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 Link to this message Neelam Dugar  posted on Tuesday, January 29, 2013 - 03:30 pm Edit Post Delete Post Print Post
We wish to imporve body part mapping for the exam codes (we use the national exam codes) with our PACS replacement.

Good body part mapping will imporve relevant prior displays. We are planning to keep body part simple. This is what we are looking to use.

Head

Neck

Chest

Abdo

Pelvis

Body (esp for overlapping CT body areas)

Spine

Upper Limb

Lower Limb

Heart

Vessels

Misc

Comments please
 Link to this message Noufal Manikkatharamal  posted on Wednesday, January 30, 2013 - 11:13 am Edit Post Delete Post Print Post
uploding the staanderd radiology codes like NHS procedure list it will be helpfull-
 Link to this message Ivan Brown  posted on Wednesday, January 30, 2013 - 11:58 am Edit Post Delete Post Print Post
I would agree that the body parts that Neelam suggests need to be acknowledged in some way and would advise the addition of Whole Body for NM and Functional studies such as PET/CT and PET/MR.

I understood howvever that the use of the National Procedure coding was now mandatory so I am just not sure how much flexibility is likely to be available.
 Link to this message Richard Longden  posted on Wednesday, January 30, 2013 - 02:03 pm Edit Post Delete Post Print Post
I would include Breast in your mapping; we use it a great deal.

Richard
 Link to this message Neelam Dugar  posted on Wednesday, January 30, 2013 - 09:17 pm Edit Post Delete Post Print Post
Ivan,

Thanks. Chris Lindop from IHE suggested "Whole Body"---However, I thought "Body" would be better as we could include multiple body areas on CT, alongwith PET-CT/PET-MR.
Body parts is predominantly useful with relevant prior so getting PET-CT as a relevant prior of Body CT would be quite useful I think.....
Happy for any different views.

Thanks Richard.
Breast,
Bowel--esp for fluroscopy
are good additions.
 Link to this message David Clunie  posted on Thursday, January 31, 2013 - 12:06 am Edit Post Delete Post Print Post
There is a standard list in DICOM (see the relevant Annex of PS 3.16).
 Link to this message Joel Lidstrom  posted on Thursday, January 31, 2013 - 05:40 am Edit Post Delete Post Print Post
Neelam, our language processing engine can map proc codes to body parts for related priors, normalize exam descriptions to standard exam terminology, and correlate any radiologic list of procedures to any other list. Send me your database of procedures or send me a sample (Proc Code, Description, Modality); I'll show you what we can do!
 Link to this message Karen Hawkins  posted on Thursday, January 31, 2013 - 08:59 am Edit Post Delete Post Print Post
Having done this recently I've found that being a bit more specific with extremities works better for us, i.e. specifying hand, foot etc. Also, maybe using dental/mandible/jaw for OPG's rather than head (or setting up priors based on modality as well as body part) so OPG's don't display as prior with a CT head!
 Link to this message Alexandra Finley  posted on Thursday, January 31, 2013 - 10:11 am Edit Post Delete Post Print Post
Neelam,
I also agree with Karen, if you have time to get that granular up front, it will save you time in the long run with considerable functionality and patient care benefits. It is also important to include laterality,there are numerous ways to do this depending on the functionality of the application with which you are configuring. Good luck! :-)
 Link to this message Joel Lidstrom  posted on Thursday, January 31, 2013 - 01:25 pm Edit Post Delete Post Print Post
Granularity is indeed important for display protocols--you'll also want to differentiate angio procedures from bony procedures, and ensure that immediately adjacent body parts will compare (here I'm referring to bony plain films where you may want an ankle to compare to a tib/fib, or a tib/fib to a knee, but never an ankle to a knee). Hierarchical relationships are important, too, so that bilateral studies compare to lefts and rights (and vice versa) without rights showing with lefts. Similarly you should take care that an entire spine compares to a C, T, or L Spine and vice versa but never a C-Spine to a T or L, etc... To map procedure codes well is highly complex, but improves efficiency remarkably. Also, what you can achieve depends on your PACS.
 Link to this message Joel Lidstrom  posted on Thursday, January 31, 2013 - 02:07 pm Edit Post Delete Post Print Post
With respect to Ivan Brown's comment about limited flexibility for body part mapping (vis a vis your fabulous national standard), how your PACS hangs related priors is independent of the procedure code list itself. For most PACS you must tag procedures with body region, laterality, and sometimes functionality. (Fuji PACS 3.x requires the creation of relationships among the procedures themselves.) It pays huge dividends to map procedures carefully and intelligently, but I would think that this would be done on a national level. Create the taggings for the entirety of your procedure code list, and voila!, everyone can load the mappings into their PACS.
 Link to this message Neelam Dugar  posted on Thursday, January 31, 2013 - 09:20 pm Edit Post Delete Post Print Post
The granularity--laterality, hip, knee etc already exists with national exam codes.

So how does body part mapping help clinical users.
1. Plain xray --relevant prior rules better with exam codes
2.CT/US--relevent prior better with body part mapping
....
This is what I was looking at.
 Link to this message Taimoore Rajah  posted on Monday, April 22, 2013 - 05:42 pm Edit Post Delete Post Print Post
Perhaps body Mapping dependent upon procedure type and modality would help?

