Aneurysm TU, TR and RS modeling Concept Map
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| TAA and AAA Concept Map - TU/TR |
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| TAA and AAA Concept Map - TU/TR |
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Case 1 - Subject has both TAA and AAA
The subject had a chest CT scan and an abdominal CT scan.
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| Dataset2 |
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Row | STUDYID | DOMAIN | USUBJID | PRSEQ | PRTRT | PRLOC | VISIT |
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| 1 | ABC | PR | ABC-123 | 1 | CT SCAN | CHEST | BASELINE |
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| 2 | ABC | PR | ABC-123 | 2 | CT SCAN | ABDOMEN | BASELINE |
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TU Approach 1: TU result location findings are modeled as variables.
An evaluator examines the images of the thoracic and abdominal regions produced by the CT scan and decides whether TAA and AAA are present as well as their locations. Note for viewing simplicity, some variables are omitted from the table below.
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| Rowcaps |
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| Rows 1-2: | I examined the image of the thoracic region (test location) and found an aneurysm in the Thoracic Aorta (result location) spanning from the aortic arch to the descending aorta (result location detail). In this case result location detail further qualifies both ORRES and RESLOC, hence this is a variable qualifier. |
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| Rows 3-4: | I examined the image of the thoracic region (test location) and found that the descending aorta (result location) had dissected (the artery is tore and a false lumen had formed), most likely due to the enormous pressure caused by the large aneurysm in this area. |
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| Rows 5-6: | I examined the image of the abdominal region (test location) and found an aneurysm in the infrarenal aorta (result location), proximal to the iliac bifurcation (result location detail). In this case result location detail is a variable qualifier for the result, I am trying to say that the aneurysm is located in the segment of the infrarenal aorta closer (proximal) to the iliac bifurcation. |
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| Rows 7-8: | I examined the image of the abdominal region (test location) and found that the infrarenal aorta (result location) had dissected. |
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| Dataset2 |
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| hi1style | #e3fcef |
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| hi2 | 10,11,12,13 |
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| hi1 | 2,4,6,8 |
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| hi3 | TURESLOC |
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| hi2style | yellow |
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| hi3style | BOLD |
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| tableid | TU1 |
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Row | STUDYID | DOMAIN | USUBJID | TUSEQ | TUGRPID | TULNKID | TUTEST | TULOC | TUORRES | TU Result LOC | TU Result LOC Detail | TUMETHOD | VISITNUM | VISIT | TUDTC |
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| 1 | ABC | TU | ABC-123 | 1 | 1 | Aneurysm 1 | Aneurysm Indicator | Thoracic region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 2 | ABC | TU | ABC-123 | 2 | 1 | Aneurysm 1 | Aneurysm Location Identification | Thoracic region | Located | Thoracic Aorta | Aortic Arch to Descending aorta | CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 3 | ABC | TU | ABC-123 | 3 | 2 | Dissection 1 | Dissection Indicator | Thoracic region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 4 | ABC | TU | ABC-123 | 4 | 2 | Dissection 1 | Dissection Location Identification | Thoracic region | Located | Descending aorta |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 5 | ABC | TU | ABC-123 | 5 | 3 | Aneurysm 2 | Aneurysm Indicator | Abdominal region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 6 | ABC | TU | ABC-123 | 6 | 3 | Aneurysm 2 | Aneurysm Location Identification | Abdominal region | Located | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 7 | ABC | TU | ABC-123 | 7 | 4 | Dissection 2 | Dissection Indicator | Abdominal region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 8 | ABC | TU | ABC-123 | 8 | 4 | Dissection 2 | Dissection Location Identification | Abdominal region | Located | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 10 | ABC | TU | ABC-123 | 1 | 1 | Aneurysm 1 | Cardiovascular Lesion Indicator | Thoracic region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 11 | ABC | TU | ABC-123 | 2 | 1 | Aneurysm 1 | Cardiovascular Lesion Location Identification | Thoracic region | Located | Thoracic Aorta | Aortic Arch to Descending aorta | CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 12 | ABC | TU | ABC-123 | 3 | 2 | Arterial Dissection 1 | Cardiovascular Lesion Indicator | Thoracic region | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
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| 13 | ABC | TU | ABC-123 | 4 | 2 | Arterial Dissection 1 | Cardiovascular Lesion Location Identification | Thoracic region | Located | Descending aorta |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
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TU Approach 2 - treating result location findings as individual tests
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| Rowcaps |
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| Row 1: | I examined the image of the thoracic region (test location) and found an aneurysm, which was identified as "Aneurysm 1". |
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| Row 2: | I examined the image of the thoracic region (test location) and found that the aneurysm identified as "Aneurysm 1" was in the Thoracic Aorta. |
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| Row 3: | (Option 1: yellow) I examined the image of the thoracic region (test location) and found that the aneurysm identified as "Aneurysm 1" was spanning from the aortic arch to the descending aorta. |
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| Row 4: | (Option 2: green) I examined the aneurysm in the thoracic aorta (test location) that was identified as "Aneurysm 1" and found that it was spanning from the aortic arch to the descending aorta. |
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| Rows 5-14: | Similar... |
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| Dataset2 |
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| hi1style | #fffae5 |
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| hi2 | 4,10,14 |
