2
4
6
Digital Imaging and Communications in Medicine (DICOM)
8
Supplement 169: Simplified Adult Echocardiography Report
10
12
14
16
18
20
22
DICOM Standards Committee
1300 N. 17th Street, Suite 900
24
Rosslyn, Virginia 22209 USA
26
Version: Working Draft, Jan 7, 2014
28
Developed pursuant to DICOM Work Item 2012-11-A
30
Supplement TBA: Simplified Adult Echocardiography Report
Page 2
Table of Contents
32
34
36
38
40
42
44
46
48
Scope and Field .............................................................................................................................................. 3
Concepts ......................................................................................................................................................... 3
TODO .............................................................................................................................................................. 4
OPEN ISSUES ................................................................................................................................................ 5
CLOSED ISSUES ........................................................................................................................................... 8
Changes to NEMA Standards Publication PS 3.2-2011 ............................................................................... 11
Changes to NEMA Standards Publication PS 3.3-2011 ............................................................................... 11
Changes to NEMA Standards Publication PS 3.16-2011 ............................................................................. 12
SIMPLIFIED ADULT ECHOCARDIOGRAPHY TEMPLATES ............................................................... 12
TID 5QQQ
Echocardiography Procedure Report ................................................................. 12
TID 5QQY
Pre-coordinated Echo Measurement .................................................................. 14
TID 5QQZ
Post-coordinated Echo Measurement ................................................................ 15
CID newcid1
Echo Derivation .................................................................................................. 17
Changes to NEMA Standards Publication PS 3.17-2011 ............................................................................. 21
ANNEX ??: Mapping Guidance? Population Guidance? (Informative) ........................................................ 22
Supplement TBA: Simplified Adult Echocardiography Report
Page 3
50
52
Scope and Field
This supplement to the DICOM Standard introduces a simplified SR template for Adult Echocardiography
measurements.
54
It provides similar content to that of TID 5200 while addressing details that were the source of
interoperability issues; in particular, varying degrees and patterns of pre- and post-coordination, multiple
codes for the same concept and numerous optional descriptive modifiers.
56
The new template will be driven significantly by currently documented ASE Guidelines and Standards.
58
Concepts
This text introduces concepts, principles, guidelines and convenient terms discussed by the committee that
influenced the contents of the supplement. It may help reviewers better understand the material. If it still
appears to be useful to implementers when the supplement moves to letter ballot it will likely be
62 incorporated into a section in Part 17.
60
64
Section containers and headings are not used in the new template. Receivers may choose group
measurements based on Finding Site or some other logic as they see fit.
66
<Note the distinction between SR being acquisition/evidence and the other side being findings which are
more CDA/etc>
Finding Site: The location at which the measurement was taken. While some measurements will be a
measurement of the structure of the finding site itself, other measurements will measure something like
70 flow in which case the Finding Site is simply the location, not the subject of the measurement.
68
72
Method: Allows distinguishing between two measurements that tell you the same thing, derived in a
different way. If two measurements tell you something different, it's not a method.
74
<<If we want to “improve” the definition of a LOINC code, we basically have to get a new code assigned to
our improved definition. Retiring the old code is optional>>
76
Supplement TBA: Simplified Adult Echocardiography Report
Page 4
TODO
DONE
Set up a Concepts Section with a “useful/important distinctions” subsection to capture them as we
go.
DONE
REVIEW how this handles selection and min/max/avg, etc. for the Core set
DONE
Choose between TID 5201 and TID 3602
3602 (used by FPC Echo) is more complete and has more mandatory elements
Go with 3602 – it means that technically a cart shouldn’t send an object without requiring the tech
to input a height weight.
DONE
Review TID 5220 Fetal Pediatric Congenital for additional elements to include/harmonize with
Review Stress Echo template for template elements to consider/include
Review CID 12280 and 12281
Confirm if ASE specifies units and whether those match
Propose additional measurements “common to most vendors” – Paul will post an initial
spreadsheet for consideration.
REDISCUSS Put a note in part 17 that all indexed values in the body of the report must use the
same index value (e.g. BSA) from the Patient Characteristics sub-template.
Submit a CP to change “Image or Spatial Coordinates” to “Spatial Coordinates or Image”. The
former was confusing for some people, implying it was Coordinates that could either be image
coordinates or spatial coordinates.
