar for unit conversion, report creators should befree to use the same units as the application’s native representation.200

9) At the May 16 meeting WG12 confirmed the decision to use the Comprehensive SOP Class UID.WG12 does not see how new UID’s would benefit interoperability.


Code Status204

The following table lists the primary context groups used by this Supplement and the status of their termsdefinition.

Context Group Terms Status PrimaryCSD

Comment leader

Vascular Headings DCM Candidate list. all

Vascular Anatomical Location SNM3 lars

Vascular Anatomical LocationModifier

SNM3 lars

Vascular UltrasoundObservations

DCM?,LN

A few LOINC terms exist. WG1 hemo lars

OB-GYN Headings DCM Candidate list all

OB-GYN UltrasoundObservations

LN, DCM Many LOINC terms exist doug

OB Gestational Age Method LN Need to start or extend existing LOINC terms ifusable

Doug/Pete

Echocardography Headings DCM Candidate list all

EchocardiographyObservations

LN Many LOINC terms exist Pete

Patient Characteristics LN, DCM all

Note: all members should should submit terms required. The leader is responsible for208

integrating the list into the concept group table and correlating these to existing terms ifavailable.


Add the following to PS 3.3 Section 4 Symbols and Abbreviations212

Placeholder for new symbols and abbreviations.

Part 3, Annex A Addendum

Add the following to PS 3.3 Annex A

The current consensus is not to create new SOP Classes. Instead, use the Comprehensive216

according to this Supplement.


1. Part 3, Annex X Addendum

Add the following to PS 3.3

ANNEX X (INFORMATIVE)220

X.1 SR Content Tree Structure

The templates for ultrasound reports are defined in PS 3.16, Annex A, DCMR Templates. The followingfigure is an outline of the common elelments of ultrasound structured reports.

ROOTDocument TitleCONTAINER

CONTAINSPatient Characteristics

CONTAINER

1

CONTAINSObservations

NUM, CODE, TEXT

1-N

CONTAINSProcedure Summary

CONTAINER

0-1


NUM, CODE, TEXT

1-N

CONTAINSImage LIbraryCONTAINER

0-1

CONTAINSImage Entry

IMAGE

1-N


NUM, CODE, TEXT

0-N

CONTAINSHeading

CONTAINER

1-N

CONTAINSObs. Group

CONTAINER

0-N


NUM, CODE, TEXT

1-N

224Figure X.1-1 Top Level Structure of Content Tree

The Patient Characateristics Container is for the patient’s relevant context. This information oringinatesoutside the procedure.

The Procedure Summary contains observations of immediate or primary significance.a summary of228

procedure highlights. This is key information a physician typically expects to see at the outset ofinterpretation.

Section Headings are specific to the particular procedure type. Typically the headings reflect anatomiccalclasssifications.232

The actual observations reside in Observation Group containers as children elements of the sectionheadings. Observation Groups share procedural context. It may be specific to a modality productimplementation or user. In vascular, the observation group is an observation set performed at a particularanatomical location. OB-GYN observation groups also relate to an anatomical site, and may consist of236

specific measurements, an average, and derived calculations. Echocardigraphy observation groupstypically share the some context such as an acquisition protocol which may be defined by the systemmanufacturer or user. TBD: The concept name of the observation group is a code meaning“observations” or a code describing the observation type such as for example: BPD, ovary, carotid artery,240

mitral regurgitation, or left ventricular ejection fracation. [Altenatively, the Observation Group is of


Value Type CODE and encoded with a concept name of “observations” and with values describingthe observation type. The children then have HAS PROPERTIES relationships.]

If present, the Image Library contains a list of images from which observations were derived from. These244

are referenced from the observations with by-reference relationships.

X.2 Vascular Observation Patterns

The common vascular pattern is a set of measurements and calcuations that apply to a specificanatomical location The anatomical loaction is the acquisition context of the observation group. For248

example, an observation group may have an acquisition context of Common Iliac Artery with severalobservations such as mean velocity, peak systolic velocity, acceleration time, etc.

CONTAINSObservation Group

CONTAINER

HAS ACQCONTEXT

Anatomic LocationCODE

HAS PROPNormality andSignificanceINCLUDE

CONTAINSObservation

NUM

HAS CONCEPTMODIFIERTechnique

CODE

HAS CONCEPTMODIFIER

Vascular LocationModifierCODE

1-N

0-1

HAS CONCEPTMODIFIER

Selected ValueCODE

0-1

mean, min,max, best value,etc.

0-1

mean velpeak systolic veldiastolic velocity

resistive indexetc.

equation,reference,etc.

0-1

TBD

eg left, right,distal,

TBD

Figure X.2-1 Vascular Numeric Observation Group252

X.3 OB-GYN Observation Patterns

A common OB-GYN pattern is that of several instances of a specific observatoin (e.g. BPD), thecalculated average of those values, and an associated gestational age calculated according to anequation or table. The measurements and calcuations are all sibling observations in the observation256

group. The specific equation or table is conveyed as a concept modifier to the gestational age. Alsoassociated with the age, is the time interval representing the standard deviation of the population withinthe range. [TBD. Need a way to state that this is STD, percentile, etc.]

260



CONTAINER

CONTAINSGestation Age

NUM

HAS CONCEPTMODIFIER

Calc TechniqueCODE

equation,reference,etc.

CONTAINSObservation

NUM

e.g. BPD

HASPROPERTIES

MethodCODE

CONTAINSObservation

NUM

e.g. Hadlock84

HAS CONCEPT MODSelected Value

CODE

values in CID 617, e.g. mean

HASPROPERTIES

LabelTEXT

Figure X.3-1 OB Numeric Biometry Observation Group


CONTAINER

CONTAINSFollicle Diameter

NUM

CONTAINSFollicle Volume

NUM

CONTAINSFollicle Diameter

NUM


CODE

HAS ACQCONTEXTIdentifierr

TEXT

values in CID 617, e.g. mean264

Figure x.x.x.4: Example: GYN Follicle Observation Group



CONTAINER

CONTAINSOvary Diameter

NUM

CONTAINSOvary Volume

NUM

CONTAINSOvary Diameter

NUM


CODE

HAS ACQCONTEXTAnatomical

Location ModifierCODE

Left or Right

Also allow:length, width, height, ?

eg. mean

Figure x.x.x.5: Example: GYN Ovary Observation Group268


CONTAINER

CONTAINSAFI Diameter

NUM


CODE

HAS ACQCONTEXTIdentifier

TEXT

e.g {Left/right,Upper Lower}t

eg. mean

CONTAINSAmniotic FluidIndex (hdng)CONTAINER

HAS PROPAmniotic Fluid

IndexNUM

Once instance of this Obs. Groupcontainter: one per quandrant

Figure x.x.x.6: Example: Amniotic Fluid Index


272

X.4 Echo Observation Patterns


CONTAINER

CONTAINS29436-3,LN, LVDd

NUM

HAS ACQCONTEXT

2D LV EF ProtocolTEXT

protocol ortechnique CONTAINS

29436-3,LN, LVDdNUM

CONTAINS29436-3,LN, LVDd

NUM


CODE= by mean

CONTAINS29438-9,LN, LVDs

NUM


NUM


NUM


CODE= by mean

CONTAINSLV Vol (d)

NUM

CONTAINSLV Vol (s)

NUM

CONTAINSStroke Volume

NUM

CONTAINSFract. Shortening

NUM

HAS CONCEPT MODMethodCODE

=Teichholz

HAS CONCEPT MODMethodCODE

=Teichholz

CONTAINSCariac Output

NUM

Figure X.4-1 Echocardiography Observation Group Example276

X.5 Selected Value

When multiple observations of the same type exist, one of these may be denoted as the chosen orselected value. Typically, the this value is the average of the others, or it may be the last entered, or user280

chosen by the observer. Attaching a “Selected Valued” concept modifier uniquely identifies this value.


