The templates that comprise the IVUS Report within the Evidence Report IOD are interconnected as shown in Figure A-5.

[pic]

Figure A-5 IVUS Report Template Hierarchy

The IVUS Report template is the root structure for the representation of IVUS measurements acquired during a catheterization procedure.

TID 3250 IVUS ReportType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | DT (18752-6, LN, “Stress Testing Report”) | 1 | M | ||||

1 | ||||||||

Row 17 | The Procedure Time Base is the time from which elapsed times are measured. The Study Time (0008,0030) may include the patient prep period, while this Procedure Time Base is typically established when baseline data collection begins. |

The Stress Test Phase Data template provides a structure for measurements acquired during a single procedure phase.

TID 3303 Stress Test Phase DataType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 |

Each instance of the Stress Test Measurement Group represents a group of data elements acquired at approximately the same instant, and conventionally rendered as row in a tabular presentation. It is typically generated during the Stress exam whenever a time interval elapses (for example, every minute of the phase), when a technician observes data worth capturing, or when measurements exceed a given range.

*
TID 3304
*
*
Stress Test Measurement Group
*
*
Type: Extensible Order: Significant
*

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | ||||||||

Row 10 | Included Template 3106 allows the recording of test medications other than the Pharmacological Stress Agent identified in Template x3301. | |||||||

Rows 17, 18 | ECG ST elevation/depression is measured in units of mV, but is conventionally reported in units of mm, based on strip recordings with scaling of 100 uV/mm. The display application should render these measurements in units meaningful to the user. | |||||||

Row 19 | Note that the MDC codes for “per lead” measurements specified in CID 3228 are base codes for post-coordination with lead identifiers conveyed in the Target Site modifier in TID 300. MDC also defines pre-coordinated codes that include both the measurement and the lead, which may be used in this row. | |||||||

Row 20 | Note that the MDC code for “QTc interval per lead” specified in CID 3227 is a base code for post-coordination with lead identifiers conveyed in the Target Site modifier in TID 300. MDC also defines pre-coordinated codes that include both the measurement and the lead, which may be used in this row. Note that TID 300 enables the encoding of a non-standard correction algorithm, either as a local code, or as a TEXT Method Citation (see TID 300 row 12). | |||||||

Row 21 | R-R interval used for QT correction algorithm | |||||||

Row 22 | Recommended range for ECG axis measurements is -90° to +270° |

TID 3307NM/PET Perfusion Measurement GroupType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | DT (121070, DCM, “Findings”) | 1 | M | ||||

1 |

TID 3311Stress Test SummaryType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 |

TID 3312Physiological SummaryType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 |

TID 3313Stress ECG SummaryType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | ||||||||

Row 12-13 | This Concept and the associated Concept Modifier may be instantiated twice, once for resting state measurements, once for stress. |

TID 3317Stress Imaging SummaryType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | ||||||||

Row 15 | The LVEF code specified in this row is defined in LOINC with method “imaging”. LVEF measurement by ultrasound may also be encoded elsewhere in the Content Tree (e.g., in TID 3309 Stress Echo Measurement Group) with LOINC code 18043-0, which has method “ultrasound”. It is recommended that such findings from the per-phase measurements be summarized here with the generic “LVEF by Imaging” concept code. |

This template describes changes in findings from a prior stress exam. Comparison is to only one prior exam, even though the generic concept name for the template uses the plural “exams”.

TID 3318Comparison to Prior Stress ExamType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (111424, DCM, “Comparison to previous exams”) | 1 | M | ||||

1 | CONTAINER | EV (121076, DCM, "Conclusions") | 1 | MC | IF Completion Flag (0040,A491) = COMPLETE | |||

1 | CONTAINER | EV (122120, DCM, “Hemodynamics Report”) | 1 | M | ||||

2 | > | HAS OBS CONTEXT | INCLUDE | DTID (1002) Observer Context | 1-n | M | ||

3 | > | INCLUDE | DTID (3601) Procedure Context | 1 | M | |||

4 | > | HAS OBS CONTEXT | INCLUDE | DTID (3602) Cardiovascular Patient Characteristics | 1 | M | ||

5 | > | HAS ACQ CONTEXT | INCLUDE | DTID (3603) Procedure Environmental Characteristics | 1 | U | ||

6 | > | CONTAINS | INCLUDE | DTID (3501) Hemodynamic Measurement Group | 1-n | M | ||

7 | > | CONTAINS | INCLUDE | DTID (3570) "Summary, Hemodynamics" | 1 | U |

The Hemodynamic Measurement Group template provides a structure for measurements acquired during a single procedure phase in a cardiac catheterization lab.

