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titleQuestions and Thoughts

Imaging modality for the CV-imaging project:

Coronary angiography:

  1. Done on the chest area, the probe rotates around the chest of the subject, but there is no such a thing as "chest Coronary angiography", it is simply called Coronary angiography.
  2. Creates images of the entire coronary artery system.
  3. We don't record PRLOC = chest for this procedure

Thransthoracic Echocardiogram (TTE):

  1. Done on the chest and upper abdominal wall. The transducer is placed on various parts of the chest and upper belly to get create ultrasonic views different views of the heart. Again, there is no such a thing as chest TTE.
  2. Creates images of the heart.
  3. We don't record PRLOC = Chest and upper abdomen for this procedure

Transesophageal Echocardiogram (TEE):

  1. Done from the inside of the Transducer is inserted into the Esophagus.
  2. Creates images of the heart.
  3. We don't record PRLOC = Esophagus

Cine Angiography:

  1. Done on the chest, again the probe is placed on top of the chest.
  2. Creates images of the entire coronary artery system.

In addition, i just recently took a family member to have a Thyroid Ultrasound:

  1. The ultrasound probe moved around her neck
  2. Creates images of the thyroid gland. In this case would you argue that PRLOC is thyroid or neck?

Referring to Richard M's email:

LOC in the interventions class is "Anatomical focus of an intervention - at which part of the body an intervention is being made". This also my understanding as well.

  • The "injection" intervention has an anatomical focus - the anatomical site of injection.
  • Percutaneous Coronary Intervention (also known as angioplasty with stent), has an anatomical location where the procedure occurs, intervenes and alters the abnormal structure of the location - i.e. in the RIGHT POSTERIOR DESCENDING ARTERY (PRLOC), the angioplasty breaks up the blockage and inserts a stent.
  • Brachytherapy places radioactive material inside a location of the body to kill cancer cells, e.g. prostate. The procedure occurs, intervenes and alters the abnormal structure of the location.

It is easy to pinpoint a location for invasive/treatment type interventions and this aligns with my understanding of how PRLOC should be used.

However, for "diagnostic imaging" procedures, where the imaging probe is placed (i.e. neck, chest, abdomen, head, etc.), is it relevant to record this information? Is this really the location where a intervention is "made"? is it even correct to place these values in PRLOC? (device attributes? maybe?)

so...my 2-cent is that diagnostic imaging procedures have no PRLOCs.

When we say "chest CT", it doesn't mean that a CT is done/made on the chest, it is a CT scan of the chest,  it creates images of the chest, more precisely the thoracic region. "Chest" is the anatomical location for subsequent evaluations, aka --LOC for --TEST in a findings domain.

Same for abdominal and pelvic CT scans, MRIs.

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Dataset wrap
titlecv.xpt
NameRS


Dataset2


Row

STUDYID

DOMAIN

USUBJID

RSSEQ

RSLNKID

RSTEST

RSCAT

RSORRES

VISITNUM

VISIT

CVDTC

1ABCRSABC-12331Dissection 1Stanford AoD ClassificationHiratzka Dissection 2010Stanford B1BASELINE2020-04-27



...

The MRI scan produced cross-sectional images of the thoracic and abdominal regions of the subject. The evaluator then examined the MRI images of the thoracic region and abdominal region, and found the presence of a large AAA, but the absence of TAA.

Because when a large AAA is found, the chance of a TAA (or an aneurysm developed elsewhere) is high (the reverse holds true as well), in the presence of a diagnosed large AAA or TAA, it is recommended to also screen for the other. A TAA is synchronous if diagnosed within 2 years from the diagnosis of an AAA. All TAAs diagnosed at a later date were considered metachronous and must have had prior chest imaging that did not show the presence of TAA. 

Dataset wrap
titlecv.xpt
NameTU


Rowcaps


Row 1:I examined the MRI image of the thoracic region (test location) and didn't find the presence of an aneurysm.
Row
Dataset wrap
titlecv.xpt
NameTU
Rowcaps
Row 1:I examined the MRI image of the thoracic region (test location) and didn't find the presence of an aneurysm.
Row 2:I examined the MRI image of the abdominal region (test location) and found an aneurysm in the left (Result LAT) renal artery (Result Loc).
Row 3:I examined the image of the abdominal region (test location) and found an aneurysm in the infrarenal aorta (Result Loc).



Dataset2


Row

STUDYID

DOMAIN

USUBJID

TUSEQ

TUGRPID

TULNKID

TUTEST

TUORRES

TULOC

TUMETHOD

VISITNUM

VISIT

TUDTC


TURESLOCTURESLAT
1ABCTUABC-4561

Aneurysm IndicatorNThoracic RegionMRI1BASELINE2020-04-27


2

ABC

TUABC-45621Aneurysm 1Aneurysm IndicatorYAbdominal RegionMRI1BASELINE2020-04-27


3ABCTUABC-45631Aneurysm 1Aneurysm Location/Identification

Target?

Identified

Abdominal RegionMRI1BASELINE2020-04-27
Renal ArteryLeft
4ABCTUABC-45642Aneurysm 2Aneurysm IndicatorYAbdominal RegionMRI1BASELINE2020-04-27


5ABCTUABC-45652Aneurysm 2Aneurysm Location/Identification

Target?

Identified

Abdominal RegionMRI1BASELINE2020-04-27
Infrarenal Aorta



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The problem with the way TU is set up now, which is originally designed for tumor identification and response evaluation, and you only care about "already identified tumors", is that it only allows the creation of only positive records. It doesn't allow the creation of a "pertinent negative" record. If I were to model case 2 in TU the way TU is designed now, I would lose the ability to represent the negative record for the Thoracic Region as shown above because an aneurysm is not identified in this region. The locations where an aneurysm is found, are mapped to TULOC instead of TURESLOC. Because when a large AAA is found, the chance of a TAA (or an aneurysm developed elsewhere) is high (the reverse holds true as well), in the presence of a diagnosed large AAA or TAA, it is recommended to also screen for the other. A TAA is synchronous if diagnosed within 2 years from the diagnosis of an AAA. All TAAs diagnosed at a later date were considered metachronous and must have had prior chest imaging that did not show the presence of TAA. in this region.  This is also in part, due to the fact that the location where an object is found, is mapped to PRLOC instead of TULOC, thusly not allowing the representation of imaging location in findings.

In the original DUKE data element, the responses provided for TAA and AAA, and all other types of aneurysms all have the responses: present, absent and unknown.

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