Observations elsewhere in the content tree that depend on an observation of this type, are assumed todepend on the selected value unless explicitly referenced with an R-INFERRED from relationship. Bydefault an average is the value used for deriving values.284


CONTAINER

CONTAINSBPD=5.2

NUM

CONTAINSBPD=5.3

NUM

CONTAINSBPD=5.1

NUM

HAS CONCEPT MODSelected Value = mean

CODE

Figure X.6-1 Selected Values

288

X.6 Explicitly Specifying Calculation Dependencies

A report creator may create Rreports may that specify the caclulation dependencies of a calculation on itsdependent observations.In where there is potential ambiguity as to which observation in the report a292

cacluation used, or, if the report creator simply chooses a convention of explit reference, the Theoperands of the calculation may be explicity referenced using by-reference relationships. The usage isoptional. The report may include it selectively to remove ambiguity as to which observations a cacluationused, or it may adopt a convention of explit reference,296



CONTAINER

CONTAINSStroke Volume

NUM

CONTAINSCariac Output

NUM

R-INFERREDFROM

CONTAINSHeart Rate

NUM

R-INFERREDFROM


CONTAINER

Figure X.6-1 Explicit Dependencies

X.7 Linking Observations to Images and Image Coordinates300

Optionally, the relationship of an observation to its image and image coordinates can be encoded with by-reference content items as the following figure shows. For conciseness, the by-reference relationshippoints to the the content item in the Imaeg Library, rather than directly to the image.

INFERRED FROMHeading

SCOORDSR-INFERRED FROM

CONTAINSImage LIbraryCONTAINER

CONTAINSImage Entry

IMAGE

CONTAINSObservation

NUM, CODE, TEXT

R-SELECTED FROM

CONTAINSObservation

NUM, CODE, TEXT

CONTAINSImage Entry

IMAGE

304

Figure X.7-1 Relationships to Images

X.8 Observation Context with Multiple Fetuses

Where multiple fetuses exist, the observations specific to a fetus must reside in separate section308

headings. The section heading must specificy the fetus observation context and designate so using


Subject ID (121030,DCM, "Subject ID) and/or numerical designation (121037,DCM, "Fetus Number”) asshown below. See TID 1008 Subject Context, Fetus.

ROOTDoc Title

CONTAINER

HAS OBS CONTEXTSubject ID

TEXT

CONTAINSFetal BiometryCONTAINER

HAS OBS CONTEXTSubject ID

TEXT

CONTAINSFetal BiometryCONTAINER

. . . . . .

first fetus second fetusCONTAINS

PatientCharacteristicsCONTAINER

otherheadings

312

Figure X.8-1 Multiple Fetuses

X.8 Procedure Summary

The Procedure Summary section heading contains the observations or observation groups of mostimmediate interest. These may or may not be duplicates of observations reported in another part of the316

content tree. If the observation in the summary heading is a duplicate, an R-INFERRED FROM by-reverence relationship may link the observation to the identical observation. This relationship enables anapplication to quickly find additional context that may be attached, such as an image reference. Also, anapplication can deduce that the observation is a duplicate by recognizing that the observation is inferred320

from an observation of identidcal concept name. The following figure illustrates an example of anobservation duplicated in the summary section.

[Note that in cases where the observation is not fully pre-coordinated diagnostic semantics isincomplete. The report creator could supply the missing semantics in the summary observation or324

the report user must recognize the absence and retrieve it.]


CONTAINSProcedure Summary

CONTAINER

CONTAINSObservation X

NUM

R-INFERREDFROM

CONTAINSObservation X

NUM

CONTAINSHeading

CONTAINER

ROOTDoc Title

CONTAINER


CONTAINER

Figure X.9-1 Procedure Summary328


Part 4 Addendum

Add the following to PS 3.4 Section 4 Symbols and Abbreviations

Update Annex B and I SOP Class tables. No new SOP Classes332

Placeholder for new SOP Classes No new SOP Classes

B.5 STANDARD SOP CLASSES


Part 6 Addendum

ANNEX A (NORMATIVE): REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID)336

Add the following UIDs to Part 6 Annex A:

UID Value UID NAME UID TYPE Part


Part 16 Addendum340

Add the following to PS 3.16 Section 2 Normative References

Add the following to PS 3.16 Section 4 Symbols and Abbreviations

344

Add the following Templates to Part 16 Annex A DCMR Templates (Normative):

Annex A DCMR Templates (Normative)

A.T: ULTRASOUND SR TEMPLATES

The templates used in the ultrasound procedure reports, and their hierarchical organization, is shown348

below.

TID nnn1-3Doc Root

TID 1001Observation Context

TID 1002Observer Context

TID 1005Procedure Context

TID 1006Subject Context

TID 1007Subject Context,

Patient

TID 1007Subject Context,

Fetus

TID nnn30Patient Charateristics

or extend TID 520

TID 1204Language of ...

TID nnnnnImage Library Entry

Figure A.T-1: Common Root Template Structure

352


TID nnn1Vascular US Proc

Doc Root

TID nnn2OB-GYN US Proc

Doc Root

TID nnn3Adult Echo Proc Doc

Root

TID nn11Vascular Observation

Group

TID nn12OB-GYN Observation

Group

TID nn13Echo Observation

Group

TID 560Normality andSignficance

TID 561Normal Range

TID nnn29Image Reference

TID nnn25US ObservationSupplementary

Figure A.T-2: Root Template Structures

In the figure above, ‘• • •’ indicates possible recursive application of subordinate templates.


A.1: VASCULAR ULTRASOUND SR TEMPLATES356

TID nnn1 Vascular Ultrasound Procedure Document Root Template

This template forms the top of a content tree that allows an ultrasound device to describe the results ofthe imaging procedure. It is instantiated at the root node. It can also be be included in other templatesthat need to incorporate this into another report as quoted evidence.360

This template is extensible. That is, other content items may be added to this template.

TID nnn1VASCULAR ULTRASOUND DOCUMENT ROOT

NL Rel withParent

VT Concept Name VM ReqType

Condition Value Set Constraint

1 CONTAINEREV(DCM, , “ VascularUltrasound ProcedureReport”)

1 M

2 > HAS OBSCONTEXT

INCLUDE ETID(1001) ObservationContext

1 M

3 > HAS ACQCONTEXT

INCLUDE DTID(nnn30) “PatientCharacteristics”

1 U

4 > CONTAINS INCLUDE (,, “Procedure Summary”) 1 U

5 > CONTAINS CONTAINERDCID(xxxx2) “VascularUltrasound Headings”

1-n M DCID(xxx) one any only one ofeach concept

6 >> CONTAINS INCLUDE 1-n M

7 > CONTAINS CONTAINER(cv, csd, “Image Library”) 1 MC If image references are present

8 >> CONTAINS INCLUDE ETID (nnnnn)“Image Library Entry”

1-n MC If image references are present

9 > HASCONCEPTMOD

INCLUDE ETID(1204) Language ofContent Item andDescendants

1 U

364

Content Item Descriptions

To facilitate finding this report the Series Description shall be set to the Concept Name meaning of theDocument Title: Vascular Ultrasound Procedure Report.368


TID nnn11 Vascular Ultrasound Observation Group Template

TID nnn11 VASCULAR ULTRASOUND OBSERVATION GROUP TEMPLATE

NL Rel withParent



1 CONTAINER(,,Observation Group) 1-n M DTID(nnn11) “VascularUltrasound Observation Group”

2 > HAS ACQCONTEXT

CODE DCID(xxxx1) VascularAnatomical Location

1 M

3 >> HASCONCEPTMOD

CODE DCID(xxx12) VascularAnatomical Location Modifier

1-n MC If needed to fully qualify

4 > CONTAINS NUM DCID(xxx13) VascularUltrasound Observations

1-n M

5 > INCLUDE DTID(nnn25) “UltrasoundObservation SupplementalTemplate”

1 U

372


Anatomical Location Specifies the anatomical context of the obseravations in the group.

