th
1300THE
North
17 Street,
Suite
1847
DICOM
2013
INTERNATIONAL
Rosslyn, VA 22209
CONFERENCE
(703)
841-3285 & SEMINAR
Fax (703)
841-3385
March
14-16, 2013
Bangalore, India
ABSTRACT
Title of presentation/poster
Enhancing Contrast Agent Informatics – A closed loop imaging model using
DICOM
Primary Author (to be listed
if only one name is listed) name, job title,
employer/affiliation, and email
Sridhar B,
Senior Software Engineer,
Bayer Radiology & Interventional, Bayer HealthCare
Sridhar.balasubramanian@bayer.com
Other/Co- Author(s)
name(s), job title(s),
employer(s)/ affiliation(s)
John Kalafut Ph.D.
Director, Informatics Research & Strategy
Bayer Radiology & Interventional, Bayer HealthCare
John.kalafut@bayer.com
Name of the author
conducting correspondence
on behalf of all authors
Sridhar B
Postal address of
corresponding author
One, Medrad Dr., Indianola PA 15051
Repeat e-mail address of
corresponding author
Sridhar.balasubramanian@bayer.com
Telephone of corresponding
author
412-406-3004
Preferred format:
Abstract: (200-750 words, in
English)
Oral presentation or poster
The administration of Contrast agent to patient as part of imaging procedure has
been widely adopted for enhancing diagnostic quality. With the advent of intelligent
injector devices, contrast agent administration could be planned, programmed and
performed at the contrast infusion workstation.
We discuss various ways enabling automation of flow of contrast agent
administration information starting from the protocoling stage until reporting and
helping enhancement of radiology workflow, and preventing workflow errors.
Closing the gap
DICOM Contrast Adhoc Group Work-In-Progress Workflow:
Currently, DICOM Contrast-Agent Adhoc Group is working on structuring
Contrast Agent Administration info under new DICOM SR objects (Supplement
164).
a. Contrast Agent Administration SR
b. Scheduled Contrast Agent Administration SR
c. Performed Contrast Agent Administration SR
d. Basic Contrast Agent Administration SR
The Scheduled Contrast Administration object is intended for representing the plan
or program to deliver contrast agent to the patient for a contrast study. It could be
programmed at the time of schedule of a study or beginning of the study. Often, it
is programmed at the power-Injector device console by the modality technician or
radiologists. The plan may be altered by the delivery system or a user based on a
variety of factors.
The Performed Contrast Administration SR is for reporting the actual plan or
program that was used to deliver the contrast agent during a medical imaging
study.
The Contrast Agent Administration SR object refers to both the scheduled and
performed objects. In addition, the Basic Contrast Agent Administration provides a
summarized version of the performed contrast administration, which could be used
as S.I.R (Summary Information Report) for any consuming system for record.
Image Archive/
Manager
CA SR
DSS/Order
Filler/Scheduler
Report Manager
(Dictation System)
Store CA SR
Obtain
MWL
Q/R
Acquisition
System
Store Summary CA object
Infusion Manager
Billing System
Store CA SR
Objects
Pharmacy
Infusion System
Store Scheduled CA SR
Protocoling Client
CA – Contrast Agent Admin. SR Object
Protocoling Client: Contrast agent protocoling, where a radiologist could
program the injection plan (a Scheduled Contrast Agent SOP SR) prior to the
study and push it to an Infusion manager. Often, this is done at the infusion
manager (injector workstation), however protocoling can also be planned by
radiologists using independent standalone applications that can push
scheduled CA SR objects, to infusion manager. While planning ahead, a
radiologist might want to review the plan that was previously performed, which
is achieved by query/retrieval of performed contrast agent admin. objects from
the infusion manager.
Infusion System: Point of care device that injects contrast to the patient.
Infusion Manager: Workstation where the delivery protocols are programmed
to be performed by infusion system. Obtains schedule context via MWL,
creates and pushes Contrast Agent SR objects to various destinations.
Certain consumers like Acquisition Systems, Reporting Systems (Dictation
systems), Pharmacy, and Billing Systems may be interested in the summary
information, hence a basic summary object is sent to have just enough info
about the contrast administered.
UPS model for enhancing workflow:
Using DICOM Unified Procedure Step (UPS) model to close the gap between
modality and infusion system could be worked out using UPS SOP Classes -
Event SOP Class or Watch SOP class services, to notify modality using NCreate/N-Set messages on various injector states like start, stop, thus
communicating live to the interested subscribers in addition to modality.
Advantages:
a. As the modality obtains status from the injector device about various
states, it could be auto-triggered for scan after the planned scan
delay.
b. Additionally, the scan delay parameter (“gold data” – i.e., a very
useful data for Infusion Systems) could be obtained more accurately
without having to rely on time based calculations and timesynchronizations and could be made available to infusion systems
(via C-Find).
Pull model for enhancing workflow
There could be workflow needs for a consumer like dictation system needing to
“pull in” contrast administration data from the infusion manager. DICOM
defines Substance Administration Query Model (S.A.Q) which could be used
enabling anyone to “C-Find” and obtain contrast dose information. An
acquisition system could also might need to “pull in” contrast summary data for
a given study.
However the present S.A.Q model does not accommodate well enough
contrast agent admin. attributes (tables C.26.1, 2, 3 defined in Part 3) like
injection start time, flow-rate, etc – to overcome this, we might enrich the
present Substance Admin. Query model to accommodate more attributes or
have a new Query Info model proposed – the new contrast agent admin query
model looks like below.
SOP Class Name
Contrast Agent Admin. Query
Information Model - FIND
SOP Class UID
1.2.840.10008.5.1.4.xx
Contrast Agent Query Information E/R Model
Enhanced
Contrast/Bolus
Admin.
has
consumable
Product
has
subject
administered
to
Patient
has
Visit
The attributes of the Information Entities found in the diagram can be found in the following
Modules in PS 3.3.
a. —
Patient Identification Module
b. —
Patient Demographics Module
c.
Visit Identification Module
—
d. —
Enhanced Contrast/Bolus Admin. would contain Enhanced Contrast/Bolus
attributes.
e. —
Product Characteristics Module
Advantages
a. Being able to query and retrieve dosage data for a given
patient/study level at any later stage in the radiology workflow, helps
enhance the workflow.
b. Since this closes the loop with “contrast data hungry” consumer, it
prevents errors arising due to manual entries of contrast dosage
data.
c. Since transfer of objects is not involved, the exchange of data is
quick over network.
d. Study Split scenarios involving contrast are better handled
automatically – as the modality can fill in the contrast info for relevant
with contrast studies.
2012 Rev. 5