From draft upcoming DICOM document for Gender and Sex

AZ.5                 WORKFLOW EXAMPLES

The following examples are for a Patient (John Smith) who is has a sex of “female”, a gender of “male” and whose previous records are for studies performed when his gender was “female”.  He is still registered in the hospital record system with his old name of “Janet Smith”.   He has not updated his records to reflect a new name.

AZ.5.1 Arrival and check-in:

Scenario 1, where patient initiates the discussion

1. When John arrives at the waiting room for a PET/CT examination he announces himself as “John”.
2. The clerk asks “John Williams?”, seeing a John Williams in the current worklist. (This example assumes that the DICOM worklist is being used. Similar scenarios apply when HL7 facilities are used.)
3. Response, “No, Smith”
4. The clerk asks “Date of birth”
5. Smith: “month, day, year”
6. The clerk performs a date of birth based lookup and finds:
   1. A DICOM worklist entry for Janet Smith, with Patient’s Sex (0010,0040) “F” and Patient’s Gender (0010,xxxx) “M”, and with a Preferred Form of Address (0010,xxx3) “Preferred name is John”. Sex Comment (0010,xxx1) contains “Hormonal treatment causes Thrombosis risk”.
   2. The birth dates match
7. The clerk asks the necessary sex related preparation questions, e.g., most recent menstruation; and checks in the patient.
8. Based on clinic policies, the clerk asks whether John wants to go through the name change process at the clinic to reflect his preferred name.

Scenario 2, where the clerk initiates the discussion

1. John arrives at the waiting room for a PET/CT examination, and goes to the clerk to check in.
2. The clerk asks “Date of birth”
3. Smith: “month, day, year”
4. The clerk performs a date of birth based lookup and finds:
   1. A DICOM worklist entry for Janet Smith, with Patient’s Sex (0010,0040) “F” and Patient’s Gender (0010,xxxx) “M”, and with a Preferred Form of Address (0010,xxx3) “Preferred name is John”. Sex Comment (0010,xxx1) contains “Hormonal treatment causes Thrombosis risk”.
   2. The birth dates match
5. The clerk sees John, who appears to be a man, and re- checks the worklist entry. This time the clerk notices Patient’s Gender (0010,xxxx) “M”, Patient’s Sex (0010,0040) “F”,  and a Preferred Form of Address (0010,xxx3) “Preferred name is John”.
6. The clerk confirms “John Smith? Here for a PET/CT exam?”
7. John agrees.
8. The clerk asks the necessary sex related preparation questions, e.g., most recent menstruation; and checks in the patient.
9. Based on clinic policies, the clerk asks whether John wants to go through the name change process at the clinic to reflect his preferred name.

AZ.5.2 Patient Preparation

1. The prep staff checks their worklist for John, and finds the order for “Janet Smith”, Patient’s Sex (0010,0040) “F” and Patient’s Gender (0010,xxxx) “M”, and with a Preferred Form of Address (0010,xxx2) “John”. Sex Comment (0010,xxx1) contains “Hormonal treatment causes Thrombosis risk”.
2. The prep staff sets up John’s radiation protection for a female body, confirms menstruation and pregnancy status, and reconfirms birthdate.

AZ.5.3 Examination

1. The technician has checked John’s worklist entry and knows to expect a female body for John this does not trigger a wrong patient concern. The technician confirms birthdate and other ID for the patient.
2. The exam is performed.
3. The study results and RDSR are stored into the archive

AZ.5.4. Recovery

1. Recovery nurse monitors the patient using the thrombosis risk protocol rather than the normal protocol.

AZ.5.5 Analysis

1. The application computing SUV uses the sex “F”. It notes the Patient’s Gender (0010,xxxx) “M” and presence of Sex Comment (0010,xxx1), and shows a pop-up to the operator to confirm that this is the correct value to use.
2. The RDSR is used to prepare a patient dose report. Because the Patient Sex (0010,0040) is F, the female body models are used for dose analysis for John.

AZ.5.6 Use of Gender Comment

Gender comment may be useful for a patient with a gender “M” and sex “F”, who is arriving for a transvaginal ultrasound exam.  Specific instructions regarding check-in, prep, etc. may be appropriate to avoid embarrassment or humiliation.