Anat. Loc. Modifiers Details the anatomical location, e.g. proximal, mid, or distal

Vascular UltrasoundObservations

The numeric observation values

376


A.U: OB-GYN ULTRASOUND SR TEMPLATES

TID nnn2 OB-GYN Ultrasound Procedure Document Root Template

This template forms the top of a content tree that allows an ultrasound device to describe the results ofthe imaging procedure. It is instantiated at the root node. It can also be be included in other templates380

that need to incorporate this into another report as quoted evidence.


TID nnn2OB-GYN Ultrasound Procedure Document Root Template384

NL Rel withParent



1 CONTAINEREV(DCM, xxx, “ OB-GYNUltrasound ProcedureReport”)

1 M

2 > HAS OBSCONTEXT

INCLUDE ETID(1001) “ObservationContext”

1 M

3 > HAS ACQCONTEXT

INCLUDE DTID(nnnnn) “PatientCharacteristics”

1 U

4 > CONTAINS INCLUDE (,,“Procedure Summary”) 1 U

5 > CONTAINS CONTAINERDCID(xxxxx) OB-GYNUltrasound ObservationHeadings


6 >> HAS OBSCONTEXT

INCLUDE ETID(1008) Subject Context,Fetus

1 U

7 >> INCLUDE 1-n M

8 > CONTAINS CONTAINER(111028, DCM, “ImageLibrary”)

1 MC If image references are present



10 > HASCONCEPTMOD


1 U

To facilitate finding this report the Series Description shall be set to the Concept Name meaning of theDocument Title: OB-GYN Ultrasound Procedure Report.388


TID nnn12 OB-GYN Observation Group Template

[Here are two variations for observation group encoding (choose one and apply it to vascular andecho also]]

NL Rel withParent



1 CONTAINER(Observation Group) 1-n M DTID(nnnnn) OB-GYNObservation Group

2 > CONTAINS NUM DCID(xxxx2) “OB-GYNUltrasound Observations”

…. …. ….

3 > INCLUDE DTID(nnn25) “UltrasoundObservation AuxiliaryTemplate”

1 U

392

[It may be desirable to create templates for specific types of an observation group. Here are someexamples. Candidates include: AFI, fetal biometric,follicle, ovaries …]

396

OB-GYN FETAL BIOMETRIC OBSERVATION GROUP TEMPLATE

NL Rel withParent



1 CODE (,,Observation Group) 1-n M (a constrained CG ofobservation types from whichGA can be inferred.)

2 > HAS PROP NUM Constrained set from CIDxxx14

1-n M

3 >> INCLUDE DTID(nnn25) “UltrasoundObservation SupplementalTemplate”

1 U

4 > HAS PROP NUM EV(,,”Gestational Age”) 1 U

5 >> HASCONCEPTMOD

DCID(xxx27) “OB GestationalAge Method”

1 U

Row 1 The observation group type: BPD, FL, …

Row 2 The numeric measurement

Row 4 The derived gestational age

Row 5 The reference that defines the equation or table of GA derivation


A.V: ECHOCARDIOGRAPHY SR TEMPLATES400

TID nnn3 Echocardiography Procedure Document Root Template

This template forms the top of a content tree that allows an ultrasound device to describe the results ofthe imaging procedure. It is instantiated at the root node. It can also be be included in other templatesthat need to incorporate this into another report as quoted evidence.404


TID nnn3Echocardiography Procedure Document Root Template

NL Rel withParent



1 CONTAINEREV(cv, csd, “AdultEchocardiography ProcedureReport”)

1 M

2 > HAS OBSCONTEXT

INCLUDE ETID(1001) ObservationContext

1 M

3 > HAS ACQCONTEXT

INCLUDE DTID(nnnnn) PatientCharacteristics

1 U

4 > CONTAINS INCLUDE “( ,,Procedure Summary”) 1 U

5 > CONTAINS CONTAINERDCID(xxxxx)Echocardiography Headings


6 >> CONTAINS INCLUDE DTID(nnn13) “Echocardio-graphy Observation Group”

1-n M

7 > CONTAINS CONTAINER(cv, csd, “Image Library”) 1 MC If image references are present



9 > HASCONCEPTMOD


1 U

408


To facilitate finding this report the Series Description shall be set to the Concept Name meaning of the412

Document Title: Adult Echocardiography Procedure Report.


TID nnn13 Echocardiography Observation Group Template

TID nnn13416

ECHOCARDIOGRAPHY OBSERVATION GROUP TEMPLATE

NL Rel withParent



1 CONTAINER(,,Observation Group) 1-n M

2 HAS ACQCONTEXT

TEXT orCODE?

(,,Observation Group Type) 1 U Use example text or terms asshown in following table

3 > CONTAINS NUM DCID(xxx13) UltrasoundEchocardiographyObservations

1-n M


1 U

[Or alternatively …]

NL Rel withParent



1 CODE (,,Observation Group) 1-n M Use terms as shown infollowing table or add HASACQ row as in above

2 > HAS PROP NUM DCID(xxx13) UltrasoundEchocardiographyObservations

1-n M DCID(xxx15)“EchocardiographyObservations”


1 U

420

The following table are examples of a descriptive terms that represent how observations are groupedduring acquisition.

Simpson's Method Volume

Apical Area/Length LV Volume (2D)

Right/Left Ventricle (2D)

Aorta/Left Atrium (2D)

LV Mass (2D)

LV Ejection Fraction (2D)

All points

LVOT

Mitral Valve

Mitral Valve Regurgitation

Ao Valve (Doppler)

Aortic Valve Insufficiency

Tricuspid Valve Inflow

Tricuspid Valve Regurgitation

Pulmonary Valve (Doppler)

Pulmonary Venous Flow (Doppler)

Pulmonary Veins

CO and Qp:Qs


Tissue Doppler Imaging

R/L Ventricle (Mmode)

Ao/LA (Mmode)

Pulmonary Valve (Doppler)

Doppler Pulmonary Venous Flow Evaluation

Tissue Doppler

Cardiac Output (Doppler)

Generic PISA

Qualitiatve Segmental Wall Motion

[Are any specialized templates desired?]424


A.W: COMMON ULTRASOUND SR TEMPLATES

TID nnn25 Ultrasound Observation Supplemental Template

This template specifies additonal semantics to accompany an observation. None of the content items is428

mandatory.

NL Rel withParent



1 HASCONCEPTMOD

CODE EV (DCM D-640-012“Selected Value”)

1 U BCID ( 617, " MeasurementType ")

2 R-INFERREDFROM

NUM 1-n U

3 HAS PROP INCLUDE ETID(560) Normality andSignificance

1 U

4 HAS PROP INCLUDE ETID(561) Normal Range 1 U XOR with row 5

5 HAS PROP TEXT EV(Normal Range) U XOR with row 4

6 HAS ACQCONTEXT

TBD: CODEor TEXT

EV( ,,”Measurement tool”) 1 U

7 R-INFERREDFROM

INCLUDE ETID(nnn29) ImageReference

1 U

8 HASCONCEPTMODIFIER

TEXT orCODE

1-n U


Selected Value Specifies whether the observation is an average, selected as best value, etc.

