Re: IHE - multiple orders - one exam - how to act as PACS/RIS?

On Oct 2, 10:03 am, M1nd0nF1r3 <ta...@xxxxxxxxxxxxxx> wrote:
Dear All,

RIS order two exams for same patient - CT Chest and CT abdomen - so we
have one PATIENT_ID and t wo ACCESSION_NUMBERS. But technician will
make one exam - full scan...so we have one MPPS, one completed study?
That is irrational - how that should be done according to IHE standard
+ DICOM + HL7?

This is the classic "group case" documented in IHE Radiology Technical
Framework. Basically, in this case the modality is supposed to leave
the Accession Number attribute of the acquired images empty/blank and
instead document to attributes of the multiple requested procedures
which were performed/satified by the acquisition of the images as
separate items in the Request Attributes Sequence.

Also, it should be noted - the values generated by the RIS are not
Accession Numbers. They are Request Procedure Ids (which may have
been included in the Accession Number attribute on the MWL). I don't
have the rad tech framework at my finger tips, so don't recall the
exact name (Performed Steps Sequence?) but there is also a sequence
which can contain multiple items, where each "item" is itself a
sequence, in the MPPS IOD. Just as the attributes of the requested
procedures are included the request attribute sequence in the images,
most of the same attributes are included in the performed steps
sequence.

As a PACS receiving the images from a properly acquired group case
image, your trigger to record the images as acquired for multiple
procedures is the fact that the Accession Number of the received
images is empty. You should be checking for a request attribute
sequence containing multiple items anyway (because somebody might put
one requested procedure Id into the Accession Number attribute, but
document the other procedures in the sequence) -- but I digress --
when you get an image with the accession number value missing, it is
your trigger to definitely go look for multiple requested procedure
items in the request attributes sequence.
.

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