Consider how consuming systems will handle Derivation (Min/Max/Mean/Selected).
e.g. if you have three measurements and a fourth that says ”Mean”, is it clear what to do.>>
<<Seems reasonable for consumers to accomodate this>>
WG-6 Questions:
Does it matter if LOINC doesn’t specify units? What if they use something odd?
Useful Tables:
CID 12227
CID 12226
CID 12224
CID 12250
CID 12222
CID 12233
CID 12236
Echocardiography Measurement Methods
Echocardiography Image Views
Ultrasound Image Modes
Cardiac Ultrasound Common Linear Measurements
Orifice Flow Properties
Cardiac Phases
Echo Anatomic Sites
Future Meetings:
2014 AIUM Las Vegas, NV 3/29/2014 – 4/2/2014
2015 AIUM Orlando, FL 3/21/2015 – 3/25/2015
2016 AIUM Las Vegas, NV 3/19/2016 – 3/23/2016
78
Supplement TBA: Simplified Adult Echocardiography Report
Page 5
OPEN ISSUES
Scope
S1
Should TID 5200 (the original) be retired when the new TID is introduced?
A: Yes.
Probably depends on how we support vendor-specific and user-defined.
Should hopefully retire it. We can still ship products that are capable of sending 5200, but new
products probably shouldn’t bother. If we offer two Adult Echo templates, some percentage of
novice vendors will choose 5200 without understanding the implications.
S2
Is it necessary/practical to guarantee convertability from Old-to-New SOP?
A: Guarantee, no. But try to keep it tractable.
Doing so would prevent making new information mandatory which would also restrict harmonization
with newer templates.
Could allow systems to output both and let recipients choose to use the new?
Note that a system that can’t fill in values could omit the measurement from the converted new
SOP.
S5
Have other international groups published “Core Set” papers we should include?
Get Public Comment input
- Look into JIRA (Japan) and EAE (Europe)
S6
What is needed to address both the processing and reporting systems on the consuming side?
Processing may want to tweak/select direct measurements and recalculate derived measurements.
Reporting might want to just reach in for a single value.
Need to encourage adoption.
Note that some of the job is for the consuming system to filter/simplify based on its needs.
One concept is to have a “summary” section.
Another concepts is for the Cart to output two instances of the same IOD, one is sparse/summary
(reporting), the other is more complete (processing).
S7
What is needed to handle “vendor-specific” measurements (beyond core)?
What information gets recorded (eg display/screen name of the measurement on the original cart)
How does it get slotted into the database, and who does that configuration?
Supplement TBA: Simplified Adult Echocardiography Report
Page 6
S8
Can the vendor-specific strategy also be used for user-defined measurements?
Maybe this is the root case and vendor-specific is just user-defined where the vendor is a user?
Maybe the vendor presets are just too hard to navigate.
Note that part of the problem is that these may not be well modelled. They “just want a label and a
number” but then later they want intelligent handling of the data they have handicapped.
S9
How should the core set be expanded to include some common vendor-specific ones?
S10
How/Should vendor education be addressed?
The new template makes finer distinctions than the old template. To reduce the validation load on
the consuming systems, confidence is needed that the producing system is in fact taking the
distinctions into account. E.g. Systole, vs End Systole, vs Atrial Systole. So if the pre-coordinated
code means exactly End Systole, then don’t use the pre-coordinated code if the system measures
at mid-systole.
What kind of a process should WG12 have (if any) to monitor and react to updates from ASE?
Structure
St2
Should the list of Core Measurements be included directly in RID rows, or dereference through CID
tables?
Strongly consider TIDs. This would allow making some measurements conditional on other
measurements and explicitly making units required, etc.
Since there are 150-200 core measurements, might want to break out a few sub TIDs to make it
more readable/manageable.
St1
Create a new SOP Class?
A: Yes.
We will create a template and will give it a new UID. This allows negotiation for the new template
(and allows systems to reject the new template if they don’t support it). The contents still parse and
process as SR (i.e. dsrdump still works, parsers don’t need to be changed, etc.)
Of course the template can still be sent inside a generic SR SOP Class.
Could this be handled with extended negotiation? Has anyone implemented it?
How do we deal with the Average of several instances and the Selector of several instances?
Should the Core Spreadsheet be maintained?
The sorting and filtering and parsing could be very handy.