Row 2 Specifies a dependency relationship on the value of another content item

Measurement Tool Allows specifying a specific tool type to obtain the measurement. TBD:manual caliper placement on image; algorthmically automated measured; …

Row 3 Flags an abnormal value and its signficance

Row 4,5 Specifiies the observation’s normal range by some reference

Row 6 Allows supplementary descriptive information about the type of tool

Row 7 Specifies the image or the image coordinates used to make the observation

Row 8 Allows supplementary descriptive information about the observation, e.g. thequadrant of an AFI diameter.

432

TID nnn29 Image Reference Template

TID nnn29IMAGE REPERENCE TEMPLATE436

NL Rel withParent



1 R-INFERREDFROM

IMAGE 1-n U XOR with row 2


NL Rel withParent



2 INFERREDFROM

SCOORD Path, trace, point, etc. 1-n U XOR with row 1

3 > R-SELECTEDFROM

IMAGE 1-n M

TID nnn30 Patient Characteristics Template

TID nnn30440

PATIENT CHARACTERISTICS TEMPLATE

[This follows the example of the hemo template but uses a single context group for all reporttypes.]

NL Rel withParent



1 CONTAINEREV (DCM D-640-023 “PatientCharacteristics”)

1 U

2 > CONTAINS NUM DCID (xxxx) PatientCharacteristics)

1 U

> CONTAINS NUM EV (DCM D-702-009 “BodySurface Area”)

1 U EV (UCUM m2 “m2”)

>> INFERREDFROM

TEXT EV (DCM D-640-013 “Equation”)

1 U

> CONTAINS NUM EV (DCM D-640-028 “Thoraxdiameter, sagittal”)

1 U EV (UCUM cm “cm”)

> CONTAINS NUM EV (DCM D-702-009 “BodyMass Index”)

1 U EV (UCUM kg/m2 “kg/m^2”)

>> INFERREDFROM

CODE EV (DCM D-640-013 “Equation”)

1 U

444


Add the following Context Groups to Part 16 Annex B DCMR Context Groups (Normative):

Annex B DCMR Context Groups (Normative)

B.U: VASCULAR ULTRASOUND CONCEPT GROUPS

Context Group xxxx1448

Vascular Ultrasound Headings

(Most Restrictive Use: Baseline) [May wish to use post-coordinate left and right for renal vessels, extremities, etc.. ]

CodingScheme

Designator(0008,0102)

CodingSchemeVersion

(0008,0103)

Code Value(0008,0100)

Code Meaning(0008,0104)

DCM Right Carotid Arteries

DCM Left Carotid Arteries

DCM Intra-Cranial Cerebral Arteries

DCM Cerebral Veins

DCM Right Leg Arterial

DCM Right Leg Venous

DCM Left Leg Arterial

DCM Left Leg Venous

DCM Abdominal Arteries

DCM Abdominal Venous

DCM Left Renal Vessels

DCM Right Renal Vessels

452

Context Group xxx11

Vascular Anatomical Location

(Most Restrictive Use: Defined)This context group specifies the anatomical location for vascular observations456

CodingScheme


CodingSchemeVersion

(0008,0103)



Common Carotid Artery

Carotid Bulb

T-45300 Internal Carotid Artery

SNM3 3.5 T-45200 External Carotid Artery

SNM3 3.5 T-45700 Vertebral Artery

SNM3 3.5 T-46100 Subclavian


CodingScheme


CodingSchemeVersion

(0008,0103)



Anterior Cerebral Artery

Middle Cerebral Artery

Posterior Cerebral Artery

Siphon

SNM3 T-45700 Vertebral Artery

SNM3 T-45400 Ophthalmic Artery

SNM3 T-45800 Basilar Artery

SNM3 T-46710 Common Iliac Artery

SNM3 T-46910 External Iliac Artery

SNM3 T-46740 Internal Iliac Artery

SNM3 T-47400 Common Femoral Artery

Profunda Femoris Artery

Superficial Femoral Artery

SNM3 T-47500 Popliteal Artery

SNM3 T-47700 Anterior Tibial Artery

SNM3 T-47600 Posterior Tibial Artery

SNM3 T-47630 Peroneal Artery

SNM3 T-47700 Anterior Tibial Artery

Dorsalis Pedis Artery

SNM3 T-48920 Common Iliac Vein

SNM3 T-48930 External Iliac Vein

SNM3 T-49410 Common Femoral Vein

T-D930A Saphenofemoral Junction

T-49530 Greater Saphenous Vein

Profunda Femoral Vein

Superficial Femoral Vein

Popliteal Vein

Posterior Tibial Vein

Anterior Tibial Vein

Peroneal Vein

SNM3 T-46420 Common Hepatic artery

SNM3 Infra-renal Aorta

Supra-renal Aorta

SNM3 T-46710 Common iliac Artery


CodingScheme


CodingSchemeVersion

(0008,0103)



SNM3 T-46510 Super. Mesenteric Artery

SNM3 T-46520 Inferior Mesenteric Artery

SNM3 T-46460 Splenic artery

Celiac Axis

SNM3 T-48710 Inferior vena cava

SNM3 T-48720 Hepatic vein

SNM3 T-48810 Portal vein

Inferior mesenteric vein

Supererior Mesenteric vein

SNM3 T-48920 Ileal vein

SNM3 T-48890 Splenic vein

SNM3 T-48920 Common iliac vein

SNM3 46600 Renal Artery

Hilar

Acruate Artery

Segmental Artery

Uterine Artery

Ovarian Artery

Context Group xxx12

Vascular Anatomical Location Modifier460

(Most Restrictive Use: Defined)This context group specifies modifiers for anatomical locations of vascular observations.[This is to allow more detailed location semantics. An alternative is to use CID 2 AnatomicModifier. Is that preferred?]464

CodingSchemeDesignator(0008,0102)

CodingSchemeVersion(0008,0103)



Origin

Main

G-A116 Superior

G-A115 Inferior

G-A109 Middle

G-A101 Left


CodingSchemeDesignator(0008,0102)

CodingSchemeVersion(0008,0103)



G-A100 Right

G-A105 Anterior

G-A106 Posterior

G-A118 Proximal

G-A119 Distal

[Possibly, modifiers of modifiers may be desired, e.g. mid-distal. This may warrant yet anotherconcept group. The goal is to have one and only one way to express an anatomical location]

468

Context Group xxx13

Vascular Ultrasound Observations

(Most Restrictive Use: Defined)472

CodingScheme


CodingSchemeVersion

(0008,0103)



Units

Minimum Diastolic Velocity cm/s

End Diastolic Velocity cm/s

Time averaged peak velocity (meanvelocity)

cm/s

Time averaged mean velocity cm/s

Peak Systolic Velocity cm/s

Vessel lumen diameter mm

Vessel lumen area mm2

Volume flow mm3/s

Acceleration Time ms

Acceleration Index 1

Deceleration Time ms

Resistive Index 1

Pulsatility Index 1

Systolic to Diastolic Velocity Ratio 1

Diastolic to Systolic Velocity Ratio 1

Percent Diameter Reduction 1

Percent Area Reduction 1

Gradient peak mmHg


CodingScheme


CodingSchemeVersion

(0008,0103)



Units

ICA/CCA Ratio 1

Renal Artery/Aorta Ratio 1

B.V: ECHOCARDIOGRAPHY CONCEPT GROUPS


Echocardiography Headings

(Most Restrictive Use: Baseline)The heading structure follows the ASE RECOMMENDATIONS FOR A STANDARDIZED REPORT FORADULT TRANSTHORACIC ECHOCARDIOGRAPHY. The recommendation is intended for physician480

reports rather than numeric machine generated numeric reports. This Supplement intends to follow theASE recommendation closely for consistency with physician reports.