TID 3501 Hemodynamics Measurement GroupType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (121070, DCM, “Findings”) | 1 | M | ||||

2 | > | HAS ACQ CONTEXT | CODE | EV (G-72BB, SRT, “Catheterization Procedure Phase”) | 1 | M | DCID (3651) Hemodynamic Measurement phase | |

3 | > | HAS ACQ CONTEXT | INCLUDE | DTID (3520) Hemodynamic Clinical Context | 1 | U | ||

4 | > | HAS ACQ CONTEXT | TEXT | EV (121124, DCM, "Procedure Action ID") | 1 | U | ||

5 | > | CONTAINS | INCLUDE | DTID (3510) Vital signs | 1-n | U | ||

6 | > | CONTAINS | INCLUDE | DTID (3504) Arterial Pressure Measurement | 1-n | U | ||

7 | > | CONTAINS | INCLUDE | DTID (3505) Atrial Pressure Measurement | 1-n | U | ||

8 | > | CONTAINS | INCLUDE | DTID (3506) Venous Pressure Measurement | 1-n | U | ||

9 | > | CONTAINS | INCLUDE | DTID (3507) Ventricular Pressure Measurement | 1-n | U | ||

10 | > | CONTAINS | INCLUDE | DTID (3508) Gradient Measurement | 1-n | U | ||

11 | > | CONTAINS | INCLUDE | DTID (3509) Blood Velocity Measurements | 1-n | U | ||

12 | > | CONTAINS | INCLUDE | DTID (3515) Cardiac Output Measurement by Indicator Dilution | 1-n | U | ||

13 | > | CONTAINS | INCLUDE | DTID (3516) Blood lab measurements | 1-n | U | ||

14 | > | CONTAINS | INCLUDE | DTID (3560) Derived Hemodynamic Measurements | 1-n | U | ||

15 | > | CONTAINS | INCLUDE | DTID (3714) ECG Lead Measurements | 1-n | U |

Row 4 Procedure Action ID allows linkage between the hemodynamic measurements recorded in this Template and a procedure step or phase recorded in the Procedure Log, e.g., using TID 3100.

The Arterial Pressure Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing systolic, diastolic, and mean measurements. This implies that the name of the measurement is effectively post-coordinated from the measurement name, the Hemodynamic Measurement Group container (procedure phase) name, and the acquisition context (finding site) value.

TID 3504Arterial Pressure MeasurementType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (P2-36102, SRT, “Arterial pressure measurements") | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | M | $LocationName = EV (G-C0E3, SRT, “Finding Site”) $LocationValue = DCID (3606) Arterial source locations | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (8480-6, LN, “Intravascular arterial Systolic pressure”) $Units = DCID (3500) Pressure Units | |

4 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (8462-4, LN, “Intravascular arterial Diastolic pressure”) $Units = DCID (3500) Pressure Units | |

5 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (8478-0, LN, “Intravascular arterial mean pressure”) $Units = DCID (3500) Pressure Units | |

6 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

The Atrial Pressure Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing a-wave, v-wave, and mean measurements. This implies that the name of the measurement is effectively post-coordinated from the measurement name, the Hemodynamic Measurement Group container (procedure phase) name, and the acquisition context (finding site) value.

TID 3505Atrial Pressure MeasurementType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122121, DCM, “Atrial pressure measurements") | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | M | $LocationName = EV (G-C0E3, SRT, “Finding Site”) $LocationValue = DCID (3608) Atrial source locations | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (109016, DCM, “A-wave peak pressure”) $Units = DCID (3500) Pressure Units | |

4 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (109034, DCM, “V-wave peak pressure”) $Units = DCID (3500) Pressure Units | |

5 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (F 31150, SRT, “Mean blood pressure”) $Units = DCID (3500) Pressure Units | |

6 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

The Venous Pressure Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing a mean measurement. This implies that the name of the measurement is effectively post-coordinated from the measurement name, the Hemodynamic Measurement Group container (procedure phase) name, and the acquisition context (finding site) value.