May be we can design Body Mapping tree structure that can be created.

Anyone has any suggestions?
 Link to this message Andrew Downie  posted on Wednesday, May 21, 2014 - 01:16 pm Edit Post Delete Post Print Post
Revisiting an old thread.
When our PACS went in, I never fully understood the use of body part information. Now we are refreshing the PACS, it seemed like a good idea to try again.

I'm unclear what the correct "flow" of body part information should be. Our HSS RIS has body part info in the exam table, but HSS say they can't send this to PACS as HL7 doesn't cover it.

The modalities are a mess, some sending it, some not, some sending it in the series description field, and no consistency in what terms they use. In concequence the DPs simply can't be made to work as we wish.

The thought of getting vendors to reprogamme every modality in the region (hundreds) to a single standard is just incomprehensible. Is there a better way? Surely it should come from a single exam code table (eg national codes) somehow?
 Link to this message Simon Hadley  posted on Wednesday, May 21, 2014 - 02:36 pm Edit Post Delete Post Print Post
Andrew,

With our recent PACS/RIS implementation, we had the opportunity for all examination codes have to be entered into the PACS system with a specific body part code to be able to utilise DDP's.

In addition to this, extension into the realms of XDS and VNA's will require Body parts to be present to allow filtering. We have utilised a simple set of body parts that we utilise within the trust that are consistent with the RIS/PACS and VNA. In the VNA, they are mapped against the relevant SNOMED CT body part codes which is what we will use going forward.

You should be able to add a body part on RIS and then replicate the same on PACS. In both cases you should be able to get your PACS/RIS vendor to script this, however, it may be chargeable.

I agree that national codes should potentially indicate body part codes, however with most systems only being able to store a single body part, a lot of ones where multiple body parts are set up become "Whole Body" for ease of convenience. (E.g. MRI Post Mortem, XR Skeletal Survey, CT Neck/Chest/Abdo/Pelvis with Contrast)

I have enclosed the codes that we use, it would be interesting to hear about what other users think moving forward?

Abdomen- T-D4000
Cardiovascular- T-30001
Chest- T-D3000
Cervical Spine- T-11501
Lower Extremity-T-D9000
Upper Extremity-T-D8080
Head- T-D1100
Lumbar Spine- T-11503
Neck- T-D1600
Pelvis- T-D6000
Thoracic Spine- T-11502
Whole Body- T-D0010
Whole Spine- T-D00CC

Regards
Simon
 Link to this message Christopher Lindop  posted on Wednesday, May 21, 2014 - 02:52 pm Edit Post Delete Post Print Post
OBR-44 Procedure Code and Procedure Description should be sufficient to prescribe the body part examined to the PACS. PACS can do the mapping from this field. If desired, OBR-46, Placer Supplemental Service Information could be used. Though desirable that modalities provide this information in the DICOM IOD, it is not practical to expect it.
 Link to this message Dave Harvey  posted on Wednesday, May 21, 2014 - 04:06 pm Edit Post Delete Post Print Post
Andrew,

In general, the codes can (and should!) be populated from the NICIP codes - if they are available, then everything else should flow from that, including:

1) RIS should be able (easily!) to populate body part in the MWL response (if of course the modality requests it!).

2) It would be nice if modalities put body part into the image (it is actually mandatory for some newer IODs), but Chris is right that this is unlikely to get 100% coverage, so don't depend on it.

3) It is possible that a PACS could add the body part information based on the NICIP code that it "knows" about from the RIS. This is not the most reliable way of doing things, as scheduled != performed, but it may be better than nothing.

4) For other uses (e.g. XDS-I publication), deriving the body part(s!) directly from NICIP code would almost certainly be the way to go.

Does this help?

Dave
 Link to this message Neelam Dugar  posted on Wednesday, May 21, 2014 - 04:24 pm Edit Post Delete Post Print Post
Andrew,
Thanks for raising this issue. We are looking at the body part mapping issue for VNA.

Our XDS- I sources uses body part as 1 of the event codes.
Perceptive/Acuo takes body part information from DICOM header information
This DICOM header information comes from modalities.
There is no national list of NICIP codes mapped to 1 or more body parts.
The result of the behaviour of XDS-I we will have a lot dirty data from DICOM headers populating our VNA XDS metadata. This is setting off alarm bells for me.

Anyone willing to share their NICIP codes mapped to body parts please? I understand you can map 1 exam to multiple body parts for example CT neck and chest with contrast would be mapped to 2 body parts, cT neck chest and abdomen -3 body parts and neck chest abdomen and pelvis to 4 body parts.
 Link to this message Christopher Lindop  posted on Wednesday, May 21, 2014 - 04:26 pm Edit Post Delete Post Print Post
I would add that if scheduled does not equal performed, the RIS should provide the procedure update message. The PACS should reconcile any image studies based on this.

Your RIS and PACS should be compliant to IHE SWF and PIR. PIR would be the avenue for the PACS to receive procedure updates.
 Link to this message Neelam Dugar  posted on Wednesday, May 21, 2014 - 04:29 pm Edit Post Delete Post Print Post
Clinically I don't find body part mapping very useful in PACS for clinical work. NICIP codes provide the granularity of
Modality
Body part(s)
Laterality
However, XDS-I sources insist on populating it into XDS metadata eventCode