C9
Coding
Do the Cardiac Phase/Cycle semantics refer to Mechanical or Electrical and the Chamber or the
Organ?
Most clear is to refer to the chamber. And be clear in the definition about time point vs time period
Supplement TBA: Simplified Adult Echocardiography Report
Page 7
and if needed time point at the end, not mid.
Could allow that if not fully specified, the default chamber is the Left Ventricle, i.e. End Systole =
Left Ventricle End Systole
If just systole or diastole is referred to, it means the period of the full duration of systole or diastole.
Often the code meaning will refer to Systolic X.
Pre-coordinate but work off the codeset in CID 12233 (but need clear definitions, does SNOMED
provide them?)
C10
Should missing codes be added in LOINC, SNOMED or DICOM?
Most of the existing (mostly) pre-coordinated codes are from LOINC, most of the existing postcoordinated concepts are from SNOMED. When fully pre-coordinated codes exist in both, let’s
prefer LOINC. If we don’t have LOINC, but we do have SNOMED, do we still ask LOINC for a new
code, or do we just use the SNOMED? YES. If you need a LOINC measurement code, ask for
one.
For now, use DICOM Supp placeholder codes and consider this closer to or during Public
Comment.
Need to review the new LOINC codes introduced in Sup 78 and use if possible.
C11
How should values that have to be estimated by the operator/clinician be addressed?
Need to allow the method for some measurements to be “estimated”.
Should perhaps mandate that if there are derived/calculated values, then all input values must be
included in the SR as well so it will be recorded if some inputs are estimated.
May also need to use the tools to point specifically to the values that were used in a given equation.
C13
Does Hand Grip and Valsalva need to be encoded (in association with specific measurements)?
C14
What needs to be captured about the package/pre-processing before the measurement?
E.g. if presence of special speckle tracking or proprietary segmentation, where does that fit in?
Or is this about a unique method or a unique measurement vs about the package that was used.
Do we need to record Stress Stage in a pre-coordinated way for each or specific measurements?
Is this better recorded at a higher level in the object? (would force separate objects for different
stages)
Finding Site – is it the structure measured, the location where a measurement was taken, etc.
Strong admiration of the problem. 
Mostly we get to avoid this by pre-coordinating the codes then there IS no Finding Site.
But we will need to revisit when we consider user-defined measurements or “annotating modifiers”
Do we have a need for grouping?
Supplement TBA: Simplified Adult Echocardiography Report
Page 8
Method modifier?
It’s what we add new ones of most.
Sometimes it matters.
Consider the difference between a value, like velocity, that can be directly measured or can be
derived from an equation. In the case of precoordination this is less of an issue since we simply
explain which it is, but needs consideration for user-defined.
Adding new methods has a rollout challenge
Note that DCM 125212 is underspecified relative to the other codes that follow it.
Supplemental information
No modifiers on core measurements
"For some attributes (e.g. the Image View for the Right Ventricule Free Wall Thickness) multiple
valid values exist and we don't really care which it is (mdc).
Prohibit senders from sending it (rather than allowing senders to code it and receivers to ignore it).
Most importantly, we don't want transmission to fail because the receiver has trouble handling it."
Do we want to differentiate equation/derived “measurements” from those measured directly?
The derived don’t exactly have a view/mode/etc, or may be derived from elements in several
views/modes/etc.
CLOSED ISSUES
80
Scope
S3
Should Cardiovascular History be reiterated in the Echo SR?
A: No.
If the worklist provides it, it might be OK to suggest it be copied, but otherwise, the Cart is not likely
to have access to this information unless the tech does manual data entry, in which case, it’s not
clear that the cart console is the best place/GUI to be typing it in. It would be better done by a
clerical person on another system (e.g. the HIS, the RIS or the CVIS).
Note that Indications have been included. Perhaps the same logic applies to those.
S4
What is in the core list of measurements?
A: The full set of concepts from the ASE papers, as collated in the ASE Core spreadsheet.
(about 150 currently) plus additional measurements proposed by vendors and found to be
reasonably “common”.
No new papers have come out recently so the original work stands (spanning 1989ish to 2012ish)
Structure
Supplement TBA: Simplified Adult Echocardiography Report
Page 9
St3
Should the TID Row Order be Significant or Insignificant?
A: Assume insignificant until a need is found for it to be significant.