TID 3506Venous
*
*
*
Pressure Measurement
*
*
Type: Extensible Order: Significant
*

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (P2-36110, SRT, “Venous pressure measurements") | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | M | $LocationName = EV (G-C0E3, SRT, “Finding Site”) $LocationValue = DCID (3607) Venous source locations | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | M | $Measurement = EV (F 31150, SRT, “Mean blood pressure”) $Units = DCID (3500) Pressure Units | |

4 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

The Ventricular Pressure Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing systolic and end-diastolic measurements. This implies that the name of the measurement is effectively post-coordinated from the measurement name, the Hemodynamic Measurement Group container (procedure phase) name, and the acquisition context (finding site) value.

TID 3507Ventricular Pressure MeasurementType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122122, DCM, “Ventricular pressure measurements") | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | M | $LocationName = EV (G-C0E3, SRT, “Finding Site”) $LocationValue = DCID (3609) Ventricular source locations | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32600, SRT, “Left Ventricle”) or subsite thereof | $Measurement = EV (F-03E0D, SRT, “Left Ventricular Systolic blood pressure”) $Units = DCID (3500) Pressure Units |

4 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32600, SRT, “Left Ventricle”) or subsite thereof | $Measurement = EV (F-03E0E, SRT, “Left Ventricular End Diastolic pressure”) $Units = DCID (3500) Pressure Units |

5 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32500, SRT, “Right Ventricle”) or subsite thereof | $Measurement = EV (F-03DFE, SRT, “Right Ventricular Systolic blood pressure”) $Units = DCID (3500) Pressure Units |

6 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32500, SRT, “Right Ventricle”) or subsite thereof | $Measurement = EV (F-03E02, SRT, “Right Ventricular End Diastolic pressure”) $Units = DCID (3500) Pressure Units |

7 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32400, SRT, “Common Ventricle”) | $Measurement = EV (122194, DCM, “Ventricular Systolic blood pressure”) $Units = DCID (3500) Pressure Units |

8 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1 | MC | IFF $LocationValue selected in row 2 is (T-32400, SRT, “Common Ventricle”) | $Measurement = EV (122191, DCM, “Ventricular End Diastolic pressure”) $Units = DCID (3500) Pressure Units |

9 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

The Gradient Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing the gradient measurement. This implies that the name of the measurement is effectively post-coordinated from the measurement name, the Hemodynamic Measurement Group container (procedure phase) name, and the acquisition context (finding site) value.

TID 3508Gradient MeasurementType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122123, DCM, “Gradient assessment”) | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | MC | XOR with Rows 3 & 4 IFF single location is appropriate | $LocationName = EV (G-C0E3, SRT, “Finding Site”) $LocationValue = DCID (3610) Gradient Source Locations | |

3 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | MC | XOR with Row 2 IFF a dual location is appropriate | $LocationName = EV (121116, DCM, “Proximal Finding Site”) $LocationValue = DCID (3630) Cardiovascular Anatomic Locations | |

4 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | MC | XOR with Row 2 IFF a dual location is appropriate | $LocationName = EV (121117, DCM, “Distal Finding Site”) $LocationValue = DCID (3630) Cardiovascular Anatomic Locations | |

5 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1-n | M | $Measurement = EV (F-023F7, ”Pressure Gradient”) $Units = DCID (3500) Pressure Units $Derivation = DCID (3627) Measurement Type | |

6 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

Row 5, which is used to encode the gradient measurements, uses Template 300 for the content item structure of the measurements. That template allows an INFERRED FROM relationship to other numeric measurements used in the computation or derivation of the current measurement. In the case of a gradient measurement, the pressure measurements at the distal and proximal locations may thus be explicitly conveyed.

The Blood Velocity Measurement template consists of a CONTAINER, with an acquisition context of the measurement anatomic site, and containing primary (not derived) velocity measurements, e.g., from a Doppler catheter. Derived velocity measurements may be recorded using TID 3560.

TID 3509Blood Velocity MeasurementType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122124, DCM, “Blood velocity measurements") | 1 | M | ||||

2 | > | INCLUDE | DTID (3530) Hemodynamic Acquisition Context | 1 | M | $LocationName = EV (G-C0E9, SRT, “Procedure site”) $LocationValue = BCID (3606) Arterial source locations | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1-n | M | $Measurement = DCID (3612) Blood Velocity Measurements $Units = EV (mm/s, UCUM, "mm/s") | |

4 | > | CONTAINS | INCLUDE | DTID (3550) Pressure waveform measurements | 1-n | U |

The Vital Signs template consists of a CONTAINER containing the various vital signs measurements. These measurements may be acquired automatically from patient monitoring equipment, or may be entered based on manual measurements.

