September, 2005Cardio - June Stress Testing Data and Display Requirements

Cardio - June ProcedureProtocolStages Stress: Protocol and Stage Uses exercise or medication to increase the work of the heart – incremental stages Continuous 12 lead ECG monitoring during study Looking for changes in ECG (ST segments) or other clinical indicators

Cardio - June Stress: Protocol and Stage Procedure : Exercise Stress Protocol: Bruce Stages:  Standard Bruce has 7 stages Stage 1: % grade Stage 1: % grade Stage 7: % grade Stage 7: % grade Important Note: A procedure can be considered complete irrespective of the patient reaching the last protocol stage!

Cardio - June Acquisition Modalities Echo – label images by stage and view Nuclear – format and label images in accordance with NM Image Profile Stress ECG – output waveforms and results as DICOM objects  DICOM 12-lead and general ECG  Structured Reports  Encapsulated PDF All modalities – synchronized time, modality worklist and performed procedure step status

Cardio - June Views Apical two chamber Apical four chamber Apical long axis Parasternal long axis Parasternal short axis Parasternal short axis at the aortic valve level Parasternal short axis at the level of the mitral chords Parasternal short axis at the Mitral Valve level Parasternal short axis at the Papillary Muscle level Right Ventricular Inflow Tract View Right Ventricular Outflow Tract View Subcostal long axis Subcostal short axis Suprasternal long axis Suprasternal short axis Stage and Views Stress Echo  Stage Number & View Number  Stage Code Sequence & View Code Sequence – SNOMED codes Coding Scheme Designator (0008,0102) Code Value (0008,0100) Code Meaning (0008,0104) SRTP Image acquisition at baseline SRTP Pre-stress image acquisition SRTP Mid-stress image acquisition SRTP Peak-stress image acquisition SRTP Image acquisition during recovery

Cardio - June Attribute Summary ConceptModality WorklistEchoECGNM Requested Procedure Requested Procedure Code Sequence (0032,1064) Procedure Code Sequence (0008,1032) ProtocolScheduled Protocol Code Sequence (0040,0008) Performed Protocol Code Sequence (0040,0260) CID 12001* Performed Protocol Code Sequence (0040,0260) CID 3261 Performed Protocol Code Sequence (0040,0260) CID 3261** Protocol Stage Number Acquisition Context Sequence (0040,0555) >(109055, DCM, “Protocol Stage”) Patient StateStage Number (0008,2122) Stage Code Sequence (0040,000A) CID 12002* Acquisition Context Sequence (0040,0555) >(109054, DCM, “Patient State”) CID 3262 Acquisition Context Sequence (0040,0555) >(109054, DCM, “Patient State”) CID 3101

Cardio - June Image Manager / Image Archive Must support all stress data objects  Echo, nuclear images  Multi-frame secondary capture images  12-lead and general ECG  Structured Reports – Enhanced, Comprehensive, Procedure Log  Encapsulated PDF

Cardio - June Image Display Must display all stress data objects  Echo images – quad screen based on image labels  Nuclear images – ACC/ASNC layout  Multi-frame secondary capture images  12-lead and general ECG  Structured Reports – Enhanced, Comprehensive, Procedure Log  Encapsulated PDF Additional display requirements for SR in Evidence Documents Profile Stress Option

Cardio - June Benefit: Stress Echo Viewing Consistency

Cardio - June Nuclear Cardiology Image formats  Stress and Rest raw data review  Stress and Rest processed data  Gated SPECT data  Quantitative data  Screen captures, “snap shots” Color maps  Gray scale is default  Color overlays can be applied

Cardio - June Raw Data Images

Cardio - June Perfusion Display Standard perfusion display Stress/Rest  Short axis  Horizontal long axis  Vertical long axis

Cardio - June Perfusion Display - Color Standard perfusion display Stress/Rest  Short axis  Horizontal long axis  Vertical long axis Color map can be overlaid on the image

Cardio - June Gated SPECT Display Apical, mid and basal short axis slices Mid-ventricle vertical and horizontal long axis slices

Cardio - June Gated SPECT Display The whole screen can be gated as an option

Cardio - June Quantitative Display Output from 3 rd party quantitative perfusion software can be displayed

Cardio - June Quantitative Display Output from 3 rd party quantitative gated software can be displayed

Cardio - June Screen Captures Screen captures can be displayed to show important images

Cardio - June