Ultrasound protocol codes

1. Very few of the SNOMED codes in CID 12001 Ultrasound Protocol Types, and none of the codes in 12002 Ultrasound Protocol Stage Types, actually exist in SNOMED. While these non-existent codes do no harm (yet), it is inappropriate for DICOM to assert them as SNOMED codes, and in fact SNOMED could use them for other concepts. [For the record, these terms were added in CP230.] 2. The codes as listed in DICOM for “Transthoracic echocardiography” and “Epicardial echocardiography” conflict with the actual codes in SNOMED, and with each other. (For the record, TTE in SNOMED is P5-B3004 but is listed in DICOM as P5-B3003 – which is the code for a different concept in SNOMED, and ECE in SNOMED is P5-B3007 but is listed in DICOM as P5-B3004). SNOMED has assigned new codes to resolve the conflict and potential ambiguity. 3. SNOMED had assigned other codes for Exercise stress echocardiography (P5-B3009), Contrast echocardiography (P5-B3008) and Fetal echocardiography (P5-B3001). SNOMED has agreed to reassign these concepts with the codes published in DICOM (P5-B3050, P5-B3090, and P5-B8215, respectively). 4. The various Stress Protocol names in CID 12001 are pre-coordinated with the term “echocardiography”, e.g., “Bruce treadmill stress echocardiography”. For other uses in stress testing we simply use a protocol name without the modality term, e.g., “Bruce protocol” (SNOMED P2-7131A). It would simplify applications if there were a common set of protocol names used across all modalities, without having to map to a different code for each modality. The pre-coordinated terms are therefore replaced by the terms of CID 3261 Stress Protocols. 5. Similarly, the various Stage names in CID 12002 are pre-coordinated with the term “image acquisition”, e.g., “Peak-stress image acquisition”. For other staged modality protocols (stress testing) we simply use a stage name, as some modalities do not acquire images. The pre-coordinated terms are therefore replaced by the terms of CID 3207 Stress Test Procedure Phases (copied from Sup128_FZ). 6. Various Stage names in CID 12002 are pre-coordinated with very specific terms for test conditions, e.g., “Image acquisition at dobutamine 50 mcg/kg/min plus atropine”. It is not clear that this is a useful or practical type of concept to be selected or entered on the imaging modality. For other uses in stress testing we rely on the protocol definition or other reporting mechanism to convey the details of the stage test conditions (see Supplement 128). These terms are retired. Sections of documents affected Add to new table to PS 3.6 Annex A Table A-3
CONTEXT GROUP UID VALUES
Context UID
Context Group Name
Identifier

Modify CID 12001 and CID 12002 in PS 3.16 Annex B


CID 12001
Ultrasound Protocol Types
Context ID 12001
Ultrasound Protocol Types
Type: Extensible
Version: 2002090420081027
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
P5-B3000
Echocardiography
P5-B3003 P5-B3012 Transthoracic echocardiography
P5-B3004 P0-05F95 Epicardial echocardiography
SRT P5-B301F Limited
M-mode only echocardiography
SRT P5-B303F
Limited Doppler only echocardiography
SRT P5-B3051
Maximal stress echocardiography
SRT P5-B3052 Submaximal
echocardiography
SRT P5-B3053
Treadmill exercise stress echocardiography
SRT P5-B3054
Bruce treadmill stress echocardiography
SRT P5-B3055
Modified Bruce treadmill stress
echocardiography

SRT P5-B3056
Naughton treadmill stress echocardiography
SRT P5-B3058
Bicycle exercise stress echocardiography
SRT P5-B3060
Echocardiography with administered drug
stress

SRT P5-B3061 Dobutamine
echocardiography
SRT P5-B3062
High dose dobutamine stress
echocardiography

SRT P5-B3063
Low dose dobutamine stress
echocardiography

SRT P5-B3065 Arbutamine
echocardiography
SRT P5-B3066
Dipyridamole stress echocardiography
SRT P5-B3070
Cardiac pacing echocardiography
SRT P5-B3081 Adult
echocardiography
P5-B3082 P5-B300F Pediatric echocardiography
P5-B3083 P5-B300C Intraoperative echocardiography
SRT P5-B3084 Upright
echocardiography
SRT P5-B3085 Supine
echocardiography
SRT P5-B3091
Contrast left ventricular opacification
echocardiography

SRT P5-B3092 Contrast perfusion echocardiography
SRT P5-B3093
Contrast Doppler enhancement
echocardiography

SRT P5-B3191
2D complete echocardiography
SRT P5-B3192
Limited 2D only echocardiography
Include CID 3261 Stress Protocols
In a prior version of this context group, Transthoracic echocardiography was assigned the code P5-
B3003 and Epicardial echocardiography was assigned the code P5-B3004; these codes conflict with
other SNOMED code assignments. In addition, the prior version used many codes that are not
actually in SNOMED. Receiving applications should be aware of this change, and the possibility of
misinterpretation of SOP Instances that may include the deprecated codes; see Annex J.