TID 3510Vital SignsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (8716-3, LN, “Vital Signs”) | 1 | M | ||||

2 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-008EC, SRT, "Systolic blood pressure") $Units = DCID (3500) $Method = BCID (3560) Blood Pressure Methods | |

3 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-008ED, SRT, "Diastolic blood pressure") $Units = DCID (3500) | |

4 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8867-4, LN, "Heart rate") $Units = EV ("{H.B.}/min", UCUM, "BPM") | |

5 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8310-5, LN, "Body temperature") $Units = EV (Cel, UCUM, “°C”) | |

6 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = DCID (3526) Blood gas saturation $Units = EV (%, UCUM, "%") | |

7 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV ( F-043E7, SRT, "Respiration rate") $Units = EV (/min, UCUM, "breaths/min") | |

8 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122195, DCM, "Pulse Strength") $Units = DT("{0:4}", UCUM, "range 0:4") | |

9 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-009EA, SRT, “Pain Score”) $Units = DT("{1:10}", UCUM, "range 1:10") | |

10 | > | CONTAINS | CODE | DT (8884-9, LN, "Cardiac Rhythm") | 1 | U | BCID (3415) Cardiac Rhythms | |

11 | > | CONTAINS | CODE | DT (9304-7, LN, "Respiration Rhythm") | 1 | U | BCID (3416) Respiration Rhythms |

The Cardiac Output Measurement by Indicator Dilution template consists of a CONTAINER containing the measurement and significant parameters of the technical method. If the measurement is based on a DICOM Hemodynamic Waveform SOP Instance, that object may also be referenced.

Note: Fick Cardiac Output is encoded in the Derived Hemodynamic Measurements Template 3560.

TID 3515Cardiac Output Measurement by Indicator DilutionType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (P2-34201, SRT, “Cardiac Output measurement”) | 1 | M | ||||

2 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | M | $Measurement = EV (8737-9, LN, “Cardiac Output by Indicator Dilution”) $Units = EV (l/min, UCUM, ”l/min”) $Method = DCID (3628) Cardiac Output Methods $WavePurpose = DT (121112, DCM, "Source of measurement”) | |

3 | > | HAS ACQ CONTEXT | NUM | EV (122319, DCM, “Catheter Size”) | 1 | MC | IFF Row 2 indicates a thermal method | UNITS = DCID (3510) Catheter Size Units |

4 | > | HAS ACQ CONTEXT | NUM | EV (122320, DCM, “Injectate Temperature”) | 1 | MC | IFF Row 2 indicates a thermal method | UNITS = EV (Cel, UCUM, “°C”) |

5 | > | HAS ACQ CONTEXT | NUM | EV (122321, DCM, “Injectate Volume”) | 1 | M | UNITS = DT (ml, UCUM, “ml”) | |

6 | > | HAS ACQ CONTEXT | NUM | EV (122322, DCM, “Calibration Factor”) | 1 | M | UNITS = DT (1, UCUM, “no units”) |

The Blood Lab Measurements template provides for the recording of measurements made on blood samples obtained during a catheterization procedure. The type and anatomic source of the blood is recorded as acquisition context. The results from the blood chemistry measurement system are quoted; the measurement names may be pre-coordinated with the type or source of the blood, or generic measurement names may be reported. In the latter case, the full measurement concept name may be effectively post-coordinated using the recorded acquisition context.