Order significant would be a harder for producer but might be easier for consumers.
Coding
C1
Should the code meanings use uniform terminology or colloquial terminology?
A: Use uniform but don’t be pedantic.
Colloquial is somewhat random which might lead to coding errors. Use uniform terms unless they
get too unwieldy. In any case, Apps can display them in the GUI/report any way they like.
C2
Bias toward pre-coordination or post-coordination?
A. Pre-coordination.
•
Make it mandatory
•
Do not include modifiers
[Structure/Location/Finding Site] [Observable][Flow Direction?] [Cardiac Phase] [Method] etc
See Google Doc.
Would it be bad to allow lots of modifiers that reiterate semantics in the pre-coordinated code to
allow “dumb” applications to handle new codes in some way (e.g. add to the
For example some measurements will have “View not specified” since we don’t care and don’t want
codes for all the different variants.
<Do we allow a measurement to add a detail like view to a NOS code>
C3
But maybe we say that user measurements are completely post-coordinated and all modifiers are
mandatory. But what process is this facilitating, and would it be better just to do the Conformance
statement.
Might want to have a user-defined-measurement flag (beyond the private coding scheme?)
And we might want to put the vendor and user defined measurements in another group/container.
Note that we will have to enforce some level of discipline on the user when creating/configuring new
measurements.
How can reasonable consistency of units be achieved?
A: Stick to what is stated in ASE, but flag & discuss deviations from the following:







Distance in cm
Area in cm2 (except BSA in m2)
Velocity in m/s (except Tissue Doppler in cm/s)
Time in ms
Volume in ml
Mass in g
Flow in ml/s
Systems are welcome to do conversions when displaying measurements to users if some
sites/users have preferences that differ from the standard.
Supplement TBA: Simplified Adult Echocardiography Report
Page 10
C4
Should $DerivationParameter, $Equation, or $Table be encoded?
A: No.
They add complexity. Few creators use them. Few consumers support them (or else they get
derailed when they are provided).
For the core set the equation is pre-coordinated in the measurement. For user-defined
measurements, it seems unlikely that consumers would parse/recomputed the value even if the
equation was included in-band, rather than just documenting it out of band. Arguably, equations
could be stuffed in the Code Meaning of the $Method (which is done in a couple of places in Part
16), since the only real user might be the clinician wanting to know what equation was used, but
usually they are named, not expressed.
Anyone with a concrete Echo use case for these should present it. (They are used somewhat in
OB for the GA calculations)
C5
Should $Quotation be encoded?
A: No.
It adds complexity. Few creators use it. Few consumers support it (or else they get derailed when
they are provided).
Anyone with a concrete Echo use case for these should present it.
C6
Should $Equivalent Meaning of Concept Name be encoded?
A: No.
It adds complexity. Few creators use it. Few consumers support it (or else they get derailed when
they are provided).
Anyone with a concrete Echo use case for these should present it.
C7
Should $Laterality and $Topographical Modifier be encoded?
A: No.
Don’t need them for Cardiology (although vascular does). Left/right chambers are not laterality.
Proximal/Distal/etc is not relevant.
Anyone with a concrete Echo use case for these should present it.
C8
C12
Should $Measurement Properties be encoded?
A: No.
It adds complexity (normality codes, level of significance, statistical properties, ranges, range
authorities). Few if any creators use it. Few consumers support it (or else they get derailed when
they are provided).
Anyone with a concrete Echo use case for these should present it.
The Selection Method concept is useful though. It will be migrated into the Derivation.
Do Flow Direction semantics refer to the viewpoint of the probe or anatomy?
A: Anatomy is most clinically useful (see CID 12221).
While the probe knows towards/away, the app must help figure out the anatomic.
