ANNEX AAA: IMPLANTATION PLAN SR DOCUMENT (Informative)

For the implantation of bone mounted implants, information that has been generated during the implantation planning phase is needed in the OR. To convey this information to the OR, this supplement to the DICOM standard introduces the DICOM format for the results of an implantation planning activity referring to implant templates. An Implantation Plan SR Document should be utilized by surgeons, navigation devices, and for documentation purposes. The Plan contains relevant intraoperative information concerning the assembly of the implant components, resection lines, registration information, and relevant patient data. Thus, the Implantation Plan SR Document can help to enhance information logistics within the workflow. It does not contain any information about the planned surgical workflow. This information may be addressed by other DICOM Supplements. Nevertheless, this SR document may reference to or may be referenced by objects containing workflow information.

Additionally, once an implantation plan has been generated, it can be used as input for a planning application to facilitate adaption of a plan in cases where this is necessary due to unforeseen situations.

The workflow is considered to be the following:

Some kind of planning application helps the user to perform implantation planning; he can choose the optimal implant for a patient using implant templates from a repository. The user aligns the implant template with patient data with or without the help of the application. (Planning without patient data can be stored in the Implantation Plan SR Document as well.)

Subsequently, an Implantation Plan SR Document Instance will be created that contains the results of the planning. No information of the process itself (previously chosen implant templates, methods, etc.) will be stored. However, an Implantation Plan Document is considered to contain the important parameters to retrace a planning result.

There are two main components an Implantation Plan SR Document consists of (see Figure AAA.1-1). The implant component selection is used to point to a selected implant template in the repository, whereas the assembly is used to describe the composition of the selected implant templates. Figure AAA.2-1 shows how the Implantation Plan SR Document parts make references to the implant templates. Each Implantation Plan SR Document can contain a single implant component selection and several assemblies but it describes only one planning result for one particular patient.

The recipient of the Implantation Plan SR Document can decide whether to read only the “list” of used implants or to go into detail and read the compositions as well. In both cases, he must have access to the repository of the Implant Templates to get detailed information about the implant (such as its geometry).

AAA.1 IMPLANTATION PLAN SR DOCUMENT CONTENT TREE STRUCTURE

The following structure shows the main content of an Implantation Plan SR Document. As can be seen in Figure AAA.1-1, the Implantation Plan consists mainly of the selected Implant Components and their Assemblies.

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Figure AAA.1-1: Implantation Plan SR Document basic content tree

AAA.2 Relationship between Implant Template and Implantation Plan

The Implantation Plan SR Document is tightly related to Implantation Templates (see PS 3.3 and PS 3.16). The following Figure AAA.2-1 shows the relationship between the Implant Templates and the Implantation Plan.

[pic]

Figure AAA.2-1: Implantation Plan SR Document and Implant Template Relationship Diagram

AAA.3 Implantation Plan SR Document Total Hip Replacement Example

The following example shows the planning result of a simple THR (Total Hip Replacement) without any registration information. One Patient Image was used and one visualization was produced. One Femoral Stem, one Femoral Head, one Acetabular Bearing Insert and one Acetabular Fixation Cup were selected to be implanted (see Figure AAA.3-1).

[pic]

Figure AAA.3-1: Total Hip Replacement Components

Table AAA.3-1 Total Hip Replacement Example

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1 Implantation Plan 7000
1.1 Language of Content Item and Descendants English 1204
1.2 Observation Context 1001
1.2.1 Person Observer Name Dr. Michael Mueller 1003
1.2.2 Subject Name John Smith 1007
1.2.3 Subject ID 1.2.3.4.5.6.7.8.9 1007
1.2.4 Subject Species L-85B00, SRT,”homo sapiens” 1007
1.3 Implant Component List 7000
1.3.1 Implant Assembly Template Reference to THR 7000
1.3.2 Selected Implant Component 7000
1.3.2.1 Component ID 1 7000
1.3.2.2 Component Type 112310 7000
1.3.2.3 Reference to Implant Template “FS1000” (derived) 7000
1.3.2.4 Frame Of Reference UID 1.2.3.4.1 7000
1.3.2.5 Manufacturer Implant Template Reference to Implant Template “FS1000” (original) 7000
1.3.3 Selected Implant Component 7000
1.3.3.1 Component ID 2 7000
1.3.3.2 Component Type A-04459 7000
1.3.3.3 Reference to Implant Template ”FH2000” (derived) 7000
1.3.3.4 Frame Of Reference UID 1.2.3.4.2 7000
1.3.3.5 Manufacturer Implant Template Reference to Implant Template ”FH2000” (original) 7000
1.3.4 Selected Implant Component 7000
1.3.4.1 Component ID 3 7000
1.3.4.2 Component Type 112305 7000
1.3.4.3 Reference to Implant Template “AFC3000” (derived) 7000
1.3.4.4 Frame Of Reference UID 1.2.3.4.3 7000
1.3.4.5 Manufacturer Implant Template Reference to Implant Template “AFC3000” (original) 7000
1.3.5 Selected Implant Component 7000
1.3.5.1 Component ID 4 7000
1.3.5.2 Component Type 112306 7000
1.3.5.3 Reference to Implant Template “ABI4000” (derived) 7000
1.3.5.4 Frame Of Reference UID 1.2.3.4.4 7000
1.3.5.5 Manufacturer Implant Template Reference to Implant Template “ABI4000” (original) 7000
1.4. Assembly 7000
1.4.1 Component Connection 7000
1.4.1.1 Connected Implantation Plan Component 7000
1.4.1.1.1 Component ID 3 7000
1.4.1.1.2 Mating Feature Set ID 1 7000
1.4.1.1.3 Mating Feature ID 1 7000
1.4.1.2 Connected Implantation Plan Component
1.4.1.2.1 Component ID 4 7000
1.4.1.2.2 Mating Feature Set ID 1 7000
1.4.1.2.3 Mating Feature ID 1 7000
1.4.2 Component Connection 7000
1.4.2.1 Connected Implantation Plan Component 7000
1.4.2.1.1 Component ID 2 7000
1.4.2.1.2 Mating Feature Set ID 1 7000
1.4.2.1.3 Mating Feature ID 1 7000
1.4.2.2 Connected Implantation Plan Component 7000
1.4.2.2.1 Component ID 1 7000
1.4.2.2.2 Mating Feature Set ID 1 7000
1.4.2.2.3 Mating Feature ID 2 7000
1.4.3 Component Connection 7000
1.4.3.1 Connected Implantation Plan Component 7000
1.4.3.1.1 Component ID 2 7000
1.4.3.1.2 Mating Feature Set ID 2 7000
1.4.3.1.3 Mating Feature ID 1 7000
1.4.3.2 Connected Implantation Plan Component 7000
1.4.3.2.1 Component ID 4 7000
1.4.3.2.2 Mating Feature Set ID 2 7000
1.4.3.2.3 Mating Feature ID 2 7000
1.5 Information used for planning 7000
1.5.1 Patient Image Reference to Image 01 7000
1.5.1.2 Horizontal Pixel Spacing 0.2 mm/pixel 7000
1.5.1.3 Vertical Pixel Spacing 0.2 mm/pixel 7000
1.6 Planning Information for Intraoperative Usage 7000
1.6.1 Supporting Information Reference to Encapsulated PDF-Document 01 7000
1.6.2 Derived Images Reference to Visualization 01 7000