TID 3516Blood Lab MeasurementsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122125, DCM, ”Blood lab measurements”) | 1 | M | ||||

2 | > | HAS ACQ CONTEXT | CODE | EV (R-00254, SRT, "Specimen Type”) | 1 | M | DCID (3520) Blood Source Type | |

3 | > | HAS ACQ CONTEXT | CODE | EV (G-C0E9, SRT, “Procedure site”) | 1 | M | BCID (3630) Cardiovascular Anatomic Locations | |

4 | > | INCLUDE | DTID (1000) Quotation | 1 | U | |||

5 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (718-7, LN, “Hemoglobin”) $Units = DT (g/dl, UCUM, "g/dl") | |

6 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3524) Blood Gas Pressures $Units = DCID (3500) | |

7 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3525) Blood Gas Content $Units = DT (ml/dl, UCUM, "ml/dl") | |

8 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3528) Blood pH $Units = EV ([pH], UCUM, "pH") | |

9 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3526) Blood Gas Saturation $Units = EV (%, UCUM, "%") | |

10 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3527) Blood Base Excess $Units = DT (meq/dl, UCUM, "meq/dl") | |

11 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122183, DCM, "Blood temperature") $Units = EV (Cel, UCUM, “°C”) |

The Clinical Context template allows the recording of information about the patient's clinical state that may affect interpretation of the hemodynamic measurements. This Template includes several coded conditions (e.g., complications, drugs, physiological challenges, etc.), each of which may have a Concept Modifier of “Relative Time”. This Modifier indicates the temporal relationship of the hemodynamic measurements to the conditions recorded in this template. E.g., the Content Item structure:

[CONTAINER] “Findings” HAS ACQ CONTEXT “Cath Procedure Phase” “Post-intervention phase” HAS ACQ CONTEXT [CONTAINER] “Clinical Context” CONTAINS [CODE] “Complication” “Arrhythmia” HAS CONCEPT MOD [CODE] “Relative Time” “After” CONTAINS [CONTAINER] “Arterial Measurements” …

conveys the semantics that this group of measurements for the post-intervention phase of a cath procedure was made after an occurrence of arrhythmia in the patient.

In the absence of a Relative Time modifier, the acquisition context is during the identified event or state.

TID 3520Hemodynamic Clinical ContextType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122127, DCM, "Clinical Context") | 1 | M | ||||

2 | > | CONTAINS | CODE | EV (109054, DCM, ”Patient State”) | 1-n | U | BCID (3602) Hemodynamic Patient State | |

3 | > | CONTAINS | TEXT | EV (109054, DCM, ”Patient State”) | 1 | U | ||

4 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (DD-60002, SRT, “Complication of Procedure”) $ConditionValue = DCID (3413) Adverse Outcomes | |

5 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (122086, DCM, "Contrast administered") $ConditionValue = BCID (12) Radiographic Contrast Agent | |

6 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (122083, DCM, "Drug administered") $ConditionValue = BCID (10) Interventional Drug | |

7 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (109059, DCM, ”Physiological challenges”) $ConditionValue = BCID (3271) Hemodynamic Physiological Challenges | |

8 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (122138, DCM, "Circulatory Support") $ConditionValue = DCID (3553) Circulatory Support | |

9 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (P2-2200A, SRT, "Ventilatory assistance") $ConditionValue = DCID (3554) Ventilation | |

10 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (P2-35000, SRT, "Cardiac Pacing") $ConditionValue = BCID (3555) Pacing | |

11 | > | CONTAINS | INCLUDE | DTID (3521) Relative Time | 1-n | U | $ConditionName = EV (P0-0000, SRT, "Procedure") $ConditionValue = BCID (3405) Procedure Action Values |

The Relative Time template is invoked by 3520 Hemodynamic Acquisition Context template. It specifies an applicable clinical context condition and the time of the current measurements relative to that condition.

*
TID 3521 Parameters
*

Parameter Name | Parameter Usage |

$ConditionName | Coded term for Concept Name of condition |

$ConditionValue | Context Group for condition values |

TID 3521Relative TimeType: Non-Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CODE | $ConditionName | 1 | M | $ConditionValue | |||

2 | > | HAS CONCEPT MOD | CODE | EV (G-D709, SRT, "Relative time") | 1 | U | BCID (3600) Relative times |

The Hemodynamic Acquisition Context template is invoked by the various hemodynamic measurement templates.