Supplement TBA: Simplified Adult Echocardiography Report
Page 11
82
Changes to NEMA Standards Publication PS 3.2-2011
Digital Imaging and Communications in Medicine (DICOM)
84
Part 2: Conformance
86
Add Section:
88
Describe documentation of vendor specific measurements. For example, the format could require that you
document the view, the mode, the method, etc, etc, etc
90
92
Changes to NEMA Standards Publication PS 3.3-2011
94
Digital Imaging and Communications in Medicine (DICOM)
Part 3: Information Object Definitions
96
Add new SOP Class if needed:
98
<Likely needed but still a point of discussion>
100
Supplement TBA: Simplified Adult Echocardiography Report
Page 12
Changes to NEMA Standards Publication PS 3.16-2011
102
Digital Imaging and Communications in Medicine (DICOM)
Part 16: Content Mapping Resource
104
106
Add new Section? to Annex A
SIMPLIFIED ADULT ECHOCARDIOGRAPHY TEMPLATES
108
The templates that comprise the Simplified Adult Echocardiography Report are interconnected as in Figure
A-x.1
TID 5QQQ
Simplified Echo
Procedure Report
TID 1204
Language of Content
Item and Descendants
TID 1001
Observation Context
TID 3602
Cardiovascular Patient
Characteristics
TID 5QQY
Precoordinated Echo
Measurement
TID 5QQZ
Postcoordinated Echo
Measurement
TID 5204
Wall Motion Analysis
110
Figure A.x-1: Echocardiography Procedure Report Template Structure
112
TID 5QQQ
Echocardiography Procedure Report
114
This template forms the top of a content tree that allows an ultrasound device to describe the results of an
adult echocardiography imaging procedure.
Supplement TBA: Simplified Adult Echocardiography Report
Page 13
116
It is instantiated at the root node. It can also be included in other templates that need to incorporate
echocardiography findings into another report as quoted evidence.
118
NL Rel with
Parent
1
VT
TID 5QQQ – Simplified Echo Procedure Report
Type: Extensible
Order: Insignificant
Concept Name
VM Req Cond
Value Set Constraint
Type ition
CONTAINER EV (125200, DCM, “Adult
Echocardiography Procedure
Report”)
HAS
INCLUDE
DTID (1204) Language of
CONCEPT
Content Item and Descendants
MOD
HAS OBS INCLUDE
DTID (1001) Observation
CONTEXT
Context
CONTAINS CONTAINER EV (121109, DCM, “Indications
for Procedure”)
1
M
1
U
1
M
1
U
2
>
3
>
4
>
5
>>
CONTAINS CODE
EV (121071, DCM, “Finding”)
1-n
U
6
>>
CONTAINS TEXT
EV (121071, DCM, “Finding”)
1
U
7
>
8
>>
9
>
CONTAINS CONTAINER DT (121064, DCM, “Current
1
Procedure Descriptions”)
CONTAINS CODE
DT (125203, DCM, “Acquisition 1-n
Protocol”)
CONTAINS INCLUDE
DTID (3602) Cardiovascular
1
Patient Characteristics
10
>
11
>>
CONTAINS CONTAINER EV (111028, DCM, “Image
Library”)
CONTAINS IMAGE
No purpose of reference
DCID (12246) Cardiac Ultrasound
Indication for Study
U
M
U
1
U
1-n
M
BCID (12001) Ultrasound Protocol Types
REVIEW
<<Note there are some mandatory
contents but it is currently optional to
include the module>>
Consider if we want to have a container
here for the pre-coords to be a midpoint
between Order significant and Order non.
Could also consider requiring they be
sorted by code value (which is
predictable/non-random and simple to
implement)
<<For the purpose of sup dev, will likely
break up the following into a few
anatomically grouped tables and maybe
merge them all at the end>>
$Measurement =
Aortic Valve Annulus Diameter (LN,
18016-6)
20
>
CONTAINS INCLUDE
DTID (5QQY) Pre-coordinated
Echo Measurement
1-n
U
21
>
CONTAINS INCLUDE
DTID (5QQY) Pre-coordinated
Echo Measurement
1-n
U
$Units = EV (cm, UCUM, “centimeter”)
$Measurement =
Aortic Valve Velocity-Time Integral (LN,
18169-3)
21
>
CONTAINS INCLUDE
DTID (5QQY) Pre-coordinated
Echo Measurement
1-n
U
$Units = EV (cm, UCUM, “centimeter”)
$Measurement =
Aortic Valve Peak Systolic Flow (LN,
11706-9)
$Units = EV (m/s, UCUM, “meter per
second”)
<<refer to spreadsheet>>
Supplement TBA: Simplified Adult Echocardiography Report
Page 14
NL Rel with
Parent
N
VT
Concept Name
CONTAINS INCLUDE
>
VM Req Cond
Type ition
DTID (5QQZ) Post-coordinated 1-n
Echo Measurement
U
Value Set Constraint
$Measurement =
…probably your vendor-specific private
pre-coordinated code…
$Units = …the units for this code….