AAA.4 Implantation Plan SR Document Dental DriLLING TEMPLATE Example

The following example shows the result of a planning activity for a dental implantation using a dental drilling template. The implant positioning is based on a CT-Scan during which the patient has been wearing a bite plate with 3 markers. In this example the markers (visible in the patient’s CT images) are detected by the planning application. After the implants have been positioned, the bite plate, in combination with the registration information of the implants, can be used to produce the dental drilling template.

In the following example, two implants are inserted which are not assembled using Mating Points.

The markers of the bite plate are identified and stored as 3 Fiducials in one Fiducial Set. This Fiducial Set has its own Frame of Reference (1.2.3.4.100).

The Registration Object created by the planning application uses the patient’s CT Frame of Reference as main Frame of Reference (See Figure F.4-1). [pic]

Figure AAA.4-1: Spatial relations of Implant, Implant Template, Bite Plate and Patient CT

Table AAA.3-2 Dental Drilling Template Example

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1 Implantation Plan 7000
1.1 Language of Content Item and Descendants English 1204
1.2 Observation Context 1001
1.2.1 Person Observer Name Dr. Michael Mueller 1003
1.2.2 Subject Name John Smith 1007
1.2.3 Subject ID 1.2.3.4.5.6.7.8.9 1007
1.2.4 Subject Species L-85B00, SRT,”homo sapiens” 1007
1.3 Implant Component List 7000
1.3.1 Selected Implant Component 7000
1.3.1.1 Component ID 1 7000
1.3.1.2 Component Type 112305 7000
1.3.1.3 Reference to Implant Template “DI1000” (derived) 7000
1.3.1.4 Frame Of Reference UID 1.2.3.4.1 7000
1.3.1.5 Manufacturer Implant Template Reference to Implant Template “DI1000” (original) 7000
1.3.2 Implant Component Selection 7000
1.3.2.1 Component ID 2 7000
1.3.2.2 Component Type 112306 7000
1.3.2.3 Reference to Implant Template ”DI2000” (derived) 7000
1.3.2.4 Frame Of Reference UID 1.2.3.4.2 7000
1.3.2.5 Manufacturer Implant Template Reference to Implant Template ”DI2000” (original) 7000
1.4 Information used for planning 7000
1.4.1 Patient Image Reference to CT Image01 7000
1.4.1.2 Horizontal Pixel Spacing 0.3 mm/pixel 7000
1.4.1.3 Vertical Pixel Spacing 0.3 mm/pixel
1.5 Planning Information for Intraoperative Usage 7000
1.5.1 Derived Planning Images Reference to Visualization01 7000
1.5.2 Spatial Registration Reference to Registration01 7000
1.5.2.1 Frame Of Reference UID 1.2.3.4.1 7000
1.5.2.2 Frame Of Reference UID 1.2.3.4.2 7000
1.5.2.3 Frame Of Reference UID 1.2.3.4.3 7000
1.5.2.4 Frame Of Reference UID 1.2.3.4.100 7000
1.5.3 Derived Planning Data Reference to Fiducial 01 7000
1.5.3.1 Derived Fiducial 1.2.3.4.3 7000
1.5.3.1.1 Fiducial Intent Bite Plate Marker 7000
1.5.3.2 Derived Fiducial 1.2.3.4.4 7000
1.5.3.2.1 Fiducial Intent Bite Plate Marker 7000
1.5.3.3 Derived Fiducial 1.2.3.4.5 7000
1.5.3.3.1 Fiducial Intent Bite Plate Marker 7000