Parameter Name | Parameter Usage |

$LocationName | Coded term for Concept Name of measurement location |

$LocationValue | Context Group for appropriate anatomic locations |

*
TID 3530
*
*
Hemodynamic Acquisition Context
*
*
Type: Extensible Order: Significant
*

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | HAS CONCEPT MOD | CODE | $LocationName | 1 | M | $LocationValue | ||

2 | > | HAS CONCEPT MOD | CODE | EV (G-A1F8, SRT, “Topographical modifier”) | 1 | U | BCID (3019) Cardiovascular anatomic location modifiers | |

3 | HAS ACQ CONTEXT | CODE | EV (G-C036, SRT, “Measurement Method ") | 1 | U | BCID (3241) Hemodynamic Measurement Technique | ||

4 | HAS ACQ CONTEXT | WAVEFORM | DT (121112, DCM, "Source of measurement”) | 1 | UC | XOR Row 5 | ||

5 | HAS ACQ CONTEXT | TCOORD | DT (121112, DCM, "Source of measurement”) | 1 | UC | XOR Row 4 | ||

6 | > | SELECTED FROM | WAVEFORM | 1 | M |

The Pressure Waveform Measurements template is invoked by the various hemodynamic measurement templates for recording general measurements made in conjunction with the specific required measurements for that anatomic location.

TID 3550Pressure Waveform MeasurementsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3611) Pressure Measurements $Units = DCID (3500) | ||

2 | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3612) Blood Velocity Measurements $Units = EV (mm/s, UCUM, "mm/s") | ||

3 | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3613) Hemodynamic Time Measurements $Units = DT (ms, UCUM, "ms") | ||

4 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-32100, SRT, "Cardiac Output") $Units = EV (l/min, UCUM, "l/min") | ||

5 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-32120, SRT, "Stroke Volume”) $Units = DT (ml, UCUM, "ml") | ||

6 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (10230-1, LN, "LV Ejection Fraction") $Units = EV (%, UCUM, "%") | ||

7 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8867-4, LN, "Heart rate") $Units = DT ("{H.B.}/min", UCUM, "BPM") | ||

8 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV ( F-043E7, SRT, "Respiration rate") $Units = DT (“/min”, UCUM, "breaths/min") | ||

9 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (109025, DCM, "Max dp/dt") $Units = DT (mm[Hg]/s, UCUM, "mmHg/s") | ||

10 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (109026, DCM, "Max neg dp/dt") $Units = DT (mm[Hg]/s, UCUM, "mmHg/s") | ||

11 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122190, DCM, "Max dp/dt/P") $Units = DT (s-1, UCUM, "/s") | ||

12 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122192, DCM, "Indicator appearance time") $Units = DT (s, UCUM, "s") | ||

13 | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122193, DCM, "Maximum pressure acceleration") $Units = DT (mm[Hg]/s2, UCUM, "mmHg/s/s") | ||

14 | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3617) Valve Flows $Units = DT (ml/min, UCUM, "ml/min") |

The Derived Hemodynamic Measurements template consists of a CONTAINER containing measurements derived from one or more other measurements. These measurements are associated with a particular procedure phase, but not necessarily with a particular anatomic location.

TID 3560Derived Hemodynamic MeasurementsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122126, DCM, "Derived Hemodynamic Measurements") | 1 | U | ||||

2 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3614) Valve Areas, non-Mitral $Units = EV (cm2, UCUM, "cm2") $Equation = DT (122262, DCM, “Area = Flow / 44.5 * sqrt(Gradient[mmHg])”) | |

3 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-02320, SRT, "Mitral Valve Area”) $Units = EV (cm2, UCUM, "cm2") $Equation = DT (122263, DCM, “MVA= Flow / 38.0 * sqrt(Gradient[mmHg])”) | |

4 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3615) Valve Areas $ModType = EV (121425, DCM, “Index”) $ModValue = EV (8277-6, LN, “Body Surface Area”) $Units = DT (cm2/m2, UCUM, "cm2/m2") | |

5 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3616) Hemodynamic Period Measurements $Units = DT ("s/min", UCUM, "s/min") | |

6 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3617) Valve Flows $Units = DT (ml/s, UCUM, "ml/s") | |

7 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-32110, SRT, "Cardiac Index”) $Units = DT (l/min/m2, UCUM, "l/min/m2") | |

8 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3529) Arterial / Venous Content $Units = DT (ml/dl, UCUM, "ml/dl") | |

9 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3618) Hemodynamic Flows $Units = DT (l/min, UCUM, "l/min") | |

10 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8736-1, LN, "FICK Cardiac Output”) $Units = DT (l/min, UCUM, "l/min") | |

11 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8750-2, LN, "FICK Cardiac Index”) $Units = DT (l/min/m2, UCUM, "l/min/m2") | |

12 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122229, DCM, "Arteriovenous difference”) $Units = DT (ml/dl, UCUM, "ml/dl") | |

