What is current best practice for contrast metadata capture?

[Sean Doyle]

Hi -

I was wondering what the current best practice is for reporting contrast in a DICOM study on a modality device.  The case that I'm interested in is in manual infusion - not using an automated injection device. The fields in the Contrast/Bolus Module (part 03, section C.7.6.4) are straightforward. However - there is the IHE CAM profile which is in trial implementation status (since 2021) where a DICOM SR IAASR instance (TID 11020) can be created and sent with the image data. Or - somewhere I saw a reference to an MPPS event which might generate an event to the RIS for billing and documentation. 

My goal is to both support standards and to maximize the value to existing clinical systems. In current clinical systems - is the combination of the Contrast/Bolus Module and the IAASR best practice so that downstream systems can track contrast administration and bill for the procedure? Or is something else required?

Thanks
Sean

[David Clunie]

Definitely the Contrast/Bolus Module (or Enhanced Contrast/Bolus Module, depending on the IOD).

The Imaging Agent Administration SR (IAASR) is intended for image- (and scanner device-) independent recording of automated mechanical injector activity.

AFAIK, the IHE Contrast Administration Management (CAM) profile has never been tested  (https://connectathon-results.ihe.net/custom-search/).

Even if an IAASR was available, the images would still be expected to contain the Contrast/Bolus Module information, otherwise the vast majority of (if not all) current downstream systems would not know whether contrast was used or not (and which contrast agent and how much).

David

[Sean Doyle]

David - 

Thanks - my main concern is what downstream systems need. It wasn't clear to me what the data path was from the PACS back out to the EHR/RIS for documentation of the contrast injection. The IHE CAM profile sounded like it was trying to address this - but since it's been in trial status for 4 years it sounded like it wasn't being deployed clinically yet.  

I've been doing more reading and it sounds like interface engines can read the IAASR objects via WADO-RS and then generate a HL7 RAS message to the EHR. It would be easy to generate both the contrast/bolus module contents for each post contrast image and also an IAASR to give the downstream systems flexibility in how they detected the contrast. If there isn't an IAASR object - do these engines parse the DICOM image metadata to get these values? Or is there a different data path? 

Thanks again!

Sean

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