1. September, 2005Cardio - June 2007 1 Stress Testing Data and Display Requirements

2. Cardio - June 2007 2 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

3. Cardio - June 2007 3 Stress: Protocol and Stage Procedure : Exercise Stress Protocol: Bruce Stages:  Standard Bruce has 7 stages Stage 1: 1.7 mph @ 10 % grade Stage 1: 1.7 mph @ 10 % grade Stage 7: 6.0 mph @ 22 % grade Stage 7: 6.0 mph @ 22 % grade Important Note: A procedure can be considered complete irrespective of the patient reaching the last protocol stage!

4. Cardio - June 2007 4 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

5. Cardio - June 2007 5 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) SRTP5-01201Image acquisition at baseline SRTP5-01202Pre-stress image acquisition SRTP5-01203Mid-stress image acquisition SRTP5-01204Peak-stress image acquisition SRTP5-01205Image acquisition during recovery

6. Cardio - June 2007 6 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

7. Cardio - June 2007 7 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

8. Cardio - June 2007 8 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

9. Cardio - June 2007 9 Benefit: Stress Echo Viewing Consistency

10. Cardio - June 2007 10 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

11. Cardio - June 2007 11 Raw Data Images

12. Cardio - June 2007 12 Perfusion Display Standard perfusion display Stress/Rest  Short axis  Horizontal long axis  Vertical long axis

13. Cardio - June 2007 13 Perfusion Display - Color Standard perfusion display Stress/Rest  Short axis  Horizontal long axis  Vertical long axis Color map can be overlaid on the image

14. Cardio - June 2007 14 Gated SPECT Display Apical, mid and basal short axis slices Mid-ventricle vertical and horizontal long axis slices

15. Cardio - June 2007 15 Gated SPECT Display The whole screen can be gated as an option

16. Cardio - June 2007 16 Quantitative Display Output from 3 rd party quantitative perfusion software can be displayed

17. Cardio - June 2007 17 Quantitative Display Output from 3 rd party quantitative gated software can be displayed

18. Cardio - June 2007 18 Screen Captures Screen captures can be displayed to show important images

19. Cardio - June 2007 19