N+1
120
CONTAINS INCLUDE
>
DTID (5204) Wall Motion
Analysis
1-n
U
$Procedure = DT (P5-B3121, SRT,
"Echocardiography for Determining
Ventricular Contraction")
.
Content Item Descriptions
Row 6
Row 11
A text string containing one or more sentences describing one or more indications, possibly with additional comments
from the physician or tech.
All images which are referenced in the body of the SR will be listed here.
122
124
TID 5QQY
Pre-coordinated Echo Measurement
This Template codes numeric echo measurements where most of the details about the nature of the
measurement have been pre-coordinated in the measurement code. In contrast, see TID 5QQZ Post128 coordinated Echo Measurement.
126
130
The pre-coordinated measurement code and units are provided when this Template is included from a
parent Template.
Note that this template is a simple subset of TID 300.
TID 5QQY Parameters
132
Parameter Name
Parameter Usage
$Measurement
Coded term or Context Group for Concept Name of measurement
$Units
Units of Measurement
TID 5QQY
Pre-coordinated Echo Measurement
Type: Extensible
Order: Insignificant
134
136
NL
Relation with
Parent
1
2
>
3
>
HAS
CONCEPT
MOD
Value Type
Concept Name
VM
Req
Type
Condition
Value Set Constraint
NUM
$Measurement
1
M
Units = $Units
CODE
EV (121401, DCM,
“Derivation”)
1
U
DCID (newcid1) Echo
Derivation
INCLUDE
DTID (320) Image or
Spatial Coordinates
1-n
U
$Purpose = EV
(121112, DCM,
Supplement TBA: Simplified Adult Echocardiography Report
Page 15
NL
Relation with
Parent
Value Type
Concept Name
VM
Req
Type
Condition
<<Do we want to permit
SCOORD3D here?
Probably since we are
seeing more Echo 3D>>
4
>
INCLUDE
DTID (321) Waveform or
Temporal Coordinates
Value Set Constraint
"Source of
measurement”)
1-n
U
$Purpose = EV
(121112, DCM,
"Source of
measurement”)
138
Content Item Descriptions
140
TID 5QQZ
142
This Template codes numeric echo measurements where most of the details about the nature of the
measurement have been post-coordinated in modifiers and acquisition context. In contrast, see TID 5QQY
Pre-coordinated Echo Measurement.
144
It is intended to be used for User-defined and Vendor-defined Echo Measurements.
Post-coordinated Echo Measurement
TID 5QQZ
Post-coordinated Echo Measurement
Type: Extensible
Order: Insignificant
146
NL
Relation with
Parent
1
Value Type
Concept Name
VM
Req
Type
Condition
Value Set Constraint
NUM
$Measurement
1
M
Units = $Units
CODE
EV (121401, DCM,
“Derivation”)
1
U
DCID (newcid1) Echo
Derivation
>
INCLUDE
DTID (320) Image or
Spatial Coordinates
1-n
U
$Purpose = EV
(121112, DCM,
"Source of
measurement”)
1c
>
INCLUDE
DTID (321) Waveform or
Temporal Coordinates
1-n
U
$Purpose = EV
(121112, DCM,
"Source of
measurement”)
2
>
CODE
EV (G-C0E3, SRT,
“Finding Site”)
1
M
BCID (12236) Echo
Anatomic
1a
>
1b
HAS CONCEPT
MOD
HAS CONCEPT
MOD
3
Observable?
Characteristic?
4
MC
IFF the measurement
is not unambiguously
associated with a
characteristic of the
structure of the
Finding Site in Row 2.
<<Do we need codes
for “Direct
Measurement” or
“NOS”>>
Measurement
5
>
HAS CONCEPT
MOD
CODE
EV (G-C036, SRT,
“Measurement Method")
1
M
6
>
HAS ACQ
CONTEXT
CODE
EV (G-0373, SRT, “Image
Mode”)
1
M
BCID (12227)
Echocardiography
Measurement Methods
DCID (12224)
Ultrasound Image
Supplement TBA: Simplified Adult Echocardiography Report
Page 16
NL
Relation with
Parent
Value Type
Concept Name
VM
Req
Type
Condition
Value Set Constraint
Modes
7
>
HAS ACQ
CONTEXT
CODE
EV (111031, DCM, “Image
View”)
1
M
BCID (12226)
Echocardiography
Image View
8
>
HAS CONCEPT
MOD
CODE
EV (R-4089A, SRT,
“Cardiac Cycle Point”)
1
U
DCID (12233) Cardiac
Phase
9
>
HAS CONCEPT
MOD
CODE
EV (G-C048, SRT, “Flow
Direction”)
1
MC
IFF the flow direction
is significant for this
measurement.