Demographics and other Identifying Information: The by Observation Context templates cover theinformation of this ASE section.484

Echocardiographic and Doppler Measurements. The following context group follows therecommendations by covering all chambers, valves and cardiac shunts. The section headingsfollow the cardiac structure partition for Descriptive Finds. A heading for Wall Motion wasadded since it did not seem to fit elsewhere.488

Descriptive Findings. These are interpretive findings and outside the current scope of thisSupplement. The physician report is a distinctly different but related report type.

Summary. This is also interpretive and outside the scope of this Supplement.

492

[Adopt DICOM codes for these? ]

CodingScheme


CodingSchemeVersion

(0008,0103)



DCM Left Ventricle

DCM Left Atrium

DCM Right Ventricle

DCM Right Atrium

DCM Mitral Valve

DCM Tricuspid Valve

DCM Aortic Valve

DCM Pulmonary Valve

DCM Aorta

DCM Pulmonary Artery

DCM Vena Cava and Pulmonary Veins


CodingScheme


CodingSchemeVersion

(0008,0103)



DCM Pericardium

DCM Cardiac Output

DCM Shunts

DCM Wall Scoring

DCM

Context Group xxx15

Echocardiography Observations496

(Most Restrictive Use: Baseline)

CodingScheme


CodingSchemeVersion

(0008,0103)



Units(Informative)

LN 18043-0 Ejection Fraction %

LN 18051-3 Fractional LVD Shortening %

LN 18154-5 IVS Thinckening Fraction %

LN 18053-9 LVPW Thickening Fraction %

LN 18084-4 RV Diameter (Diastolic) cm

RV Diameter (Systolic) cm

LN 29436-3 LV Diameter (Diastolic) cm

LN 29438-9 LV Diameter (Systolic) cm

LN 18152-9 LVPW (Diastolic) cm

LN 18156-0 LVPW (Systolic) cm

LN 18154-5 Interventricular Septum (Diastolic) cm

LN 18158-6 Interventricular Septum (Systolic) cm

LN 17985-3 LA/Ao 1

LN 18018-2 LVOT Dia cm

LN 18010-9 Aortic Root Diameter cm

LN 29469-4 LA Dimension cm

LV Volume (Diastolic) ml

LV Volume (Systolic) ml

LN 18033-1 Stroke Volume ml

LN 20213-5 Cardiac Output l/min

Cardiac Index 1

LN 20198-8 SV Index 1

500


B.W: OB-GYN ULTRASOUND CONCEPT GROUPS


OB-GYN Headings


CodingScheme


CodingSchemeVersion

(0008,0103)



DCM Biophysical Profile

DCM Amniotic Sac

DCM Fetal Biometry

DCM Fetal Biometry Ratios

DCM Early Gestation

DCM Fetal Long Bones

DCM Fetal Cranium

DCM Fetal Comments

DCM Uterus

DCM Ovaries

DCM Follicles

DCM Pelvic Vasculature

508

Code Description

Biophysical Profile Assessment of biophysical observations that evaluate fetal well-being

Amniotic Sac The four quadrant distances and their sum

Fetal Biometry Measurements and derived gestational ages to determine age, size andmalformation

Fetal Biometry Ratios Ratios of biometric measurements, e.g. HC/AC, FL/AC, …

Early Gestation Biometric data for early gestation: CRL, Gest Sac, Yolk Sac

Fetal Long Bones Biometric measurements and derived gestational ages using long bones

Fetal Cranium

Fetal Comments

Uterus uterus

Ovaries

Follicles

Pelvic Vasculature Vascular observations. This heading has observation groups using vascularobservation groups


Context Group xxx14

OB-GYN Ultrasound Observations


[I am organizing these as if they were separate context groups, but am not yet willing to committo this.]

516

CodingScheme


CodingSchemeVersion

(0008,0103)



LN 18185-9 ? Gestational Age (GA):NOS

Estimated Due Date (EDD): NOS

LN 11727-5 Effective Body Weight (EFW or EFBW) NOS

LN 11955-2 Date of Last Normal Menstrual Period (LMP or LNMP)(8665-2 is duplicate)

Estimated LMP by EDD

LN 11948-7 Heart Rate (HR)

Biometry Ratios

LN 11947-9 HC/AC

LN 11871-1 FL/AC

LN 11872-9 FL/BPD

LN 11823-2 Cephalic Index (CI=BPD/OFD)

LN 11873-7 FL/HC

520

LN 11820-8 Biparietal Diameter (BPD)

LN 11824-0 BPD area corrected (BPDa)

LN 11851-3 Occipital-Frontal Diameter (OFD)

LN 11984-2 Head Circumference (HC)

LN 11862-0 Tranverse Abdominal Diamter (TAD)

LN 11818-2 Anterior-Posterior Abdominal Diameter (APD)

LN 11979-2 Abdominal Circumference (AC)

LN 11963-6 Femur Length (FL)

LN 11819-0 Anterior-Posterior Trunk/Thorax Diameter (APTD)

LN 11863-8 Trans Cerebellar Diameter (TCD)

LN 11966-9 Humerus length


LN 11967-7 Radius length

LN 11969-3 Ulna length

LN 11968-5 Tibia length

LN 11964-4 Fibula length

LN 11962-8 Clavicle length

Early Gestation524

LN 11850-5 Gestational Sac length

LN 11816-6 Yolk Sac length

LN 11957-8 Crown Rump Length (CRL)

Biophysical profile

LN 11631-9 Gross Fetal Movement (0, 1, 2 or empty)

LN 11632-7 Fetal Breathing Movement (0, 1, 2 or empty)

LN 11635-0 Fetal Tone (0, 1, 2 or empty) (0, 1, 2 or empty)

LN 11633-5 Reactive Fetal Heart (0, 1, 2 or empty)

LN 11630-1 Amniotic Fluid Volume (0, 1, 2 or empty)

LN 11634-3 Biophysical Profile Sum Score (0-10, or empty)

Amniotic Sac528

LN 11624-4 First Quadrant Diameter

LN 11626-9 Second Quadrant Diameter

LN 11625-1 Third Quadrant Diameter

LN 11623-6 Fourth Quadrant Diameter

LN 11627-7 Amniotic Fluid Index (AFI)

Fetal Cranium

LN 12171-5 Lateral Ventrical length (of fetal cranium)

LN 11863-8 Transverse Cerebellum Diameter (TCD)

LN 11860-4 Cisterna Magna length

LN 12146-7 Nuchal Fold thickness

LN 11629-3 Outer Orbital Diameter (OOD)

LN 11863-8 Trans Cerebellar Diameter (TCD)

Uterus Volume

LN 11842-2 Uterus Length

LN 11865-3 Uterus Width

LN 11859-6 Uterus Height

LN 11961-0 Cervix Length


LN 12145-9 Endometrium Thickness

532

LN 12165-7 Right Ovary Volume

LN 11841-4 Right Ovary Length

LN 11830-7 Right Ovary Width

LN 11858-8 Right Ovary Height

LN 12164-0 Left Ovary Volume

LN 11840-6 Left Ovary Length

LN 11829-9 Left Ovary Width

LN 11857-0 Left Ovary Height

Pelvic Vasculature

Mean blood velocity

[the above is used in a vascular Observation Group similar to vascular]

Follicles536

LN Follicle Volume

LN 11793-7 Follicle Diameter

LN 11880-2 Numer of follicles in left ovary

LN 11880-2 Number of follicles in right ovary

Context Group xxx27

OB Gestational Age Method540

(Most Restrictive Use: Defined)This context group alters the default interpretation of the observation origin.[Some of of the following are already in LOINC but they were intended to designate the gestationalage rather than the message to create the age. Can we still use the terms for this purpose?. Need544

to assemble a complete list and submit. Need to create a similar Context Group for EFW.]

