Version Published Changed By Comment
CURRENT (v. 1) Sep 13, 2021 18:05
Robert Horn

Use Case Description:

This will be one of the DICOM use cases.

Radiation Exposure Monitoring is the monitoring of diagnostic, therapeutic, and other radiation exposures for a patient.  It is a long term tracking of exposures that will follow a person for their whole life.

The current systems are standardized, and this use case refers to those standards rather than duplicate them wholesale.

The significant change is the ability to separate the patient's gender identity from the SFCU for exposure monitoring.  There are a variety of ways that patients vary in their dose sensitivity.  It is known that genetics (male/female) and surgery (often for cancer treatment) affect dose sensitivity.  There are other environmental factors that might affect dose sensitivity.  

Current systems use the "patient sex", which is not consistently either gender identity nor SFCU.  This reduces the utility of the radiation exposure monitoring.

Note: The SFCU for a specific procedure will be chosen based on the procedure, which might not be the SFCU that would be chosen for radiation exposure monitoring.

Note: The long term tracking of exposures means that patient matching must take into consideration many changes to patient demographics (name, address, gender identity, SFCU, etc.)  At present, there could potentially be exposure records created for historical events many years ago.  There are exposure records that were created concurrently with the exposing procedures for at least the past ten years.

Actors:

The actors and their relationships are summarized at https://wiki.ihe.net/index.php/Radiation_Exposure_Monitoring

Scope Statement:

This use case begins with the completion of a procedure that results in radiation exposure to the patient.

Precondition(s):

This use case assumes that all of the patient administration (admitting, etc.) and ordering processes have incorporated the use of the Gender Harmony information on patient gender identity and SFCU.

Postcondition(s):


Workflow/Storyboard:

  1. The systems responsible for procedures that result in patient radiation exposure capture Radiation Dose Structured Reports (RDSR) and send them to a DICOM capable Archive.   These reports hold both the Patient Gender Identity and the SFCU for the patient.  (Issue to discuss, in an RDSR the SFCU will be the SFCU for radiation exposure analysis, which might not be the RDSR for the procedure.  Conflicts may arise.  The SFCU for an X-ray to diagnose a broken finger doesn't matter, and might be missing.  Should this be made the responsibility of the medical policies of the site?  I think so.  But it's something for implementers to be aware of.)
  2. The archived RDSR are analyzed and reported locally.  Use of SFCU can improve analysis results by selecting the most appropriate dose sensitivity models, and by conveying (by means of the SFCU specified and the SFCU contextual information) other patient specific dose sensitivity information.  (Current systems may examine the images and results from patient procedures to determine the SFCU to be used.  E.g., a CT may provide organ inventory and locations.)


REM-Diagram.PNG

Alternative and/or related Workflow(s):

The specific transactions, messages, etc. defined in the IHE REM profile are not the only available workflow.  Most of the other workflows will be affected in the same way.

Alignment and/or Misalignment with Gender Harmony Model:

Current implementations and profiles convey the single patient sex value, often PID-8.  

Current Standard Support:

  • HL7 V2.x   
V2.x Resource: PIX, ??
  • HL7 V3
V3 Resource:
  • HL7 FHIR
FHIR Resource: Patient Gender Identity, SFCU
  • DICOM
DICOM Resource: Radiation Dose Structured Report
  • NCPDP
NCPDP Resource:
  • X12
X12 Resource:

  • Other (please specify standard and resource below)

Other:

Required Additional Standard Support:


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