13 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = BCID (3620) Hemodynamic Ratios $Units = DT (1, UCUM, "ratio") | |

14 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122237, DCM, "Corrected Sinus Node Recovery Time”) $Units = DT (ms, UCUM, "ms") | |

15 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8861-7, LN, "Left Ventricular Stroke Work”) $Units = DT (gf.m, UCUM, "gf.m") | |

16 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8862-5, LN, "Right Ventricular Stroke Work”) $Units = DT (gf.m, UCUM, "gf.m") | |

17 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8863-3, LN, "Left Ventricular Stroke Work Index”) $Units = DT (gf.m/m2, UCUM, "gf.m/m2") | |

18 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (8864-1, LN, "Right Ventricular Stroke Work Index”) $Units = DT (gf.m/m2, UCUM, "gf.m/m2") | |

19 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122238, DCM, "Max volume normalized to 50mmHg pulse pressure”) $Units = DT (ml, UCUM, "ml") | |

20 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122239, DCM, "Oxygen Consumption”) $Units = DT (ml/min, UCUM, "ml/min") $Equation = BCID (3664) Oxygen Consumption Equations and Tables | |

21 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (19217-9, LN, "Oxygen partial pressure at 50% saturation (P50)") $Units = DCID (3500) $Equation = BCID (3666) P50 Equations | |

22 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (11556-8, LN, "Blood Oxygen partial pressure”) $Units = DCID (3500) | |

23 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3618) Hemodynamic Flows $ModType = EV (121425, DCM, “Index”) $ModValue = EV (8277-6, LN, “Body Surface Area”) $Units = DT (l/min/m2, UCUM, "l/min/m2") | |

24 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3619) Hemodynamic Resistance Measurements $Units = BCID (3502) Hemodynamic Resistance Units | |

25 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3619) Hemodynamic Resistance Measurements $ModType = EV (121425, DCM, “Index”) $ModValue = EV (8277-6, LN, “Body Surface Area”) $Units = BCID (3503) Indexed Hemodynamic Resistance Units | |

26 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122227, DCM, "Left to Right Flow”) $Units = DT (l/min, UCUM, "l/min") | |

27 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (122228, DCM, "Right to Left Flow”) $Units = DT (l/min, UCUM, "l/min") | |

28 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-32120, SRT, "Stroke Volume”) $Units = DT (ml, UCUM, "ml") | |

29 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-32120, SRT, "Stroke Volume”) $ModType = EV (121425, DCM, “Index”) $ModValue = EV (8277-6, LN, “Body Surface Area”) $Units = DT (ml,/m2 UCUM, "ml/m2") | |

30 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1 | U | $Measurement = EV (F-042BA, SRT, "Total blood volume”) $Units = DT (l, UCUM, "l") | |

31 | > | CONTAINS | INCLUDE | TID (300) Measurement | 1-n | U | $Measurement = DCID (3667) Framingham Scores $Units = DT (%, UCUM, "%") $Equation = DCID (3668) Framingham Tables |

This Template allows the recording of any significant numeric measurements or findings.

TID 3570Summary, HemodynamicsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINS | CONTAINER | EV (121111, DCM, "Summary") | 1 | M | |||

2 | > | CONTAINS | TEXT | EV (121111, DCM, "Summary") | 1 | U | ||

3 | > | CONTAINS | INCLUDE | DTID (300) Measurement | 1-n | U | ||

4 | > | CONTAINS | CODE | EV (121071, DCM, "Finding") | 1-n | U | DCID (3640) Hypertension | |

5 | >> | INCLUDE | DTID (1350) “Negation Modifier, Presence of Finding” | 1 | U | |||

6 | >> | HAS PROPERTIES | CODE | EV (G-C197, SRT, "Severity") | 1 | U | DCID (3716) Severity | |

7 | > | CONTAINS | CODE | DCID (3641) Hemodynamic Assessments | 1-n | U | DCID (3642) Degree Findings | |

8 | >> | HAS PROPERTIES | CODE | EV (G-C0B2, SRT, “Condition”) | 1 | U | EV (R-102B9, SRT, “Large v-wave”) | |

9 | > | CONTAINS | CODE | EV (121071, DCM, “Finding”) | 1 | U | EV (R-102BA, SRT, “Diastolic pressure equalization”) |

The Procedure Context template describes acquisition context for measurements made or events recorded in a procedure.