CodingScheme


CodingSchemeVersion

(0008,0103)



Manual entryUser entered estimate

LN 11885-1 Gestational Age by LMP

LN 11884-4 Composite GA

GA by conception date

BPD-oi, Altman 1997

BPD-oo, Altman 1997

11902-4 BPD, Hadlock 1984

11901-6 BPDa, Hadlock 1982


CodingScheme


CodingSchemeVersion

(0008,0103)



11905-7 BPD, Jeanty 1984

HC measured, Chitty 1994

HC derived, Chitty 1994

11932-1 HC, Hadlock 1984

TCD, Chitty 1994

11892-7 AC, Hadlock 1984

11920-6 FL, Hadlock 1984

FL, Altman 1997

11923-0 FL, Jeanty 1994

GS, Nyberg 1992

11910-7 CRL, Hadlock 1992

11914-9 CRL, Robinson 1975

11941-2 Tibia, Jeanty 1984

11936-2 Humerus, Jeanty 1984

11944-6 Ulna, Jeanty 1984

11896-8 OOD, Jeanty 1984

AC,FL, Hadlock 1985

HC,AC FL, Hadlock

BPD, HC,AC,FL, Hadlock

BPD, AC,FL, Hadlock

Hadlock84(EFW)

Doubilet97(EFW)

Context Group xxx28

OB Fetal Body Weight Method548

(Most Restrictive Use: Defined)[This list below is a small subset of what is in LOINC because many are no longer in use and it isbest to omit unused codes. All members should ensure the ones they inted to use are in the tablebelow.]552

CodingScheme


CodingSchemeVersion

(0008,0103)



LN 11751-5 EFW by AC, FL, Hadlcok 1985

LN 11746-5 EFW by HC, AC, FL, Hadlcok 1985

LN 11732-5 EFW by BPD, HC, AC, FL, Hadlcok 1985

LN 11735-8 EFW by BPD, AC, FL, Hadlcok 1985

LN 11756-4 EFW by AC, Campbell 1975


Context Group xxxxx

EDD Modifiers


LN 11779-6 Delivery Date by LMP

LN 11780-4 Delivery Date by ovulation date

LN 11781-2 Delivery Date by Composite GA

LN 11778-8 Estimated Delivery Date

B.X: COMMON ULTRASOUND CONCEPT GROUPS

Context Group xxx20560

Patient Characteristics

(Most Restrictive Use: Defined)CONTEXT GROUP xxx20 – Patient Characteristics

CodingScheme


CodingSchemeVersion

(0008,0103)



DCM Patient Age

Patient Gender

Patient Height

Patient Weight

LN 3145-0 Start of last Menstrual Period (LMP)

LN 11996-6 Gravida

LN 11977-6 Para

LN 11612-9 Aborta

Ectopic

Smoking duration

Smoking consumption

Hypertension

564

Acquisition Context Templates in the scope of this Supplement

Annex C Acquisition Context Templates (Normative)

This Annex specifies the content of Templates for Acquisition Context required by DICOM IODs.568

[none identified]


Add the following definitions to Part 16 Annex D DICOM Controlled Terminology Definitions(Normative):

Annex D DICOM Controlled Terminology Definitions (Normative)572

This Annex specifies the meanings of codes defined in DICOM, either explicitly or by reference to anotherpart of DICOM or an external reference document or standard.

DICOM Code Definitions (Coding Scheme Designator “DCM” Coding Scheme Version “01”)

CodeValue

Code Meaning Definition

OB-GYN Ultrasound Procedure ReportRoot Document Title

Vascular Ultrasound Procedure ReportRoot Document Title

Adult Echocardiography ProcedureReport

Root Document Title

Patient Characteristics Document Heading

Procedure Summary Document Heading

Right Carotid Arteries Vascular Document Heading

Left Carotid Arteries Vascular Document Heading

Intra-Cranial Cerebral Arteries Vascular Document Heading

Cerebral Veins Vascular Document Heading

Right Leg Arterial Vascular Document Heading

Right Leg Venous Vascular Document Heading

Left Leg Arterial Vascular Document Heading

Left Leg Venous Vascular Document Heading

Abdominal Arteries Vascular Document Heading

Abdominal Venous Vascular Document Heading

Left Renal Vessels Vascular Document Heading

Right Renal Vessels Vascular Document Heading

Left Ventricle Echocard Document Heading

Left Atrium Echocard Document Heading

Right Ventricle Echocard Document Heading

Right Atrium Echocard Document Heading

Mitral Valve Echocard Document Heading

Tricuspid Valve Echocard Document Heading

Aortic Valve Echocard Document Heading

Pulmonary Valve Echocard Document Heading


CodeValue

Code Meaning Definition

Aorta Echocard Document Heading

Pulmonary Artery Echocard Document Heading

Vena Cava and Pulmonary Veins Echocard Document Heading

Pericardium Echocard Document Heading

Cardiac Output Echocard Document Heading

Wall Scoring Echocard Document Heading

Biophysical Profile OB-GYN Document Heading

Amniotic Fluid Index OB-GYN Document Heading

Fetal Biometry OB-GYN Document Heading

Early Gestation OB-GYN Document Heading

Fetal Long Bones OB-GYN Document Heading

Fetal Cranium OB-GYN Document Heading

Ancillary Biometric OB-GYN Document Heading

Fetal Environment OB-GYN Document Heading

Fetal Description OB-GYN Document Heading

Image Library Document Heading

Observation Group Observation container

576


Add the following definitions to Part 16 Annex E French Translations…


These Appendices are copies from recent DICOM Supplements for convenience580

Appendix (Relevant DICOM Templates)

TID 1001 OBSERVATION CONTEXT

Specifies attributes of observation context that may be defined, extended or replaced at any location inthe SR tree.584

This includes attributes that specify:

Table X.- who or what the observation is about (“subject context”)

Table XI.- what procedure the observation is about (“procedure context”)

Table XII.- who or what is making the observation (“observer context”)588

Establishing context includes two aspects of each dimension: identification and description (e.g. patientname and ID vs. patient’s age, height or weight).

Whenever one dimension of context is changed or an attribute is added, all attributes of that dimension of592

context are “flushed”, that is they need to be repeated in their entirety. For example, when the subject ischanged from patient (name, id) to fetus (number), then the parameters of the patient are discarded. E.g.the patient’s ID does not apply to the fetus.

“Extending” the same class and dimension of observation context isn’t feasible, since one cannot “null596

out” or remove a previously set attribute. Any time a dimension of observation context is “replaced”, anyattributes that are unspecified remain unspecified (i.e. they are not inherited).

TID 1001 OBSERVATION CONTEXT600

NL Rel withParent



1 HAS OBSCONTEXT

INCLUDE ETID (1002) “ObserverContext”

1 MC Required if all aspects ofobserver context are notinherited.

2 HAS OBSCONTEXT

INCLUDE ETID (1005) “ProcedureContext”

1 MC Required if all aspects ofprocedure context are notinherited.

3 HAS OBSCONTEXT

INCLUDE ETID (1006) “Subject Context”1 MC Required if all aspects ofobservation subject contextare not inherited.

TID 1002 OBSERVER CONTEXT

The observer (person or device) that created the Content Items to which this context applies.604

Whenever this template is invoked, all previously inherited attributes of Observer Context are discardedand replaced.


There may be more than one observer, and both person and device observers.