BCID (12221) Flow
Direction
10
>
HAS CONCEPT
MOD
CODE
EV (R-40899, SRT,
“Respiratory Cycle Point”)
1
MC
IFF the respiratory
cycle point is
significant for this
measurement.
DCID (12234)
Respiration State
N
>
HAS CONCEPT
MOD
INCLUDE
DTID (1210) Equivalent
Meaning of Concept Name
1
U
Post-coordinated Code
here? Or send it as
parameter to the 5QQY
include at the top?
148
Echo Measurement Descriptions
150
152
Row 1
<< vendor values and user values would look similar except for Dictionary>>
Row 2
The finding site should reflect the anatomical location where the measurement is taken, preferably coded using
SNOMED to a find detail as possible
Row 3
For example, in the case of Doppler, the Characteristic is the Antegrade Flow or the Retrograde Flow at the
Finding Site. In the case of a diameter measurement with a finding site of a blood vessel, generally Row 3 would
not be present.
Row N
“Equivalent Meaning of Concept Name” allows the creating application to specify the preferred composed concept
name representing the measurement and the associated post-coordination Concept Modifiers.
Supplement TBA: Simplified Adult Echocardiography Report
Page 17
154
Add the following CID’s to Part 16 Annex B:
CID newcid1
Echo Derivation
Context ID newcid1
Echo Derivation
Type: Extensible
Version: yyyymmdd
156
158
Coding Scheme
Designator
(0008,0102)
160
Code Value
(0008,0100)
Code Meaning
(0008,0104)
SRT
G-A437
Maximum
SRT
R-404FB
Minimum
SRT
R-00317
Mean
DCM
121410
User chosen value
DCM
121411
Most recent value chosen
Supplement TBA: Simplified Adult Echocardiography Report
Page 18
162
Add the following Definitions to Annex D
DICOM Code Definitions (Coding Scheme Designator “DCM” Coding Scheme Version “01”)
Code
Value
Code Meaning
Definition
…
Definition Template:
The <attribute> in <units> of the
<structure/characteristic> measured in
<mode/view> at/during <time/phase> using the
<method> normalized by <index>. The
measurement may have been taken using any
<leftovers>.
Consider removing units since that is not
fundamental to the concept and is communicated
in the $units anyway.
Aortic Valve Annulus Diameter
The diameter in cm of the Aortic Valve Annulus
measured in 2D mode at End Systole. The
measurement may have been taken using any
view or method.
Aortic Valve Flow VTI
The Velocity Time Integral in cm of the Aortic
Valve Flow measured in Doppler mode during
Systole. The measurement may have been
taken using any view or method.
Aortic Valve Flow Peak Velocity
The Peak Velocity in m/s of the Aortic Valve Flow
measured in Doppler mode during Systole. The
measurement may have been taken using any
view or method.
The Mean Velocity in m/s of the Aortic Valve
Flow measured in Doppler mode during Systole.
The measurement may have been taken using
any view or method.
Aortic Valve Flow Mean Velocity
Aortic Valve Peak Instantaneous
Gradient
Aortic Valve Mean Gradient
Aortic Valve Regurgitant Flow VTI
The Peak Instantaneous Pressure Gradient in
mmHg across the Aortic Valve measured in
Doppler mode during Systole using the Simplified
Bernoulli method.
The Mean Pressure Gradient in mmHg across
the Aortic Valve measured in Doppler mode
during Systole using the Simplified Bernoulli
method.
The Velocity Time Integral in cm of the Aortic
Valve Regurgitant Flow measured in Doppler
mode during Diastole. The measurement may
have been taken using any view or method.
Supplement TBA: Simplified Adult Echocardiography Report
Page 19
Aortic Valve Regurgitant Flow Volume
by PISA
The Volume in ml of the Aortic Valve Regurgitant
Flow measured in Doppler mode during Diastole
using the PISA method. The measurement may
have been taken using any view.