CID 12002
Ultrasound Protocol Stage Types
Context ID 12002
Ultrasound Protocol Stage Types
Type: Extensible
Version: 2002090420081027
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
Include CID 3207 Stress Test Procedure Phases
Include CID12102 Temporal Periods Relating to Procedure or Therapy
SRT P5-01000
Image acquisition procedure
SRT P5-01101
Image acquisition after administration of contrast
agent

P5-01103 P2-35000 Image acquisition during Cardiac pacing
SRT P5-01104
Image acquisition at user-defined cardiac pacing
rate

P5-01111 P2-71306 Image acquisition during Hand grip maneuver
P5-01112 R-40928 Image acquisition during Valsalva
SRT P5-01113
Image acquisition during postural maneuver
SRT P5-01120 Pre-procedure image acquisition
SRT P5-01121
Preoperative image acquisition
SRT P5-01130 Intra-procedure image acquisition
SRT P5-01131 Intra-operative image acquisition
SRT P5-01140 Post-procedure image acquisition
SRT P5-01141 Post-operative image acquisition
SRT P5-01142
Image acquisition following first cardiopulmonary
SRT P5-01143
Image acquisition following second
cardiopulmonary bypass

SRT P5-01144
Image acquisition following third cardiopulmonary
bypass

SRT P5-01200
Image acquisition during stress procedure
SRT P5-01201
Image acquisition at baseline
SRT P5-01202 Pre-stress image acquisition
SRT P5-01203 Mid-stress image acquisition
SRT P5-01204 Peak-stress image acquisition
SRT P5-01205 Image
acquisition during recovery
SRT P5-01300
Image acquisition after drug administration
SRT P5-01310
Image acquisition at user-defined dobutamine dose
SRT P5-01311
Image acquisition at low-dose dobutamine
SRT P5-01312
Image acquisition at mid-dose dobutamine
P5-01313
Image acquisition at peak dose dobutamine
SRT P5-01314
Image acquisition at dobutamine 5 mcg/kg/min
SRT P5-01315
Image acquisition at dobutamine 10 mcg/kg/min
SRT P5-01316
Image acquisition at dobutamine 20 mcg/kg/min
SRT P5-01317 Image
acquisition at dobutamine 30 mcg/kg/min
SRT P5-01318
Image acquisition at dobutamine 40 mcg/kg/min
SRT P5-01319
Image acquisition at dobutamine 50 mcg/kg/min
SRT P5-0131A
Image at dobutamine 40 mcg/kg/min plus atropine
SRT P5-0131B
Image acquisition at dobutamine 50 mcg/kg/min
plus atropine

SRT P5-01323
Image acquisition at peak Arbutamine dose
SRT P5-01333
Image acquisition at peak dipyridamole
SRT P5-01341
Image acquisition after nitroglycerin
SRT P5-01342
Image acquisition after amyl nitrite
SRT P5-01343
Image acquisition after adenosine
A prior version of this context group used many codes that are not actually in SNOMED. Although
there is minimal possibility of misinterpretation with SOP Instances that may include the
deprecated use, receiving applications should be aware of this change; see Annex J.

Add CID 3207 (also defined in Supplement 128 Frozen Draft for Trial Use) Context ID 3207
Stress Test Procedure Phases
Type: Extensible
Version: 20081031
Code Value Code Meaning
Scheme
Designator


Modify CID 3261 (including modifications in Supplement 128 Frozen Draft for Trial Use)

CID 3261
Stress Protocols
Context ID 3261
Stress Protocols
Type: Extensible
Version: 2002090420081027
Code Value
Code Meaning
P2-31102
Stress test using Bicycle Ergometer
P2-31107
Pharmacologic Stress protocol
P2-3110A
Dipyridamole Stress protocol
P2-31109
Adenosine Stress protocol
P2-31108
Dobutamine Stress protocol
P2-31011
Pharmacologic and exercise stress test
P2-3110B
Stress test using cardiac pacing

For reference, CID 12102 from PS3.16-2008 (no change)

CID 12102
Temporal Periods Relating to Procedure or Therapy
Context ID 12102
Temporal Periods Relating to Procedure or Therapy
Type: Extensible
Version: 20050110
Code Value
Code Meaning
(0008,0100)
(0008,0104)
Designator
(0008,0102)
Add the following rows to PS 3.16 Annex J SNOMED DICOM Microglossary Retired Codes
Code Meaning
Replacement
(SNOMED)
“Stress test using Bicycle Ergometer” “Stress test using cardiac pacing”

Source: ftp://medical.nema.org/medical/dicom/final/cp817_ft.pdf

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