608

TID 1002 OBSERVER CONTEXT

NL Rel withParent



1 HAS OBSCONTEXT

CODE EV (121005,DCM, “ObserverType”)

1-n U EV (121006,DCM, “Person”)EV (121007,DCM, “Device”)

Defaults to Person2 HAS OBS

CONTEXTINCLUDE DTID (1003) “Person observer

identifying attributes”1-n MC IFF (121005,DCM, “Observer

Type”) = (121006,DCM,“Person”)

3 HAS OBSCONTEXT

INCLUDE DTID (1004) “Device observeridentifying attributes”

1-n MC IFF (121005,DCM, “ObserverType”) = (121007,DCM,“Device”)

612

TID 1003 PERSON OBSERVER IDENTIFYING ATTRIBUTES

This template contains identifying (and optionally descriptive) attributes of persons that are observers.

TID 1003PERSON OBSERVER IDENTIFYING ATTRIBUTES616

NL Rel withParent



1 PNAME EV (121008,DCM, “PersonObserver Name”)

1 M

2 TEXT EV (121009,DCM, “ PersonObserver’s OrganizationName”)

1 U Defaults to Institution Name(0008,0080) of the GeneralEquipment Module

3 CODE EV (121010,DCM, “ PersonObserver’s Role in theOrganization”)

1 U BCID(7452) OrganizationalRoles

4 CODE EV (121011,DCM, “ PersonObserver’s Role in thisProcedure”)

1 U BCID(7453) Performing Roles

TID 1004 DEVICE OBSERVER IDENTIFYING ATTRIBUTES

This template (derived from the DICOM General Equipment Module, Section C.7.5.1 of PS3.3) contains620

identifying (and optionally descriptive) attributes of devices that are observers.

TID 1004DEVICE OBSERVER IDENTIFYING ATTRIBUTES

NL Rel withParent



1 UIDREF EV (121012,DCM, “DeviceObserver UID”)

1 M

2 TEXT EV (121013,DCM, “DeviceObserver Name”)

1 U Defaults to value of StationName (0008,1010) in GeneralEquipment Module


3 TEXT EV (121014,DCM, “DeviceObserver Manufacturer”)

1 U Defaults to value ofManufacturer (0008,0070) inGeneral Equipment Module

4 TEXT EV (121015,DCM, “DeviceObserver Model Name”)

1 U Defaults to value ofManufacturer’s Model Name(0008,1090) in GeneralEquipment Module

5 TEXT EV (121016,DCM, “DeviceObserver Serial Number”)

1 U Defaults to value of DeviceSerial Number (0018,1000) inGeneral Equipment Module

6 TEXT EV (121017,DCM, “DeviceObserver Physical Locationduring observation”)

1 U

624

TID 1005 PROCEDURE CONTEXT

This template contains identifying (and optionally descriptive) attributes of the procedure that is thesource of evidence being interpreted.628

Whenever this template is invoked, all previously inherited attributes of Procedure Context are discardedand replaced.

Note: If an observed digital image is identified by other than a DICOM UID, a Study Instance UID must begenerated for the non-DICOM evidence. The same must be done to document interpretation of hard-632copy radiographs generated outside of the scope of the DICOM system.

TID 1005 PROCEDURE CONTEXT636

NL Rel withParent



1 UIDREF EV (121018,DCM,“Procedure StudyInstance UID”)

1 U Defaults to Study InstanceUID (0020,000D ) ofGeneral Study Module

2 UIDREF EV (121019,DCM,“Procedure StudyComponent UID”)

1-n U Defaults to Referenced SOPInstance UID (0008,1155) inReferenced StudyComponent UID(0008,1111) of GeneralSeries Module

3 TEXT EV (121020,DCM,“Procedure HL7 PlacerNumber of Evidence”)

1 U Defaults to (0040,2016)

4 TEXT EV (121021,DCM,“Procedure HL7 FillerNumber of Evidence”)


5 TEXT EV(121022,DCM,”Procedure AccessionNumber”)


6 CODE EV(121023,DCM,”Procedure Code”)

1 U Defaults to Procedure CodeSequence (0008,1032) ofGeneral Study Module

TID 1006 SUBJECT CONTEXT

This template contains identifying (and optionally descriptive) attributes of the subject of the interpretation.

Subject context identifies (and optionally) describes the subject of the interpretation, whether it be a640

patient (human or animal), a fetus (human or animal), or a specimen.


TID 1006SUBJECT CONTEXT

NL Rel withParent



1 CODE

EV (121024, DCM,"Subject Class”)

1

U

EV (121025, DCM,"Patient")EV (121026, DCM, "Fetus")EV (121027, DCM,"Specimen")

Defaults to Patient2 INCLUDE

DTID (1007) "SubjectContext, Patient"

1UC

IFF (121024, DCM,"Subject Class") =(121025,DCM, "Patient")

May be used for human oranimal patients

3 INCLUDEDTID (1008) "SubjectContext, Fetus"

1UC

IFF (121024, DCM,"Subject Class") =(121026,DCM, "Fetus")

May be used for human oranimal fetuses

4 INCLUDEDTID (1009) “SubjectContext, Specimen”

1

UC

IFF (121024, DCM,“Subject Class”) =(121026, DCM,“Specimen”)

644

TID 1007 SUBJECT CONTEXT, PATIENT

Identifies (and optionally describes) a patient who is the subject.

TID 1007648

SUBJECT CONTEXT, PATIENT

NL Rel withParent



1 UIDREF EV (121028,DCM, "SubjectUID”)

1 U E.g. SOP Instance UID ofDetached Patient Instance

2 PNAME EV (121029,DCM, "SubjectName”)

1 MC Required if not inherited. Defaults to value of Patient’sName (0010,0010) in PatientModule

3 CODE EV (121030,DCM, "SubjectID”)

1 MC Required if not inherited. Defaults to value of Patient ID(0010,0020) in Patient Module

4 DATE EV (121031,DCM, "SubjectBirth Date”)

1 U Defaults to value of Patient’sBirth Date (0010,0030) inPatient Module

5 CODE EV (121032,DCM, "SubjectSex”)

1 U Defaults to value of Patient’sSex (0010,0040) in PatientModule

ECID 74556 NUM EV (121033,DCM, "Subject

Age”)1 U Defaults to value ofPatient’s

Age (0010,1010) in PatientStudy Module

Units ECID 74567 CODE EV (121034,DCM, "Subject

Species”)1 MC Required if not inherited. DCID 7454 to define various

animals or plants, e.g.veterinary or research.

Defaults to (L-85B00,SNM3,”homo sapiens”).


TID 1008 SUBJECT CONTEXT, FETUS

Identifies (and optionally describes) a fetus who is the subject.652

TID 1008 SUBJECT CONTEXT, FETUS

NL Rel withParent



1 PNAME EV (121036,DCM, "Mother offetus”)

1 U Defaults to an observationsubject that is a patient prior toreplacing the ObservationSubject Class with Fetus.

2 UIDREF EV (121028,DCM, "SubjectUID”)

1 U For longitudinal tracking ofindividual fetuses

3 TEXT EV (121030,DCM, "SubjectID”)

1 U For longitudinal tracking ofindividual fetuses (humanreadable value e.g. “A” or “1”)

4 NUM EV (121037,DCM, "FetusNumber”)

1 M For separation of multipltefetuses during this proceduree.g. fetus ‘1” of ‘2” … not forlongitudinal comparisons.; ie.the “m” of fetus “m” of “n”

Units EV (1,UCUM,”1”)5 NUM EV (121038,DCM, "Number of

Fetuses”)1 M i.e. the “n” of fetus “m” of “n”

Units EV (1,UCUM,”1”)

TID 1200 LANGUAGE DESIGNATION656

Defines a mechanism for specifying a language, optionally with designation of the country in which thatlanguage applies.