Aortic Valve Regurgitant Flow Jet Area
to LVOT Area
The Ratio in % of the Aortic Valve Regurgitant
Flow Jet Area to the LVOT Area measured in
Doppler mode during Diastole (?). The
measurement may have been taken using any
view.
Aortic Valve Regurgitant Flow Effective
Orifice Area
The Effective Orifice Area in cm2 of the Aortic
Valve Regurgitant Flow measured in Doppler
mode during Diastole using the volume derived
from the PISA method? The measurement may
have been taken using any view.
Aortic Valve Regurgitant Fraction
The Ratio in % of the Aortic Valve Regurgitant
Volume to the Aortic Valve Stroke Volume
measured in Doppler mode. The measurement
may have been taken using any view.
Aortic Valve Area by Continuity VTI /
BSA
An indexed value in cm2/m2 representing the
Area in cm2 of the Aortic Valve measured in
Doppler mode using the Continuity VTI method,
normalized to the Body Surface Area in m2.
Pulmonary Vein Flow S-wave Peak
Velocity
The Peak Velocity in m/s of the Pulmonary Vein
Flow measured in pulsed Doppler mode during
Systole. The measurement may have been
taken using any view or method and in any of the
Pulmonary Veins.
Pulmonary Vein Flow A-wave Duration
The Duration in ms of the Pulmonary Vein Flow
measured in pulsed Doppler mode during Atrial
Systole. The measurement may have been
taken using any view or method and in any of the
Pulmonary Veins.
Delta D
The difference in duration in ms between the
duration of the Pulmonary Vein Flow measured
in pulsed Doppler mode during Atrial Systole,
and the duration of the Mitral Valve Flow
measured in pulsed Doppler mode during Atrial
Systole. The measurement may have been
taken using any view or method and in any of the
Pulmonary Veins.
164
Modify Definitions in Annex D as shown:
Supplement TBA: Simplified Adult Echocardiography Report
Page 20
166
DICOM Code Definitions (Coding Scheme Designator “DCM” Coding Scheme Version “01”)
Code
Value
168
Code Meaning
Definition
Supplement TBA: Simplified Adult Echocardiography Report
Page 21
170
172
174
Changes to NEMA Standards Publication PS 3.17-2011
Digital Imaging and Communications in Medicine (DICOM)
176
Part 17: Explanatory Information
Supplement TBA: Simplified Adult Echocardiography Report
Page 22
178
Add Annex ??
ANNEX ??: Mapping Guidance? Population Guidance? (Informative)
180
Use Case 0: Store and Use Core Set
182
Use Case 1: Store and Display on PACS (non-semantic number)
[User configures Cart: define tool/interaction and link to new measurement = ID + Label String]
184
[User writes down detailed description of new measurement] (which then gets thrown in the shredder)
User takes measurement on Cart
186
Cart stores measurement value & units in SR for the exam under the ID+Label String
Cart sends SR to PACS
188
User selects an exam on PACS for display
PACS opens image and renders to screen
190
[User configures PACS: define layout/overlay and link row to SR Tag = ID]
PACS opens SR, finds ID, renders Label String, renders value+units
192
194
Q. Can we allow the customer to sometimes use LN code for the ID and sometimes local code? In
any case it would be handy to use the same ID on several carts so they
Use Case 2: Store and Insert in Report (non-semantic)
Same as PACS, but PACS=>Reporting Station, Layout=>Template, Render=>Insert
196
Use Case 3: Store and Plot Graph? Trending? Database? Etc.
198
May be useful to limit Use Case 3 to single/individual patient and push Big Data/Population health into Use
Case 4.
200
** Include a description of the sub-case where the object is from some other hospital. How do you track
down the paper? E.g. look in the header for the institution, call their Echo group, quote the name of the
measurement and ask for documentation.
202
Q. How do we handle dumb reporting systems? Could send a two objects, a stripped down one for the
reporters and a fully fledged one for the CVIS. Could assume that the CVIS will pre-process and
206 spoonfeed the reporter. Could assume that the cart will be down-configured to minimal outputs. Could
imagine a flag. The cases are: how do I handle multiples of the same measurement (and know you should
208 take the last, or the mean) vs recognizing specialized (e.g. X by Method A and X by Method B to be
instances of generic X).
204