TID 3601 Procedure ContextType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | HAS ACQ CONTEXT | TEXT | EV (121065, DCM, "Procedure Description") | 1 | U | Defaults to Study Description (0008,1030) of the General Study Module | ||

2 | HAS ACQ CONTEXT | CODE | EV (G-C0E8, SRT, “Has Intent”) | 1 | U | BCID (3629) Procedure Intent | ||

3 | HAS ACQ CONTEXT | CODE | EV (G-C09C, SRT, “Procedure Priority”) | 1 | U | BCID (3414) Procedure Urgency | ||

4 | HAS OBS CONTEXT | CODE | EV (121023, DCM, ”Procedure Code”) | 1-n | U | Defaults to Procedure Code Sequence (0008,1032) of General Study Module |

This template describes the characteristics of the patient that are specific to the current clinical presentation (visit). Patient Characteristic concepts in this template, which may replicate attributes in the Patient Study Module, are included here as possible targets of by-reference relationships from other content items in the SR tree.

Note: Several of the concepts in this template duplicate concepts in TID 1007 “Subject Context, Patient”. The difference in use is that this template has those concepts as primary observations of the patient, while in TID 1007 the concepts are used to set (or reset) the context for other observations.

TID 3602Cardiovascular Patient CharacteristicsType: Extensible Order: Significant

NL | |

Row 16 | Breast size for interpretation of attenuation in nuclear medicine imaging |

TID 3603Procedure Environmental CharacteristicsType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINER | EV (122222, DCM, “Procedure Environmental Characteristics”) | 1 | M | ||||

2 | > | CONTAINS | NUM | EV (122223, DCM, “Room oxygen concentration”) | 1 | U | UNITS = EV (%, UCUM, “%”) | |

3 | > | CONTAINS | NUM | EV (122224, DCM, “Room temperature”) | 1 | U | UNITS = EV (Cel, UCUM, “ºC”) | |

4 | > | CONTAINS | NUM | EV (122225, DCM, “Room Barometric pressure”) | 1 | U | UNITS = DT (mbar, UCUM, “millibar”) |

The ECG Report template is the root structure for the representation of analysis of an ECG waveform, potentially in comparison to a prior ECG waveform analysis. The analyzed waveform may or may not be stored as a DICOM SOP Instance.

TID 3700 ECG ReportType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | TEXT | EV (122149, DCM, "Beat Number") | 1 | U | Up to three numeric characters | |||

2 | CODE | EV (G-C036, SRT, "Measurement Method") | 1 | U | DCID (3676) Lead Measurement Technique | |||

3 | TCOORD | EV (121112, DCM, "Source of measurement”) | 1 | U | ||||

4 | > | SELECTED FROM | WAVEFORM | 1 | U |

Row 1 Beat Number is specified as a numeric text string, and shall be treated as the ordinal of the beat (cardiac cycle) within the waveform acquisition for this lead that was analyzed for the measurements in this container (i.e., “1” for the first beat, “2” for the second, etc.). If absent, the measurements may have been made by a technique across multiple cycles as specified in Row 2 Measurement Method.

Rows 3 and 4 Source of measurement identify the specific channel and time period within a DICOM ECG Waveform SOP Instance that was analyzed for the measurements in this container.

The ECG Qualitative Analysis template allows a free text qualitative interpretation of the analyzed ECG, as well as a structure for a coded analysis.

*
TID 3717
*
*
Qualitative Analysis, ECG
*
*
Type: Extensible Order: Significant
*

NL | |

Row 5-6 | Each primary ECG Finding of Row 3 may have multiple supporting coded findings in Row 5, with longer human-readable text strings if necessary in Row 6. |

This Template is retired. See PS3.16-2009.

TID 3719Summary, ECGType: Extensible Order: Significant

NL | Relation with Parent | Value Type | Concept Name | VM | Req Type | Condition | Value Set Constraint | |

1 | CONTAINS | CONTAINER | EV (121111, DCM, "Summary") | 1 | M | |||

2 | > | CONTAINS | TEXT | EV (121111, DCM, "Summary") | 1 | U | ||

3 | > | CONTAINS | CODE | DT(18810-2, LN, “ECG overall finding”) | 1 | U | DCID (3677) Summary Codes ECG |