/ THE DICOM 2013 INTERNATIONAL
CONFERENCE & SEMINAR
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 e-mail / Sridhar B,
Senior Software Engineer,
Bayer Radiology & Interventional, Bayer HealthCare

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

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 /
Telephone of corresponding author / 412-406-3004
Preferred format: / Oral presentation or poster
Abstract: (200-750 words, in English) / 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).
  1. Contrast Agent Administration SR
  2. Scheduled Contrast Agent Administration SR
  3. Performed Contrast Agent Administration SR
  4. 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 AdministrationSR 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.

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 devicethat 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 N-Create/N-Set messages on various injector states like start, stop, thus communicating live to the interested subscribers in addition to modality.
Advantages:
  1. As the modality obtains status from the injector device about various states, it could be auto-triggered for scan after the planned scan delay.
  1. 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 time-synchronizations 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 / SOP Class UID
Contrast Agent Admin. Query Information Model - FIND / 1.2.840.10008.5.1.4.xx
Contrast Agent Query Information E/R Model

The attributes of the Information Entities found in the diagram can be found in the following Modules in PS 3.3.
  1. —Patient Identification Module
  2. —Patient Demographics Module
  3. —Visit Identification Module
  4. —Enhanced Contrast/Bolus Admin. would contain Enhanced Contrast/Bolus attributes.
  5. —Product Characteristics Module
Advantages
  1. 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.
  1. Since this closes the loop with “contrast data hungry” consumer, it prevents errors arising due to manual entries of contrast dosage data.
  1. Since transfer of objects is not involved, the exchange of data is quick over network.
  1. 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