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| hi1 | 3,9,13 |
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| hi2style | #e3fcef |
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| tableid | tu1 |
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Row | STUDYID | DOMAIN | USUBJID | TUSEQ | TUGRPID | TULNKID | TUTEST | TUORRES | TULOC | TUMETHOD | VISITNUM | VISIT | TUDTC |
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| 1 | ABC | TU | ABC-123 | 1 | 1 | Aneurysm 1 | Aneurysm Indicator | Y | Thoracic region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 2 | ABC | TU | ABC-123 | 2 | 1 | Aneurysm 1 | Aneurysm Location | Thoracic Aorta | Thoracic region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 3 | ABC | TU | ABC-123 | 3 | 1 | Aneurysm 1 | Aneurysm Location Detail | Aortic Arch to Descending aorta | Thoracic region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 4 | ABC | TU | ABC-123 | 3 | 1 | Aneurysm 1 | Aneurysm Location Detail | Aortic Arch to Descending aorta | Thoracic Aorta | CT SCAN | 1 | BASELINE | 2020-04-27 | | 5 | ABC | TU | ABC-123 | 4 | 2 | Dissection 1 | Dissection Indicator | Y | Thoracic region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 6 | ABC | TU | ABC-123 | 5 | 2 | Dissection 1 | Dissection Location | Descending aorta | Thoracic region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 7 | ABC | TU | ABC-123 | 6 | 3 | Aneurysm 2 | Aneurysm Indicator | Y | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 8 | ABC | TU | ABC-123 | 7 | 3 | Aneurysm 2 | Aneurysm Location | Infrarenal aorta | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 9 | ABC | TU | ABC-123 | 8 | 3 | Aneurysm 2 | Aneurysm Location Detail | Proximal to the iliac bifurcation | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 10 | ABC | TU | ABC-123 | 8 | 3 | Aneurysm 2 | Aneurysm Location Detail | Proximal to the iliac bifurcation | Infrarenal aorta | CT SCAN | 1 | BASELINE | 2020-04-27 | | 11 | ABC | TU | ABC-123 | 9 | 4 | Dissection 2 | Dissection Indicator | Y | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 12 | ABC | TU | ABC-123 | 10 | 4 | Dissection 2 | Dissection Location | Infrarenal aorta | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 13 | ABC | TU | ABC-123 | 11 | 4 | Dissection 2 | Dissection Location Detail | Proximal to the iliac bifurcation | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-27 | | 14 | ABC | TU | ABC-123 | 11 | 4 | Dissection 2 | Dissection Location Detail | Proximal to the iliac bifurcation | Infrarenal aorta | CT SCAN | 1 | BASELINE | 2020-04-27 |
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| title | Questions and Thoughts |
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The results for TU, TUORRES = target, non-target, or new target. This convention was designed for tumor assessment. Target and non-target have very specific definitions depending on the tumor under study. Generally for solid tumor, according to RECIST: Measurable lesions - lesions that can be accurately measured in at least one dimension with longest diameter 20 mm using conventional techniques or 10 mm with spiral CT scan. - All measurable lesions up to a maximum of five lesions per organ and 10 lesions in total, representative of all involved organs should be identified as target lesions and recorded and measured at baseline.
Non-measurable lesions - all other lesions, including small lesions (longest diameter <20 mm with conventional techniques or <10 mm with spiral CT scan), i.e., bone lesions, leptomeningeal disease, ascites, pleural/pericardial effusion, inflammatory breast disease, lymphangitis cutis/pulmonis, cystic lesions, and also abdominal masses that are not confirmed and followed by imaging techniques. - All other lesions (or sites of disease) should be identified as non-target lesions and should also be recorded at baseline. Measurements of these lesions are not required, but the presence or absence of each should be noted throughout follow-up.
Since TU is also shared by Lesion Identification, to have a result as "target" is misleading and doesn't always apply to non-tumor settings. When you say there is a target aneurysm, what does that mean? Target for treatment and response evaluation? what is the criteria that makes it a target? Usually an aneurysm larger than 5cm requires surgery. Does that mean the ones that are smaller than 5 cm are considered "non-target"? and non-target for what? surgery not needed? The values for TU responses right now, doesn't make sense for non-tumor lesion identification process. |
Case 2 - Subject has AAA but TAA is not found
The subject had a MRI that scanned his torso, from chest to abdomen. Should PRLOC be "torso", or "chest" and "abdomen"? The places where you point the probe to, are they locations of the procedure?
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| Rowcaps |
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| Row 1: | An aneurysm is present in the left renal artery. |
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| Row 2: | An aneurysm is present in the Infrarenal Aorta |
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| Dataset2 |
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Row | STUDYID | DOMAIN | USUBJID | TUSEQ | TULNKID | TUTEST | TUORRES | TULOC | TULAT | TUMETHOD | VISITNUM | VISIT | TUDTC |
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| 1 | ABC | TU | ABC-456 | 1 | Aneurysm 1 | Aneurysm Identification | Target | Renal Artery | Left | MRI | 1 | BASELINE | 2020-04-27 |
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| 2 | ABC | TU | ABC-456 | 2 | Aneurysm 2 | Aneurysm Identification | Target | Infrarenal Aorta |
| MRI | 1 | BASELINE | 2020-04-27 |
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What goes into TULOC?
After all this, i struggle with what values should go into TULOC. When a CT scans the chest, it produces cross-sectional images of the chest/thorax and everything in it. You can view the images in three angles: a) axial view (you are looking at the picture of the thorax from the direction of head to toe), b) the coronal view (you are looking at the images of the thorax as if you are standing in front of the person), c) sagittal view (you are looking at the picture of the thorax from the side). Hence TULOCs are populated with Thoracic Region and Abdominal Region for now. Especially in the axial view, as you move from cross-sectional images of the thorax to images of the abdomen, you are looking at sectioned images of the thoracic region to abdominal region, there is no mistake about which region you are looking at because the anatomy of both regions are so different and clearly sperpated. I think it is not wrong to populate TULOC with chest and abdomen as well, they are just not the most precise anatomical terms.
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