Note: For example, the French language could be specified unmodified, or French as written in France orCanada could be distinguished.660

TID 1204 LANGUAGE OF CONTENT ITEM AND DESCENDANTS

Defines a mechanism for specifying the language in which the value and the Concept Name of the parentcontent item and any other descendants of the parent content item is written.664

TID 1204LANGUAGE OF CONTENT ITEM AND DESCENDANTS

NL Rel withParent



1 HASCONCEPTMOD

CODE (121049,DCM,”Language ofContent Item andDescendants”)

1 M DCID(5000)

2 > HASCONCEPTMOD

CODE (121046,DCM,”Country ofLanguage”)

1 U DCID(5001)


Appendix (Relevant DICOM Concept Groups)668

For convenience, referenced parts of proposed Supplements are replicated here. Unless otherwise noted,all tables are from Supplement 53.

CID 617 Measurement Type

From hemo template version 5672

Context Group ID 617Context Group Name Measurement Type

Coding SchemeDesignator(0008,0102)



DCM D-617-001 mean

DCM D-617-002 point source

DCM D-617-003 peak to peak

DCM D-617-004 median

DCM D-617-005 mode

DCM D-617-006 visual estimation

DCM D-617-007 Best Value

CID 5 Transducer Approach676

Context ID 5

Transducer Approach





SNM3 G-A100 Right

SNM3 G-A101 Left

SNM3 G-A104 Lateral

SNM3 G-A105 Anterior

SNM3 G-A105 Ventral

SNM3 G-A106 Posterior

SNM3 G-A106 Dorsal

SNM3 G-A108 Caudal

SNM3 G-A109 Medial

SNM3 G-A110 Central

SNM3 G-A111 Peripheral

SNM3 G-A112 External

SNM3 G-A113 Internal


SNM3 G-A115 Inferior

SNM3 G-A115 Lower

SNM3 G-A116 Superior

SNM3 G-A116 Upper

SNM3 G-A117 Transverse

SNM3 G-A118 Proximal

SNM3 G-A119 Distal

SNM3 G-A122 Apical

SNM3 G-A168 Surface

SNM3 G-A599 Ascending

SNM3 G-A600 Descending

SNM3 T-03000 Subcutaneous tissue, NOS

SNM3 T-A1120 Dura mater

SNM3 T-A1280 Pia mater

SNM3 A-2C600 External prosthesis for sonographicprocedure [Stand-off]

SNM3 A-2C602 Water bag prosthesis for imagingprocedure

SNM3 A-2C604 Saline bag prosthesis for imagingprocedure

SNM3 A-2C606 Gel prosthesis for imaging procedure

SNM3 G-A10A Cranial

SNM3 G-A10A Midline

SNM3 G-A11A Mid-longitudinal

SNM3 G-A11B Parasagittal

SNM3 G-A12A Intraluminal

SNM3 G-A16A Capsule

SNM3 G-A16B Lumen

SNM3 G-A16C Direct contact

SNM3 G-A16C Contact

SNM3 G-A16D Parenchyma

680

Context ID 6

Transducer Orientation





SNM3 G-A138 Coronal

SNM3 G-A143 Longitudinal

SNM3 G-A145 Sagittal

SNM3 G-A11B Parasagittal


SNM3 G-A472 Oblique

SNM3 G-A185 Long axis

SNM3 G-A13B Off axis

SNM3 G-A186 Short axis

SNM3 G-A191 Five chamber

SNM3 G-A19B Two chamber

SNM3 G-A19C Four chamber

SNM3 R-11300 Transverse

684

CID 7 Ultrasound Beam Pat

Context ID 7

Ultrasound Beam Path

(Most Restrictive Use: Baseline)688




SNM3 G-A1A9 Trans-hepatic

SNM3 G-A1B2 Trans-gastric

SNM3 G-A1A5 Trans-pleural

SNM3 G-A1B3 Trans-mural

SNM3 G-A1A8 Trans-orbital

SNM3 G-A1A6 Trans-pancreatic

SNM3 G-A1A4 Trans-renal

SNM3 G-D032 Trans-temporal

SNM3 G-A1A2 Trans-thecal

SNM3 G-A1A1 Trans-vesical

SNM3 G-A1A3 Trans-splenic

SNM3 G-D033 Trans-esophageal

SNM3 G-D001 Trans-abdominal

SNM3 G-D002 Trans-vaginal (endovaginal)


CID 7456 Units of Measure for Age

CID 7456692

Units of Measure for Age

(Most Restrictive Use: Enumerated)


Coding SchemeVersion

(0008,0103)



UCUM 1.4 a year

UCUM 1.4 mo month

UCUM 1.4 wk week

UCUM 1.4 d day

UCUM 1.4 h hour

UCUM 1.4 min minute

696

CID 7460 Units of Linear Measurement

CONTEXT GROUP 7460

Units of Linear Measurement


CodingScheme


CodingSchemeVersion

(0008,0103)



UCUM 1.4 cm centimeter

UCUM 1.4 mm millimeter

UCUM 1.4 um micrometer

CID 7461 Units of Area Measurement

CONTEXT GROUP 7461

Units of Area Measurement704

(Most Restrictive Use: Defined)

CodingScheme


CodingSchemeVersion

(0008,0103)



UCUM 1.4 cm2 Square centimeter

UCUM 1.4 mm2 Square millimeter

UCUM 1.4 um2 Square micrometer


CID 7462 Units of Volume Measurement

CONTEXT GROUP 7462708

Units of Volume Measurement


CodingScheme


CodingSchemeVersion

(0008,0103)



UCUM 1.4 dm3 Cubic decimeter

UCUM 1.4 cm3 Cubic centimeter

UCUM 1.4 mm3 Cubic millimeter

UCUM 1.4 um3 Cubic micrometer

Note: A “cubic decimeter” is a “liter”, just as a “cubic centimeter” is a “milliliter” (of water). Though there are712specific units “l” and “ml” in UCUM, only one form is included here, since this context group is intendedfor use for volume measurements of a physical object derived from one or more images, rather than offluid volume.

716

CID 7470 Linear Measurements

CONTEXT GROUP 7470

Linear Measurements


CodingScheme


CodingSchemeVersion

(0008,0103)



SRT V1.1 G-A22A Length

DCM 121211 Path length

DCM 121206 Distance

SNM3 G-A220 Width

SRT V1.1 G-D785 Depth

SNM3 M-02550 Diameter

SNM3 G-A185 Long Axis

SNM3 G-A186 Short Axis

SRT V1.1 G-A193 Major Axis

SRT V1.1 G-A194 Minor Axis

SRT V1.1 G-A195 Perpendicular Axis

SNM3 G-A196 Radius

SRT V1.1 G-A197 Perimeter

SNM3 M-02560 Circumference

SRT V1.1 G-A198 Diameter of circumscribed circle


CID 7471 Area Measurements

CONTEXT GROUP 7471

Area Measurements724


CodingScheme


CodingSchemeVersion

(0008,0103)



SNM3 G-A166 Area

SRT V1.1 G-A167 Area of defined region

CID 7472 Volume Measurements

CONTEXT GROUP 7472728

Volume Measurements


CodingScheme


CodingSchemeVersion

(0008,0103)



SNM3 G-D705 Volume

DCM 121216 Volume estimated from single 2D region

DCM 121218 Volume estimated from two non-coplanar 2Dregions

DCM 121217 Volume estimated from three or more non-coplanar 2D regions

DCM 121222 Volume of sphere

DCM 121221 Volume of ellipsoid

DCM 121220 Volume of circumscribed sphere

DCM 121219 Volume of bounding three dimensional region

Digital Imaging and Communications in Medicine (DICOM) Supplement 26: Ultrasound...

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